Motor Vehicle (Catastrophic Injuries) Regulations 2016 (Western Australia)

These regulations operationalise eligibility, application, assessment, provider registration, dispute resolution and certain administrative procedures for the Catastrophic Injuries Support Scheme (CISS) created under the Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Act 2016 (the Act). They prescribe medical and functional criteria that define a “catastrophic injury” in specified categories: spinal cord injury, traumatic brain injury, amputations, burns and permanent blindness (regs 6-11). The regulations set time limits and procedural requirements for applying to participate in the CISS (reg 12), allow the Commission discretion to defer consideration until an injury stabilises (reg 13), and define the limited period and conditions for interim participation (reg 19).

The instrument establishes practical rules for assessing treatment, care and support needs, including statutory assessment principles (reg 22), powers to require information and examinations from participants and service providers (regs 23-24), and an obligation for participants to take reasonable steps to comply with specified treatment or support requirements (reg 25). Schedule 1 prescribes a non‑exhaustive list of excluded treatment, care and support needs that the Commission will not meet under the CISS, including certain attendant care, domestic assistance, aids and appliances, education support, vocational support, home and vehicle modifications, respite in unsafe settings, and prostheses repair or replacement due to neglect (Schedule 1).

The regulations create a registration regime for providers required to supply certain services to participants (reg 26), set application and notice procedures for registration, and give the Commission powers to vary, add conditions to, or revoke registrations (regs 27-30). For dispute resolution the regulations establish review processes, including review officers for non‑medical decisions (Div 2) and expert review panels for medical decisions and assessments (Divs 3-5). They set procedural time limits (for example 28 days for review applications, reg 31(3)), confidentiality and admissibility rules for expert panel proceedings (regs 59(4)-(5), 60-61), and make second review panel decisions final and binding subject only to judicial review for jurisdictional error (regs 43(1)-(2), 48(1)-(2)). The Minister appoints and maintains a publicly available experts list and appoints convenor and deputy convenor to run the expert panels (regs 51-53).

CrestWestern Australia

Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Act 2016

Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Regulations 2016

Western Australia

Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Regulations 2016

Contents

Part 1 — Preliminary

Citation 1
Commencement 1
Terms used 1
Assessment tools 3
Excluded treatment, care and support needs 3

Part 2 — Participation in CISS

Division 1 — Criteria for catastrophic injury

Purpose of Division 4
Spinal cord injury 4
Traumatic brain injury 4
Amputations 6
Burns 7
Permanent blindness 9

Division 2 — Application to participate in CISS

Application under s. 9 of Act 9
Deferral of consideration of application 10
Application under s. 13 of Act 10
Additional information relevant to CISS application 10
Consent to obtain information 11
Notice of decision on CISS application 11
Functional independence assessments 11

Division 3 — Interim participation

Period of interim participation 12

Division 4 — Suspension of participation

Commission may suspend participation 12
Notice of decision to suspend 13

Part 3 — Treatment, care and support needs

Principles to be observed in assessment of treatment, care and support needs 14
Requirement to provide information 15
Requirement to undergo examination 15
Participant to comply with requirements in treatment, care and support assessment 16

Part 4 — Registered providers

Services to be provided by registered provider 17
Application for registration 17
Notice of decision on application 18
Variation, addition or cancellation of conditions of registration 18
Revocation of registration 18

Part 5 — Dispute resolution

Division 1 — Review applications

Review application 19
Commission may request further information 19

Division 2 — Review of non‑medical decisions

Referral of decision to review officer 20
Objection to review officer 20
Conduct of review 20
Decision on review 21
Review officers 21

Division 3 — Review of medical decisions

Referral of decision to expert review panel 21
Decision of expert review panel 22
Application for review of original review decision 22
Referral of original review decision to another expert review panel 23
Decision of second review panel 23
Effect of decision of second review panel 24
Commission to reimburse treatment, care and support expenses in certain circumstances 24

Division 4 — Review of treatment, care and support assessments

Term used: assessment 25
Referral of decision to expert review panel 25
Decision of expert review panel 25
Effect of decision of expert review panel 25
Commission to revise assessment 26

Division 5 — Expert review panels

Establishment 26
Appointment of medical experts 26
Experts list 27
Convenor and deputy convenor 27
Constitution of expert review panel 28
Convenor to give notice of members of panel 28
Objection to member of panel 28
Procedures: general provisions 29
Acts and decisions of 2 or 3 member panel 29
Powers and procedures on review 30
Use of information in subsequent proceedings 31
Admissibility 31
Services and facilities 31
Guidelines 32

Division 6 — Other matters

Costs 32
Extension of period for application or objection 32
Correction of errors 33
Period for commencing appeal 33

Schedule 1 — Excluded treatment, care and support needs

Terms used 34
Attendant care services 34
Domestic assistance 34
Aids and appliances 35
Education support 35
Vocational or workplace support 35
Home modifications 36
Transport modifications 37
Respite care 37
Prostheses 38

Notes

Compilation table 39

Other notes 39

Defined terms

Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Act 2016

Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Regulations 2016

Part 1 — Preliminary

1. Citation

	These regulations are the *Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Regulations 2016*.

[Regulation 1 amended: SL 2024/133 r. 4.]

2. Commencement

These regulations come into operation on the day on which section 34 of the Act comes into operation.

3. Terms used

In these regulations, unless the contrary intention appears —

application for registration means an application for registration under section 23 of the Act;

ASIA Impairment Scale has the meaning given in regulation 4(1);

CISS application means an application made under section 9(1) or 13 of the Act;

Commission officer means —

(a) a person appointed as an officer or employee of the Commission under the Insurance Commission of Western Australia Act 1986 section 12(1); or

(b) a person engaged by the Commission under section 12(4) of that Act;

conditions of registration means conditions determined under section 23(5) of the Act in respect of a registration;

expert review panel means an expert review panel constituted under Part 5 Division 5;

experts list means the list referred to in regulation 52(1);

FIMTM has the meaning given in regulation 4(2);

Glasgow Coma Scale has the meaning given in regulation 4(3);

injured person, in relation to an expert review panel, means the injured person to whom the proceedings before the panel relate;

medical decision means —

(a) a decision referred to in paragraph (a)(iv) of the definition of eligibility decision in section 24 of the Act; or

(b) a decision referred to in paragraph (a)(iii) of that definition if the decision does not involve a question of law or a question of mixed fact and law;

non‑medical decision means —

(a) a decision referred to in paragraph (a)(i) or (ii) or (b) of the definition of eligibility decision in section 24 of the Act; or

(b) a decision referred to in paragraph (a)(iii) of that definition if the decision involves a question of law or a question of mixed fact and law;

original review decision means a decision made under regulation 39(1);

referred decision, in relation to an expert review panel, means a decision referred to the panel under Part 5 Division 3 or 4;

review application means an application made under section 25 or 26 of the Act;

review officer means a person designated as a review officer under regulation 37;

second review panel has the meaning given in regulation 41(3);

Snellen Scale has the meaning given in regulation 4(4);

WeeFIM® has the meaning given in regulation 4(5);

Westmead Post‑Traumatic Amnesia Scale has the meaning given in regulation 4(6).

4. Assessment tools

(1) The ASIA Impairment Scale is the scale known by that name that is used to describe a person’s functional impairment as a result of a spinal cord injury.

(2) The FIMTM is the instrument known by that name that is used to assess a person’s functional independence.

(3) The Glasgow Coma Scale is the scale known by that name that is used to assess a person’s response to stimuli after a head injury.

(4) The Snellen Scale is the standardised test known by that name that is used to measure a person’s visual acuity.

(5) The WeeFIM® is the instrument known by that name that is similar to the FIMTM but adapted for paediatric use.

(6) The Westmead Post‑Traumatic Amnesia Scale is the standardised test known by that name that is used to measure a person’s post‑traumatic amnesia.

5. Excluded treatment, care and support needs

The care, support and services listed in Schedule 1 are prescribed for the purposes of the definition of excluded treatment, care and support needs in section 3(1) of the Act.

Part 2 — Participation in CISS

Division 1 — Criteria for catastrophic injury

6. Purpose of Division

This Division sets out the criteria for eligibility for participation in the CISS for the purposes of the definition of catastrophic injury in section 3(1) of the Act.

7. Spinal cord injury

The criteria for a spinal cord injury are —

(a) the injury results in permanent neurological deficit as evidenced by an ASIA Impairment Scale score of A to D conducted as part of a medical assessment; and

(b) the injury occurs —

(i) if the injury is a motor vehicle injury — on or after 1 July 2016; or

(ii) if the injury is a workplace injury — on or after 1 July 2024.

[Regulation 7 amended: SL 2024/133 r. 5.]

8. Traumatic brain injury

(1) The criteria for a traumatic brain injury suffered by a person who has reached 8 years of age at the time of medical assessment are —

(a) either or both of the following —

(i) a recorded post‑traumatic amnesia of 7 days or more measured using the Westmead Post‑Traumatic Amnesia Scale or a similar clinically accepted, validated scale for post‑traumatic amnesia;

(ii) a significant brain imaging abnormality or evidence of a very significant impact to the head causing coma for longer than one hour;

and

(b) a score of 5 or less on any item on the FIMTM or WeeFIM® due to the injury; and

(i) if the injury is a motor vehicle injury — on or after 1 July 2016; or

(ii) if the injury is a workplace injury — on or after 1 July 2024.

(2) The criteria for a traumatic brain injury suffered by a person who has reached 3 years of age but is under 8 years of age at the time of medical assessment are —

(a) one or more of the following —

(i) a Glasgow Coma Scale score of less than 9 (assessed after resuscitation or on admission to the emergency department of a hospital);

(ii) a recorded post‑traumatic amnesia of 7 days or more measured using the Westmead Post‑Traumatic Amnesia Scale or a similar clinically accepted, validated scale for post‑traumatic amnesia;

(iii) a significant brain imaging abnormality or evidence of a very significant impact to the head causing coma for longer than one hour;

and

(b) a score 2 less than the age norm on any item on the WeeFIM® due to the injury; and

(i) if the injury is a motor vehicle injury — on or after 1 July 2016; or

(ii) if the injury is a workplace injury — on or after 1 July 2024.

(3) The criteria for a traumatic brain injury suffered by a person who is under 3 years of age at the time of medical assessment are —

(a) a medical certificate from a paediatric rehabilitation physician or specialist that states the person will probably have permanent impairment due to the injury resulting in a significant adverse impact on the person’s normal development; and

(b) the injury occurs —

(i) if the injury is a motor vehicle injury — on or after 1 July 2016; or

(ii) if the injury is a workplace injury — on or after 1 July 2024.

[Regulation 8 amended: SL 2024/133 r. 6.]

9. Amputations

(1) The criteria for an injury resulting in amputation, or the equivalent impairment, are —

(a) the criteria set out in subregulation (2); and

(b) the injury occurs —

(i) if the injury is a motor vehicle injury — on or after 1 July 2016; or

(ii) if the injury is a workplace injury — on or after 1 July 2024.

(2) For subregulation (1)(a), the criteria are —

(a) a brachial plexus or lumbosacral avulsion equivalent to an amputation; or

(b) one amputation of either of the following types —

(i) forequarter amputation or shoulder disarticulation;

(ii) amputation of a lower limb at or above 65% of the femur;

(i) amputation of a lower limb at or above 50% of the tibia;

(ii) amputation of an upper limb at or above the first metacarpophalangeal joint of the thumb and index finger of the same hand.

[Regulation 9 amended: SL 2024/133 r. 7.]

10. Burns

(1) The criteria for a burns injury suffered by a person who has reached 8 years of age at the time of medical assessment are —

(a) the criteria set out in subregulation (4); and

(b) a score of 5 or less on any item on the FIMTM or WeeFIM® due to the injury; and

(i) if the injury is a motor vehicle injury — on or after 1 July 2016; or

(ii) if the injury is a workplace injury — on or after 1 July 2024.

(2) The criteria for a burns injury suffered by a person who has reached 3 years of age but is under 8 years of age at the time of medical assessment are —

(a) the criteria set out in subregulation (4); and

(b) a score 2 less than the age norm on any item on the WeeFIM® due to the injury; and

(i) if the injury is a motor vehicle injury — on or after 1 July 2016; or

(ii) if the injury is a workplace injury — on or after 1 July 2024.

(3) The criteria for a burns injury suffered by a person who is under 3 years of age at the time of medical assessment are —

(a) the criteria set out in subregulation (4); and

(b) a medical certificate from a paediatric rehabilitation physician or specialist that states the person will probably have permanent impairment due to the injury resulting in a significant adverse impact on the person’s normal development; and

(i) if the injury is a motor vehicle injury — on or after 1 July 2016; or

(ii) if the injury is a workplace injury — on or after 1 July 2024.

(4) For subregulations (1)(a), (2)(a) and (3)(a), the criteria are —

(a) full thickness burns greater than 40% of total body surface area or, for a person under 16 years of age, greater than 30% of total body surface area; or

(b) inhalation burns causing long‑term respiratory impairment (as assessed by a respiratory physician); or

[Regulation 10 amended: SL 2024/133 r. 8.]

11. Permanent blindness

The criteria for an injury resulting in blindness are —

(a) permanent legal blindness as demonstrated by —

(i) visual acuity on the Snellen Scale after correction by suitable lenses being less than 6/60 in both eyes; or

(ii) field of vision being constricted to 10 degrees or less of arc around central fixation in the better eye irrespective of corrected visual acuity (equivalent to 1/100 white test object); or

(iii) a combination of visual defects resulting in the same degree of visual loss described in subparagraph (i) or (ii);

and

(b) the injury occurs —

(i) if the injury is a motor vehicle injury — on or after 1 July 2016; or

(ii) if the injury is a workplace injury — on or after 1 July 2024.

[Regulation 11 amended: SL 2024/133 r. 9.]

Division 2 — Application to participate in CISS

12. Application under s. 9 of Act

(1) In this regulation —

relevant accident means either of the following —

(a) the motor vehicle accident that resulted in the motor vehicle injury to which the application relates; or

(b) the workplace accident that resulted in the workplace injury to which the application relates.

(2) An application under section 9 of the Act must be made within 3 years after the day on which the relevant accident occurred or any longer period allowed under subregulation (3).

(3) The Commission may extend the 3 year period referred to in subregulation (2) if satisfied that there are exceptional reasons to do so.

[Regulation 12 amended: SL 2024/133 r. 10.]

13. Deferral of consideration of application

(1) The Commission may defer consideration of an application under section 9 of the Act until the Commission is satisfied that the motor vehicle injury or workplace injury to which it relates has stabilised.

(2) The Commission must give the applicant written notice of a deferral under subregulation (1).

[Regulation 13 amended: SL 2024/133 r. 11.]

14. Application under s. 13 of Act

An application under section 13 of the Act must be —

(a) made in the form approved by the Commission; and

(b) accompanied by any information specified in the form as information required to accompany the application.

15. Additional information relevant to CISS application

(1) The Commission may, by written notice, require an applicant to provide additional information the Commission considers relevant to its consideration of a CISS application.

(2) The Commission may refuse to deal with, or to continue to deal with, the CISS application until the additional information is provided.

16. Consent to obtain information

(1) The Commission may, by written notice, require an applicant to provide a consent or other authorisation the Commission considers necessary in order to obtain information relevant to its consideration of a CISS application.

(2) The Commission may refuse to deal with, or to continue to deal with, the CISS application until the consent or authorisation is provided.

17. Notice of decision on CISS application

(1) The Commission must give written notice of its decision on a CISS application to the applicant.

(2) If the decision is to refuse the CISS application, the notice must include —

(a) the reasons for the decision; and

(b) information about the dispute resolution process under Part 5 of the Act and these regulations.

18. Functional independence assessments

(1) In this regulation —

functional independence assessment means an assessment conducted using the FIMTM or WeeFIM®.

(2) When determining an injured person’s eligibility for participation in the CISS, the Commission is not required to consider a functional independence assessment in respect of the injured person unless it is conducted —

(a) by a person who, in the opinion of the Commission, is appropriately qualified to use the FIMTM or WeeFIM®, as the case requires; and

(b) within one month before the day on which the injured person’s CISS application is made or within one month after that day.

Division 3 — Interim participation

19. Period of interim participation

(1) For the purposes of section 11(1) of the Act, but subject to subregulation (2), the period for which an interim participant remains a participant in the CISS is —

(a) the period ending 2 years after the day on which the interim participant is accepted as a participant in the CISS; or

(b) if, at the end of the period referred to in paragraph (a), the Commission is not satisfied that the interim participant’s injury has stabilised, any longer period the Commission considers necessary to allow the injury to stabilise.

(2) A person’s interim participation in the CISS ends if the person is accepted as a lifetime participant.

Division 4 — Suspension of participation

20. Commission may suspend participation

The Commission may suspend the participation of a person in the CISS if —

(a) there is evidence of fraud by the person (or another person with lawful authority to act on the person’s behalf) in connection with a payment received pursuant to an agreement referred to in section 18(5) of the Act; or

(b) the person (or another person with lawful authority to act on the person’s behalf) fails to comply with a requirement under regulation 23(2); or

(d) the person fails to comply with regulation 25(2).

21. Notice of decision to suspend

(1) If the Commission decides under section 14(1) of the Act or regulation 20 to suspend the participation of a person in the CISS, the Commission must give the person written notice of its decision.

(2) The notice must include —

(a) the reasons for the decision; and

(b) information about the dispute resolution process under Part 5 of the Act and these regulations.

Part 3 — Treatment, care and support needs

22. Principles to be observed in assessment of treatment, care and support needs

(1) When assessing the treatment, care and support needs of a participant in the CISS, the Commission must take into account the principles set out in subregulation (2).

(2) The principles are as follows —

(a) any treatment, care, support or service for the participant should be necessary and reasonable to achieve the participant’s treatment, care and support goals and to maximise the participant’s capacity to undertake daily activities independently, whether in employment or in the community generally;

(b) any treatment, care, support or service for the participant should be demonstrably beneficial in terms of the participant’s treatment, care and support goals and should reasonably be expected to provide for a positive outcome for the participant that outweighs any known risks based on information from comparable cases;

(c) any treatment, care, support or service for the participant should be provided by a suitably qualified and experienced person who is appropriate to the participant’s personal circumstances and who is readily accessible to the participant;

(d) any treatment, care, support or service for the participant should represent value for money and should be delivered in a manner that ensures maximum benefits at minimum cost.

23. Requirement to provide information

(1) In this regulation —

service provider means a person who, under the CISS, provides treatment, care, support or another service to a participant in the CISS.

(2) The Commission may, by written notice, require a participant in the CISS or a service provider to provide information the Commission considers relevant to its assessment of the participant’s treatment, care and support needs.

(3) In the case of a participant in the CISS, the notice must inform the participant that failure to comply with the requirement may result in suspension of the person’s participation in the CISS under regulation 20.

(4) In the case of a service provider, the notice must inform the service provider that failure to comply with the requirement may constitute an offence.

(5) A service provider who, without reasonable excuse, fails to comply with a requirement under subregulation (2) commits an offence.

Penalty for this subregulation: a fine of $10 000.

24. Requirement to undergo examination

(1) For the purposes of determining the treatment, care and support needs of a participant in the CISS, the Commission may, by written notice, require the participant to undergo a medical examination or other examination by a health professional, or other appropriately qualified person, specified in the notice.

(2) The notice must inform the participant that failure to comply with the requirement may result in suspension of the person’s participation in the CISS under regulation 20.

25. Participant to comply with requirements in treatment, care and support assessment

(1) In this regulation —

specified means specified in the participant’s treatment, care and support assessment;

treatment, care and support requirement means a requirement for —

(a) the participant to participate in a specified activity; or

(b) the participant to receive specified treatment, care or support or another specified service.

(2) A participant in the CISS must take reasonable steps to comply with each specified treatment, care and support requirement.

Part 4 — Registered providers

26. Services to be provided by registered provider

For the purposes of section 23(1) of the Act, the following services are to be provided by a registered provider —

(a) attendant care services;

(b) case management services;

(d) dietetic services;

(e) disability employment services;

(f) domestic assistance services (for example, cleaning, gardening or home maintenance);

(g) education services;

(h) exercise services (for example, exercise physiology or personal training);

(i) home modification services;

(j) orthotic or prosthetic services;

(k) recreational services;

(l) social work services;

(m) speech pathology services;

(n) therapy assistance services;

(o) vocational training or vocational rehabilitation services;

(p) workplace training or workplace rehabilitation services.

[Regulation 26 amended: SL 2024/133 r. 12.]

27. Application for registration

An application for registration must be —

(a) made in the form approved by the Commission; and

(b) accompanied by any information specified in the form as information required to accompany the application.

28. Notice of decision on application

(1) The Commission must give written notice of its decision on an application for registration to the applicant.

(2) If the Commission decides to grant a registration, the notice must include any conditions of registration.

29. Variation, addition or cancellation of conditions of registration

(1) The Commission may, by written notice given to a registered provider, vary, add to or cancel any of the conditions of registration.

(2) Before varying or adding to the conditions of registration, the Commission must give the registered provider a reasonable opportunity to make written submissions on the proposed variation or addition.

30. Revocation of registration

(1) The Commission may, by written notice given to a registered provider, revoke its registration.

(2) Before revoking the registration, the Commission must give the registered provider a reasonable opportunity to make written submissions on the proposed revocation.

Part 5 — Dispute resolution

Division 1 — Review applications

31. Review application

(1) In this regulation —

decision, in relation to a review application, means the decision to which the review application relates.

(2) A review application must —

(a) be in writing; and

(b) include the applicant’s name, address and contact details; and

(d) give details of the injury or alleged injury to which the decision relates; and

(e) set out the reasons for disputing the decision; and

(f) be accompanied by all documents relating to the decision that are in the possession, custody or control of the applicant; and

(g) be accompanied by any medical reports or other information the applicant considers relevant to the application.

(3) A review application must be made within 28 days after the day on which notice of the decision is given or any longer period allowed under regulation 65.

32. Commission may request further information

If the Commission considers that additional information is required in connection with a review application, the Commission —

(a) may, by written notice, ask the applicant to provide the information within 28 days after the notice is given; and

(b) may defer the making of a referral under regulation 33(1), 38(1) or 46(1), as the case requires, until the information is provided or the end of the 28 day period, whichever occurs first.

Division 2 — Review of non‑medical decisions

33. Referral of decision to review officer

(1) If the Commission receives an application under section 25 of the Act in respect of a non‑medical decision, the Commission must refer the decision to a review officer for review.

(2) Subregulation (1) is subject to regulation 32(b).

(3) The Commission must give the applicant written notice of the referral and of the name of the review officer.

34. Objection to review officer

(1) The applicant may, within 14 days after notice is given under regulation 33(3) or any longer period allowed under regulation 65, object in writing to the person named in the notice being the review officer.

(2) An objection under subregulation (1) must set out the applicant’s reasons for the objection.

(3) If the applicant makes an objection under subregulation (1), the Commission may refer the decision to a different review officer.

35. Conduct of review

(1) When conducting a review, the review officer —

(a) may adopt the procedures the review officer considers appropriate; and

(b) is not bound by the rules of evidence but may inform themself in any way the review officer considers appropriate.

(2) The review officer may, by written notice, require a person to appear before the review officer at a specified time and place to answer questions or to produce material, or both.

(3) A person must not, without reasonable excuse, refuse or fail to comply with a requirement under subregulation (2).

Penalty for this subregulation: a fine of $10 000.

36. Decision on review

(1) On completion of a review, the review officer must make a decision that either —

(a) confirms or varies the non‑medical decision; or

(b) revokes the non‑medical decision and substitutes another decision.

(2) The review officer must give written notice of the decision to the applicant and to the Commission.

(3) The notice must include —

(a) the reasons for the decision; and

(b) information about the applicant’s right to appeal against the decision under section 27 of the Act.

37. Review officers

The Commission may designate a Commission officer as a review officer for the purposes of this Division.

Division 3 — Review of medical decisions

38. Referral of decision to expert review panel

(1) If the Commission receives an application under section 25 of the Act in respect of a medical decision, the Commission must refer the decision to the convenor for review by an expert review panel.

(2) Subregulation (1) is subject to regulation 32(b).

(3) The Commission must give written notice of the referral to the applicant.

(4) The convenor must convene an expert review panel to conduct the review.

39. Decision of expert review panel

(1) On completion of a review, the expert review panel must make a decision that either —

(a) confirms or varies the medical decision; or

(b) revokes the medical decision and substitutes another decision.

(2) The expert review panel must give written notice of the decision to the applicant and to the Commission.

(3) The notice must include —

(a) the reasons for the decision; and

(b) information about the applicant’s right to apply for a review of the decision under regulation 40(1).

40. Application for review of original review decision

(1) The applicant to whom an original review decision relates may apply to the Commission to have the original review decision reviewed by another expert review panel.

(2) An application under subregulation (1) must be made in writing and set out the grounds for review.

(3) The grounds for review are restricted to one or more of the following —

(a) a change in the condition of the person to whom the original review decision relates has occurred, being a change that —

(i) occurred or first became apparent after the medical decision was referred for review under regulation 38(1); and

(ii) is capable of having a material effect on the original review decision;

(b) additional information about the injury suffered by the person to whom the original review decision relates has become available, being information that —

(i) was not available, or could not reasonably have been obtained, before the medical decision was referred for review under regulation 38(1); and

(ii) is capable of having a material effect on the original review decision;

(d) the original review decision is demonstrably incorrect in a material respect.

41. Referral of original review decision to another expert review panel

(1) If the Commission receives an application under regulation 40(1), the Commission must refer the original review decision to the convenor for review by another expert review panel.

(2) The Commission must give written notice of the referral to the applicant.

(3) The convenor must convene an expert review panel (the second review panel) to conduct the review.

(4) The second review panel must consist of members who were not members of the expert review panel that made the original review decision.

42. Decision of second review panel

(1) On completion of a review, the second review panel must make a decision that either —

(a) confirms or varies the original review decision; or

(b) revokes the original review decision and substitutes another decision.

(2) The second review panel must give written notice of the decision to the applicant and to the Commission.

(3) The notice must include the reasons for the decision.

43. Effect of decision of second review panel

(1) A decision made by a second review panel under regulation 42(1) is final and binding for the purposes of the Act and cannot be reviewed or appealed against.

(2) Subregulation (1) does not affect judicial review for jurisdictional error.

44. Commission to reimburse treatment, care and support expenses in certain circumstances

(1) This regulation applies if —

(a) a medical decision the subject of a review under this Division results in a person who was an interim participant ceasing to be eligible to be a participant in the CISS; and

(b) the decision on the review revokes or has the effect of revoking the medical decision and results in the person who was an interim participant again being eligible to be a participant in the CISS.

(2) The Commission must reimburse the person for any necessary and reasonable expenses incurred by the person in relation to the person’s treatment, care and support needs in the period beginning on the day on which the medical decision was made and ending on the day on which the decision on the review was made.

Division 4 — Review of treatment, care and support assessments

45. Term used: assessment

In this Division —

assessment means a treatment, care and support assessment.

46. Referral of decision to expert review panel

(1) If the Commission receives an application under section 26 of the Act in respect of an assessment, the Commission must refer the assessment to the convenor for review by an expert review panel.

(2) Subregulation (1) is subject to regulation 32(b).

(3) The convenor must convene an expert review panel to conduct the review.

47. Decision of expert review panel

(1) On completion of a review, the expert review panel must make a decision that either —

(a) confirms or varies the assessment; or

(b) revokes the assessment and substitutes another assessment.

(2) The expert review panel must give written notice of the decision to the applicant and to the Commission.

(3) The notice must include the reasons for the decision.

48. Effect of decision of expert review panel

(1) A decision made by an expert review panel under regulation 47(1) is final and binding for the purposes of the Act and cannot be reviewed or appealed against.

(2) Subregulation (1) does not affect judicial review for jurisdictional error.

49. Commission to revise assessment

(1) If an expert review panel makes a decision under regulation 47(1) in relation to an assessment, the Commission must revise the assessment to include any changes that are needed to give effect to the decision.

(2) The Commission’s revised assessment replaces the earlier assessment.

Division 5 — Expert review panels

50. Establishment

There are to be such expert review panels as are necessary for the purposes of this Part.

51. Appointment of medical experts

(1) In this regulation —

health professional means a person registered under the Health Practitioner Regulation National Law (Western Australia) to practise a health profession (other than as a student).

(2) The Minister must appoint health professionals as medical experts for the purposes of this Part.

(3) A person appointed under subregulation (2) —

(a) is to be appointed on terms and conditions, and for a term (not exceeding 3 years), determined by the Minister; and

(b) on the expiration of a term of office, is eligible for reappointment; and

(c) is entitled to be paid any remuneration and allowances that the Minister determines on the recommendation of the Public Sector Commissioner.

(4) The office of a person appointed under subregulation (2) becomes vacant if the person —

(a) resigns by written notice addressed to the Minister; or

(b) is removed from office by the Minister for —

(i) breach of, or non‑compliance with, a condition of appointment; or

(ii) mental or physical incapacity to carry out duties of office satisfactorily; or

(iii) misconduct; or

(iv) neglect of duty; or

(v) incompetence;

(d) ceases to be registered under the Health Practitioner Regulation National Law (Western Australia); or

(e) is convicted of an indictable offence or of an offence which, if committed in this State, would be an indictable offence; or

(f) is sentenced to imprisonment for an offence.

52. Experts list

(1) The Minister must compile and maintain a list of the medical experts appointed under regulation 51(2).

(2) The Minister must ensure that the experts list is publicly available.

53. Convenor and deputy convenor

(1) From the experts list, the Minister must appoint on terms and conditions determined by the Minister —

(a) a convenor; and

(b) a deputy convenor.

(2) The deputy convenor may, subject to the direction of the convenor, exercise the functions and powers conferred on the convenor under this Division.

(3) The deputy convenor has, and may exercise, the functions and powers conferred on the convenor under this Division while the office of the convenor is vacant.

54. Constitution of expert review panel

(1) An expert review panel convened under regulation 38(4) or 41(3) must consist of 3 members selected by the convenor from the experts list.

(2) An expert review panel convened under regulation 46(3) must consist of the number of members, not exceeding 3, selected by the convenor from the experts list.

(3) If a person appointed under regulation 51(2) (the medical expert) has been engaged to treat or examine, or to furnish a report in relation to, a person (other than as a member of an expert review panel), the medical expert must not sit as a member of an expert review panel examining the person.

(4) The convenor must appoint a presiding member for each expert review panel constituted by more than one person, who is to have general responsibility for managing the operations of the panel in a particular case.

55. Convenor to give notice of members of panel

When the convenor convenes an expert review panel under regulation 38(4), 41(3) or 46(3), the convenor must give the applicant written notice of the names of the members of the panel.

56. Objection to member of panel

(1) The applicant may, within 14 days after notice is given under regulation 55 or any longer period allowed under regulation 65, object in writing to a person named in the notice being a member of the expert review panel.

(2) An objection under subregulation (1) must set out the applicant’s reasons for the objection.

(3) If the applicant makes an objection under subregulation (1), the convenor may replace the member of the expert review panel.

57. Procedures: general provisions

(1) An expert review panel is not bound by the rules of evidence but may inform itself in any way it considers appropriate.

(2) An expert review panel may act informally and without regard to technicalities and legal forms.

(3) An expert review panel may engage consultants and seek expert advice as it considers necessary in any particular case.

(4) The convenor may give directions as to the arrangement of the business of the expert review panels.

(5) The convenor may give directions as to the procedures of the expert review panels but may not give directions inconsistent with any guidelines issued by the Minister under regulation 63(1).

(6) Subject to this regulation and the other provisions of this Division, an expert review panel may determine its own procedures.

58. Acts and decisions of 2 or 3 member panel

(1) In the case of an expert review panel constituted by 2 members —

(a) an act or decision of both members of the panel constitutes an act or decision of the panel; and

(b) if the members cannot agree on a matter, another person selected by the convenor from the experts list must determine the matter as if the person constituted the expert review panel.

(2) In the case of an expert review panel constituted by 3 members, an act or decision of a majority of the members of the panel constitutes an act or decision of the panel.

59. Powers and procedures on review

(1) The applicant must give the expert review panel —

(a) a document specifying —

(i) the injury or alleged injury to which the referred decision relates; and

(ii) the facts or questions of fact relevant to the referred decision which the applicant is satisfied have been agreed and the facts or questions that are in dispute;

and

(b) copies of all documents relating to the referred decision that are in the possession, custody or control of the applicant.

(2) An expert review panel may, by written notice, require —

(a) the injured person (or a person with lawful authority to act on the injured person’s behalf) to meet with the panel and answer questions; and

(b) the injured person (or a person with lawful authority to act on the injured person’s behalf) to give to the panel copies of all documents relating to the referred decision that are in the possession, custody or control of the person; and

(3) If the injured person (or a person with lawful authority to act on the injured person’s behalf) consents, the expert review panel may, by written notice, require a person who has provided a service to the injured person in relation to the injury or alleged injury to which the referred decision relates —

(a) to meet with the panel and answer questions; and

(b) to give to the panel copies of all documents relating to the referred decision that are in the possession, custody or control of that person.

(4) Any attendance of a person before an expert review panel must be in private, unless the panel considers that it is necessary for another person to be present.

(5) A person must not, without reasonable excuse, refuse or fail to comply with a requirement under subregulation (2) or (3).

Penalty for this subregulation: a fine of $10 000.

60. Use of information in subsequent proceedings

Information given to an expert review panel cannot be used in subsequent proceedings unless —

(a) the proceedings are before a court; or

(b) the injured person, or a person with lawful authority to consent on the injured person’s behalf, consents to the use of the information.

61. Admissibility

An opinion, report, notice of determination or other document given by an expert review panel is admissible in evidence in any proceedings before a court.

62. Services and facilities

(1) The Minister must ensure that the convenor, deputy convenor and each expert review panel are provided with the services and facilities that are reasonably necessary to enable them to perform their functions.

(2) Without limiting subregulation (1), the Minister may, by arrangement with the Commission, allow the convenor, the deputy convenor or an expert review panel to make use, either full‑time or part‑time, of —

(a) the services of a Commission officer; and

(b) any services or facilities of the Commission.

63. Guidelines

(1) The Minister may issue guidelines as to the procedures of expert review panels for the purposes of —

(a) ensuring procedural fairness in those procedures; and

(b) facilitating the proper administration of those panels.

(2) The Minister must ensure that guidelines issued under subregulation (1) are publicly available.

Division 6 — Other matters

64. Costs

(1) In this regulation —

travel costs means necessary costs of travel and accommodation.

(2) The Commission must pay travel costs incurred by an applicant, or by a parent or other carer who accompanies an applicant, in order to attend proceedings relating to a review under this Part.

(3) The Commission is not liable for legal costs for or in respect of legal services provided to an applicant in relation to a review under this Part.

65. Extension of period for application or objection

The Commission may extend the period for making an application or objection under this Part if the Commission considers it appropriate to do so.

66. Correction of errors

(1) In this regulation —

reviewer means a review officer or an expert review panel.

(2) A reviewer may correct a notice of decision given by the reviewer under regulation 36(2), 39(2), 42(2) or 47(2) (the original notice of decision) if it contains a clerical or typographical error or an obvious omission or inconsistency.

(3) A reviewer may exercise the power in subregulation (2) on the application in writing of a person to whom the original notice of decision was given or on the reviewer’s own initiative.

(4) If a reviewer exercises the power in subregulation (2), the reviewer must give a replacement notice of decision to each person to whom the original notice of decision was given.

(5) A replacement notice of decision —

(a) supersedes the original notice of decision; and

(b) has effect as if given on the day on which the original notice of decision was given.

67. Period for commencing appeal

For the purposes of section 27(5) of the Act, the period is 28 days.

[Part 6 (r. 68) deleted: SL 2024/274 r. 4.]

Schedule 1 — Excluded treatment, care and support needs

[r. 5]

Terms used

In this Schedule —

participant means a participant in the CISS;

relevant injury, in relation to a participant, means the motor vehicle injury or workplace injury in respect of which the participant is a participant in the CISS;

relevant legislation means legislation of this State, the Commonwealth, another State or a Territory.

[Clause 1 amended: SL 2024/133 r. 14(1).]

Attendant care services

Attendant care services of the following kinds —

(a) services for a participant who resides overseas;

(b) services provided while a participant in the CISS is an inpatient in a hospital or undergoing inpatient rehabilitation;

(d) services provided in an unsafe environment or in circumstances that place an attendant care worker at risk of harm;

(e) services that replace parental responsibilities (for example, supervision of a young child).

Domestic assistance

Domestic assistance services of the following kinds —

(a) the provision of cleaning products or equipment;

(b) waste removal or disposal;

(d) services provided while a participant is away from the participant’s usual place of residence.

Aids and appliances

The provision of equipment of the following kinds —

(a) equipment that, under normal circumstances, is considered to be general household equipment or leisure equipment;

(b) equipment to replace equipment neglected, abused or misused by a participant;

(c) equipment that is more expensive than is required to meet a participant’s identified necessary and reasonable treatment, care and support needs.

Education support

Education support or services of the following kinds —

(a) support or services that a participant is entitled to under relevant legislation;

(b) support or services that are more appropriately funded by another person or body as part of a common or universal service obligation;

(c) support or services that a participant accessed, was assessed as needing, or was on a waiting list for, before the participant suffered the relevant injury;

(d) support involving payment of amounts charged by a school or other educational institution (for example, school or course fees, fees for excursions or school camps, stationary costs or uniform costs).

Vocational or workplace support

Vocational or workplace support or services of the following kinds —

(a) support involving capital expenditure (for example, the costs of establishing and running a business);

(b) support or services that a participant was receiving before the participant suffered the relevant injury;

(d) support to keep a business open (for example, paying for temporary staff to do a participant’s job);

(e) support involving wages subsidies for a person who employs a participant;

(f) support involving payment of ordinary expenses associated with employment or training (for example, travel costs, meal costs or uniform costs);

(g) support involving payment of the fees or other costs of a training course that a participant was enrolled in before the relevant injury.

[Clause 6 amended: SL 2024/133 r. 14(2).]

Home modifications

(1) In this clause —

belongs, community titles scheme and scheme by‑laws have the meanings given in the Community Titles Act 2018 section 3(1);

leasehold scheme, strata company and strata titles scheme have the meanings given in the Strata Titles Act 1985 section 3(1);

leasehold scheme owner has the meaning given to owner, in relation to a leasehold scheme, by the Strata Titles Act 1985 section 3(1).

(2) Modifications to a participant’s usual place of residence of the following kinds —

(a) modifications involving maintenance or repairs identified in a strata report, building report or pest inspection report;

(b) modifications that have not been permitted by the owner of the place of residence;

(i) the relevant strata company; or

(ii) if the strata titles scheme is a leasehold scheme — the leaseholder scheme owner;

(ca) if the place of residence is subject to a community titles scheme, modifications that have not been permitted by —

(i) the scheme by‑laws for the scheme; or

(ii) the scheme by‑laws for a community titles scheme to which the scheme belongs;

(d) modifications involving the construction or installation of a pool, spa or aquatic therapy facility;

(e) modifications involving the provision of ordinary household items (for example, furniture, whitegoods, fans, lights, smoke alarms or surge protectors).

[Clause 7 inserted: Gazette 31 Dec 2019 p. 4651‑2; amended: SL 2021/76 r. 4.]

Transport modifications

Modifications to a motor vehicle of the following kinds —

(a) modifications to change a manual transmission system to an automatic transmission system;

(b) modifications to more than one motor vehicle used by a participant at a particular time;

(d) modifications to a motor vehicle that is outside Australia;

(e) modifications involving repairs or replacement carried out under warranty or because of a participant’s neglect, abuse or misuse;

(f) modifications that an employer has a duty to make under relevant legislation.

Respite care

Respite care provided in an unsafe environment or in circumstances that place a participant at risk of harm.

Prostheses

The repair or replacement of prostheses because of a participant’s neglect, abuse or misuse.

[Schedule 2 deleted: SL 2024/274 r. 5.]

View image in the official source

Notes

This is a compilation of the Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Regulations 2016 and includes amendments made by other written laws. For provisions that have come into operation see the compilation table.

Compilation table

Citation	Published	Commencement
Motor Vehicle (Catastrophic Injuries) Regulations 2016 1	13 May 2016 p. 1441-85	r. 1 and 2: 13 May 2016 (see r. 2(a)); Regulations other than r. 1 and 2: 14 May 2016 (see r. 2(b) and Gazette 13 May 2016 p. 1421)
Motor Vehicle (Catastrophic Injuries) Amendment Regulations 2019	31 Dec 2019 p. 4651‑2	r. 1 and 2: 31 Dec 2019 (see r. 2(a)); Regulations other than r. 1 and 2: 1 May 2020 (see r. 2(b) and SL 2020/39 cl. 2)
Motor Vehicle (Catastrophic Injuries) Amendment Regulations 2021	SL 2021/76 18 Jun 2021	r. 1 and 2: 18 Jun 2021 (see r. 2(a)); Regulations other than r. 1 and 2: 30 Jun 2021 (see r. 2(b) and SL 2021/69 cl. 2)
Treasurer Regulations Amendment (Workers Compensation) Regulations 2024 Pt. 2	SL 2024/133 26 Jun 2024	1 Jul 2024 (see r. 2(b))
Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Amendment Regulations 2024	SL 2024/274 18 Dec 2024	r. 1 and 2: 18 Dec 2024 (see r. 2(a)); Regulations other than r. 1 and 2: 19 Dec 2024 (see r. 2(b))

Other notes

1 Now known as the Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Regulations 2016; citation changed (see note under r. 1).

Defined terms

[This is a list of terms defined and the provisions where they are defined. The list is not part of the law.]

Defined term Provision(s)

application for registration 3

ASIA Impairment Scale 3

assessment 45

belongs Sch. 1 cl. 7(1)

CISS application 3

Commission officer 3

community titles scheme Sch. 1 cl. 7(1)

conditions of registration 3

decision 31(1)

expert review panel 3

experts list 3

FIMTM 3

functional independence assessment 18(1)

Glasgow Coma Scale 3

health professional 51(1)

injured person 3

leasehold scheme Sch. 1 cl. 7(1)

leasehold scheme owner Sch. 1 cl. 7(1)

medical decision 3

medical expert 54(3)

non-medical decision 3

original notice of decision 66(2)

original review decision 3

participant Sch. 1 cl. 1

referred decision 3

relevant accident 12(1)

relevant injury Sch. 1 cl. 1

relevant legislation Sch. 1 cl. 1

review application 3

reviewer 66(1)

review officer 3

scheme by-laws Sch. 1 cl. 7(1)

second review panel 3, 41(3)

service provider 23(1)

Snellen Scale 3

specified 25(1)

strata company Sch. 1 cl. 7(1)

strata titles scheme Sch. 1 cl. 7(1)

travel costs 64(1)

treatment, care and support requirement 25(1)

WeeFIM® 3

Westmead Post-Traumatic Amnesia Scale 3

This work is licensed under a Creative Commons Attribution 4.0 International Licence (CC BY 4.0). To view relevant information and for a link to a copy of the licence, visit www.legislation.wa.gov.au.

By Authority: GEOFF O. LAWN, Government Printer

Western Australia

Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Act 2016

Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Regulations 2016

Western Australia

Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Regulations 2016

Contents

Part 1 — Preliminary

Citation 1
Commencement 1
Terms used 1
Assessment tools 3
Excluded treatment, care and support needs 3

Part 2 — Participation in CISS

Division 1 — Criteria for catastrophic injury

Purpose of Division 4
Spinal cord injury 4
Traumatic brain injury 4
Amputations 6
Burns 7
Permanent blindness 9

Division 2 — Application to participate in CISS

Application under s. 9 of Act 9
Deferral of consideration of application 10
Application under s. 13 of Act 10
Additional information relevant to CISS application 10
Consent to obtain information 11
Notice of decision on CISS application 11
Functional independence assessments 11

Division 3 — Interim participation

Period of interim participation 12

Division 4 — Suspension of participation

Commission may suspend participation 12
Notice of decision to suspend 13

Part 3 — Treatment, care and support needs

Principles to be observed in assessment of treatment, care and support needs 14
Requirement to provide information 15
Requirement to undergo examination 15
Participant to comply with requirements in treatment, care and support assessment 16

Catastrophic injury eligibility: The regulations define objective criteria for each listed injury category that must be met for CISS participation. For spinal cord injuries the test is a permanent neurological deficit evidenced by an ASIA Impairment Scale score of A to D (reg 7). For traumatic brain injury the test varies by age cohort and combines clinical measures (Westmead Post‑Traumatic Amnesia Scale, Glasgow Coma Scale or significant neuroimaging/clinical record) with functional impairment on the FIMTM or WeeFIM® (reg 8). Amputations are defined by anatomical thresholds or equivalents such as brachial plexus or lumbosacral avulsions (reg 9). Burns criteria combine total body surface area thresholds, inhalation injury causing long‑term respiratory impairment, or full thickness burns to functionally critical sites, with concurrent functional impairment for older age groups (reg 10). Permanent blindness is defined by Snellen visual acuity or constricted visual fields or equivalent combined defects (reg 11). Each criterion includes temporal cut‑offs: motor vehicle injuries from 1 July 2016; workplace injuries from 1 July 2024 (regs 7-11).

Application and timing: An ordinary application under section 9 of the Act must be lodged within three years of the relevant accident unless extended for exceptional reasons (reg 12). The Commission may defer consideration of applications until the injury has stabilised (reg 13). Functional independence assessments (FIMTM or WeeFIM®) are only required to be considered by the Commission if performed by an assessor the Commission regards as appropriately qualified and conducted within one month before or after the CISS application (reg 18).

Assessment principles and exclusions: The regulations set four assessment principles: necessity and reasonableness to meet goals and maximise independent capacity; demonstrable benefit where benefits outweigh risks; provision by suitably qualified and accessible practitioners; and value for money to maximise benefits at minimum cost (reg 22). Schedule 1 prescribes a list of treatment, care and support needs that are excluded from funding, giving granular examples (e.g. cleaning products, school fees, capital expenditure to start a business, vehicle conversions to automatic transmission) and cross‑referring to other legislation such as the Community Titles Act 2018 and Strata Titles Act 1985 for home modification permissions (Schedule 1 cl 7).

Information, examinations and compliance: The Commission can require participants or service providers to provide information or consents for obtaining information (regs 15-16). Service providers who fail to comply with an information requirement without reasonable excuse face a $10,000 fine (reg 23(5)). The Commission may require a participant to undergo medical or other examinations to determine needs (reg 24). Participants must take reasonable steps to comply with specified treatment, care and support requirements (reg 25).

Provider registration: A defined list of services must be provided by registered providers for the purposes of s 23(1) of the Act, including attendant care, case management, counselling, dietetics, disability employment, domestic assistance, education, exercise, home modification, orthotic/prosthetic services and vocational/rehabilitation services (reg 26). Registration, conditions, variation and revocation follow administrative notice procedures with opportunities for submissions (regs 27-30).

Dispute resolution architecture: Non‑medical decisions are reviewed by a review officer designated from Commission officers; review officers are not bound by evidence rules and have enforcement powers including requiring attendance or production of material with penalties for non‑compliance (Div 2, regs 33-37). Medical decisions and treatment, care and support assessments are reviewed by expert review panels convened from a ministerially appointed experts list; panels operate informally, may seek consultants, and their decisions are admissible in court (Divs 3-5, regs 38-63). Second review panels exist and their decisions are final and binding for the Act’s purposes, subject only to judicial review for jurisdictional error (regs 41-43, 47-49).

Administrative and ministerial roles: The Minister appoints medical experts and maintains the experts list (regs 51-52), appoints convenor and deputy convenor (reg 53), and may issue guidelines for expert review panel procedures which must be publicly available (reg 63). The Commission administers applications, deferrals, suspensions, provider registration and pays travel costs for review attendance but is not liable for applicants’ legal costs (reg 64).

Key procedural timeframes and enforcement measures: Review applications ordinarily must be lodged within 28 days after notice of the decision (reg 31(3)); applicants have 14 days to object to nominated review officers or panel members (regs 34(1), 56(1)); the Commission may extend these periods (reg 65). Penalties of up to $10,000 attach to certain non‑compliance with information or attendance requirements (regs 23(5), 35(3), 59(5)). The regulations therefore create a rulebook that converts clinical and functional thresholds into administrative eligibility, sets compliance obligations for participants and providers, and channels contested decisions into specialised expert reviews with limited appellate rights.

Participants and applicants: Individuals who suffer motor vehicle or workplace injuries that may meet the catastrophic injuries criteria are the primary affected cohort. Eligibility criteria vary by injury type and by age cohort for traumatic brain injury and burns (regs 7-11). Time limits for applying (reg 12), deferral until stabilisation (reg 13), and the interim participation regime (reg 19) directly structure applicants’ access to the CISS.

Interim participants and lifetime participants: The regulations differentiate interim participants (subject to a set interim participation period and potential suspension) from lifetime participants. Interim participation ends if the person becomes a lifetime participant (reg 19(2)). The Commission may suspend a person’s participation for specified non‑compliance or fraud-related grounds (reg 20). Participants must provide information, attend examinations and comply with treatment, care and support requirements (regs 23-25). Failure to comply can result in suspension (reg 20) or, for providers, criminal fines (reg 23(5)).

Service providers and registered providers: Persons or entities that provide services under the CISS are affected both as potential registered providers (eligible to be registered to supply services specified in reg 26) and as regulated parties subject to information requests and potential fines. The list of services that must be provided by registered providers is explicit (reg 26). Registered providers face administrative consequences including variation of registration conditions (reg 29) and revocation (reg 30), with procedural safeguards requiring an opportunity to make written submissions prior to variation or revocation (reg 29(2), reg 30(2)).

The Commission and Commission officers: The Insurance Commission of Western Australia (the Commission) and its officers administer applications, registration, assessments and reviews. The definition of Commission officer expressly relies on appointments or engagements under the Insurance Commission of Western Australia Act 1986 (reg 3). The Commission has powers to defer applications (reg 13), suspend participation (reg 20), require information and examinations (regs 15, 16, 23-24), and to appoint review officers (reg 37).

Minister and medical experts: The Minister appoints medical experts under the Health Practitioner Regulation National Law (WA) (reg 51(1)-(3)), compiles and publicly publishes an experts list (reg 52), and appoints a convenor and deputy convenor to manage expert review panels (reg 53). Medical experts so appointed may be remunerated and are subject to removal for specified misconduct or incapacity (reg 51(3)-(4)).

Employers and other funders: Schedule 1 directly references “relevant legislation” and circumstances where an employer has duties (for example, certain vehicle or home modifications, cl 6(c) and Sch 1 cl 8(f)). The Schedule carves out items that are more appropriately funded by other persons or bodies, which implicates employers, education systems, insurers, or other statutory schemes in determining funding responsibility (Sch 1 cl 5(b), cl 6(b)).

Legal and advocacy representatives: The rules on review, the requirement to include all documents in an applicant’s possession with a review application (reg 31(2)(f)), and the Commission’s position that it is not liable for applicants’ legal costs (reg 64(3)) shape the practical role of legal advisers and advocates. Expert review panel proceedings are private unless the panel decides otherwise (reg 59(4)), and information given to a panel cannot be used in subsequent proceedings without consent or in court (reg 60). These constraints affect the evidentiary strategy for lawyers and advocates.

Wider public sector interfaces: The regulations explicitly reference other statutory regimes and bodies, for example the Health Practitioner Regulation National Law (WA) for registration of health professionals (reg 51(1)), the Community Titles Act 2018 and Strata Titles Act 1985 for home modification permissions (Sch 1 cl 7(1)), and the Insurance Commission of Western Australia Act 1986 for Commission officers (reg 3). Entities operating under those regimes may be drawn into disputes or asked to provide consents and information.

In short, the regulations affect injured people seeking long‑term support, the service providers who deliver CISS services, the Commission and Minister as decision makers, the pool of medical experts who will adjudicate contested medical questions, employers and other statutory funders whose duty or entitlement to provide services is acknowledged in Schedule 1, and legal representatives working within constrained review and evidentiary rules.

Duties on the Commission and Minister

Make decisions on CISS applications and give written reasons and information about dispute resolution when refusing or suspending participation (regs 17(1)-(2), 21(1)-(2)). The notice must include reasons and details of the dispute resolution process (reg 17(2); reg 21(2)).
Maintain and publish the experts list and appoint convenor/deputy convenor and medical experts under terms determined by the Minister, including remuneration and removal grounds (regs 51-53).
Provide services and facilities to enable convenor and panels to perform functions and may resource panels via the Commission (reg 62).

Duties on applicants and participants

File applications in approved form with required information and within time limits: ordinary applications within three years of the relevant accident unless extended (reg 12); review applications within 28 days after notice unless extended by the Commission (reg 31(3); reg 65).
Respond to written notices from the Commission requiring additional information or consents; the Commission may refuse to deal with an application until requirements are met (regs 15-16).
Attend examinations or assessments when required by notice and face potential suspension for non‑compliance (regs 24(1)-(2), 20).
Take reasonable steps to comply with treatment, care and support requirements specified in an assessment (reg 25).

Duties on service providers

Provide information required by written notice relevant to assessment of participant needs; failure without reasonable excuse is an offence punishable by a fine of $10,000 (reg 23(2), (5)).
If consenting, attend an expert review panel and provide documents when required (reg 59(3)).

Rights of applicants and participants

Right to written notice and reasons for decisions on CISS applications and for suspension of participation (regs 17, 21).
Right to review decisions: non‑medical decisions to a review officer (regs 33-36); medical decisions and assessments to expert review panels (regs 38-39, 46-49).
Right to be informed of review officer or panel members and to object to nominated persons within 14 days (regs 33(3), 34(1)-(3), 55-56).
Right to apply for a second expert review panel in relation to original review decisions, subject to restricted grounds (reg 40(1)-(3)) and the second panel must consist of members not on the original panel (reg 41(4)).
Right to reimbursement of travel costs to attend review proceedings (reg 64(2)).
Right to a corrected notice if clerical errors or obvious omissions are present in a reviewer’s notice (reg 66).

Procedural powers and limits

Expert review panels are not bound by rules of evidence and may determine procedures, engage consultants and act informally, but the convenor must comply with Ministerial guidelines where issued (regs 57-59, 63).
Information provided to panels is confidential and cannot be used in later proceedings unless court proceedings or consent (reg 60). Opinions and determinations of panels are admissible in court proceedings (reg 61).
Decisions of second review panels are final and binding for the purposes of the Act and not subject to further internal review or appeal except for judicial review limited to jurisdictional error (regs 43(1)-(2), 48(1)-(2)).

Registration and provider obligations

Providers who seek registration must apply using Commission‑approved forms and supply any specified information; the Commission must give notice of decisions and include registration conditions where registration is granted (regs 27-28).
The Commission must give providers an opportunity to make written submissions before varying or adding conditions or revoking registration (regs 29(2), 30(2)).

Enforcement and sanctions

Fines up to $10,000 for service providers or other persons who refuse to comply without reasonable excuse with attendance or information requirements (regs 23(5), 35(3), 59(5)).
Suspension of participation for fraud, non‑compliance with information/examination notices, or failure to comply with treatment requirements (reg 20).
Revocation of registration for registered providers after a procedural opportunity to make submissions (reg 30).

These duties and rights allocate behavioural expectations across the Commission, applicants, participants, service providers, medical experts and the Minister, with specified procedural safeguards, timeframes and sanctions set out in the regulations.

Statutory sanctions and enforcement mechanisms in the regulations are narrowly focused and primarily administrative, with limited criminal penalties attached to specific non‑compliance.

Monetary penalties

A fine of $10,000 applies to a service provider who, without reasonable excuse, fails to comply with an information requirement under reg 23(2) (reg 23(5)). The same penalty amount attaches to refusal or failure without reasonable excuse to comply with requirements to appear before a review officer (reg 35(2)) and to comply with expert review panel attendance or production requirements (reg 59(5)). These monetary penalties are expressed as fines; the regulations do not set imprisonment as a sanction for these failures.

Suspension and administrative exclusion

The Commission may suspend a person’s participation in the CISS for specified grounds: evidence of fraud in connection with payments under agreements referred to in s 18(5) of the Act; failures to comply with Commission requirements to provide information (reg 23(2)), to undergo examinations (reg 24(1)), or to comply with treatment, care and support requirements (reg 25(2)) (reg 20). Suspension requires written notice including reasons and dispute resolution information (reg 21(1)-(2)). The practical effect is temporary exclusion from scheme benefits pending compliance or resolution.

Registration sanctions

The Commission can vary, add or cancel conditions of a provider’s registration, and can revoke registration after giving the registered provider a reasonable opportunity to make written submissions (regs 29-30). Those are administrative sanctions that can remove the provider’s ability to participate in delivering services under the CISS.

Procedural enforcement powers

Review officers and expert review panels may require persons to appear and produce material, and persons must not refuse without reasonable excuse (regs 35(2), 59(2)-(3)). Non‑compliance with those notices attracts the $10,000 fine (regs 35(3), 59(5)). Review officers and panels are not bound by technical rules of evidence and may inform themselves in any way they consider appropriate (regs 35(1)(b), 57(1)). Expert review panels may also engage consultants and seek expert advice (reg 57(3)).

Admissibility and confidentiality

Expert panel opinions and reports are admissible in evidence in court proceedings (reg 61). However, information given to a panel cannot be used in subsequent proceedings unless the proceedings are before a court or the injured person consents (reg 60). This creates a controlled confidentiality environment for panel processes while preserving their evidentiary utility in court.

Finality and judicial review

A decision of a second review panel is final and binding for the purposes of the Act and cannot be reviewed or appealed against under the Act, but this does not affect judicial review for jurisdictional error (regs 43(1)-(2)). Similarly, decisions of expert review panels on assessment reviews are final and binding, subject to judicial review (regs 47(1)-(2), 48(1)-(2)). These provisions limit internal appeals while preserving external judicial oversight on questions of jurisdiction.

Financial obligations and reimbursements

The Commission must reimburse travel costs incurred by an applicant or accompanying parent/carer to attend proceedings relating to a review (reg 64(2)). The Commission is explicitly not liable for applicants’ legal costs for reviews (reg 64(3)). In circumstances where an interim participant is wrongly taken off eligibility by a medical decision and later reinstated on review, the Commission must reimburse necessary and reasonable expenses incurred during the period between the medical decision and the review decision (reg 44).

Procedural safeguards

Before varying registration conditions or revoking registration, the Commission must give the registered provider a reasonable opportunity to make written submissions (regs 29(2), 30(2)). Applicants have rights to object to nominated review officers or panel members within fixed timeframes (regs 34, 56). Reviewers may correct clerical or typographical errors in notices and must issue replacement notices (reg 66).

Operational enforcement risks and limits

The majority of enforcement is administrative and procedural; criminal penalties are limited to fines and apply to refusal to comply with specified notices. The regulations vest substantial discretionary powers in the Commission and convenor (defer consideration, suspend participation, vary registration conditions, convene panels), so enforcement will rely heavily on administrative decision‑making and resource capacity to run expert panels, manage information requests, and prosecute non‑compliance. The regulations do not authorise search or seizure powers, nor do they specify detailed procedural hearing rights beyond notice, opportunity to make submissions and limited objection rights.

In sum, enforcement under these regulations is a mix of administrative consequences (suspension, condition variation, revocation), statutory fines for non‑compliance in information and attendance contexts, procedural obligations on decision‑makers to provide reasons and opportunities for submissions, and limited financial protections (travel reimbursement and one form of retrospective reimbursement for reinstated interim participants).

Reference to the Act and other statutory regimes

The regulations operate under and give effect to the Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Act 2016 (the Act). Multiple operative references to sections of the Act appear throughout the regulations: applications under s 9 and s 13 (reg 12, reg 14), interim participation under s 11 (reg 19), suspension under s 14 (reg 21), eligibility decisions under s 24 (see definition of medical and non‑medical decisions, reg 3), review rights under ss 25-27 (regs 31-49), and obligations on providers under s 23 (reg 26). The regulations must therefore be read together with the Act and its substantive entitlements and procedural rules.

Insurance Commission of Western Australia Act 1986

The definition of Commission officer in reg 3 expressly relies on appointments or engagements under the Insurance Commission of Western Australia Act 1986 (reg 3). Administrative functions, staffing and the possibility of the Commission providing services and facilities to expert review panels (reg 62(2)) are thus connected to the Commission’s statutory framework.

Health Practitioner Regulation National Law (Western Australia)

Appointment and removal of medical experts for expert review panels is conditioned on registration status under the Health Practitioner Regulation National Law (WA) (reg 51(1), (4)(d)). A medical expert’s office becomes vacant if they cease to be registered under that national law (reg 51(4)(d)). This links panel eligibility to national practitioner registration mechanisms and fitness to practise regimes.

Strata and community titles legislation

Schedule 1 cl 7 addresses home modifications and cross‑refers to definitions in the Community Titles Act 2018 and Strata Titles Act 1985. The Schedule disallows funding for modifications not permitted by owners, strata companies, leasehold scheme owners or scheme by‑laws. That cross‑reference integrates private property and strata governance rules into the Commission’s funding decisions for home modifications (Sch 1 cl 7(1)-(3)).

Other funding and statutory obligations

Schedule 1 frequently defers to “relevant legislation” and circumstances where another body or person would appropriately fund an item (Sch 1 cl 1, cl 5(b), cl 6(b)). For vocational and workplace support, the Schedule excludes items that an employer must provide under relevant legislation, or that are more properly funded under common or universal service obligations (Sch 1 cl 6(c)-(f)). These provisions require administrators and decision makers to consider overlapping statutory entitlements and private obligations (workers compensation, workplace health and safety, education funding, social security frameworks) when deciding whether the CISS meets particular needs.

Evidence and court proceedings

Expert review panel opinions and determinations are admissible in court (reg 61), but information given to a panel is generally protected from subsequent use unless proceedings are before a court or the injured person consents (reg 60). That construct preserves panel confidentiality while allowing the panels’ work to inform judicial litigation, linking administrative review to civil proceedings and evidentiary rules outside the regulations.

Finality and judicial oversight

Decisions of second review panels are made final and binding for the purposes of the Act (reg 43(1)) and decisions of expert panels on treatment assessments are likewise final (reg 48(1)), but both explicitly preserve judicial review for jurisdictional error (regs 43(2), 48(2)). This places internal administrative finality against a constitutional backdrop where courts have supervisory jurisdiction to correct jurisdictional defects.

Interoperation with employer obligations and workers’ compensation

The introduction of workplace injuries coverage from 1 July 2024 (compilation table; regs 7-11 amended by SL 2024/133) means overlap between the CISS and workers compensation regimes. The regulations’ exclusions relating to employer duties, wage subsidies, and employer-provided equipment (Sch 1 cl 6(c), cl 6(e)) signal an intent to leave certain employer obligations with the employer or the workers compensation system. Administrative coordination will be required in practice to sort responsibility for particular supports.

Regulatory interplay and discretion

The Commission’s discretion to defer applications until injuries stabilise (reg 13), to extend statutory time limits for exceptional reasons (reg 12(3)), to extend periods for applications or objections (reg 65), and to vary registration conditions (reg 29) creates touchpoints where the Commission must interpret and apply both the regulations and overlapping legislative duties from other statutes. Those discretionary powers mean that effective inter‑agency and statutory coordination will influence application outcomes.

In summary, the regulations are not a freestanding regime; they are embedded in a matrix of other statutory frameworks , the Act itself, health practitioner registration law, strata/community titles law, the Insurance Commission Act, and workers compensation and employer obligations , that will influence practical decision‑making, cost allocation and dispute resolution. The regulations both draw on and constrain those intersecting legal regimes through specific cross‑references and exclusions.

Compilation and amendment instruments recorded in the regulations set out the history of changes and operational rollouts.

Principal instrument and initial commencement

The regulations were originally published as the Motor Vehicle (Catastrophic Injuries) Regulations 2016 with regulations other than r 1 and r 2 commencing 14 May 2016; the citation and title have since changed (compilation table).

Subsequent amendments and notable changes

Motor Vehicle (Catastrophic Injuries) Amendment Regulations 2019 (published 31 Dec 2019): amendments took effect in 2020 for most provisions (compilation table). The 2019 instrument inserted Schedule 1 cl 7 regarding home modifications and made other refinements (see Schedule 1 and Gazette note).
Motor Vehicle (Catastrophic Injuries) Amendment Regulations 2021 (SL 2021/76): amendments effective 30 June 2021 refined lists and perhaps other technical aspects (compilation table; reg notes indicate amendments).
Treasurer Regulations Amendment (Workers Compensation) Regulations 2024 Pt. 2 (SL 2024/133): took effect 1 July 2024. The 2024 instruments align commencement dates and extend the scheme to workplace injuries from 1 July 2024 for each injury category (see regs 7-11 which were amended to add workplace injury commencement dates of 1 July 2024).
Motor Vehicle and Workplace Accidents (Catastrophic Injuries) Amendment Regulations 2024 (SL 2024/274): published 18 Dec 2024 and mostly commenced 19 Dec 2024. The 2024/274 instrument deleted Part 6 (r 68) and Schedule 2 and made other technical updates referenced in the compilation table and footnotes in the regulations (compilation table; notes).

Textual amendments recorded inline

Throughout the body of the regulations margins and bracketed notes record where specific regulations were amended by SL 2024/133 and SL 2024/274 (for example regs 1, 7-11, 12, 13, 15, 18, 19, 20, 26, 29 and multiple Schedule 1 clauses show amendment footnotes). These indicate iterative refinement of eligibility criteria, procedural timeframes and registration lists.

Operational effect of amendments

The most operationally significant amendment visible in the compiled text is the staged inclusion of workplace injuries effective from 1 July 2024 in all injury category criteria (regs 7-11). That expansion alters the affected population and creates new interactions with workers compensation frameworks and employer obligations (Schedule 1 references to employer duties).

Public availability and transparency

The Minister must maintain and ensure public availability of the experts list and guidelines for expert review panel procedures (regs 52(2), 63(2)), and the compilation itself includes publicised commencement and amendment dates in the Gazette and SL references, enabling practitioners to track temporal applicability and transition rules.

Limitations on historical insight

The compilation table records amendment instruments and dates but does not provide detailed explanatory material or an explanatory memorandum within the compiled text. To understand legislative intent behind particular amendments (for example why workplace injuries were added from 1 July 2024), practitioners should consult the amending instruments’ Gazette notices, parliamentary debates or explanatory memoranda associated with the parent Act and amending regulations.

Practical takeaway

Practitioners must check the compilation table and the legislative history for the operative commencement dates of individual provisions, notably the 1 July 2024 trigger for workplace injuries and the 2019-2024 amendments modifying Schedule 1 and certain procedural rules. Administrative decisions taken before an amendment’s commencement may be governed by prior versions, so file/time stamping and careful attention to the regulation’s compilation history is essential when advising clients or challenging decisions.

The regulations themselves do not list or cite any judicial decisions. They set internal review mechanisms (review officers, expert review panels and second review panels) and give limited scope for internal appeal, but expressly preserve judicial review on questions of jurisdictional error.

Internal review and finality implications

Decisions of a second review panel are final and binding for the purposes of the Act and cannot be reviewed or appealed against internally (reg 43(1)). The equivalent finality applies to expert review panel decisions on treatment, care and support assessments (reg 48(1)). Both provisions preserve access to judicial review only for jurisdictional error (regs 43(2), 48(2)). This structure channels most factual and medical disputes into the administrative expert panel process and constrains repeated internal review.

Admissibility and confidentiality that shape litigation strategy

Expert review panel opinions and reports are admissible in court (reg 61). Information given to a panel is protected from subsequent use in proceedings unless the proceedings are before a court or the injured person consents (reg 60). That affects how parties may use expert panel findings in later civil litigation and shapes strategic decisions about disclosure and consenting to use of panel material.

No cases named in the regulations

The instrument does not cite or summarise any cases nor does it provide an annotated litigation history. The compilation table and other notes record statutory amendments but not judicial interpretation. Therefore any litigation history relevant to interpreting these regulations must be obtained by case law research external to this text.

Practical risk for litigators and judicial oversight

Because finality clauses constrain internal appeals, litigants may be compelled to seek judicial review rather than sequential administrative appeals when alleging jurisdictional errors. Practitioners should therefore consider early judicial review where there are arguable jurisdictional defects, and consider admissibility rules regarding expert reports when preparing or defending proceedings in court.

Recommended enquiries for litigation background

To build a litigation strategy, practitioners should search WA tribunals and superior courts for judicial consideration of: the CISS Act and regulations’ interpretation; disputes over eligibility thresholds (for example application of ASIA, FIMTM, WeeFIM®, Glasgow or Westmead scales); procedural fairness in expert review panel processes; and the Commission’s exercise of discretion in deferral and suspension. None of those decisions appear in this text; locating them requires external legal research.

In short, the regulations remove most internal appellate routes once a second expert panel decision is made, preserve admissibility for panel determinations in court while protecting panel materials, and leave judicial review as the external check on jurisdictional error. The regulations themselves do not record case law; practitioners must look to court databases and legal reporting for litigation history.

Timing traps

Three‑year application window: Ordinary applications under s 9 must be made within three years of the relevant accident unless the Commission extends time for exceptional reasons (reg 12(2)-(3)). Missing this window without an exceptional reason risks losing access to the scheme. For workplace injuries many injury criteria only apply to injuries occurring on or after 1 July 2024 (regs 7-11), creating potential temporal complexity for injuries around the cut‑off dates.
Short windows for reviews and objections: Review applications must be made within 28 days after notice of the decision (reg 31(3)), and objections to nominated review officers or panel members must be made within 14 days (regs 34(1), 56(1)). The Commission can extend these periods (reg 65), but practitioners should not rely on extensions.

Functional assessment technicalities

Functional independence assessments (FIMTM or WeeFIM®) will not be considered by the Commission unless conducted by a person the Commission considers appropriately qualified and within one month before or after the CISS application (reg 18). That narrow timing and qualification requirement may invalidate otherwise persuasive functional assessments taken outside that window or performed by assessors not acceptable to the Commission.

Interim participant risks

Interim participation is limited to two years by default (reg 19(1)(a)), and interim participants who are ceased from eligibility by a medical decision and later reinstated by review can only be reimbursed for necessary and reasonable expenses incurred during the intervening period (reg 44). Interim participants should be aware of the transient nature of their rights and preserve evidence of expenses to claim reimbursement if the review outcome supports reinstatement.

Confidentiality but admissibility paradox

Information given to expert review panels is protected from use in subsequent proceedings unless the injured person consents or the proceedings are before a court (reg 60). At the same time, panels’ opinions and determinations are admissible in court (reg 61). Parties need to be careful about consenting to disclosure of panel materials because consent may enable broader use in litigation; conversely non‑consent limits the usefulness of panel material outside court.

Finality of second review panels

Decisions of second review panels are final and binding (reg 43(1)) and cannot be internally reviewed. Only judicial review is available for jurisdictional error (reg 43(2)). This creates stakes where a second panel decision on a contentious medical issue leaves the applicant with limited administrative remedies and forces them to consider judicial review early.

Excluded items with fine detail

Schedule 1 contains detailed exclusions that may not be intuitively obvious. Examples include: refusal to fund school fees or excursion costs (Sch 1 cl 5(d)), refusal to fund capital expenditure to establish or run a business (cl 6(a)), refusal to fund vehicle modifications that change manual transmission to automatic (cl 8(a)) and refusal to fund prostheses repair due to participant neglect (cl 10). Practitioners must map needs against Schedule 1 carefully; an item that seems linked to disability may nonetheless be excluded because it is deemed a general household item or an employer responsibility.

Service provider exposure

Service providers who refuse or fail without reasonable excuse to comply with information requests or appearance notices to review bodies may be fined up to $10,000 (regs 23(5), 59(5)). Providers should have processes to respond promptly to Commission or panel notices and to preserve documentary evidence of compliance or reasonable excuse.

Home modification permissions and strata complexities

Home modification funding is excluded where modifications have not been permitted by an owner, strata company, leaseholder scheme owner or where community titles scheme by‑laws restrict the modification (Sch 1 cl 7(2)(b)-(c)). Funding depends on third parties’ approvals, potentially delaying works and creating disputes about when work is “necessary and reasonable.” Applicants must secure necessary permissions or risk funding refusal.

Potential overlap with other funders

Schedule 1 repeatedly excludes items that are the responsibility of other bodies (relevant legislation, employers, schools, universal services). Practically, this requires early coordination with workers compensation insurers, employers, education providers and other statutory funders to establish funding responsibility and to avoid duplicated claims or denials.

Evidence management requirements

Review applications must be accompanied by all documents in the applicant’s possession, custody or control that relate to the decision (reg 31(2)(f)). Failure to produce relevant documents could be treated as non‑compliance or weaken an applicant’s case. Conversely, information given in panel processes is to be treated as confidential and its later use is limited without consent; balancing disclosure to panels against litigation strategy requires considered planning.

Procedural posture for provider registration

Registered providers must use Commission‑approved forms and supply specified information (reg 27). The Commission may vary registration conditions after giving the provider an opportunity to make written submissions (reg 29). Providers should maintain clear compliance records and governance processes to manage registration conditions and potential revocation risks.

In short, practical pitfalls arise from strict timing rules, narrow evidence admissibility and assessment windows, detailed exclusions in Schedule 1, and the finality of second‑panel decisions. Practitioners and applicants should structure applications and evidence-gathering with those constraints in mind and prepare for coordinated inter‑agency approaches where excluded items intersect other funding or statutory responsibilities.

Document and time your application

Lodge an application under s 9 within three years of the relevant accident unless an exceptional extension is justified and sought in writing (reg 12(2)-(3)). For workplace injuries post 1 July 2024, ensure the accident date falls within the workplace coverage window specified in regs 7-11. Keep a strict file timeline and preserve contemporaneous clinical notes, imaging, rehabilitation reports and expense receipts to support eligibility and later reviews.

Prepare and qualify functional assessments

If submitting FIMTM or WeeFIM® assessments, ensure they are performed by a person the Commission will regard as appropriately qualified and that they are dated within one month before or after the CISS application (reg 18). Before commissioning assessments, check the Commission’s guidance or contact the Commission to confirm acceptable assessors to avoid wasting time and expense on assessments the Commission will not consider.

Anticipate information and consent requests

Expect and promptly comply with written notices requiring additional information, documents or authorisations to obtain information relevant to the application (regs 15-16). The Commission may refuse to deal with an application until these are provided (regs 15(2), 16(2)). Keep track of notices served, comply within stipulated timeframes and retain evidence of compliance to defend against suspension risks.

Respond to examination requests

The Commission may require medical or other examinations to determine treatment, care and support needs (reg 24). Failure to comply may result in suspension (reg 20). Arrange attendance and, where relevant, ensure medical professionals are briefed to provide targeted assessments aligned with the injury criteria in regs 7-11 and the assessment principles in reg 22.

Comply with treatment and support requirements

Once a treatment, care and support assessment specifies requirements, participants must take reasonable steps to comply (reg 25). Document adherence to therapy plans, appointments, vocational or workplace training and participation in specified activities. Non‑compliance can lead to suspension (reg 20).

Manage excluded items and alternative funding

Review Schedule 1 in detail to identify likely excluded items (Schedule 1). For excluded needs, pursue alternative funding pathways: employers, workers compensation schemes, education departments, local government assistance, or national disability programs where applicable. Where a need borders on exclusion, prepare evidence showing necessity and why it does not fit an exclusion (for example, demonstrate that a modification is not ordinary household equipment and is directly necessary for independence).

Prepare for review processes

If a decision is adverse, file a review application within 28 days of notice (reg 31(3)); include the applicant’s contact details, full details of the decision, the reasons for dispute, copies of all documents in your possession and any medical reports (reg 31(2)). Anticipate that expert review panels may ask applicants to supply additional documents and attend to answer questions (reg 59). When assembling documents, bear in mind confidentiality rules regarding panel materials (reg 60) and admissibility of panel opinions in court (reg 61).

Engage with expert review panels strategically

If a medical decision is under review, the convenor will select panel members from the Minister’s experts list (regs 38-39, 54). If a proposed panel member has been engaged to treat or examine the injured person outside the panel, they must not sit on that panel (reg 54(3)). Applicants have 14 days to object to panel membership (reg 56(1)); use this right swiftly if there are reasonable grounds. Panels may act informally and may obtain external expert advice (reg 57). Consider preparing succinct statements of agreed facts and disputed issues as required by reg 59(1)(a).

Protect rights and consider litigation options early

Recognise that second review panel decisions are final and binding under the Act (reg 43(1)) subject only to judicial review for jurisdictional error (reg 43(2)). If there are arguable jurisdictional defects in process or jurisdiction, consider early advice on judicial review, including time limits and grounds. For other appeals, follow the specified administrative review pathways (regs 33-49) and preserve records of procedural fairness breaches.

For providers: meet registration and information obligations

Providers seeking registration must use the Commission’s approved form and provide specified information (reg 27). Recordkeeping systems should enable rapid production of documents when panels or review officers require them under reg 59(2)(b) or reg 35(2). Ensure compliance policies address the $10,000 fine exposure for failure to comply without reasonable excuse (reg 23(5)).

Coordinate cross‑jurisdictional and employer claims

Where Schedule 1 excludes items that may fall under employer obligations, workers compensation or other statutory entitlements, open liaison with those entities early. Document communications and attempts to secure employer or insurer funding to demonstrate why CISS funding is or is not appropriate. If the Commission requires information or consents to obtain material from other bodies (reg 16), provide those authorisations promptly.

Maintain practical case files and receipts

For reimbursement risks and any later review of interim participation (reg 44), keep records of expenses, receipts and proof of necessity and reasonableness. The Commission will reimburse necessary and reasonable expenses if an interim participant is reinstated following review (reg 44(2)), but the clause applies to a specific fact pattern and requires contemporaneous evidence.

Use procedural safeguards

Where the Commission proposes to vary or cancel registration conditions or revoke registration, providers have a right to a reasonable opportunity to make written submissions (regs 29(2), 30(2)). Use those opportunities and submit comprehensive evidence. Seek extensions under reg 65 where necessary and justified to avoid missing tight windows for review, objection or submission.

Practical checklist summary

Confirm the accident date and applicable injury criteria (regs 7-11).
Compile medical records, imaging, FIMTM/WeeFIM® assessments within the one‑month window where required (reg 18).
Lodge applications on Commission forms and include all documents in possession (regs 12, 14, 31(2)).
Respond to Commission notices for additional information or consents promptly (regs 15-16).
Attend required examinations and follow treatment plans, documenting compliance (regs 24-25).
For adverse decisions, file review applications promptly, prepare documentary bundles and raise timely objections to panel membership where appropriate (regs 31, 34, 56).
Keep receipts and records for possible reimbursement if an interim participant is reinstated (reg 44).
For providers, maintain registration documentation, compliance processes and rapid document production capacity to avoid fines (regs 27, 23(5)).

Following these steps will position applicants and providers to meet the regulatory tests and to preserve rights of review and reimbursement contained in the regulations.

Deep Dive

What it does

Current sections