Quick answer: what section 60 means in practice
Section 60 usually requires the insurer to pay for reasonably necessary treatment linked to your work injury. Most disputes are won or lost on evidence quality: whether your treating team clearly explains necessity, causation, and what happens if care is delayed. In the early triage stage after a refusal, secure the written notice, your current Certificate of Capacity, and a treating-doctor update that directly answers the insurer's stated reasons.
What section 60 usually covers
- GP and specialist consultations
- Physiotherapy, psychology, and allied health treatment plans
- Scans, diagnostics, medicines, and some equipment
- Hospital treatment and surgery where clinically justified
- Travel costs for approved treatment in eligible circumstances
If you are already dealing with a refusal, start with the dedicated guides for treatment denials and surgery denials. If the insurer says your treatment window has expired, review section 59A time limits.
Why insurers refuse section 60 requests
- The insurer argues treatment is not reasonably necessary right now.
- The clinical notes do not clearly connect treatment to work injury causation.
- Reports are old, generic, or inconsistent across providers.
- An IME report is given more weight than your treating practitioner evidence.
- The insurer says there is a better or cheaper treatment pathway.
If an IME report is driving the refusal, compare the refusal with SIRA guidance, the insurer's written reasons, and the Personal Injury Commission pathway before the narrative hardens. Use this IME response strategy before the narrative hardens.
Early triage stage after a refusal: practical plan
The early triage stage should be used to lock down the refusal reason, update the clinical evidence, and decide whether the dispute needs insurer reconsideration, a section 78 response, or Personal Injury Commission escalation.
| Timing | Action | Evidence target |
|---|---|---|
| Early triage stage | Request written reasons and preserve the denial notice. | Identify whether refusal is about causation, necessity, timing, or missing documents. |
| Day 2-3 | Ask the treating doctor for an updated report. | Address section 60 necessity, work-injury connection, urgency, and functional risk if delayed. |
| Day 3-5 | Attach imaging, specialist letters, treatment history, and response-to-treatment notes. | Show objective support instead of relying on bare assertion. |
| Day 5-7 | Choose reconsideration, section 78 response, section 59A route, or PIC escalation. | Keep one decision path and one indexed document bundle. |
If the refusal sits alongside payment pressure or liability disputes, map your options using claim denied steps, section 78 notice strategy, and the PIC disputes guide.
Evidence checklist that improves approval odds
- Current certificate of capacity aligned to the proposed treatment
- Provider letter explaining why this treatment is reasonably necessary now
- Clear causation statement linking current symptoms to the accepted injury
- Prior treatment outcomes (what worked, what failed, what remains impaired)
- Functional impact detail: work tasks, daily activities, and risk if care is delayed
Use one indexed treatment-request pack to control insurer delay
A single indexed treatment-request pack is the safest way to answer repeated “more information” requests because it links each attachment to the insurer's stated refusal reason and creates a clean escalation record.
- Part 1: Cover note that quotes each insurer question and answers it line-by-line.
- Part 2: Current Certificate of Capacity and treating report focused on necessity, causation, and urgency.
- Part 3: Objective support bundle (imaging, specialist letters, treatment history, and functional impact summary).
- Part 4: Index table listing each attachment, date, and what refusal reason it addresses.
- Part 5: Written request for a decision date and confirmation of the responsible claims team.
Keep all follow-up in one email thread and preserve subject-line continuity. If escalation becomes necessary, that record makes delay patterns easy to prove.
Which guide to open first: refusal route map
- Need the full strategy map first: workers compensation NSW service hub.
- Non-surgical treatment refusal: treatment denied guide.
- Surgery refusal: surgery denied guide.
- Insurer says treatment is out of time: section 59A time-limit guide.
- IME report is driving refusal: unfair IME strategy.
- Formal notice / liability dispute / legal escalation: section 78 notice guide, claim denied steps, then PIC disputes process.
If more than one path applies, structure your file around one timeline and one supporting documents so each pathway reuses the same facts cleanly.