If you’re receiving workers compensation in NSW, some important changes to the regulations around medical treatment started on 1 July 2026. These changes affect what your employer or insurer has to pay for, and it’s worth understanding them so you know where you stand and what to do if a treatment request is knocked back.
The basic test hasn’t changed yet — but it’s getting tougher soon
Right now, you’re entitled to treatment that’s “reasonably necessary” because of your injury. That’s a fairly generous standard, and it’s still the test that applies today. Later this year (1 October 2026), that standard is set to become “reasonable and necessary” — a subtly higher bar. When that change lands, expect insurers to ask not just whether a treatment helps you, but whether the same benefit could be achieved a cheaper way. If your insurer starts pushing back on treatment using language like “value for money,” that’s this change playing out in practice.
Some treatments are no longer automatically covered
The updated regulations set out a specific list of treatments and services that your employer or insurer doesn’t have to pay for anymore, no questions asked. This doesn’t mean these things are banned or that you can never get help with them — it means they’re no longer accepted automatically, and you’ll usually need a proper medical prescription to have a chance of getting them funded.
The main categories are:
- Alternative and complementary therapies — things like aromatherapy, crystal therapy, cuddle therapy, gaming therapy, homeopathy, kinesiology, neuroreflective therapy (a type of pain therapy using a cryotherapy machine), reflexology, sound therapy and wilderness therapy
- Life and wellness coaching, including wellness retreats
- Massage — unless it’s been prescribed specifically by a doctor
- Energy and healing practices — including things like energy clearing, energy balanced massage, energy therapy, frequency healing, reiki therapy, shamanic healing and spinal flow technique
- General health, fitness, social or recreational activities — unless a doctor has specifically prescribed them as part of your treatment
- Costs relating to companion animals (like pet food or vet bills) — unless the animal is a recognised assistance animal, which we explain in more detail below
An important detail here: for massage and fitness activities, it now needs to be a doctor — not just any health professional — who prescribes it for the exclusion not to apply. A referral from your physiotherapist alone won’t be enough anymore. If you’re getting genuine benefit from one of these treatments, it’s worth asking your doctor to formally prescribe it (by issuing a referral to the insurer for approval) and document (usually in the referral and the management plan part of your certificate of capacity) why it’s part of your treatment, rather than just relying on a general recommendation.
If you were already getting help with the costs of a companion animal before 1 July 2026, that existing support should continue — the change doesn’t apply retrospectively to take away something you were already receiving. But it only covers that same animal, not any future pet.
Good news: some treatments stayed off the list
Earlier drafts of these regulations would have also cut off funding for cannabinoid medication (medicinal cannabis) and GLP-1 medications (a class of medication, including drugs like Ozempic and Mounjaro, originally developed for diabetes and weight management but increasingly used to help manage some chronic pain conditions). In the final version, that didn’t happen — those medications aren’t on the exclusion list. If you’re managing a chronic injury, ongoing pain, or a psychological injury that hasn’t responded to more standard treatments, this means these medications are still assessed on their own merits, the same as any other treatment, rather than being ruled out automatically. It’s a genuinely positive outcome for workers whose recovery has needed this kind of treatment.
Companion animal vs assistance animal — what’s the real difference?
This is one of the more confusing parts of the new regulations, so it’s worth spelling out clearly.
An assistance animal isn’t just any pet that makes you feel better — it has a specific legal meaning. To count as an assistance animal, a dog (or other animal) needs to be formally accredited, or specifically trained to help with your disability and to behave appropriately in public. It’s a genuine training and accreditation process, not something that happens informally.
A therapy dog or emotional support animal, by contrast, doesn’t need any of that. Many people find real comfort and support from a pet during a difficult recovery, especially with a psychological injury — and that’s completely understandable. But under the law, an animal that hasn’t gone through formal training and accreditation isn’t recognised as an assistance animal, no matter how much it genuinely helps you. That means, under the new regulations, the everyday costs of keeping that animal — food, vet bills and so on — generally won’t be covered.
If you have a dog that’s providing real therapeutic benefit and there’s a realistic path to having it formally trained and accredited, it may be worth exploring that with your treating team early. Doing so is what would move the costs of that animal from “not covered” to “potentially covered.”
What you should do
- Ask for a proper prescription, not just a recommendation. If you want funding for something like massage, a fitness program, or another treatment on the exclusion list, get your doctor to prescribe it specifically and explain in writing why it’s needed for your injury. This will be needed for the insurer to consider.
- Check any existing arrangements are documented. If you’re already getting help with companion animal costs from before 1 July 2026, make sure that’s clearly on file with your insurer in case it’s questioned later.
- Don’t assume medication like medicinal cannabis or GLP-1 drugs is automatically excluded — it isn’t. If it’s been recommended as part of your treatment, it should still be considered on its merits.
- Get advice early if a treatment request is refused. These are new regulations, and insurers are still working out how to apply them. If something you believe is reasonably necessary for your recovery gets knocked back, don’t assume that’s the final word — there are ways to challenge that decision, and getting advice early gives you the best chance of a good outcome.
These changes are still bedding in, and more updates are expected later this year as the tougher “reasonable and necessary” test comes into effect. If you’re unsure how any of this applies to your situation, it’s worth speaking with a lawyer who handles workers compensation claims regularly, so you understand your options before agreeing to anything or letting a refusal go unchallenged. Give us a call on 1300 026 875 or contact us via our website.
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This article is general information only and isn’t a substitute for legal advice about your individual circumstances.