What happens if a Certificate of Fitness expires?
A current SIRA Certificate of Fitness is required for weekly statutory benefits. An expired certificate creates an evidence gap, but it does not authorise an insurer to ignore the notice and suspension procedure. Act quickly: arrange a clinical review, give the insurer the new certificate and ask for its written position on the affected period.
A Certificate of Fitness normally covers no more than 28 days. It can cover longer only if the practitioner states special reasons and the insurer accepts them. A certificate has no effect for any period more than 90 days before it is provided. The insurer is not required to pay until the evidence requirement is met and may suspend after communicating the requirement, allowing the applicable compliance period and following Guidelines clauses 4.61–4.63. Suspension can forfeit entitlement during the suspension period, so do not rely on later backdating.
Key points to check
Use these points to match the guide to the document or issue you are dealing with.
Must every Certificate of Fitness be limited to 28 days?
Ordinarily yes. A longer period requires special reasons stated by the practitioner and acceptance by the insurer.
Do weekly payments stop automatically on the expiry date?
Not simply by an unexplained automatic rule. The insurer must apply section 3.15 and the Guidelines notice and suspension procedure, but it is not required to pay until the evidence requirement is met.
Can a new certificate backdate the whole gap?
Not necessarily. It must have a clinical basis, and it has no effect for a period more than 90 days before it is provided. A suspension period can also involve forfeiture.
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The statutory Certificate of Fitness rules
Section 3.15 requires Certificates of Fitness and a declaration of employment for the period of weekly benefits claimed. The first certificate must come from the treating medical practitioner in accordance with the Guidelines. Under Guidelines clause 4.69, a later certificate may be given in the approved form by a medical practitioner or the treating physiotherapist or psychologist, subject to the rule about overlapping certificates.
A certificate must state whether the person has current fitness or no current fitness for work and specify the expected duration. The ordinary maximum certified period is 28 days. A longer period is valid only where the practitioner states special reasons and the insurer is satisfied that the longer certificate should be accepted.
Expiry does not mean every payment stops automatically that day
The insurer is not required to make weekly payments until section 3.15(1) has been complied with. If it communicates the requirement and the claimant fails to comply within seven days, or another prescribed period, it may suspend subject to the Guidelines. Clauses 4.61–4.63 require written contact, an explanation of what is required, reasonable assistance, at least seven calendar days to comply, IRO details and a written suspension notice with reasons and review rights if non-compliance continues.
This procedure does not make a certificate gap harmless. Section 3.15(8) says entitlement is forfeited during a suspension. The safest step is to avoid expiry and respond immediately to any notice, rather than assuming a later certificate will recover every missed week.
The 90-day limit on retrospective effect
A certificate is of no effect to the extent it relates to a period more than 90 days before the claimant provides it to the insurer. A practitioner should not simply reproduce an old certificate without a clinical basis. If an appointment delay caused a gap, keep the booking history, clinical notes and explanation and ask the insurer to state how it treats each affected week.
What to do when the certificate has expired
Contact the treating practitioner promptly and provide the previous certificate, actual job duties, current hours, treatment changes and the insurer’s letter. Ask for a clinically accurate certificate; do not ask the practitioner to certify facts they cannot support. Send it through an accepted insurer channel, keep the receipt and request confirmation of whether payments are continuing, paused or suspended.
- Record the old expiry date and the date the new certificate was provided.
- Keep appointment requests and reasons for any unavoidable delay.
- Check the employment declaration and all capacity fields are complete.
- Ask for any non-compliance or suspension notice in writing.
- Compare the notice with Guidelines 4.61–4.63 and its review information.
- Keep payslips, rosters and leave records for the gap period.
The certificate is evidence, not the entire weekly-payment decision
A current certificate does not itself prove PAWE, actual earnings loss or every aspect of work capacity. Conversely, certificate expiry should not be confused with a final medical determination that the injury has resolved. Ask whether the insurer’s decision concerns non-compliance, medical capacity, PAWE, actual earnings or another statutory rule.
Treatment approval and damages are also separate. A weekly-payment suspension does not by itself decide whether treatment is reasonable and necessary or whether common-law damages requirements are met.
Review and complaint options after suspension
Read the written notice and decision-specific review information. A dispute about suspension for section 3.15 non-compliance is not necessarily the same as a medical dispute about capacity. Internal review and the correct PIC stream depend on the decision made. IRO can address insurer service complaints but does not replace a merits review application.
Last reviewed: 11 August 2026. Source basis: Motor Accident Injuries Act 2017 (NSW), Schedule 1; SIRA Motor Accident Guidelines version 10.1, including clauses 4.44–4.70; and current official SIRA and PIC material.
Get urgent help if payments have stopped
Send the previous and new certificates, insurer notices, proof of delivery and the weekly-payment schedule through the contact page. NSW CTP Claim is a specialised service of Stephen Young Lawyers. Contact does not extend any compliance or review period and no payment outcome is guaranteed.
Frequently asked questions
- Must every Certificate of Fitness be limited to 28 days?
- Ordinarily yes. A longer period requires special reasons stated by the practitioner and acceptance by the insurer.
- Do weekly payments stop automatically on the expiry date?
- Not simply by an unexplained automatic rule. The insurer must apply section 3.15 and the Guidelines notice and suspension procedure, but it is not required to pay until the evidence requirement is met.
- Can a new certificate backdate the whole gap?
- Not necessarily. It must have a clinical basis, and it has no effect for a period more than 90 days before it is provided. A suspension period can also involve forfeiture.
- Who can issue a later certificate?
- The Guidelines permit a medical practitioner or the treating physiotherapist or psychologist to give a second or later approved certificate, subject to the detailed rules.
- What if I could not obtain a GP appointment?
- Keep booking evidence, arrange review as soon as possible, provide the updated certificate promptly and explain the delay. The insurer must still apply the statutory process to the facts.
- Is an expired certificate a PAWE decision?
- No. Certificate compliance, medical work capacity and PAWE are distinct issues even though each can affect the weekly amount.
Sources
Official public sources relevant to this guide.