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WORKERS' COMPENSATION AND REHABILITATION REGULATION 2014 - REG 117O
Appropriateness of service
117O Appropriateness of service
(1) The insurer must consider whether treatment, care or support for, or
relating to, the worker’s treatment, care and support needs— (a) is
consistent with other treatment, care or support being received by the worker;
and
(b) is consistent with current clinical practice and other industry best
practice for the treatment, care or support of persons with similar injuries.
(2) In considering the matters mentioned in subsection (1) , the insurer must
also have regard to the following matters— (a) whether the treatment, care
or support will be consistent with the worker’s future treatment, care or
support needs;
(b) whether the treatment, care or support relates directly to
the worker’s individual goals;
(c) whether the treatment, care or support
could be harmful to the worker;
(d) whether similar treatment, care or
support is already being, or is to be, provided to the worker for the injury;
(e) whether there is evidence that supports the effectiveness of the
treatment, care or support. Examples of evidence— • peer-reviewed
journal articles
• inclusion of the treatment in clinical guidelines and
frameworks
• successful clinical trials
• inclusion in the medical
benefits schedule administered by the Commonwealth
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