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WORKERS' COMPENSATION AND REHABILITATION REGULATION 2014 - REG 117V
Deciding service request
117V Deciding service request
(1) For section 232P (4) of the Act , this section prescribes the matters an
insurer must consider in deciding a service request relating to an eligible
worker.
(2) The insurer must consider the following matters— (a) whether or
not the requested service relates to— (i) the worker’s treatment, care and
support needs resulting from the worker’s serious personal injury; or
(ii)
the worker’s need for treatment, care or support resulting from another
injury resulting from the same event as the worker’s serious personal
injury;
(b) if the requested service relates to the treatment, care and
support needs mentioned in paragraph (a) (i) —whether or not the needs are
necessary and reasonable in the circumstances;
(c) if the requested service
relates to the treatment, care or support mentioned in paragraph (a) (ii)
—whether or not the treatment, care or support is necessary and reasonable
in the circumstances;
(d) if the requested service does not relate to
treatment, care and support needs or treatment, care or support mentioned in
paragraph (a) , or the insurer does not consider the needs or the treatment,
care or support mentioned in the paragraph are necessary and reasonable in the
circumstances—whether or not the insurer considers the insurer should,
wholly or partly, pay for the requested service under chapter 4A of the Act ,
having regard to the matters mentioned in section 117T (2) (f) .
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