Queensland Consolidated Regulations

[Index] [Table] [Search] [Search this Regulation] [Notes] [Noteup] [Previous] [Next] [Download] [Help]

WORKERS' COMPENSATION AND REHABILITATION REGULATION 2014 - REG 117X

Deciding payment request

117X Deciding payment request

(1) For section 232R (2) of the Act , this section prescribes matters about an insurer deciding a payment request for an expense for the treatment, care or support of an eligible worker.
(2) If the insurer makes an information request and the person of whom it is made does not provide the information requested by the stated day or a later day agreed between the insurer and the person—
(a) the payment request lapses; and
(b) the insurer is not required to approve or refuse the request.
(3) The insurer must approve the payment request if—
(a) the expense is incurred in the eligibility period for the worker; and
(b) the treatment, care or support the request relates to is an approved service for the worker.
(4) To remove any doubt, it is declared that the insurer may approve the payment request even though the treatment, care or support the request relates to is not an approved service for the worker.
(5) In this section—

"approved service" does not include treatment, care or support that is excluded treatment, care or support, unless—
(a) if a support plan has been made for the eligible worker—the excluded treatment, care or support is specifically stated in the support plan to be—
(i) treatment, care or support for, or relating to, the worker’s treatment, care and support needs resulting from the worker’s serious personal injury the insurer considers is necessary and reasonable in the circumstances; or
(ii) treatment, care or support resulting from another injury resulting from the same event as the worker’s serious personal injury the insurer considers is necessary and reasonable in the circumstances; or
(iii) treatment, care or support the insurer agrees to, wholly or partly, pay for under chapter 4A of the Act ; or
(b) if a support plan has not been made for the eligible worker—the excluded treatment, care or support is specifically approved under an approval of a service request relating to the worker.

"information request" , for a payment request, means a written request made by the insurer—
(a) asking a relevant person for further information about the payment request by a stated day of at least 10 business days after the insurer makes the request; and
(b) stating that, if the requested information is not given to the insurer by the stated day, the payment request will lapse.

"relevant person" , for an information request, means—
(a) the person who made the payment request; or
(b) if the person who made the payment request is not the eligible worker—the eligible worker.



AustLII: Copyright Policy | Disclaimers | Privacy Policy | Feedback