(1) Subject to this
section, a worker is entitled to be compensated for costs of services
described in subsection (2) that are reasonably incurred by the worker in
consequence of having suffered a work injury—
accordance with a scale published by the Minister under this section; or
the relevant service is not covered by a scale under this section—to the
extent of a reasonable amount for the provision of the service.
(2) The costs referred
to in subsection (1) are the necessary costs of:
hospitalisation and all associated medical, surgical and nursing services;
approved recovery/return to work services;
travelling, or being transported, to and from any place for the purpose of
receiving medical services, hospitalisation or approved recovery/return to
work services (but not where the worker travels in a private vehicle);
where it is necessary for the worker to be accommodated away from home for the
purpose of receiving medical services or approved recovery/return to work
services—such accommodation (but not exceeding limits prescribed by
attendance by a registered or enrolled nurse, or by some other person approved
by the Corporation or of a class approved by the Corporation, where the injury
is such that the worker must have nursing or personal attendance;
provision, maintenance, replacement or repair of therapeutic appliances;
medicines and other material purchased on the prescription or recommendation
of a health practitioner;
other services (or classes of services) authorised by the
(3) Compensation in
respect of costs to which this section applies may be paid—
the worker; or
directly to the person to whom the worker is liable for those costs.
(4) If a worker has
been charged more than the amount that the worker is entitled to claim for the
provision of a service in respect of which compensation is payable under this
section, the Corporation may reduce the charge by the amount of the excess.
(5) A decision of the
Corporation under subsection (4) does not constitute a
reviewable decision under Part 6.
services of a kind to which this section applies were provided to a worker in
relation to a work injury; and
Corporation considers that the services were, in the circumstances of the
case, unnecessary or unreasonably incurred,
the Corporation may disallow charges for the services.
(7) If the Corporation
disallows or reduces a charge under this section—
must give to the provider of the service a notice setting out—
the basis of the Corporation's decision to disallow or
reduce the charge; and
where the charge has been disallowed under
subsection (6) the provider's right to have the decision reviewed under
this section; and
worker is not liable to the provider for the disallowed charge, or for more
than the reduced charge, (as the case requires) and, if the worker has in fact
paid an amount for which he or she is not liable, the Corporation will
reimburse the worker for that amount and may recover it from the provider as a
(8) If a worker
travels in a private vehicle to or from any place for the purpose of receiving
medical services, hospitalisation or approved recovery/return to work
services, and the travel is reasonably necessary in the circumstances of the
case, the worker is entitled to a travel allowance at rates fixed by a scale
published by the Minister under this section.
(9) A reference in
this section to approved recovery/return to work services is a reference to
recovery/return to work services provided by a person who has an agreement
with the Corporation for the provision of those services.
(10) If a treatment
protocol or framework for the provision of services has been published by the
Minister under this section, costs for the provision of those services are
only compensable where—
services are provided in accordance with the protocol or framework; or
provider of the services establishes, to the Corporation's satisfaction, that
services outside the terms of the protocol or framework are justified in the
circumstances of the particular case.
(11) The amount of
compensation for a service covered by a scale of charges published by the
Minister under this section must be in accordance with the scale.
(12) The Minister may,
by notice in the Gazette, on the recommendation of the Corporation,
scales of charges for the purposes of this section (ensuring as far as
practicable that the scales comprehensively cover the various kinds of
services to which this section applies);
treatment protocols or frameworks as contemplated by this section.
(13) Subject to
subsection (14), a scale of charges published under this section must be
based on the average charge to private patients for the relevant service
unless the Minister determines that it is not reasonably practicable or
feasible to determine such an average charge for a relevant service (but in
any event the amount fixed for the service must not exceed the amount
recommended by the relevant professional association).
(14) A scale of
charges for services provided by a public hospital may be based on government
charges for the relevant service.
(15) Before the
Corporation makes a recommendation to the Minister about the publishing of a
scale of charges, or a treatment protocol or framework, the Corporation must
professional associations representing the providers of medical services of
the relevant kind; and
associations representing self-insured employers (including Self-Insurers of
South Australia Incorporated); and
associations representing employers other than self-insured employers
(including the South Australian Employers Chamber of Commerce and Industry);
associations representing employees (including the United Trades and Labor
(16) A person who
provides a service for an injured worker, knowing the worker to be entitled to
compensation for the service under this section, must not charge for the
service an amount exceeding the amount allowed under a scale of charges
published under this section.
Maximum penalty: $2 500.
(17) A worker is
entitled, in relation to prescribed classes of services, appliances, medicines
or materials referred to in subsection (2), to apply to the Corporation
for approval to obtain the provision of those services or otherwise to incur
costs on the basis that the Corporation will agree in advance to be liable for
the relevant costs rather than the worker being required to claim compensation
under this section once the costs have been incurred.
(18) An application
under subsection (17) must be made in accordance with the regulations and
the Corporation must make a decision in relation to the application within the
period prescribed by the regulations.
(19) The Corporation
must give the same consideration to an application under subsection (17)
that would be given to an application if the worker were to incur the relevant
costs and then claim compensation under subsection (1).
(20) Subject to
subsection (21), an entitlement to compensation under this section
(including an entitlement to make an application under subsection (17))
comes to an end if the worker has not had an entitlement to receive weekly
payments in relation to the work injury under Division 4 for a continuous
period of 12 months (or has not had an entitlement to receive weekly
payments under Division 4 and a period of 12 months has expired)
(insofar as costs are incurred after the end of that period).
not apply in relation to a seriously injured worker; and
in relation to any therapeutic appliance required to
maintain the worker's capacity; or
in relation to surgery, any associated medical, nursing
or medical rehabilitation services (including the cost of hospitalisation),
where the Corporation has determined or accepted, on application made before
the end of the period referred to in subsection (20), that it is
reasonable and appropriate for such surgery to be undertaken at a later time
due to the impact (or likely impact) of the work injury on the worker's health
and capacity (or future health and capacity); or
in relation to prescribed classes of injury, where the
Corporation has determined or accepted, on application made before the end of
the period referred to in subsection (20), that it is reasonable and
appropriate for the services to be provided after the end of that period (and
then, in such a case, the services will be compensable to the extent
determined by the Corporation); or
in any other circumstances prescribed by the regulations.
(22) The right of
review referred to in subsection (7)(a)(ii) is a right to have the
decision of the Corporation to disallow or reduce a charge reviewed by the
Tribunal by application to the Tribunal under the South Australian Employment
Tribunal Act 2014 .