{"id":"qld:sl-2016-0089","name":"National Injury Insurance Scheme (Queensland) Regulation 2016","slug":"national-injury-insurance-scheme-queensland-regulation-2016","collection":"regulation","jurisdiction":"qld","status":"in_force","isInForce":true,"actNumber":"89 of 2016","makingDate":null,"administeringDepartment":null,"currentVersion":{"id":175137,"registerId":"qld-qld:sl-2016-0089-current","compilationNumber":null,"startDate":"2026-04-05","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"pt.1","sectionType":"part","heading":"Preliminary","content":"# Preliminary","sortOrder":0},{"sectionNumber":"sec.1","sectionType":"section","heading":"Short title","content":"### sec.1 Short title\n\nThis regulation may be cited as the National Injury Insurance Scheme (Queensland) Regulation 2016 .","sortOrder":1},{"sectionNumber":"sec.2","sectionType":"section","heading":"Commencement","content":"### sec.2 Commencement\n\nThis regulation, other than part 5 , commences on 1 July 2016.\nPart 5 commences on 1 October 2016.\n(sec.2-ssec.1) This regulation, other than part 5 , commences on 1 July 2016.\n(sec.2-ssec.2) Part 5 commences on 1 October 2016.","sortOrder":2},{"sectionNumber":"sec.3","sectionType":"section","heading":"Definitions","content":"### sec.3 Definitions\n\nThe dictionary in schedule 2 defines particular terms used in this regulation.","sortOrder":3},{"sectionNumber":"pt.2","sectionType":"part","heading":"Eligibility criteria for serious personal injuries","content":"# Eligibility criteria for serious personal injuries","sortOrder":4},{"sectionNumber":"pt.2-div.1","sectionType":"division","heading":"Eligibility criteria","content":"## Eligibility criteria","sortOrder":5},{"sectionNumber":"sec.4","sectionType":"section","heading":"Purpose of division","content":"### sec.4 Purpose of division\n\nThis division prescribes, for section 12 (1) (b) of the Act , the eligibility criteria for particular serious personal injuries.","sortOrder":6},{"sectionNumber":"sec.5","sectionType":"section","heading":"Eligibility criteria for permanent spinal cord injury","content":"### sec.5 Eligibility criteria for permanent spinal cord injury\n\nThe eligibility criteria for a permanent spinal cord injury resulting in a permanent neurological deficit suffered by an adult or a child aged more than 8 years are—\nthe permanent neurological deficit is classified as grade A, B, C or D on the ASIA impairment scale, as assessed under the ISNCSCI; and\nthe injury has resulted in a residual significant impact on the function of the autonomic nervous system, evidenced by a score of 0 for an item relating to bladder, bowel or sexual function, as assessed under the ISAFSCI.\nThe eligibility criteria for a permanent spinal cord injury resulting in a permanent neurological deficit suffered by a child aged 8 years or less are—\nthe injury has resulted in an ongoing bladder or bowel dysfunction; and\nan appropriately qualified medical specialist has given a medical certificate or report stating that, in the medical specialist’s opinion, the injury has resulted in—\nthe condition mentioned in paragraph (a) ; and\na permanent neurological deficit.\nIn this section—\nASIA impairment scale means the scale, known as the American Spinal Injury Association impairment scale, used for measuring impairment resulting from a spinal cord injury and published by the American Spinal Injury Association.\nISAFSCI means the document called ‘International standards to document remaining autonomic function after spinal cord injury’, published by the American Spinal Injury Association.\nISNCSCI means the document called ‘International standards for neurological classification of spinal cord injury’, published by the American Spinal Injury Association.\n(sec.5-ssec.1) The eligibility criteria for a permanent spinal cord injury resulting in a permanent neurological deficit suffered by an adult or a child aged more than 8 years are— the permanent neurological deficit is classified as grade A, B, C or D on the ASIA impairment scale, as assessed under the ISNCSCI; and the injury has resulted in a residual significant impact on the function of the autonomic nervous system, evidenced by a score of 0 for an item relating to bladder, bowel or sexual function, as assessed under the ISAFSCI.\n(sec.5-ssec.2) The eligibility criteria for a permanent spinal cord injury resulting in a permanent neurological deficit suffered by a child aged 8 years or less are— the injury has resulted in an ongoing bladder or bowel dysfunction; and an appropriately qualified medical specialist has given a medical certificate or report stating that, in the medical specialist’s opinion, the injury has resulted in— the condition mentioned in paragraph (a) ; and a permanent neurological deficit.\n(sec.5-ssec.3) In this section— ASIA impairment scale means the scale, known as the American Spinal Injury Association impairment scale, used for measuring impairment resulting from a spinal cord injury and published by the American Spinal Injury Association. ISAFSCI means the document called ‘International standards to document remaining autonomic function after spinal cord injury’, published by the American Spinal Injury Association. ISNCSCI means the document called ‘International standards for neurological classification of spinal cord injury’, published by the American Spinal Injury Association.\n- (a) the permanent neurological deficit is classified as grade A, B, C or D on the ASIA impairment scale, as assessed under the ISNCSCI; and\n- (b) the injury has resulted in a residual significant impact on the function of the autonomic nervous system, evidenced by a score of 0 for an item relating to bladder, bowel or sexual function, as assessed under the ISAFSCI.\n- (a) the injury has resulted in an ongoing bladder or bowel dysfunction; and\n- (b) an appropriately qualified medical specialist has given a medical certificate or report stating that, in the medical specialist’s opinion, the injury has resulted in— (i) the condition mentioned in paragraph (a) ; and (ii) a permanent neurological deficit.\n- (i) the condition mentioned in paragraph (a) ; and\n- (ii) a permanent neurological deficit.\n- (i) the condition mentioned in paragraph (a) ; and\n- (ii) a permanent neurological deficit.","sortOrder":7},{"sectionNumber":"sec.6","sectionType":"section","heading":"Eligibility criteria for traumatic brain injury","content":"### sec.6 Eligibility criteria for traumatic brain injury\n\nThe eligibility criteria for a traumatic brain injury resulting in a permanent impairment suffered by an adult or a child aged more than 8 years are—\nany or all of the following apply—\nthe injury results in post-traumatic amnesia lasting 7 days or more as evidenced by an assessment using an approved scale;\nthe person is or was in a coma, other than an induced coma, for 1 hour or more as a result of the injury;\nbrain imaging shows a significant brain abnormality as a result of the injury; and\nthe person’s functional ability as a result of the injury is assessed as 5 or less for a motor or cognitive item using—\nfor an adult—the functional independence measure instrument; or\nfor a child—the childrens functional independence measure instrument.\nThe eligibility criteria for a traumatic brain injury resulting in a permanent impairment suffered by a child aged between 3 years and 8 years are—\neither or both of the following apply—\non resuscitation or admission to an accident or emergency department of a hospital, the child was given a score of less than 9 on the Glasgow coma scale;\nbrain imaging shows a significant brain abnormality as a result of the injury; and\nthe child’s functional ability as a result of the injury is assessed as 2 points or more below the age norm for the child for a motor or cognitive item using the childrens functional independence measure instrument.\nThe eligibility criteria for a traumatic brain injury resulting in a permanent impairment suffered by a child aged less than 3 years are—\nthe injury is likely to cause a significant adverse impact on the child’s normal development; and\na relevant medical specialist has given a medical certificate or report stating that, in the medical specialist’s opinion, the injury is likely to cause a significant adverse impact mentioned in paragraph (a) .\nIn this section—\napproved scale , for assessing post-traumatic amnesia, means—\nthe Westmead PTA scale; or\na clinically accepted scale similar to the Westmead PTA scale approved by the agency for this definition.\nGlasgow coma scale means the scale, known as the Glasgow coma scale, used for assessing the level of consciousness of a person following a traumatic brain injury, using eye, verbal and motor responses.\nrelevant medical specialist means—\na paediatric rehabilitation specialist; or\na paediatric neurologist.\nWestmead PTA scale means the clinical tool, known as the Westmead Post-traumatic Amnesia Scale, used to assess the period a person suffers post-traumatic amnesia.\n(sec.6-ssec.1) The eligibility criteria for a traumatic brain injury resulting in a permanent impairment suffered by an adult or a child aged more than 8 years are— any or all of the following apply— the injury results in post-traumatic amnesia lasting 7 days or more as evidenced by an assessment using an approved scale; the person is or was in a coma, other than an induced coma, for 1 hour or more as a result of the injury; brain imaging shows a significant brain abnormality as a result of the injury; and the person’s functional ability as a result of the injury is assessed as 5 or less for a motor or cognitive item using— for an adult—the functional independence measure instrument; or for a child—the childrens functional independence measure instrument.\n(sec.6-ssec.2) The eligibility criteria for a traumatic brain injury resulting in a permanent impairment suffered by a child aged between 3 years and 8 years are— either or both of the following apply— on resuscitation or admission to an accident or emergency department of a hospital, the child was given a score of less than 9 on the Glasgow coma scale; brain imaging shows a significant brain abnormality as a result of the injury; and the child’s functional ability as a result of the injury is assessed as 2 points or more below the age norm for the child for a motor or cognitive item using the childrens functional independence measure instrument.\n(sec.6-ssec.3) The eligibility criteria for a traumatic brain injury resulting in a permanent impairment suffered by a child aged less than 3 years are— the injury is likely to cause a significant adverse impact on the child’s normal development; and a relevant medical specialist has given a medical certificate or report stating that, in the medical specialist’s opinion, the injury is likely to cause a significant adverse impact mentioned in paragraph (a) .\n(sec.6-ssec.4) In this section— approved scale , for assessing post-traumatic amnesia, means— the Westmead PTA scale; or a clinically accepted scale similar to the Westmead PTA scale approved by the agency for this definition. Glasgow coma scale means the scale, known as the Glasgow coma scale, used for assessing the level of consciousness of a person following a traumatic brain injury, using eye, verbal and motor responses. relevant medical specialist means— a paediatric rehabilitation specialist; or a paediatric neurologist. Westmead PTA scale means the clinical tool, known as the Westmead Post-traumatic Amnesia Scale, used to assess the period a person suffers post-traumatic amnesia.\n- (a) any or all of the following apply— (i) the injury results in post-traumatic amnesia lasting 7 days or more as evidenced by an assessment using an approved scale; (ii) the person is or was in a coma, other than an induced coma, for 1 hour or more as a result of the injury; (iii) brain imaging shows a significant brain abnormality as a result of the injury; and\n- (i) the injury results in post-traumatic amnesia lasting 7 days or more as evidenced by an assessment using an approved scale;\n- (ii) the person is or was in a coma, other than an induced coma, for 1 hour or more as a result of the injury;\n- (iii) brain imaging shows a significant brain abnormality as a result of the injury; and\n- (b) the person’s functional ability as a result of the injury is assessed as 5 or less for a motor or cognitive item using— (i) for an adult—the functional independence measure instrument; or (ii) for a child—the childrens functional independence measure instrument.\n- (i) for an adult—the functional independence measure instrument; or\n- (ii) for a child—the childrens functional independence measure instrument.\n- (i) the injury results in post-traumatic amnesia lasting 7 days or more as evidenced by an assessment using an approved scale;\n- (ii) the person is or was in a coma, other than an induced coma, for 1 hour or more as a result of the injury;\n- (iii) brain imaging shows a significant brain abnormality as a result of the injury; and\n- (i) for an adult—the functional independence measure instrument; or\n- (ii) for a child—the childrens functional independence measure instrument.\n- (a) either or both of the following apply— (i) on resuscitation or admission to an accident or emergency department of a hospital, the child was given a score of less than 9 on the Glasgow coma scale; (ii) brain imaging shows a significant brain abnormality as a result of the injury; and\n- (i) on resuscitation or admission to an accident or emergency department of a hospital, the child was given a score of less than 9 on the Glasgow coma scale;\n- (ii) brain imaging shows a significant brain abnormality as a result of the injury; and\n- (b) the child’s functional ability as a result of the injury is assessed as 2 points or more below the age norm for the child for a motor or cognitive item using the childrens functional independence measure instrument.\n- (i) on resuscitation or admission to an accident or emergency department of a hospital, the child was given a score of less than 9 on the Glasgow coma scale;\n- (ii) brain imaging shows a significant brain abnormality as a result of the injury; and\n- (a) the injury is likely to cause a significant adverse impact on the child’s normal development; and\n- (b) a relevant medical specialist has given a medical certificate or report stating that, in the medical specialist’s opinion, the injury is likely to cause a significant adverse impact mentioned in paragraph (a) .\n- (a) the Westmead PTA scale; or\n- (b) a clinically accepted scale similar to the Westmead PTA scale approved by the agency for this definition.\n- (a) a paediatric rehabilitation specialist; or\n- (b) a paediatric neurologist.","sortOrder":8},{"sectionNumber":"sec.7","sectionType":"section","heading":"Eligibility criterion for the amputation of a leg through or above the femur","content":"### sec.7 Eligibility criterion for the amputation of a leg through or above the femur\n\nThe eligibility criterion for the amputation of a leg through or above the femur is that the amputation involves the loss of 65% or more of the length of the femur.\nFor subsection (1) , the percentage of the length of the femur lost must be worked out by—\ncomparing the length of the femur before and after the amputation using X-rays taken before and after the amputation; or\nif X-rays of the femur are not available—comparing the length of the femur of the amputated leg with the length of the contralateral femur.\nTo remove any doubt, it is declared that the eligibility criterion in subsection (1) may be satisfied even if the person suffers from a personal injury that is the amputation of more than 1 limb or parts of different limbs.\n(sec.7-ssec.1) The eligibility criterion for the amputation of a leg through or above the femur is that the amputation involves the loss of 65% or more of the length of the femur.\n(sec.7-ssec.2) For subsection (1) , the percentage of the length of the femur lost must be worked out by— comparing the length of the femur before and after the amputation using X-rays taken before and after the amputation; or if X-rays of the femur are not available—comparing the length of the femur of the amputated leg with the length of the contralateral femur.\n(sec.7-ssec.3) To remove any doubt, it is declared that the eligibility criterion in subsection (1) may be satisfied even if the person suffers from a personal injury that is the amputation of more than 1 limb or parts of different limbs.\n- (a) comparing the length of the femur before and after the amputation using X-rays taken before and after the amputation; or\n- (b) if X-rays of the femur are not available—comparing the length of the femur of the amputated leg with the length of the contralateral femur.","sortOrder":9},{"sectionNumber":"sec.8","sectionType":"section","heading":"Eligibility criteria for the amputation of more than 1 limb or parts of different limbs","content":"### sec.8 Eligibility criteria for the amputation of more than 1 limb or parts of different limbs\n\nThe eligibility criteria for the amputation of more than 1 limb or parts of different limbs are—\nthe amputations involve the loss of 50% or more of the length of each of the person’s tibias; or\nboth of the person’s upper limbs are amputated at or above the first metacarpophalangeal joint of the thumb and index finger of each hand; or\nthe amputations involve—\nthe loss of 50% or more of the length of 1 of the person’s tibias; and\n1 of the person’s upper limbs being amputated at or above the first metacarpophalangeal joint of the thumb and index finger of the same hand.\nFor subsection (1) , the percentage of the length of the tibia lost must be worked out by—\ncomparing the length of the tibia before and after the amputation using X-rays taken before and after the amputation; or\nif X-rays of the tibia are not available—comparing the length of the tibia of the amputated leg with the length of the contralateral tibia; or\nif the length of the contralateral tibia can not be determined—using the estimated knee height based on overall height before the amputation.\n(sec.8-ssec.1) The eligibility criteria for the amputation of more than 1 limb or parts of different limbs are— the amputations involve the loss of 50% or more of the length of each of the person’s tibias; or both of the person’s upper limbs are amputated at or above the first metacarpophalangeal joint of the thumb and index finger of each hand; or the amputations involve— the loss of 50% or more of the length of 1 of the person’s tibias; and 1 of the person’s upper limbs being amputated at or above the first metacarpophalangeal joint of the thumb and index finger of the same hand.\n(sec.8-ssec.2) For subsection (1) , the percentage of the length of the tibia lost must be worked out by— comparing the length of the tibia before and after the amputation using X-rays taken before and after the amputation; or if X-rays of the tibia are not available—comparing the length of the tibia of the amputated leg with the length of the contralateral tibia; or if the length of the contralateral tibia can not be determined—using the estimated knee height based on overall height before the amputation.\n- (a) the amputations involve the loss of 50% or more of the length of each of the person’s tibias; or\n- (b) both of the person’s upper limbs are amputated at or above the first metacarpophalangeal joint of the thumb and index finger of each hand; or\n- (c) the amputations involve— (i) the loss of 50% or more of the length of 1 of the person’s tibias; and (ii) 1 of the person’s upper limbs being amputated at or above the first metacarpophalangeal joint of the thumb and index finger of the same hand.\n- (i) the loss of 50% or more of the length of 1 of the person’s tibias; and\n- (ii) 1 of the person’s upper limbs being amputated at or above the first metacarpophalangeal joint of the thumb and index finger of the same hand.\n- (i) the loss of 50% or more of the length of 1 of the person’s tibias; and\n- (ii) 1 of the person’s upper limbs being amputated at or above the first metacarpophalangeal joint of the thumb and index finger of the same hand.\n- (a) comparing the length of the tibia before and after the amputation using X-rays taken before and after the amputation; or\n- (b) if X-rays of the tibia are not available—comparing the length of the tibia of the amputated leg with the length of the contralateral tibia; or\n- (c) if the length of the contralateral tibia can not be determined—using the estimated knee height based on overall height before the amputation.","sortOrder":10},{"sectionNumber":"sec.9","sectionType":"section","heading":"Eligibility criteria for a full thickness burn to all or part of the body","content":"### sec.9 Eligibility criteria for a full thickness burn to all or part of the body\n\nThe eligibility criteria for a full thickness burn to all or part of the body are—\nthe full thickness burn is to—\nfor a child aged less than 16 years—more than 30% of the total body surface area; or\nfor a person other than a child aged less than 16 years—more than 40% of the total body surface area; or\nboth hands; or\nthe face; or\nthe genital area; and\nif the injured person is an adult or child aged more than 8 years—the person’s functional ability as a result of the injury is assessed as 5 or less for a motor or cognitive item using—\nfor an adult—the functional independence measure instrument; or\nfor a child—the childrens functional independence measure instrument; and\nif the injured person is a child aged between 3 and 8 years—the child’s functional ability as a result of the injury is assessed as 2 or more points below the age norm for the child for a motor or cognitive item using the childrens functional independence measure instrument; and\nif the injured person is a child aged less than 3 years—\nthe child is, as a result of the injury, likely to suffer permanent impairment requiring attendant care and support services; and\nan appropriately qualified medical specialist has given a medical certificate or report stating that, in the medical specialist’s opinion, the child is, as a result of the injury, likely to suffer the permanent impairment mentioned in subparagraph (i) .\n(sec.9-ssec) The eligibility criteria for a full thickness burn to all or part of the body are— the full thickness burn is to— for a child aged less than 16 years—more than 30% of the total body surface area; or for a person other than a child aged less than 16 years—more than 40% of the total body surface area; or both hands; or the face; or the genital area; and if the injured person is an adult or child aged more than 8 years—the person’s functional ability as a result of the injury is assessed as 5 or less for a motor or cognitive item using— for an adult—the functional independence measure instrument; or for a child—the childrens functional independence measure instrument; and if the injured person is a child aged between 3 and 8 years—the child’s functional ability as a result of the injury is assessed as 2 or more points below the age norm for the child for a motor or cognitive item using the childrens functional independence measure instrument; and if the injured person is a child aged less than 3 years— the child is, as a result of the injury, likely to suffer permanent impairment requiring attendant care and support services; and an appropriately qualified medical specialist has given a medical certificate or report stating that, in the medical specialist’s opinion, the child is, as a result of the injury, likely to suffer the permanent impairment mentioned in subparagraph (i) .\n- (a) the full thickness burn is to— (i) for a child aged less than 16 years—more than 30% of the total body surface area; or (ii) for a person other than a child aged less than 16 years—more than 40% of the total body surface area; or (iii) both hands; or (iv) the face; or (v) the genital area; and\n- (i) for a child aged less than 16 years—more than 30% of the total body surface area; or\n- (ii) for a person other than a child aged less than 16 years—more than 40% of the total body surface area; or\n- (iii) both hands; or\n- (iv) the face; or\n- (v) the genital area; and\n- (b) if the injured person is an adult or child aged more than 8 years—the person’s functional ability as a result of the injury is assessed as 5 or less for a motor or cognitive item using— (i) for an adult—the functional independence measure instrument; or (ii) for a child—the childrens functional independence measure instrument; and\n- (i) for an adult—the functional independence measure instrument; or\n- (ii) for a child—the childrens functional independence measure instrument; and\n- (c) if the injured person is a child aged between 3 and 8 years—the child’s functional ability as a result of the injury is assessed as 2 or more points below the age norm for the child for a motor or cognitive item using the childrens functional independence measure instrument; and\n- (d) if the injured person is a child aged less than 3 years— (i) the child is, as a result of the injury, likely to suffer permanent impairment requiring attendant care and support services; and (ii) an appropriately qualified medical specialist has given a medical certificate or report stating that, in the medical specialist’s opinion, the child is, as a result of the injury, likely to suffer the permanent impairment mentioned in subparagraph (i) .\n- (i) the child is, as a result of the injury, likely to suffer permanent impairment requiring attendant care and support services; and\n- (ii) an appropriately qualified medical specialist has given a medical certificate or report stating that, in the medical specialist’s opinion, the child is, as a result of the injury, likely to suffer the permanent impairment mentioned in subparagraph (i) .\n- (i) for a child aged less than 16 years—more than 30% of the total body surface area; or\n- (ii) for a person other than a child aged less than 16 years—more than 40% of the total body surface area; or\n- (iii) both hands; or\n- (iv) the face; or\n- (v) the genital area; and\n- (i) for an adult—the functional independence measure instrument; or\n- (ii) for a child—the childrens functional independence measure instrument; and\n- (i) the child is, as a result of the injury, likely to suffer permanent impairment requiring attendant care and support services; and\n- (ii) an appropriately qualified medical specialist has given a medical certificate or report stating that, in the medical specialist’s opinion, the child is, as a result of the injury, likely to suffer the permanent impairment mentioned in subparagraph (i) .","sortOrder":11},{"sectionNumber":"sec.10","sectionType":"section","heading":"Eligibility criteria for an inhalation burn resulting in a permanent respiratory impairment","content":"### sec.10 Eligibility criteria for an inhalation burn resulting in a permanent respiratory impairment\n\nThe eligibility criteria for an inhalation burn resulting in a permanent respiratory impairment are—\nif the injured person is an adult or child aged more than 8 years—the person’s functional ability as a result of the injury is assessed as 5 or less for a motor or cognitive item using—\nfor an adult—the functional independence measure instrument; or\nfor a child—the childrens functional independence measure instrument; or\nif the injured person is a child aged between 3 and 8 years—the child’s functional ability as a result of the injury is assessed as 2 or more points below the age norm for the child for a motor or cognitive item using the childrens functional independence measure instrument; or\nif the injured person is a child aged less than 3 years—\nthe child is, as a result of the injury, likely to suffer permanent impairment requiring attendant care and support services; and\nan appropriately qualified medical specialist has given a medical certificate or report stating that, in the medical specialist’s opinion, the child is, as a result of the injury, likely to suffer the permanent impairment mentioned in subparagraph (i) .\n(sec.10-ssec) The eligibility criteria for an inhalation burn resulting in a permanent respiratory impairment are— if the injured person is an adult or child aged more than 8 years—the person’s functional ability as a result of the injury is assessed as 5 or less for a motor or cognitive item using— for an adult—the functional independence measure instrument; or for a child—the childrens functional independence measure instrument; or if the injured person is a child aged between 3 and 8 years—the child’s functional ability as a result of the injury is assessed as 2 or more points below the age norm for the child for a motor or cognitive item using the childrens functional independence measure instrument; or if the injured person is a child aged less than 3 years— the child is, as a result of the injury, likely to suffer permanent impairment requiring attendant care and support services; and an appropriately qualified medical specialist has given a medical certificate or report stating that, in the medical specialist’s opinion, the child is, as a result of the injury, likely to suffer the permanent impairment mentioned in subparagraph (i) .\n- (a) if the injured person is an adult or child aged more than 8 years—the person’s functional ability as a result of the injury is assessed as 5 or less for a motor or cognitive item using— (i) for an adult—the functional independence measure instrument; or (ii) for a child—the childrens functional independence measure instrument; or\n- (i) for an adult—the functional independence measure instrument; or\n- (ii) for a child—the childrens functional independence measure instrument; or\n- (b) if the injured person is a child aged between 3 and 8 years—the child’s functional ability as a result of the injury is assessed as 2 or more points below the age norm for the child for a motor or cognitive item using the childrens functional independence measure instrument; or\n- (c) if the injured person is a child aged less than 3 years— (i) the child is, as a result of the injury, likely to suffer permanent impairment requiring attendant care and support services; and (ii) an appropriately qualified medical specialist has given a medical certificate or report stating that, in the medical specialist’s opinion, the child is, as a result of the injury, likely to suffer the permanent impairment mentioned in subparagraph (i) .\n- (i) the child is, as a result of the injury, likely to suffer permanent impairment requiring attendant care and support services; and\n- (ii) an appropriately qualified medical specialist has given a medical certificate or report stating that, in the medical specialist’s opinion, the child is, as a result of the injury, likely to suffer the permanent impairment mentioned in subparagraph (i) .\n- (i) for an adult—the functional independence measure instrument; or\n- (ii) for a child—the childrens functional independence measure instrument; or\n- (i) the child is, as a result of the injury, likely to suffer permanent impairment requiring attendant care and support services; and\n- (ii) an appropriately qualified medical specialist has given a medical certificate or report stating that, in the medical specialist’s opinion, the child is, as a result of the injury, likely to suffer the permanent impairment mentioned in subparagraph (i) .","sortOrder":12},{"sectionNumber":"sec.11","sectionType":"section","heading":"Eligibility criterion for permanent blindness caused by trauma","content":"### sec.11 Eligibility criterion for permanent blindness caused by trauma\n\nThe eligibility criterion for permanent blindness caused by trauma is that the injured person has a visual defect, or a combination of visual defects, that result in visual loss that is, or is equivalent to—\nvisual acuity of less than 6/60 in both eyes, assessed using the Snellen scale after correction by suitable lenses; or\nthe constriction of the person’s field of vision to 10 degrees or less of the arc around central fixation in the person’s better eye, regardless of corrected visual acuity (equivalent to 1/100 white test object).\nIn this section—\nSnellen scale means the scale for measuring visual acuity using rows of letters printed in decreasing sizes.\n(sec.11-ssec.1) The eligibility criterion for permanent blindness caused by trauma is that the injured person has a visual defect, or a combination of visual defects, that result in visual loss that is, or is equivalent to— visual acuity of less than 6/60 in both eyes, assessed using the Snellen scale after correction by suitable lenses; or the constriction of the person’s field of vision to 10 degrees or less of the arc around central fixation in the person’s better eye, regardless of corrected visual acuity (equivalent to 1/100 white test object).\n(sec.11-ssec.2) In this section— Snellen scale means the scale for measuring visual acuity using rows of letters printed in decreasing sizes.\n- (a) visual acuity of less than 6/60 in both eyes, assessed using the Snellen scale after correction by suitable lenses; or\n- (b) the constriction of the person’s field of vision to 10 degrees or less of the arc around central fixation in the person’s better eye, regardless of corrected visual acuity (equivalent to 1/100 white test object).","sortOrder":13},{"sectionNumber":"pt.2-div.2","sectionType":"division","heading":"Assessing eligibility criteria","content":"## Assessing eligibility criteria","sortOrder":14},{"sectionNumber":"sec.12","sectionType":"section","heading":"Requirements for using functional independence measure instrument or childrens functional independence measure instrument to assess injuries","content":"### sec.12 Requirements for using functional independence measure instrument or childrens functional independence measure instrument to assess injuries\n\nAn assessment using the functional independence measure instrument or childrens functional independence measure instrument may be used for deciding whether a serious personal injury meets the eligibility criteria for the injury only if the assessment is carried out by a person who is—\naccredited by the Australasian Rehabilitation Outcomes Centre to carry out the assessment; and\napproved by the agency to carry out the assessment.\n(sec.12-ssec) An assessment using the functional independence measure instrument or childrens functional independence measure instrument may be used for deciding whether a serious personal injury meets the eligibility criteria for the injury only if the assessment is carried out by a person who is— accredited by the Australasian Rehabilitation Outcomes Centre to carry out the assessment; and approved by the agency to carry out the assessment.\n- (a) accredited by the Australasian Rehabilitation Outcomes Centre to carry out the assessment; and\n- (b) approved by the agency to carry out the assessment.","sortOrder":15},{"sectionNumber":"pt.3","sectionType":"part","heading":"Application to participate in scheme and information exchange","content":"# Application to participate in scheme and information exchange","sortOrder":16},{"sectionNumber":"sec.13","sectionType":"section","heading":"Requirements for application— Act , s 19 (1) (b)","content":"### sec.13 Requirements for application— Act , s 19 (1) (b)\n\nFor section 19 (1) (b) of the Act , an application must be accompanied by the following information—\nthe injured person’s full name, contact details and date of birth;\nif the application is made by a person other than the injured person—\nthe person’s full name and contact details; and\nthe reason why the person is making the application instead of the injured person;\ndetails of the circumstances of the motor accident resulting in the serious personal injury, including the day the motor accident happened;\ndetails of the serious personal injury;\ninformation demonstrating how the serious personal injury meets the eligibility criteria for the injury;\ndetails of hospitalisation or other medical treatment the injured person has undergone for the serious personal injury, including the name and address of the hospital or medical provider that provided the medical treatment;\ndetails of any other medical condition, or injury, suffered by the injured person before or after the motor accident that may affect the person’s eligibility to participate in the scheme;\na pre-existing serious personal injury, respiratory disease, cancer or chronic cardiovascular disease\nwhether the injured person has made or intends to make a claim for the serious personal injury under the Workers’ Compensation Act.\nIf a person other than the injured person makes the application, the information under subsection (1) need only be provided to the best of the person’s knowledge.\n(sec.13-ssec.1) For section 19 (1) (b) of the Act , an application must be accompanied by the following information— the injured person’s full name, contact details and date of birth; if the application is made by a person other than the injured person— the person’s full name and contact details; and the reason why the person is making the application instead of the injured person; details of the circumstances of the motor accident resulting in the serious personal injury, including the day the motor accident happened; details of the serious personal injury; information demonstrating how the serious personal injury meets the eligibility criteria for the injury; details of hospitalisation or other medical treatment the injured person has undergone for the serious personal injury, including the name and address of the hospital or medical provider that provided the medical treatment; details of any other medical condition, or injury, suffered by the injured person before or after the motor accident that may affect the person’s eligibility to participate in the scheme; a pre-existing serious personal injury, respiratory disease, cancer or chronic cardiovascular disease whether the injured person has made or intends to make a claim for the serious personal injury under the Workers’ Compensation Act.\n(sec.13-ssec.2) If a person other than the injured person makes the application, the information under subsection (1) need only be provided to the best of the person’s knowledge.\n- (a) the injured person’s full name, contact details and date of birth;\n- (b) if the application is made by a person other than the injured person— (i) the person’s full name and contact details; and (ii) the reason why the person is making the application instead of the injured person;\n- (i) the person’s full name and contact details; and\n- (ii) the reason why the person is making the application instead of the injured person;\n- (c) details of the circumstances of the motor accident resulting in the serious personal injury, including the day the motor accident happened;\n- (d) details of the serious personal injury;\n- (e) information demonstrating how the serious personal injury meets the eligibility criteria for the injury;\n- (f) details of hospitalisation or other medical treatment the injured person has undergone for the serious personal injury, including the name and address of the hospital or medical provider that provided the medical treatment;\n- (g) details of any other medical condition, or injury, suffered by the injured person before or after the motor accident that may affect the person’s eligibility to participate in the scheme; Examples of a medical condition or injury for paragraph (g) — a pre-existing serious personal injury, respiratory disease, cancer or chronic cardiovascular disease\n- (h) whether the injured person has made or intends to make a claim for the serious personal injury under the Workers’ Compensation Act.\n- (i) the person’s full name and contact details; and\n- (ii) the reason why the person is making the application instead of the injured person;","sortOrder":17},{"sectionNumber":"sec.14","sectionType":"section","heading":"Entities agency may exchange information with— Act , s 19 (3)","content":"### sec.14 Entities agency may exchange information with— Act , s 19 (3)\n\nThe following entities are prescribed for section 19 (3) of the Act —\nthe commission;\nthe Nominal Defendant under the Insurance Act ;\nan entity that is the same as or similar to the Nominal Defendant under a law of the Commonwealth or another State;\nan insurer carrying on the business of providing workers’ compensation insurance, personal accident or illness insurance, or insurance against loss of income through disability;\nan entity that is the same as or similar to the agency under a law of the Commonwealth or another State;\na department, agency or instrumentality of the Commonwealth, the State or another State;\nthe agency under the National Disability Insurance Scheme Act 2013 (Cwlth) ;\na hospital, including a private hospital;\nan ambulance or other emergency service;\na doctor;\na person who is appropriately qualified to assess the treatment, care or support needs of a person;\na provider of treatment, care or support services, including, for example, attendant care and support services;\nan employer or previous employer of an injured person;\nan educational institution.\n(sec.14-ssec) The following entities are prescribed for section 19 (3) of the Act — the commission; the Nominal Defendant under the Insurance Act ; an entity that is the same as or similar to the Nominal Defendant under a law of the Commonwealth or another State; an insurer carrying on the business of providing workers’ compensation insurance, personal accident or illness insurance, or insurance against loss of income through disability; an entity that is the same as or similar to the agency under a law of the Commonwealth or another State; a department, agency or instrumentality of the Commonwealth, the State or another State; the agency under the National Disability Insurance Scheme Act 2013 (Cwlth) ; a hospital, including a private hospital; an ambulance or other emergency service; a doctor; a person who is appropriately qualified to assess the treatment, care or support needs of a person; a provider of treatment, care or support services, including, for example, attendant care and support services; an employer or previous employer of an injured person; an educational institution.\n- (a) the commission;\n- (b) the Nominal Defendant under the Insurance Act ;\n- (c) an entity that is the same as or similar to the Nominal Defendant under a law of the Commonwealth or another State;\n- (d) an insurer carrying on the business of providing workers’ compensation insurance, personal accident or illness insurance, or insurance against loss of income through disability;\n- (e) an entity that is the same as or similar to the agency under a law of the Commonwealth or another State;\n- (f) a department, agency or instrumentality of the Commonwealth, the State or another State;\n- (g) the agency under the National Disability Insurance Scheme Act 2013 (Cwlth) ;\n- (h) a hospital, including a private hospital;\n- (i) an ambulance or other emergency service;\n- (j) a doctor;\n- (k) a person who is appropriately qualified to assess the treatment, care or support needs of a person;\n- (l) a provider of treatment, care or support services, including, for example, attendant care and support services;\n- (m) an employer or previous employer of an injured person;\n- (n) an educational institution.","sortOrder":18},{"sectionNumber":"sec.15","sectionType":"section","heading":"Entities agency may give personal information to— Act , s 131 (2) (c)","content":"### sec.15 Entities agency may give personal information to— Act , s 131 (2) (c)\n\nThe agency may give personal information about a participant, or a person who applies to participate, in the scheme to an entity mentioned in section 14 if giving the information is for the purpose of the agency performing its functions under the Act .","sortOrder":19},{"sectionNumber":"pt.4","sectionType":"part","heading":"Assessing needs","content":"# Assessing needs","sortOrder":20},{"sectionNumber":"pt.4-div.1","sectionType":"division","heading":"Necessary and reasonable treatment, care and support needs","content":"## Necessary and reasonable treatment, care and support needs","sortOrder":21},{"sectionNumber":"sec.16","sectionType":"section","heading":"Purpose of division","content":"### sec.16 Purpose of division\n\nThis division prescribes, for section 15 (b) of the Act , matters the agency must consider in deciding whether a person’s treatment, care and support needs as a result of a serious personal injury are necessary and reasonable in the circumstances.\nThis division does not limit the matters the agency may consider in making a decision mentioned in subsection (1) .\n(sec.16-ssec.1) This division prescribes, for section 15 (b) of the Act , matters the agency must consider in deciding whether a person’s treatment, care and support needs as a result of a serious personal injury are necessary and reasonable in the circumstances.\n(sec.16-ssec.2) This division does not limit the matters the agency may consider in making a decision mentioned in subsection (1) .","sortOrder":22},{"sectionNumber":"sec.17","sectionType":"section","heading":"Benefit to person","content":"### sec.17 Benefit to person\n\nThe agency must consider whether providing the treatment, care or support for, or relating to, the person’s treatment care and support needs—\nis likely to maximise the person’s independence, participation in the community and employment; and\nwill assist the person in managing the injury.\nIn considering the matters mentioned in subsection (1) , the agency must also have regard to the following matters—\nwhether the treatment, care or support relates directly to the person’s individual goals;\nwhether the treatment, care or support will improve or maintain the person’s ability to conduct daily activities or participate in the community or employment;\nwhether the treatment, care or support has been provided to the person previously, resulting in an improvement to, or assistance in managing, the person’s injury;\nwhether the treatment, care or support has a measurable outcome;\nwhether the person has agreed or is likely to agree that the treatment, care or support will benefit the person in the ways mentioned in subsection (1) ;\nany associated risks of the treatment, care or support to the person, weighed against the expected benefit of the treatment, care or support to the person.\n(sec.17-ssec.1) The agency must consider whether providing the treatment, care or support for, or relating to, the person’s treatment care and support needs— is likely to maximise the person’s independence, participation in the community and employment; and will assist the person in managing the injury.\n(sec.17-ssec.2) In considering the matters mentioned in subsection (1) , the agency must also have regard to the following matters— whether the treatment, care or support relates directly to the person’s individual goals; whether the treatment, care or support will improve or maintain the person’s ability to conduct daily activities or participate in the community or employment; whether the treatment, care or support has been provided to the person previously, resulting in an improvement to, or assistance in managing, the person’s injury; whether the treatment, care or support has a measurable outcome; whether the person has agreed or is likely to agree that the treatment, care or support will benefit the person in the ways mentioned in subsection (1) ; any associated risks of the treatment, care or support to the person, weighed against the expected benefit of the treatment, care or support to the person.\n- (a) is likely to maximise the person’s independence, participation in the community and employment; and\n- (b) will assist the person in managing the injury.\n- (a) whether the treatment, care or support relates directly to the person’s individual goals;\n- (b) whether the treatment, care or support will improve or maintain the person’s ability to conduct daily activities or participate in the community or employment;\n- (c) whether the treatment, care or support has been provided to the person previously, resulting in an improvement to, or assistance in managing, the person’s injury;\n- (d) whether the treatment, care or support has a measurable outcome;\n- (e) whether the person has agreed or is likely to agree that the treatment, care or support will benefit the person in the ways mentioned in subsection (1) ;\n- (f) any associated risks of the treatment, care or support to the person, weighed against the expected benefit of the treatment, care or support to the person.","sortOrder":23},{"sectionNumber":"sec.18","sectionType":"section","heading":"Appropriateness of service","content":"### sec.18 Appropriateness of service\n\nThe agency must consider whether the treatment, care or support for, or relating to, the person’s treatment care and support needs—\nis consistent with other treatment, care or support being received by the person; and\nis consistent with current clinical practice and other industry best practice for the treatment, care or support of persons with similar injuries.\nIn considering the matters mentioned in subsection (1) , the agency must also have regard to the following matters—\nwhether the treatment, care or support will be consistent with the person’s future treatment, care or support needs;\nwhether the treatment, care or support relates directly to the person’s individual goals;\nwhether the treatment, care or support could be harmful to the person;\nwhether similar treatment, care or support is already being, or is to be, provided to the person for the injury;\nwhether there is evidence that supports the effectiveness of the treatment, care or support.\npeer reviewed journal articles\ninclusion of the treatment in clinical guidelines and frameworks\nsuccessful clinical trials\ninclusion in the medical benefits schedule administered by the Commonwealth\n(sec.18-ssec.1) The agency must consider whether the treatment, care or support for, or relating to, the person’s treatment care and support needs— is consistent with other treatment, care or support being received by the person; and is consistent with current clinical practice and other industry best practice for the treatment, care or support of persons with similar injuries.\n(sec.18-ssec.2) In considering the matters mentioned in subsection (1) , the agency must also have regard to the following matters— whether the treatment, care or support will be consistent with the person’s future treatment, care or support needs; whether the treatment, care or support relates directly to the person’s individual goals; whether the treatment, care or support could be harmful to the person; whether similar treatment, care or support is already being, or is to be, provided to the person for the injury; whether there is evidence that supports the effectiveness of the treatment, care or support. 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\n- (a) is consistent with other treatment, care or support being received by the person; and\n- (b) is consistent with current clinical practice and other industry best practice for the treatment, care or support of persons with similar injuries.\n- (a) whether the treatment, care or support will be consistent with the person’s future treatment, care or support needs;\n- (b) whether the treatment, care or support relates directly to the person’s individual goals;\n- (c) whether the treatment, care or support could be harmful to the person;\n- (d) whether similar treatment, care or support is already being, or is to be, provided to the person for the injury;\n- (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\n- • peer reviewed journal articles\n- • inclusion of the treatment in clinical guidelines and frameworks\n- • successful clinical trials\n- • inclusion in the medical benefits schedule administered by the Commonwealth\n- • peer reviewed journal articles\n- • inclusion of the treatment in clinical guidelines and frameworks\n- • successful clinical trials\n- • inclusion in the medical benefits schedule administered by the Commonwealth","sortOrder":24},{"sectionNumber":"sec.19","sectionType":"section","heading":"Appropriateness of provider","content":"### sec.19 Appropriateness of provider\n\nThe agency must consider whether the treatment, care or support for, or relating to, the person’s treatment care and support needs is provided by an appropriate provider.\nIn considering the matter mentioned in subsection (1) , the agency must also have regard to the following matters—\nwhether the provider, or the provider’s staff, are appropriately qualified to provide the treatment, care or support;\nwhether the provider is appropriate having regard to, for example, the person’s location, age, culture and ethnicity;\nwhether the provider is acceptable to the person;\nwhether the provider has or may have a conflict of interest in providing the treatment, care or support to the person;\nwhether the provider’s fee is reasonable;\nif the treatment, care or support must be provided by a registered provider—whether the provider is a registered provider.\n(sec.19-ssec.1) The agency must consider whether the treatment, care or support for, or relating to, the person’s treatment care and support needs is provided by an appropriate provider.\n(sec.19-ssec.2) In considering the matter mentioned in subsection (1) , the agency must also have regard to the following matters— whether the provider, or the provider’s staff, are appropriately qualified to provide the treatment, care or support; whether the provider is appropriate having regard to, for example, the person’s location, age, culture and ethnicity; whether the provider is acceptable to the person; whether the provider has or may have a conflict of interest in providing the treatment, care or support to the person; whether the provider’s fee is reasonable; if the treatment, care or support must be provided by a registered provider—whether the provider is a registered provider.\n- (a) whether the provider, or the provider’s staff, are appropriately qualified to provide the treatment, care or support;\n- (b) whether the provider is appropriate having regard to, for example, the person’s location, age, culture and ethnicity;\n- (c) whether the provider is acceptable to the person;\n- (d) whether the provider has or may have a conflict of interest in providing the treatment, care or support to the person;\n- (e) whether the provider’s fee is reasonable;\n- (f) if the treatment, care or support must be provided by a registered provider—whether the provider is a registered provider.","sortOrder":25},{"sectionNumber":"sec.20","sectionType":"section","heading":"Cost-effectiveness","content":"### sec.20 Cost-effectiveness\n\nThe agency must consider whether the treatment, care or support for, or relating to, the person’s treatment care and support needs is cost-effective.\nIn considering the matter mentioned in subsection (1) , the agency must also have regard to the following matters—\nthe likely benefit to the person of receiving the treatment, care or support weighed against the cost of providing the treatment, care or support to the person;\nthe cost of the treatment, care or support compared with the cost of the same or similar treatment, care or support provided by other suitable providers;\nwhether there is a more cost-effective way to provide the treatment, care or support;\nconsidering whether leasing equipment would be more cost-effective than purchasing new equipment\nconsidering whether the treatment, care or support can be more appropriately funded under another scheme\nwhether the cost of the treatment, care or support is reasonable having regard to the period for which it is required;\nwhether the cost of the treatment, care or support exceeds an amount prescribed for the treatment, care or support under section 37 (5) (a) of the Act .\n(sec.20-ssec.1) The agency must consider whether the treatment, care or support for, or relating to, the person’s treatment care and support needs is cost-effective.\n(sec.20-ssec.2) In considering the matter mentioned in subsection (1) , the agency must also have regard to the following matters— the likely benefit to the person of receiving the treatment, care or support weighed against the cost of providing the treatment, care or support to the person; the cost of the treatment, care or support compared with the cost of the same or similar treatment, care or support provided by other suitable providers; whether there is a more cost-effective way to provide the treatment, care or support; considering whether leasing equipment would be more cost-effective than purchasing new equipment considering whether the treatment, care or support can be more appropriately funded under another scheme whether the cost of the treatment, care or support is reasonable having regard to the period for which it is required; whether the cost of the treatment, care or support exceeds an amount prescribed for the treatment, care or support under section 37 (5) (a) of the Act .\n- (a) the likely benefit to the person of receiving the treatment, care or support weighed against the cost of providing the treatment, care or support to the person;\n- (b) the cost of the treatment, care or support compared with the cost of the same or similar treatment, care or support provided by other suitable providers;\n- (c) whether there is a more cost-effective way to provide the treatment, care or support; Examples— • considering whether leasing equipment would be more cost-effective than purchasing new equipment • considering whether the treatment, care or support can be more appropriately funded under another scheme\n- • considering whether leasing equipment would be more cost-effective than purchasing new equipment\n- • considering whether the treatment, care or support can be more appropriately funded under another scheme\n- (d) whether the cost of the treatment, care or support is reasonable having regard to the period for which it is required;\n- (e) whether the cost of the treatment, care or support exceeds an amount prescribed for the treatment, care or support under section 37 (5) (a) of the Act .\n- • considering whether leasing equipment would be more cost-effective than purchasing new equipment\n- • considering whether the treatment, care or support can be more appropriately funded under another scheme","sortOrder":26},{"sectionNumber":"pt.4-div.2","sectionType":"division","heading":"Other matters for assessing needs","content":"## Other matters for assessing needs","sortOrder":27},{"sectionNumber":"sec.21","sectionType":"section","heading":"Treatment, care or support that must be provided by a registered provider— Act , s 9 (2) (b)","content":"### sec.21 Treatment, care or support that must be provided by a registered provider— Act , s 9 (2) (b)\n\nThe following treatment, care or support is prescribed for section 9 (2) (b) of the Act —\na home modification;\na service for the coordination of treatment, care or support.\na case manager engaged to coordinate a participant’s treatment, care and support\n(sec.21-ssec) The following treatment, care or support is prescribed for section 9 (2) (b) of the Act — a home modification; a service for the coordination of treatment, care or support. a case manager engaged to coordinate a participant’s treatment, care and support\n- (a) a home modification;\n- (b) a service for the coordination of treatment, care or support. Example for paragraph (b) — a case manager engaged to coordinate a participant’s treatment, care and support","sortOrder":28},{"sectionNumber":"sec.22","sectionType":"section","heading":"Matter that may be considered when assessing treatment, care or support","content":"### sec.22 Matter that may be considered when assessing treatment, care or support\n\nThis section applies if the agency is assessing a person’s needs for, or relating to—\nhome modification;\nvehicle modification;\nattendant care and support services that are personal assistance services or services to assist a person to participate in the community.\nIn carrying out the assessment, the agency must obtain and consider information about the needs mentioned in subsection (1) from a person who is—\nappropriately qualified to give advice about the needs; and\nan occupational therapist specialising in home modifications\napproved by the agency for this section.\n(sec.22-ssec.1) This section applies if the agency is assessing a person’s needs for, or relating to— home modification; vehicle modification; attendant care and support services that are personal assistance services or services to assist a person to participate in the community.\n(sec.22-ssec.2) In carrying out the assessment, the agency must obtain and consider information about the needs mentioned in subsection (1) from a person who is— appropriately qualified to give advice about the needs; and an occupational therapist specialising in home modifications approved by the agency for this section.\n- (a) home modification;\n- (b) vehicle modification;\n- (c) attendant care and support services that are personal assistance services or services to assist a person to participate in the community.\n- (a) appropriately qualified to give advice about the needs; and Example— an occupational therapist specialising in home modifications\n- (b) approved by the agency for this section.","sortOrder":29},{"sectionNumber":"sec.23","sectionType":"section","heading":"Intervals for carrying out assessments— Act , s 25 (4)","content":"### sec.23 Intervals for carrying out assessments— Act , s 25 (4)\n\nFor section 25 (4) of the Act , an assessment under section 25 (1) of the Act for a participant must be carried out—\nas soon as practicable after the participant is accepted as a participant in the scheme; and\nif an assessment has been previously carried out for the participant—within 1 year after the last assessment was carried out.\nThe intervals mentioned in subsection (1) (b) must, under section 26 (1) (f) of the Act , be stated in the participant’s support plan.\n(sec.23-ssec.1) For section 25 (4) of the Act , an assessment under section 25 (1) of the Act for a participant must be carried out— as soon as practicable after the participant is accepted as a participant in the scheme; and if an assessment has been previously carried out for the participant—within 1 year after the last assessment was carried out.\n(sec.23-ssec.2) The intervals mentioned in subsection (1) (b) must, under section 26 (1) (f) of the Act , be stated in the participant’s support plan.\n- (a) as soon as practicable after the participant is accepted as a participant in the scheme; and\n- (b) if an assessment has been previously carried out for the participant—within 1 year after the last assessment was carried out.","sortOrder":30},{"sectionNumber":"pt.5","sectionType":"part","heading":"Levy","content":"# Levy","sortOrder":31},{"sectionNumber":"sec.24","sectionType":"section","heading":"Amount of levy— Act , s 99","content":"### sec.24 Amount of levy— Act , s 99\n\nThe levy fixed for the 2025–2026 financial year for each class of motor vehicle stated in schedule 1 is the amount stated in schedule 1 opposite the class of motor vehicle.\nFor subsection (1) , a motor vehicle has, for a registration period, the same class as it has for working out the appropriate insurance premium payable for the registration period in relation to the vehicle under the Insurance Act , section 21 .\nThe levy fixed under subsection (1) is the amount appropriate to a registration period of 1 year and, if the registration period is more or less than 1 year, the amount of the levy is worked out using the formula—\nwhere—\nA is the amount of the levy fixed under subsection (1) .\nN is the number of days in the registration period.\nHowever, if the motor vehicle is a motor vehicle, other than a trailer, for which an unregistered vehicle permit has been or is to be issued, the levy under subsection (1) applies irrespective of the period of the permit.\nIn this section—\nmotor vehicle see the Insurance Act , section 4 .\nregistration period see the Motor Accident Insurance Regulation 2018 , schedule 5 .\nunregistered vehicle permit see the Motor Accident Insurance Regulation 2018 , schedule 5 .\ns 24 amd 2017 SL No. 39 s 7 ; 2018 SL No. 32 s 14 ; 2018 SL No. 113 s 37 ; 2019 SL No. 34 s 8 ; 2020 SL No. 38 s 9 ; 2021 SL No. 22 s 7 ; 2022 SL No. 32 s 7 ; 2023 SL No. 22 s 7 ; 2024 SL No. 28 s 8 ; 2025 SL No. 17 s 7\n(sec.24-ssec.1) The levy fixed for the 2025–2026 financial year for each class of motor vehicle stated in schedule 1 is the amount stated in schedule 1 opposite the class of motor vehicle.\n(sec.24-ssec.2) For subsection (1) , a motor vehicle has, for a registration period, the same class as it has for working out the appropriate insurance premium payable for the registration period in relation to the vehicle under the Insurance Act , section 21 .\n(sec.24-ssec.3) The levy fixed under subsection (1) is the amount appropriate to a registration period of 1 year and, if the registration period is more or less than 1 year, the amount of the levy is worked out using the formula— where— A is the amount of the levy fixed under subsection (1) . N is the number of days in the registration period.\n(sec.24-ssec.4) However, if the motor vehicle is a motor vehicle, other than a trailer, for which an unregistered vehicle permit has been or is to be issued, the levy under subsection (1) applies irrespective of the period of the permit.\n(sec.24-ssec.5) In this section— motor vehicle see the Insurance Act , section 4 . registration period see the Motor Accident Insurance Regulation 2018 , schedule 5 . unregistered vehicle permit see the Motor Accident Insurance Regulation 2018 , schedule 5 .","sortOrder":32},{"sectionNumber":"sec.25","sectionType":"section","heading":"Levy not refundable if class of motor vehicle changes or registration is cancelled","content":"### sec.25 Levy not refundable if class of motor vehicle changes or registration is cancelled\n\nThe levy paid for a motor vehicle is not refundable if—\nthere is a change of class of the motor vehicle to a class for which a lower levy is payable; or\nthe registration of the motor vehicle under the Transport Operations (Road Use Management) Act 1995 is cancelled.\n(sec.25-ssec) The levy paid for a motor vehicle is not refundable if— there is a change of class of the motor vehicle to a class for which a lower levy is payable; or the registration of the motor vehicle under the Transport Operations (Road Use Management) Act 1995 is cancelled.\n- (a) there is a change of class of the motor vehicle to a class for which a lower levy is payable; or\n- (b) the registration of the motor vehicle under the Transport Operations (Road Use Management) Act 1995 is cancelled.","sortOrder":33}],"analysis":{"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":false,"description":"This regulation primarily operationalises the Act by putting detailed eligibility tests, assessment procedures, information‑exchange rules and administrative mechanics (including an annual levy figure) into delegated form. It does not expand the scheme’s substantive scope beyond the purposes set out in the Act; rather it defines clinical thresholds, who may assess, which providers must be registered, application content, and the levy mechanics. The inclusion of a current levy amount for 2025–26 (sec 24 and schedule 1) is a routine annual update rather than a material change of scope."},"complexity_factors":["Multiple medically technical eligibility rules across secs 5–11 with age‑based branching (adult, 3–8 years, <3 years, etc.).","Several external clinical instruments and standards are referenced (ASIA impairment scale, ISNCSCI, ISAFSCI, Westmead PTA scale, Glasgow Coma Scale, Functional Independence Measure and Children’s FIM, Snellen scale).","Cross‑references to the Act and other legislation/regulations (e.g. Insurance Act s 21, Motor Accident Insurance Regulation schedule references, Act sections 9,12,15,19,25,37).","Accreditation and approval conditions for assessors and specialists (sec 12, sec 22) creating operational dependency on third‑party bodies (Australasian Rehabilitation Outcomes Centre) and agency approval processes.","Detailed multi‑factor decision tests for necessity, appropriateness and cost‑effectiveness (secs 16–20) with illustrative examples and evidentiary sources (peer‑reviewed articles, clinical guidelines, trials, MBS inclusion).","Inventory/type lists and permissions for information exchange covering many entity types (sec 14) and a separate rule for disclosures (sec 15).","Levy mechanics include an annual schedule, a pro‑rata formula for non‑annual registration periods, and non‑refund rules; schedule 1 (sec 24) is updated yearly (administrative complexity).","Several measurement alternatives and fallback methods where primary evidence is absent (e.g. using contralateral bone length or estimated knee height for amputations) (secs 7–8).","Prescriptive provider requirements for some service types (home modifications, coordination/case manager) which interact with registration rules (sec 21)."],"plain_english_summary":"**What this regulation does (mechanics)\n\n- Sets precise medical and functional eligibility rules for particular serious personal injuries so the National Injury Insurance Scheme (Queensland) can decide who qualifies (see divisions in Part 2; e.g. spinal cord, traumatic brain injury, amputations, burns, inhalation injury, blindness) (secs 4–11). The rules often vary by age and rely on named clinical instruments or specialist certificates (secs 5–11). \n\n- Specifies how some clinical assessments must be carried out and by whom (assessors must be accredited by the Australasian Rehabilitation Outcomes Centre and approved by the agency when using the Functional Independence Measure or the Children's FIM) (sec 12).\n\n- Prescribes the information that must accompany an application to join the scheme and allows applications by third parties (sec 13). It also lists the government and non‑government entities the agency may exchange or disclose personal information to, where needed to perform its functions (secs 14–15). \n\n- Specifies the matters the agency must consider when deciding whether particular treatment, care or support needs are \"necessary and reasonable\" (benefit to person, appropriateness of service/provider, and cost‑effectiveness), and gives examples of evidence and factors to guide those judgments (secs 16–20). It prescribes that some services (home modifications and coordination services such as a case manager) must be provided by registered providers (sec 21), and requires the agency to obtain specialist occupational‑therapy advice when assessing home/vehicle modification or certain attendant care needs (sec 22). It also fixes timing for reassessments (sec 23).\n\n- Fixes the amount of the motor‑vehicle levy for the 2025–2026 financial year for each vehicle class listed in schedule 1, explains how to pro‑rate the levy for non‑annual registration periods, and clarifies that the levy is not refundable when vehicle class changes or registration is cancelled (secs 24–25).\n\n**Who is affected and who decides\n\n- People with serious personal injuries from motor accidents: their eligibility is decided against the clinical and functional criteria in Part 2 and by agency assessment (secs 4–12). Applicants must supply detailed medical, treatment and accident information (sec 13).\n\n- Assessors and providers: certain assessments must be done by accredited and agency‑approved assessors (sec 12); some services must be delivered by registered providers (sec 21); the agency may evaluate provider qualifications, conflicts of interest and fees when approving services (sec 19).\n\n- Vehicle owners/registrants: pay the levy that funds the scheme; the levy amount for 2025–26 is set in schedule 1 and is generally non‑refundable (secs 24–25).\n\n- Third parties and other agencies: the scheme operator (the agency) may exchange or disclose participant or applicant information to a prescribed list of entities (insurers, hospitals, doctors, employers, the National Disability Insurance Agency, etc.) when necessary to perform scheme functions (secs 14–15).\n\n**Why it matters (stated purpose and practical effects)\n\n- Stated purpose: the regulation operationalises the Act by (a) defining the specific injuries and objective tests that qualify a person as a participant (sec 4), (b) setting who may carry out key assessments (sec 12), (c) specifying application and information‑sharing rules (secs 13–15), and (d) setting decision factors the agency must use to decide what treatment, care and support the scheme funds (secs 16–23). It also fixes the levy level for the 2025–26 year and rules on refundability (secs 24–25).\n\n- Practical trade‑offs and implementation considerations:\n - Who pays: registered vehicle owners fund the scheme through the levy (sec 24). The levy is set annually by regulation for each vehicle class and is non‑refundable on class change or registration cancellation (secs 24–25). That spreads cost broadly across vehicle registrants but concentrates direct financial benefit on accepted participants.\n - Administrative and compliance burden: applicants must supply detailed accident, hospital and medical information; third‑party applicants provide information to the best of their knowledge (sec 13). The agency must manage accreditation and approval of assessors and occupational‑therapy approvals for certain assessments (secs 12, 22), which requires administrative capacity and operational rules.\n - Clinical standardisation vs. flexibility: eligibility relies on named clinical instruments and specialist certificates (secs 5–11). That creates objective thresholds (useful for consistency) but requires assessors and clinicians to be familiar with specific scales and could exclude borderline cases where measures are not available or recordings were not made at the time of injury.\n - Provider selection and cost pressure: the agency must weigh benefit to the person against cost and consider more cost‑effective alternatives (sec 20). This gives the agency discretion to prefer lower‑cost providers or leasing over purchase and to consider funding under other schemes—these are mechanisms that can contain scheme costs but may shift choices or timing of services for participants (sec 20).\n - Information sharing and privacy balance: the regulation authorises exchange of personal information with a broad list of entities to administer the scheme (secs 14–15). That facilitates coordination of care and cross‑scheme funding checks but raises operational privacy and data‑security responsibilities for the agency and recipients.\n - Concentrated benefits and diffuse costs: those admitted to the scheme receive funded long‑term care and supports; costs are borne by a large pool of vehicle registrants via the levy (secs 24–25). The regulation contains safeguards (clinical thresholds, accredited assessors, cost‑effectiveness tests) that determine who receives concentrated benefits.\n\n**Concrete behavioural effects**\n- Applicants and clinicians will need to produce and rely on specific clinical measures and specialist reports to meet eligibility thresholds (secs 5–11, 13).\n- Assessors must obtain accreditation and agency approval to perform some functional assessments (sec 12). Providers of home modification and coordination services must be registered where required (sec 21).\n- The agency will exercise judgment about appropriateness and cost‑effectiveness when approving services, including considering alternative funding sources and lower‑cost delivery methods (sec 20).\n- Vehicle registrants bear the levy cost set by schedule 1 for 2025–26 and cannot recover the levy if vehicle class falls or registration is cancelled (secs 24–25).\n\n**Implementation risks and opportunity costs (brief)**\n- Dependence on named clinical instruments and specific recorded measures (e.g. imaging, coma scores, PTA scales) may exclude eligible people where historic records are incomplete (secs 5–6, 11).\n- Accreditation and approval requirements concentrate assessment work among certified assessors and approved occupational therapists (secs 12, 22), which could create bottlenecks if supply is limited.\n- The agency’s cost‑effectiveness obligations (sec 20) may reduce expenditures but could also shift costs to other schemes or to participants if alternatives are not available.\n\n(References to sections: eligibility and instruments — secs 4–12; application and information exchange — secs 13–15; assessment criteria and provider rules — secs 16–23; levy mechanics and refund rules — secs 24–25.)"},"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"},"kimi_summary":{"content_quality":"ok","complexity_score":6,"scope_assessment":{"changed":false,"description":"The regulation appears consistent with its original purpose of operationalising the National Injury Insurance Scheme Act. It elaborates on eligibility criteria, assessment processes, and funding mechanisms as expected for subordinate legislation of this type. No significant scope creep is evident."},"complexity_factors":["Multiple age brackets (under 3, 3–8, over 8) creating parallel but distinct eligibility pathways for each injury type","Extensive incorporation of external medical standards and assessment instruments (ASIA impairment scale, ISNCSCI, ISAFSCI, Glasgow coma scale, Westmead PTA scale, Functional Independence Measure, Snellen scale)","Detailed measurement methodologies for amputations requiring X-ray comparisons or contralateral limb measurements","Cross-references to multiple other Acts including the Insurance Act, National Disability Insurance Scheme Act, Workers' Compensation Act, and Transport Operations Act","Nested conditional logic in eligibility criteria (e.g., 'any or all of the following apply' combined with functional assessment thresholds)","Dual accreditation requirements for assessors (Australasian Rehabilitation Outcomes Centre plus agency approval)","Prescribed lists of entities for information exchange spanning 14 categories from insurers to educational institutions","Multi-factorial decision-making framework for 'necessary and reasonable' care with 6 primary considerations and multiple sub-factors","Formula-based levy calculations with exceptions for unregistered vehicle permits"],"plain_english_summary":"This regulation sets out the detailed rules for Queensland's National Injury Insurance Scheme (NIIS), which provides lifetime care and support for people who suffer catastrophic injuries in motor vehicle accidents.\n\n**What it does:**\n- **Defines who qualifies** for the scheme by setting specific medical criteria for six types of serious injuries: spinal cord injuries, traumatic brain injuries, amputations, severe burns, inhalation burns, and permanent blindness. These criteria use international medical standards and assessment tools.\n- **Sets age-based rules**: Children under 3, children 3–8, and people over 8 have different eligibility thresholds because their bodies and developmental stages differ.\n- **Specifies who can assess injuries**: Only accredited assessors using approved tools (like the Functional Independence Measure) can evaluate whether someone meets the criteria.\n- **Lists application requirements**: People applying must provide detailed personal, medical, and accident information, including details of any workers' compensation claims.\n- **Allows information sharing**: The scheme can exchange information with hospitals, doctors, employers, other insurers, and government agencies like the NDIS.\n- **Sets standards for care decisions**: When deciding what treatment and support to fund, the agency must consider whether it benefits the person, follows best medical practice, uses qualified providers, and offers value for money.\n- **Fixes a levy** on vehicle registrations to fund the scheme, with amounts varying by vehicle class.\n\n**Who it affects:**\n- People catastrophically injured in Queensland motor vehicle accidents and their families\n- Doctors, hospitals, and rehabilitation specialists who assess and treat injuries\n- The government agency administering the scheme\n- All Queensland vehicle owners (who pay the levy)\n\n**Why it matters:**\nThis regulation determines whether someone receives lifetime funded care after a devastating injury. The strict medical criteria ensure only those with genuinely catastrophic injuries enter the scheme, while the assessment rules aim to ensure funded care is effective, appropriate, and financially sustainable."},"summary":{"complexity_score":7,"scope_assessment":{"changed":false,"description":"The regulation closely tracks its enabling Act (National Injury Insurance Scheme (Queensland) Act 2016) by filling in the technical detail the Act expressly delegates to regulation — eligibility thresholds, application requirements, information-sharing entities, assessment criteria, and the annual levy. There is no evidence of scope creep beyond the Act's original intent. The annual levy updates (amended yearly since 2017) are routine and anticipated by the legislative framework."},"complexity_factors":["Multiple injury categories each with distinct, age-tiered eligibility criteria creating a matrix of conditions","Heavy reliance on external international medical standards and clinical instruments (ASIA scale, ISNCSCI, ISAFSCI, Glasgow Coma Scale, Westmead PTA Scale, FIM/WeeFIM instruments) incorporated by reference","Age-banded rules (under 3, 3–8, over 8, under 16, adults) creating parallel eligibility pathways for children vs adults","Precise anatomical and measurement thresholds (e.g., 65% femur length, 50% tibia length, metacarpophalangeal joint references) requiring specialist interpretation","Interaction with multiple other Queensland and Commonwealth laws (Insurance Act, Workers' Compensation Act, NDIS Act, Motor Accident Insurance Regulation, Transport Operations Act)","Information-sharing provisions spanning 14 categories of entities with privacy implications","Annual levy mechanism with pro-rata formula and cross-references to vehicle classification under separate legislation","Multi-factor 'necessary and reasonable' assessment framework for ongoing care decisions adds administrative complexity"],"plain_english_summary":"Queensland’s NIIS regulation details how the no-fault, lifetime care scheme works for people who suffer catastrophic injuries in motor vehicle crashes. It defines who qualifies, how to apply, what treatment and supports the scheme will fund, and how personal health information may be shared to manage care. All Queensland vehicle owners fund the NIIS via an annual, non‑refundable registration levy. The rules matter because they determine access to lifetime, funded care without proving fault."},"issue_detection":{"absurdities":[],"contradictions":[]}},"importantCases":[],"_links":{"self":"/api/acts/national-injury-insurance-scheme-queensland-regulation-2016","history":"/api/acts/national-injury-insurance-scheme-queensland-regulation-2016/history","analysis":"/api/acts/national-injury-insurance-scheme-queensland-regulation-2016/analysis","conflicts":"/api/acts/national-injury-insurance-scheme-queensland-regulation-2016/conflicts","importantCases":"/api/acts/national-injury-insurance-scheme-queensland-regulation-2016/important-cases","documents":"/api/acts/national-injury-insurance-scheme-queensland-regulation-2016/documents"}}