122Determination of claims for payment of expenses

122 Determination of claims for payment of expenses

(1)  Within 10 business days of receiving a claim under section 121(1) for expenses, the Commissioner –

(a) must, under section 123 , if the expenses have not been paid, pay the expenses or, if the expenses have been paid by a person, reimburse to the person the amount of the expenses; or

(b) must –

(i) serve the person who lodged the claim with notice in writing disputing the claim; and

(ii) if the expense has not been paid, notify in writing the person who provided the compensable service, if any, to which the claim relates that liability for the expenses is disputed and outline the reasons for disputing the liability; and

(iii) if the refusal of the Commissioner to pay the expenses relates to a medical question, refer the matter to a medical panel.

(2)  A notice under subsection (1)(b) to a person who lodged a claim for expenses is to –

(a) state that the Commissioner disputes liability to pay the expenses; and

(b) state the reasons why the Commissioner disputes liability to pay the expenses; and

(c) attach or identify the medical or other evidence that the Commissioner relies on for disputing liability to pay the expenses; and

(d) if the refusal of the Commissioner to pay the expenses relates to a medical question, advise the person that the matter has been referred to a medical panel.

(3)  A notice under subsection (1)(b) to a person who lodged a claim for expenses is also to state whether the Commissioner disputes –

(a) only the expenses to which the claim for expenses relates; or

(b) all –

(i) expenses of a specified kind; or

(ii) expenses incurred with a particular person who supplies medical, hospital, nursing, constant attendance, rehabilitation or ambulance services; or