223Future treatment payment—assessment and calculation

223 Future treatment payment—assessment and calculation If the relevant insurer for a motor accident receives an application under section 222, the insurer must— (a) assess— (i) whether the applicant’s approved medical treatment, and the costs of the medical treatment, are reasonable and necessary; and (ii) the period for which the applicant will need the approved medical treatment; and (b) consider the opportunities available to the applicant for investing a future treatment payment; and (c) calculate the amount payable to the applicant; and Example—calculation of amount payable A person injured in a motor accident receives the following continuous medical treatment in the 6 months before the relevant date for the motor accident: • 2 appointments at 3-monthly intervals with a medical specialist; • 2 appointments at 3-monthly intervals with a physiotherapist; • 2 appointments at 3-monthly intervals with a psychiatrist. For the purposes of calculating the amount payable to the person, if they continue to require treatment with the 3 health practitioners after their entitlement to treatment and care benefits ends, expenses for the 3 health practitioners may be included in the calculation. (d) within 2 months after the day the application is made, give the applicant a written notice that includes the following: (i) the amount calculated; (ii) information about how the amount was calculated, including what information was considered in calculating the amount;

(iii) a statement to the effect that the amount calculated relates only to expenses for approved medical treatment the applicant receives— (A) after the person’s entitlement to defined benefits for treatment and care ends; and (B) not later than 10 years after the date of the motor accident; (iv) a statement to the effect that— (A) the applicant may agree to the amount calculated or negotiate with the insurer for a different amount; and (B) if the applicant negotiates with the insurer for a different amount—the applicant may rely on medical information the applicant sought for the purposes of the negotiation; and (C) an amount agreed to under this section (including a negotiated amount) applies only to future medical treatment.