sec.42Payment of medical expenses etc.

### sec.42 Payment of medical expenses etc. Once liability has been admitted, it is the duty of the insurer to make payments to or for the claimant for private hospital, medical and pharmaceutical expenses reasonably and appropriately incurred because of the injury or a proportionate part of the expenses reflecting the extent of the insurer’s responsibility (assuming the claimant to be guilty of contributory negligence as asserted by the insurer). A payment must be made under this section on presentation of an account made up, and verified, as required by regulation. However, the insurer is not required to make a payment in relation to the claimant’s treatment, care and support needs as a result of the injury if— the claimant is, when the needs arise, a participant in the injury insurance scheme in relation to a serious personal injury resulting from the motor vehicle accident the subject of the claim; or the needs arise after an amount is paid to the claimant, or a person acting for the claimant, under the National Injury Act , section 44 (3) (a) in relation to a personal injury resulting from the motor vehicle accident the subject of the claim. Subsection (3) applies— whether or not the injury the subject of the claim is a serious personal injury; and whether or not the treatment, care and support needs are an approved service for the claimant under the National Injury Act ; and whether or not the insurance agency must, under that Act, make a payment in relation to the treatment, care and support needs; and whether or not the treatment, care and support is provided without charge. An insurer may recover payments made under this section if it later appears that the admission of liability was induced by fraud. s 42 amd 2000 No. 17 s 22 ; 2016 No. 34 s 161 (sec.42-ssec.1) Once liability has been admitted, it is the duty of the insurer to make payments to or for the claimant for private hospital, medical and pharmaceutical expenses reasonably and appropriately incurred because of the injury or a proportionate part of the expenses reflecting the extent of the insurer’s responsibility (assuming the claimant to be guilty of contributory negligence as asserted by the insurer). (sec.42-ssec.2) A payment must be made under this section on presentation of an account made up, and verified, as required by regulation. (sec.42-ssec.3) However, the insurer is not required to make a payment in relation to the claimant’s treatment, care and support needs as a result of the injury if— the claimant is, when the needs arise, a participant in the injury insurance scheme in relation to a serious personal injury resulting from the motor vehicle accident the subject of the claim; or the needs arise after an amount is paid to the claimant, or a person acting for the claimant, under the National Injury Act , section 44 (3) (a) in relation to a personal injury resulting from the motor vehicle accident the subject of the claim. (sec.42-ssec.4) Subsection (3) applies— whether or not the injury the subject of the claim is a serious personal injury; and whether or not the treatment, care and support needs are an approved service for the claimant under the National Injury Act ; and whether or not the insurance agency must, under that Act, make a payment in relation to the treatment, care and support needs; and whether or not the treatment, care and support is provided without charge. (sec.42-ssec.5) An insurer may recover payments made under this section if it later appears that the admission of liability was induced by fraud. - (a) the claimant is, when the needs arise, a participant in the injury insurance scheme in relation to a serious personal injury resulting from the motor vehicle accident the subject of the claim; or - (b) the needs arise after an amount is paid to the claimant, or a person acting for the claimant, under the National Injury Act , section 44 (3) (a) in relation to a personal injury resulting from the motor vehicle accident the subject of the claim. - (a) whether or not the injury the subject of the claim is a serious personal injury; and - (b) whether or not the treatment, care and support needs are an approved service for the claimant under the National Injury Act ; and - (c) whether or not the insurance agency must, under that Act, make a payment in relation to the treatment, care and support needs; and - (d) whether or not the treatment, care and support is provided without charge.