83Duty of insurer to make hospital, medical and other payments

83 Duty of insurer to make hospital, medical and other payments

83 Duty of insurer to make hospital, medical and other payments

(cf s 45 (2)–(4) MAA)

(1) Once liability has been admitted (wholly or in part) or determined (wholly or in part) against the person against whom the claim is made, it is the duty of an insurer to make payments to or on behalf of the claimant in respect of—

(a) hospital, medical and pharmaceutical expenses, and

(b) rehabilitation expenses, and

(c) respite care expenses in respect of a claimant who is seriously injured and in need of constant care over a long term, and

(d) attendant care services expenses in respect of a claimant who is seriously injured and in need of constant care over a long term (being services provided by a person with appropriate training to provide those services, but not including services provided by a person who is related to the claimant or any services for which the claimant has not paid and is not liable to pay),

as incurred.

(2) The duty of an insurer under this section to make payments applies only to the extent to which those payments—

(a) are reasonable and necessary in the circumstances, and

(b) are properly verified, and

(c) relate to the injury caused by the fault of the owner or driver of the motor vehicle to which the third-party policy taken to have been issued by the insurer relates.

Note.

Medical disputes about payments under this section may be referred by the insurer or claimant to a medical assessor for assessment under Part 3.4. Other disputes may be referred to the Commission under section 96 for assessment.

(2A) If the Motor Accidents Medical Guidelines approve particular treatment as appropriate treatment, or particular procedures as appropriate procedures with respect to the provision of rehabilitation services or attendant care services, in respect of any matter, any treatment, rehabilitation services or attendant care services provided to the injured person that accords with the approved treatment or procedures is taken to be reasonable in the circumstances for the purposes of subsection (2) (a).

Note.

Subsection (2) (a) also requires that treatment and services be necessary in the circumstances.