Part 4Benefits under Scheme

Part 4—Benefits under Scheme Division 1—Extent of benefits 27—Assessed treatment, care and support needs (1) The Authority is to pay for all the necessary and reasonable expenses incurred by or on behalf of a person in relation to the assessed treatment, care and support needs of the person while the person is a participant in the Scheme. (2) The assessed treatment, care and support needs of a person who is a participant in the Scheme are those treatment, care and support needs assessed by the Authority, in its treatment, care and support needs assessment, to be treatment, care and support needs that— (a) are necessary and reasonable in the circumstances; and (b) relate to the injury or injuries to which this Act applies. (3) The Authority is not liable for any expenses in respect of— (a) excluded treatment, care and support needs; or (b) treatment, care and support needs that are not assessed treatment, care and support needs; or (c) treatment, care and support needs excluded from the operation of this section by the LSS Rules. (4) Without limiting subsection (3), subsections (1) and (2) operate subject to— (a) any criteria set out in the LSS Rules that make provision for or with respect to determining which treatment, care and support needs of a participant in the Scheme— (i) are necessary and reasonable in the circumstances; and (ii) relate to the injury or injuries to which this Act applies; and (b) any monetary or other limits placed on the provision of particular treatment, care and support needs to a participant in the Scheme set out in the LSS Rules; and (c) any provision made by the LSS Rules as to how expenses are to be paid or covered. (5) As an alternative to paying the expenses for which it is liable under this section as and when they are incurred, the Authority may pay those expenses by the payment to the participant of an amount to cover those expenses over a fixed period pursuant to an agreement between the Authority and the participant for the payment of those expenses by the participant (and this will satisfy any liability that would otherwise arise in relation to the matters to which the agreement relates). 28—Payment not required in certain circumstances (1) The Authority is not required to make a payment in relation to any of the following: (a) any treatment, care, support or service provided to a participant in the Scheme on a gratuitous basis (that is, anything provided to a participant for which the participant has not paid and is not liable to pay); (b) in the case of a child—any treatment, care, support or service that would ordinarily fall within the ordinary costs of raising a child; (c) any treatment, care, support or service that is required to be provided by an approved provider but is provided by a person who is not, at the time of provision, an approved provider; (d) any treatment, care, support or service that is provided in contravention of the LSS Rules. (2) However, the Authority may elect to make a payment in relation to any treatment, care, support or service referred to in subsection (1) if the Authority considers that such a payment is justified in the circumstances. (3) The LSS Rules may make provision for or with respect to determining whether a payment is justified under subsection (2). (4) Subsection (1)(c) does not apply in relation to services provided— (a) by a medical practitioner; or (b) by a person acting in circumstances allowed under the LSS Rules. (5) To avoid doubt, subsection (1) applies even if the treatment, care, support or services concerned are provided in connection with the assessed treatment, care and support needs of a participant in the Scheme. (6) The Authority is not required to pay for any treatment, care, support or service provided to a person while the person's participation in the Scheme is suspended. (7) In this section— ordinary costs of raising a child include all costs associated with the child's care, upbringing, education and advancement in life other than costs reasonably incurred because the child has suffered the injury or injuries to which this Act applies. 29—Approved providers (1) The Authority may approve— (a) specified persons; or (b) persons of a specified class, to provide the treatment, care, support or services under the Scheme that are identified under the LSS Rules as treatment, care, support or services that are to be provided by an approved provider. (2) The LSS Rules may also make provision for or with respect to— (a) the standards of competency of approved providers; and (b) the matters that relate to applications for approval under this section. (3) An approval may be granted on conditions or limitations determined by the Authority. (4) An approved provider must not, without reasonable excuse, contravene or fail to comply with a condition or limitation of the approval. Maximum penalty: $10 000. (5) The Authority may, in accordance with the LSS Rules— (a) vary a condition of approval; (b) revoke an approval. (6) A condition of approval may be varied by the addition, substitution or deletion of 1 or more conditions. Division 2—Treatment, care and support needs assessments 30—Assessment of treatment, care and support needs (1) The Authority is to make an assessment of the treatment, care and support needs of a participant in the Scheme (as required from time to time). (2) The assessment must relate to those treatment, care and support needs that— (a) are necessary and reasonable in the circumstances; and (b) relate to the injury or injuries to which this Act applies. (3) The Authority is to certify in writing as to its assessment of the treatment, care and support needs of the participant, including its reasons for any finding on which the assessment is based, and is to give a copy of the certificate to the participant. (4) The Authority may appoint or engage health professionals and other suitably qualified persons to act as assessors for the purposes of this Part (and a decision by an assessor acting under this section will be taken to be a decision of the Authority). 31—Cooperation by participant A participant in the Scheme must comply with any reasonable request made by the Authority or an assessor in connection with an assessment of the treatment, care and support needs of the participant, including a request to undergo a medical examination or other examination by a health professional or other suitably qualified person. 32—Requirements under LSS Rules (1) The LSS Rules may make provision for or with respect to the assessment of the treatment, care and support needs of a participant in the Scheme. (2) In particular, the LSS Rules may make provision for or with respect to the following: (a) the procedures to be followed in connection with such an assessment; (b) the intervals at which such assessments are to be carried out and the review of assessments from time to time as occasion requires; (c) the methods and criteria to be used to determine the treatment, care and support needs of participants; (d) the information to be provided by participants in connection with assessments; (e) the suspension of the participation of a person in the Scheme if the person fails to comply with a requirement specified by the LSS Rules in connection with an assessment of the treatment, care and support needs of the person (including to undergo a medical examination or other examination by a health professional or other suitably qualified person). (3) An assessment of the treatment, care and support needs of a participant in the Scheme is to be carried out in accordance with the LSS Rules.