Part 5Disputes and reviews

Part 5—Disputes and reviews Division 1—Disputes about non‑medical matters 33—Preliminary (1) In this Division— relevant determination means— (a) a threshold determination; or (b) a determination of the Authority that results in the suspension of the participation of a person in the Scheme; or (c) a determination prescribed by the regulations for the purposes of this definition; threshold determination means a determination by the Authority as to any of the following: (a) whether a person is eligible to be a participant in the Scheme under section 24(1)(a); (b) whether an incident that results in bodily injury is an incident that was caused by or arose out of the use of a motor vehicle; (c) whether a person is eligible to be a participant in the Scheme under section 24(1)(c) or (d); (d) whether an application by a person to become a participant in the Scheme has been made within a relevant period specified by the LSS Rules. (2) The following are interested parties in relation to a relevant determination: (a) in relation to a threshold determination— (i) the person to whom an application under this Act relates; and (ii) an insurer or the nominal defendant; (b) in relation to any other determination—the person to whom the determination relates. 34—Resolution of disputes (1) If there is a dispute about a relevant determination, an interested party in relation to the determination may apply at first instance to have the dispute reviewed by a review officer. (2) An application must be made in a manner and form prescribed by the LSS Rules. (3) Notice of an application must be given to any other interested party in relation to the determination and any such interested party may, on application made in accordance with the LSS Rules, become a party to the dispute. (4) For the purposes of a review by a review officer, the review officer— (a) may adopt such procedures as the review officer thinks fit; and (b) is not bound by the rules of evidence but may inform himself or herself in any way that the review officer considers appropriate. (5) Without limiting subsection (4), a review officer may require a person to appear before the review officer at a specified time and place to answer questions or to produce material (or both). (6) A person must not, without reasonable excuse, fail to comply with a requirement under subsection (5). Maximum penalty: $5 000. (7) At the completion of the review proceedings, the review officer may— (a) confirm or vary the determination to which the proceedings relate; or (b) revoke the determination to which the proceedings relate and substitute another determination. (8) The outcome of the review must be incorporated into a written determination setting out the review officer's reasons for his or her determination. (9) The costs of any proceedings before a review officer under this section are payable by the Authority. (10) The costs to which subsection (9) applies— (a) include the necessary costs and expenses of travel and accommodation incurred by the person to whom the application under this Act relates, and by a carer of such a person (which may include a parent) in order to accompany and support the person, in attending before a review officer; but (i) any costs associated with being represented before a review officer; or (ii) any costs excluded from the operation of subsection (9) by the regulations. (11) For the purposes of this section, the Authority must assign or appoint persons to act as review officers (who may, but need not, be members of the staff of the Authority). 35—Review by Tribunal (1) A party to a dispute to which a determination of a review officer under this Division relates may apply to the Tribunal under section 34 of the South Australian Civil and Administrative Tribunal Act 2013 for review of the determination of the review officer. (2) An application for review must be made within 28 days of the date of the determination of the review officer. Division 2—Disputes about eligibility 36—Disputes about eligibility (1) If there is a dispute— (a) about whether an injury results from a motor vehicle accident or is attributable to some other condition, event, incident or factor; or (b) about whether an injury suffered by a person satisfies the criteria specified by the LSS Rules for eligibility for the Scheme provided by this Act; or (c) about the relationship between 2 or more injuries, including whether an injury is wholly or predominantly related to a motor vehicle injury; or (d) without limiting a preceding paragraph—about whether an injury falls within, or is excluded from, the coverage of this Act under the LSS Rules; or (e) about a matter prescribed by the regulations, the dispute may be referred to an expert review panel. (2) The dispute may be referred— (a) by the Authority; or (b) by notice to the Authority given— (i) by or on behalf of an injured person; or (ii) by an insurer or the nominal defendant. (3) A notice under subsection (2)(b) must comply with any requirement prescribed by the LSS Rules. (4) The expert review panel to which a dispute is referred for determination is to determine the dispute and give a certificate as to its determination setting out the reasons for its determination. (5) The costs of any proceedings before an expert review panel under this section are payable by the Authority. (6) The costs to which subsection (5) applies— (a) include the necessary costs and expenses of travel and accommodation incurred by the injured person, and by a carer of the injured person (which may include a parent) in order to accompany and support the person, in attending before an expert review panel (or a member of an expert review panel); but (i) any costs associated with being represented before an expert review panel; or (ii) any costs excluded from the operation of subsection (5) by the regulations. 37—Review by Tribunal (1) Subject to subsection (2), a person may apply to the Tribunal under section 34 of the South Australian Civil and Administrative Tribunal Act 2013 for review of a determination of an expert review panel under this Division that a person is ineligible or otherwise does not qualify to participate in the Scheme. (2) An application for review by the Tribunal may only be made by or on behalf of the person to whom the determination relates. (3) An application for review must be made within 28 days of the date of the determination of the expert review panel. Division 3—Review of assessments 38—Review of assessments (1) A participant in the Scheme may apply to have an assessment of the Authority about the treatment, care and support needs of the participant under Part 4 reviewed by an expert review panel. (2) An application must be made in a manner and form prescribed by the LSS Rules. (3) The application must be made within 28 days after the participant is given notice of the assessment of the participant's treatment, care and support needs (unless an extension of time is allowed under the LSS Rules). (4) On a review, the expert review panel may— (a) confirm or vary the assessment; or (b) revoke the assessment and substitute its own assessment. (5) The expert review panel must give a certificate as to the outcome of the review setting out the reasons for any decision or assessment made by the expert review panel under this section. (6) The Authority must, to such extent (if any) as may be necessary, revise its assessment of the treatment, care and support needs of the participant to give effect to the outcome of a review by an expert review panel. (7) A decision or assessment of an expert review panel under this section is final and binding for the purposes of this Act and any proceedings under this Act. (8) Subsection (7) does not apply in relation to any proceedings for judicial review and does not prevent or restrict a court from exercising any judicial power or from determining a matter according to law. (9) An expert review panel undertaking a review under this section must act consistently with, and apply, any relevant provision of the LSS Rules. (10) The costs of any proceedings before an expert review panel under this section are payable by the Authority. (11) The costs to which subsection (10) applies— (a) include the necessary costs and expenses of travel and accommodation incurred by the participant, and by a carer of the participant (which may include a parent) in order to accompany and support the participant, in attending before an expert review panel (or a member of an expert review panel); but (i) any costs associated with being represented before an expert review panel; or (ii) any costs excluded from the operation of subsection (10) by the regulations.