sec.538Internal review by insurer

### sec.538 Internal review by insurer Before an insurer makes any of the following decisions, the insurer must undertake an internal review of the proposed decision— a decision to reject an application for compensation; a decision not to provide a service under section 232AB ; a decision under section 232M that a worker is not entitled to treatment, care and support payments; a decision to refuse a service request, or approve a service request on conditions, under section 232P ; a decision to refuse a payment request under section 232R ; a decision under section 232S that the insurer is not satisfied that a worker’s serious personal injury is likely to continue to meet the chapter 4A eligibility criteria for the injury after the interim period ends; a decision under section 232S that a worker’s entitlement to treatment, care and support payments ends before the end of the interim period; a decision to not accept liability to make treatment, care and support payments under section 232ZD ; a decision to amend approved services for an eligible worker under section 232ZG ; a decision to suspend, under section 232ZH , a worker’s entitlement to treatment, care and support payments for all or part of a period the worker is absent from Australia; a decision to terminate compensation; a decision under section 325C to refuse an examination application. The review must be made by a person who is in a more senior position than the person who proposes to make the decision. s 538 amd 2016 No. 44 s 42 ; 2017 No. 27 s 29 ; 2019 No. 33 s 74 (sec.538-ssec.1) Before an insurer makes any of the following decisions, the insurer must undertake an internal review of the proposed decision— a decision to reject an application for compensation; a decision not to provide a service under section 232AB ; a decision under section 232M that a worker is not entitled to treatment, care and support payments; a decision to refuse a service request, or approve a service request on conditions, under section 232P ; a decision to refuse a payment request under section 232R ; a decision under section 232S that the insurer is not satisfied that a worker’s serious personal injury is likely to continue to meet the chapter 4A eligibility criteria for the injury after the interim period ends; a decision under section 232S that a worker’s entitlement to treatment, care and support payments ends before the end of the interim period; a decision to not accept liability to make treatment, care and support payments under section 232ZD ; a decision to amend approved services for an eligible worker under section 232ZG ; a decision to suspend, under section 232ZH , a worker’s entitlement to treatment, care and support payments for all or part of a period the worker is absent from Australia; a decision to terminate compensation; a decision under section 325C to refuse an examination application. (sec.538-ssec.2) The review must be made by a person who is in a more senior position than the person who proposes to make the decision. - (a) a decision to reject an application for compensation; - (aa) a decision not to provide a service under section 232AB ; - (b) a decision under section 232M that a worker is not entitled to treatment, care and support payments; - (c) a decision to refuse a service request, or approve a service request on conditions, under section 232P ; - (d) a decision to refuse a payment request under section 232R ; - (e) a decision under section 232S that the insurer is not satisfied that a worker’s serious personal injury is likely to continue to meet the chapter 4A eligibility criteria for the injury after the interim period ends; - (f) a decision under section 232S that a worker’s entitlement to treatment, care and support payments ends before the end of the interim period; - (g) a decision to not accept liability to make treatment, care and support payments under section 232ZD ; - (h) a decision to amend approved services for an eligible worker under section 232ZG ; - (i) a decision to suspend, under section 232ZH , a worker’s entitlement to treatment, care and support payments for all or part of a period the worker is absent from Australia; - (j) a decision to terminate compensation; - (k) a decision under section 325C to refuse an examination application.