sec.174Deciding payment request— Act , s 232R

sec.174 Deciding payment request— Act , s 232R

For section 232R (2) of the Act , this section prescribes matters about an insurer deciding a payment request for the payment of all or part of an expense for the treatment, care or support of an eligible worker. If the insurer makes an information request for the payment request and the person of whom it is made does not provide the information requested by the stated day or a later day agreed to by the insurer and the person— the request lapses; and the insurer is not required to approve or refuse the request. The insurer must approve the payment request if— the expense is incurred in the eligibility period for the eligible worker; and the treatment, care or support to which the request relates is an approved service for the eligible worker. For subsection (3) (b) , excluded treatment, care or support is an approved service only if the treatment, care or support— is specifically stated in a support plan for the worker to be— treatment, care or support resulting from the worker’s serious personal injury that the insurer considers is necessary and reasonable in the circumstances; or treatment, care or support resulting from another injury resulting from the same event as the worker’s serious personal injury that the insurer considers is necessary and reasonable in the circumstances; or treatment, care or support the insurer agrees to, wholly or partly, pay for under chapter 4A of the Act ; or if a support plan has not been made for the worker—is specifically approved under an approval of a service request relating to the worker. To remove any doubt, it is declared that an insurer may approve a payment request even though the treatment, care or support to which the request relates is not an approved service for the eligible worker. (sec.174-ssec.1) For section 232R (2) of the Act , this section prescribes matters about an insurer deciding a payment request for the payment of all or part of an expense for the treatment, care or support of an eligible worker. (sec.174-ssec.2) If the insurer makes an information request for the payment request and the person of whom it is made does not provide the information requested by the stated day or a later day agreed to by the insurer and the person— the request lapses; and the insurer is not required to approve or refuse the request. (sec.174-ssec.3) The insurer must approve the payment request if— the expense is incurred in the eligibility period for the eligible worker; and the treatment, care or support to which the request relates is an approved service for the eligible worker. (sec.174-ssec.4) For subsection (3) (b) , excluded treatment, care or support is an approved service only if the treatment, care or support— is specifically stated in a support plan for the worker to be— treatment, care or support resulting from the worker’s serious personal injury that the insurer considers is necessary and reasonable in the circumstances; or treatment, care or support resulting from another injury resulting from the same event as the worker’s serious personal injury that the insurer considers is necessary and reasonable in the circumstances; or treatment, care or support the insurer agrees to, wholly or partly, pay for under chapter 4A of the Act ; or if a support plan has not been made for the worker—is specifically approved under an approval of a service request relating to the worker. (sec.174-ssec.5) To remove any doubt, it is declared that an insurer may approve a payment request even though the treatment, care or support to which the request relates is not an approved service for the eligible worker.