Part 7 Occupational rehabilitation services
In this Part, approved guidelines means guidelines that are approved by the Authority and issued to insurers.
17 Occupational rehabilitation service—additional services
For the purposes of the definition of occupational rehabilitation service in section 59 of the Act, the service of monitoring a return-to-work plan is prescribed.
18 Occupational rehabilitation services—maximum amount for which employer liable
(1) For the purposes of section 63A (3) (b) of the Act, the prescribed amount is $1,500, adjusted in accordance with Division 6 of Part 3 of the Act as if it were an adjustable amount for the purposes of that Division.(2) The prescribed amount applies in relation to occupational rehabilitation services in respect of injuries received before the commencement of this clause (or before any adjustment of that amount as referred to in subclause (1)) in the same way as it applies in relation to services in respect of injuries received after that commencement.
19 Directions to employers under sec 63A (4)—insurers authorised
For the purposes of section 63A (4) of the Act, an insurer who is liable to indemnify an employer for any occupational rehabilitation service provided to or for the benefit of a worker is prescribed (in addition to the Authority) as a person who may direct that the employer is liable for a further amount to that prescribed by section 63A (3) of the Act.
20 Applications under sec 63A—generally
(1) An application under section 63A (4) of the Act:(a) is to be in the form of a rehabilitation plan or in such other form (if any) as the Authority may approve, and(b) is to contain such particulars as the Authority may determine.(2) An accredited provider is required to make an application under section 63A (4) as soon as practicable after the accredited provider becomes aware that the total cost of occupational rehabilitation services provided to or for the benefit of a worker in respect of an injury will, or is likely to, exceed the maximum amount prescribed by section 63A (3).
21 Applications under sec 63A (4)—services provided by more than one provider etc
(1) An accredited provider may, for the purpose of determining whether an application under section 63A (4) of the Act is necessary, request the relevant insurer (in writing) to supply details of any costs that have been claimed from the insurer in respect of occupational rehabilitation services previously provided by another provider in respect of the same injury.(2) If the insurer does not, within 14 days or such longer period as the Authority may determine, supply the accredited provider with those details, the provider need only make an application under section 63A (4) of the Act if the total cost of services provided by that provider to or for the benefit of the worker concerned will, or is likely to, exceed the maximum amount prescribed by section 63A (3) of the Act.
22 Directions by insurers—special provisions
(1) If an application under section 63A (4) of the Act is made to an insurer:(a) the insurer may request further information from the applicant, and(b) the insurer is, as far as practicable, to deal with the application within 7 days after receiving it or the further information (whichever is the later).(2) A direction by an insurer under section 63A (4) of the Act must be in accordance with the approved guidelines (if any) relating to such directions.(3) Any such direction may, subject to those approved guidelines:(a) specify that an employer’s liability for a further amount to that prescribed by section 63A (3) of the Act is limited by reference to a maximum further amount for which the employer is liable for the proposed services (including, if appropriate, particular services) or to the nature, number or duration of those services, or both, or(b) specify that the employer is liable for such amount as is reasonably appropriate, having regard to the reasonable necessity for the provision of the services concerned.
23 Conditions etc—directions under sec 63A (4)
(1) If a direction is given under section 63A (4) of the Act and the accredited provider concerned becomes aware that, because of a change of circumstances or otherwise, it is no longer necessary for the occupational rehabilitation service covered by the direction to be provided to or for the benefit of the worker, the provider is to cease providing the service and notify the Authority or the relevant insurer.(2) The Authority or an insurer may, subject to any approved guidelines, give a direction under section 63A (4) of the Act:(a) that is subject to such conditions as may be specified in the direction, and(b) by notice in writing given to the provider concerned, amend or revoke the conditions specified in any such direction or add to those conditions,and any such amendment, revocation or addition takes effect on and from the time the notice is served on the provider concerned or from a later time specified in the notice.(3) The Authority or the insurer is to ensure that the employer concerned also receives a copy of the notice as soon as practicable after it takes effect.
(1) If an insurer, after an application under section 63A (4) of the Act has been made to it:(a) refuses to give a direction under section 63A (4) of the Act, or(b) gives only part of any such direction applied for by or on behalf of the worker or the accredited provider concerned,the insurer must refer the matter as soon as practicable to the Authority in such form and in such manner as the Authority may determine.(2) If an insurer gives a direction under section 63A (4) of the Act, the worker or accredited provider concerned may apply to the Authority for a review of the direction:(a) if the worker or provider objects to a condition (or an amendment or revocation of a condition) that the insurer has attached or added to the direction, or(b) if the insurer declines further liability on behalf of the relevant employer for any occupational rehabilitation service covered by a direction previously given by the insurer.(3) An application for review is required to be:(a) made in such form, and(b) accompanied by such information, and(c) made in such manner,as the Authority may determine.(4) The Authority may, in relation to a matter that has been referred to it or in relation to an application for a review under this clause:(a) confirm the decision of the insurer, or(b) confirm the decision with such modification as the Authority considers to be appropriate, or(c) give a direction under section 63A (4) of the Act that the Authority considers to be appropriate.(5) The Authority is to notify in writing the relevant insurer, employer, accredited provider and worker of the outcome of its review.
25 Revocation by Authority of direction under sec 63A (4)
(1) The Authority may, after giving a direction under section 63A (4) of the Act, revoke (in whole or in part) the direction if it considers it appropriate to do so in the circumstances.(2) The Authority may suspend any such direction pending its decision on whether to revoke the direction.(3) The Authority is to give notice in writing to all parties of any such suspension or revocation (but may, in the case of suspension, give oral notice and confirm the notice later in writing).(4) If the Authority suspends or revokes a direction under section 63A (4) of the Act, the employer concerned ceases to be liable (subject to any order of the District Court or the Commission) for any occupational rehabilitation services or class of service specified in the notice of suspension or revocation and to which the direction relates.(5) The suspension or revocation has effect in respect of services provided after the accredited provider concerned receives notice of the suspension or revocation or after such later time as may be specified in the notice.
The Authority must, before making a decision on:(a) an application for a direction under section 63A (4) of the Act or a review of an insurer’s decision in respect of such an application, or(b) whether to amend, revoke or add to the conditions to which any such direction is subject, or(c) whether to suspend or revoke any such direction,give any person who may be adversely affected by the decision a reasonable opportunity to make submissions to the Authority on the matter.
27 Payment under direction by Authority not admission of liability
The payment of any amount in accordance with a direction by the Authority under section 63A (4) of the Act is not to be taken as an admission of liability.
28 Claims relating to uninsured liabilities
In the case of a claim under Division 6 of Part 4 of the Act involving the provision of occupational rehabilitation services to or for the benefit of the worker concerned:(a) any application for a direction under section 63A (4) of the Act may only be made to the Authority, and(b) for the purpose of the definition of occupational rehabilitation service in section 59 of the Act, services may be provided to or for the benefit of the worker by any person determined by the Authority to be suitable (as well as by a provider accredited under section 152 of the Act) and, in that case, references in this Part to an accredited provider are to be read as references to such a person.
29 Application of Part to self-insurers
If, in respect of an application under section 63A (4) of the Act, a self-insurer decides or refuses to pay a further amount to that prescribed by section 63A (3) of the Act:(a) the decision is, for the purposes of this Part, taken to be a direction that the employer concerned is liable for that further amount, or(b) the refusal is, for the purposes of this Part, taken to be a refusal to give a direction under section 63A (4) of the Act,and for any such purposes, a reference in this Part to an insurer includes a reference to a self-insurer.
30 Application of Part to proceedings pending in District Court or Commission
If proceedings are pending in the District Court or the Commission, the Authority may, in relation to an application or a reference for review received by it under this Part that is connected with the proceedings:(a) give a direction under section 63A (4) of the Act (unless the Court or the Commission otherwise orders), or(b) decline to deal with the matter.
31 Authority not prevented from giving opinion on rehabilitation liability
Nothing in this Part (for example clause 24 (Review by the Authority)) prevents the Authority from giving its opinion on matters relating to the liability of an employer under the Act for particular occupational rehabilitation services.