South Australian Consolidated Acts South Australian Consolidated Acts32—Compensation for medical expenses
(1) Subject to this
section, a worker is entitled to be compensated for costs of a kind described
in subsection (2) reasonably incurred by the worker in consequences of
having suffered a compensable disability—
(a) in
accordance with a scale published by the Minister under this section; or
(b) if
the relevant service is not covered by a scale under this section—to the
extent of a reasonable amount for the provision of the service.
(2) The costs referred
to in subsection (1) are as follows:
(a) the
cost of medical services;
(b) the
cost of hospitalisation and all associated medical, surgical and nursing
services;
(c) the
cost of approved rehabilitation;
(d) the
cost of travelling, or being transported, to and from any place for the
purpose of receiving medical services, hospitalisation or approved
rehabilitation (but not where the worker travels in a private vehicle);
(e)
where it is necessary for the worker to be accommodated away from home for the
purpose of receiving medical services or approved rehabilitation—the
cost of such accommodation (but not exceeding limits prescribed by
regulation);
(f) the
cost of attendance by a registered or enrolled nurse, or by some other person
approved by the Corporation or of a class approved by the Corporation, where
the disability is such that the worker must have nursing or personal
attendance;
(g) the
cost of the provision, maintenance, replacement or repair of
therapeutic appliances;
(h) the
cost of medicines and other material purchased on the prescription or
recommendation of a medical expert;
(i)
any other costs (or classes of costs) authorised by the
Corporation.
(3) Compensation in
respect of costs to which this section applies may be paid—
(a) to
the worker; or
(b)
directly to the person to whom the worker is liable for those costs.
(4) Where a worker has
been charged more than the amount that the worker is entitled to claim for the
provision of a service in respect of which compensation is payable under this
section, the Corporation may reduce the charge by the amount of the excess.
(4a) A decision of the
Corporation under subsection (4) is not reviewable.
(a)
services of a kind to which this section applies were provided to a worker in
relation to a compensable disability; and
(b) the
Corporation considers that the services were, in the circumstances of the
case, inappropriate or unnecessary,
the Corporation may disallow charges for the services.
(6) Where the
Corporation disallows or reduces a charge under this section—
(a) it
must give to the provider of the service a notice setting out—
(i)
the basis of the Corporation's decision to disallow or
reduce the charge; and
(ii)
where the charge has been disallowed under
subsection (5) the provider's right to have the decision reviewed under
this Act; and
(b) the
worker is not liable to the provider for the disallowed charge, or for more
than the reduced charge, (as the case requires) and, if the worker has in fact
paid an amount for which he or she is not liable, the Corporation will
reimburse the worker for that amount and may recover it from the provider as a
debt.
(7) Where a worker
travels in a private vehicle to or from any place for the purpose of receiving
medical services, hospitalisation or approved rehabilitation, and the travel
is reasonably necessary in the circumstances of the case, the worker is
entitled to a travel allowance at rates fixed by a scale published by the
Minister under this section.
(8) A reference in
this section to approved rehabilitation is a reference to rehabilitation
programmes or services provided by a person who has an agreement with the
Corporation for the provision of those programmes or services.
(9) If a treatment
protocol for a disability of a particular kind has been published by the
Minister under this section, costs of medical services for treatment of a
disability of the relevant kind (and related hospitalisation and nursing
services) are only compensable where—
(a) the
services are provided in accordance with the protocol; or
(b) the
provider of the services establishes, to the Corporation's satisfaction, that
services outside the terms of the protocol are justified in the circumstances
of the particular case.
(10) The amount of
compensation for a service covered by a scale of charges published by the
Minister under this section must be in accordance with the scale.
(11) The Minister may,
by notice in the Gazette, on the recommendation of the Corporation,
publish—
(a)
scales of charges for the purposes of this section (ensuring as far as
practicable that the scales comprehensively cover the various kinds of
services to which this section applies);
(b)
treatment protocols for treatment of disabilities of particular kinds.
(12) Subject to
subsection (12a), a scale of charges published under this section must be
based on the average charge to private patients for the relevant service (but
the amount fixed for the service must not exceed the amount recommended by the
relevant professional association).
(12a) A scale of
charges for services provided by a public hospital may be based on government
charges for the relevant service.
(13) Before the
Corporation makes a recommendation to the Minister about the publishing of a
scale of charges, or a treatment protocol, the Corporation must consult
with—
(a)
professional associations representing the providers of medical services of
the relevant kind; and
(b) the
Self-Insurers Association of South Australia Incorporated and associations
representing self-managed employers; and
(c)
associations representing employers (including the South Australian Employers
Chamber of Commerce and Industry); and
(d)
associations representing employees (including the United Trades and Labor
Council).
(14) A person who
provides a service for a disabled worker, knowing the worker to be entitled to
compensation for the service under this section, must not charge for the
service an amount exceeding the amount allowed under a scale of charges
published under this section.
Maximum penalty: $1 000.