Maximum amounts payable by insurer for certain treatment
20 Maximum amounts payable by insurer for certain treatment
This clause applies in relation to treatment to which section 56 of the Act applies, being treatment—
that is provided to an injured person by a health care professional, and
in respect of which a fee is specified in the AMA List.
However, this clause does not apply in relation to treatment received by an injured person before 17 December 1999.
For the purposes of section 56(3) of the Act, the maximum amount for which an insurer is liable in respect of any claim for fees payable for treatment to which this clause applies is the amount listed, in respect of the treatment concerned, in the AMA List.
Note.
Section 56 of the Act does not apply to treatment that is provided at a hospital (whether to an in-patient or out-patient) and for which any payment is required to be made to the hospital and not to the provider of the treatment. The section does apply to the fee payable to a private hospital for any treatment at the hospital.
In this clause—
AMA List means the document called List of Medical Services and Fees published by the Australian Medical Association and dated 1 December 2019 as amended or replaced, from time to time, by a document that—
has been published by the Australian Medical Association, as an amendment to, or replacement of, the AMA List, and
has been recognised by the Authority, by notice published in the Gazette.
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