Rules for determining whether treatments and services reasonable and necessary

In force

(1)

For the 1987 Act, section 60(2C)(a), the following rules must be applied when determining whether it is reasonable and necessary for a treatment or service to be given or provided to an injured worker—

(a)

a primary purpose of the treatment or service must be to treat the injury that is the subject of the worker’s claim,

(b)

the treatment or service must—

(i)

be clinically justified for the treatment of the injury that is the subject of the worker’s claim, and

(ii)

be cost-effective and represent value for money.

(2)

For this clause, a treatment or service represents value for money if the costs of the treatment or service are reasonable relative to—

(a)

the benefits achieved from the treatment or service, and

(b)

the costs of alternative treatments or services.

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8P Rules for determining whether treatments and services reasonable and necessary