Requests to review decisions about claims for payment—Act, s 158
16 Requests to review decisions about claims for payment—Act, s 158
This section prescribes, for section 158(4) of the Act, the way in which the chief executive must deal with a request, made by a claimant under section 158(2) of the Act, to review a decision of a licensed provider (the provider’s decision).
The chief executive must either review, or refuse to review, the provider’s decision.
The chief executive may refuse to review the provider’s decision only if—
the request was not made within 10 days after the claimant received the claim result notice for the decision; or
the chief executive considers the request was not made in good faith or is frivolous.
If the chief executive decides to refuse to review the provider’s decision, the chief executive must—
give written notice of the chief executive’s decision to the licensed provider and claimant; and
give the claimant a written notice stating the reasons for the chief executive’s decision.
If the chief executive decides to review the provider’s decision, the chief executive must—
give the licensed provider a copy of the claimant’s request; and
by written notice given to the provider and the claimant, invite submissions about the provider’s decision within 1 month after receiving the notice (the submission period).
Submissions must be made in writing.
As soon as practicable after the end of the submission period, the chief executive must—
consider all submissions properly made; and
consider the results of any investigation carried out by the chief executive under section 158(4)(b) of the Act; and
make a decision about the review; and
give the licensed provider and claimant an information notice for the decision.
Nothing in this section affects or prejudices any other right or remedy of a licensed provider or a claimant in an authorised game.
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