South Australian Current Acts South Australian Current Acts127A—Control of medical services and charges for medical services to
injured persons
(1) In this
section—
"injured person" means a person who has suffered bodily injury caused by or
arising out of the use of a motor vehicle;
"prescribed limit", in relation to prescribed services, means the limit
applying to the prescribed services for the purposes of section 32 of the
Workers Rehabilitation and Compensation Act 1986 ;
"prescribed scale", in relation to prescribed services, means the scale of
charges applying to the prescribed services for the purposes of section 32 of
the Workers Rehabilitation and Compensation Act 1986 ;
"prescribed services" means services of a kind referred to in section 32(2) of
the Workers Rehabilitation and Compensation Act 1986 , but does not
include services of a kind excluded from the application of this section by
notice made under subsection (2).
(2) The Minister may,
by notice in the Gazette—
(a)
require that, for the purposes of this section, the scales of charges made for
the purposes of section 32 of the
Workers Rehabilitation and Compensation Act 1986 be read subject to
modifications specified in the notice;
(b)
exclude specified services from the application of this section;
(c) vary
or revoke a notice under this subsection.
(3) The Minister must,
before issuing a notice under subsection (2)(a) or a notice varying or
revoking such a notice, consult with professional associations representing
the providers of services to which the notice relates.
(3a) In addition, the
Minister may, by instrument in writing, in relation to a particular case or
class of case, increase a limit or charge that applies for the purposes of
this section (and the prescribed limit or prescribed scale will, in that case,
then be taken to be increased to the extent allowed by the instrument).
(4) For the purposes
of this section, a reference in section 32 of the
Workers Rehabilitation and Compensation Act 1986 or the scales of charges
made for the purposes of that section to a worker is to be taken to include a
reference to an injured person.
(5) For the purposes
of this section, a charge for prescribed services is excessive if—
(a) the
charge exceeds the prescribed limit or the charge allowed for the
prescribed services under the prescribed scale; or
(b) in
the case of prescribed services for which there is not a prescribed limit and
to which a prescribed scale does not apply—the charge exceeds an amount
that the Magistrates Court considers reasonable for the provision of the
services.
(6) The Magistrates
Court may, on application by the insurer—
(a)
where an injured person has been charged an excessive amount for
prescribed services—reduce the charge by the amount of the excess and,
if the charge has been paid to the service provider, order the service
provider to pay the amount of the excess to the insurer; or
(b)
where an injured person has received prescribed services that the Court
considers were, in the circumstances of the case, inappropriate or
unnecessary—disallow the charge for the services and, if the charge has
been paid to the service provider, order the service provider to pay the
amount of the charge to the insurer.
(7) Proceedings may
not be commenced under subsection (6)(a) in relation to a charge for a
prescribed service for which there is not a prescribed limit and to which a
prescribed scale does not apply if, prior to the injured person being charged
for the service, the insurer agreed to the amount of the charge.
(8) Proceedings may
not be commenced under subsection (6) unless the insurer has—
(a)
first given the service provider notice that the insurer claims the charge to
be excessive or the services to be inappropriate or unnecessary, as the case
may be, and of the reasons for the claim; and
(b)
allowed at least 30 days from the giving of the notice for the service
provider and any professional association or other person acting on behalf of
the service provider to respond to the claim and consult with the insurer; and
(c)
given due consideration to any response to the claim and proposals for
settlement of the matter made by or on behalf of the service provider; and
(d)
given the service provider notice of the result of the insurer's consideration
of the matter and allowed a further period of 30 days to elapse from the
giving of that notice for any further consultations if requested by the
service provider.
(9) A person who
provides prescribed services to an injured person, knowing that the person's
injury has been caused by or arisen out of the use of a motor vehicle, must
not, if a prescribed scale applies to the services, charge an amount for the
services exceeding the amount allowed under the prescribed scale.
Maximum penalty: $1 250.
(10) Proceedings may
not be commenced under subsection (6) or for an offence against
subsection (9) in respect of prescribed services provided in relation to
bodily injury caused by or arising out of the use of a motor vehicle unless
liability to damages (whether being the whole or part only of the amount
claimed) in respect of that injury has been accepted by or established against
an insured person or the insurer.
(11) Proceedings for
an offence against subsection (9) may be commenced at any time within 12
months after—
(a)
liability to damages (whether being the whole or part only of the amount
claimed) has been accepted or established as referred to in
subsection (10); or
(b)
receipt by the insurer of an account for payment of the charge to which the
proceedings relate,
whichever is the later.
(12) In proceedings
for an offence against subsection (9) it is a defence if the defendant
proves that, at the time the defendant charged for the services, the
defendant, having made reasonable inquiries, had reason to believe that
neither an insured person nor the insurer has or might have any liability to
damages in respect of the injury.