Queensland Consolidated Regulations

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Appropriateness of service

117O Appropriateness of service

(1) The insurer must consider whether treatment, care or support for, or relating to, the worker’s treatment, care and support needs—
(a) is consistent with other treatment, care or support being received by the worker; and
(b) is consistent with current clinical practice and other industry best practice for the treatment, care or support of persons with similar injuries.
(2) In considering the matters mentioned in subsection (1) , the insurer must also have regard to the following matters—
(a) whether the treatment, care or support will be consistent with the worker’s future treatment, care or support needs;
(b) whether the treatment, care or support relates directly to the worker’s individual goals;
(c) whether the treatment, care or support could be harmful to the worker;
(d) whether similar treatment, care or support is already being, or is to be, provided to the worker for the injury;
(e) whether there is evidence that supports the effectiveness of the treatment, care or support.
Examples of evidence—
• peer-reviewed journal articles
• inclusion of the treatment in clinical guidelines and frameworks
• successful clinical trials
• inclusion in the medical benefits schedule administered by the Commonwealth

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