Queensland Numbered Acts

NATIONAL INJURY INSURANCE SCHEME (QUEENSLAND) ACT 2016 - SECT 37

37 Deciding payment request

(1) The agency must, within the decision-making period, decide to—

(a) approve the payment request; or

(b) refuse the payment request.

(2) The agency must approve the payment request if—

(a) the expense is incurred in the period the participant is a participant in the scheme; and

(b) the treatment, care or support that the request relates to is an approved service for the participant.

(3) To remove any doubt, it is declared that the agency may approve the payment request even though the treatment, care or support is not an approved service.

(4) If the agency approves the payment request, the agency must pay the requested amount to the person who made the request within 28 days after making the decision.

(5) However, the agency is not liable to pay a part of the requested amount that exceeds—

(a) if the requested amount relates to treatment, care or support provided within Australia—an amount prescribed by regulation for the treatment, care or support; or

(b) if the requested amount relates to treatment, care or support provided outside Australia—the average cost of providing the treatment, care or support in Queensland.

(6) In this section—

"approved service" does not include excluded treatment, care and support, unless—

(a) if a support plan has been made for the participant—the excluded treatment, care and support is specifically stated in the support plan to be—

(i) a treatment, care and support need that the agency considers is necessary and reasonable in the circumstances as a result of the participant’s injury; or

(ii) treatment, care or support the agency considers should be funded, in whole or part, under the scheme; or

(b) if a support plan has not been made for the participant—the excluded treatment, care and support is specifically approved under a service request approval relating to the participant.