SIRA Logo

Appendix 1: Context and relevant provisions - Standard 4: Liability for medical or related treatment

StandardContext
Standard 4 - Liability for medical or related treatment

Making medical or treatment liability decisions promptly, in consultation with key stakeholders and based on all available evidence will reduce the likelihood of disputes and ensure workers can focus on recovery and return to work.

Insurers are required to make liability decisions at various points during a claim. Each time a worker makes a claim for medical or related treatment, the insurer is required to determine liability in accordance with the legislation. Insurers are to gather the relevant evidence, consult with key stakeholders and ensure that the decision is soundly based, made in a timely manner and communicated appropriately.

Liability decisions must be made in accordance with the legislation and informed through careful consideration of all evidence. Key to the principles of fairness and transparency is the observation of procedural fairness and proactive consultation with the worker and employer.

NSW workers compensation legislation requires liability to be determined within 21 calendar days after a claim for medical expenses has been made. If the treatment requested is already covered under the pre-approval provisions of the Workers compensation guidelines, the worker and provider are to be informed to avoid unnecessary delay.

Decisions should be made in a fair and transparent manner and include communication with the worker, nominated treating doctor and other relevant parties.