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Sira medical assessors fee schedule for medical and review panel assessments 2017

Medical Assessment Fees
Fees (excluding GST) applicable to MAS 1A, 2A and 4A assessments
conducted on or after 1 April 2017
Assessment typeon papersPhysicalComplex physical or non-complex occupational therapyABIComplex ABI or complex occupational therapypsychiatriccomplex psychiatric
       
Medical Assessment Fees
Fees (excluding GST) applicable to MAS 1A, 2A and 4A assessments
conducted on or after 1 April 2017
Assessment TypeOn PapersPhysicalComplex Physical or
Non-Complex Occupational Therapy
ABIComplex ABI or Complex
Occupational Therapy
PsychiatricComplex Psychiatric
Single application$1230$1230$1640$1640$2050$1640$2050

Medical Review Panel Assessment FeesFees (excluding GST) applicable to MAS 5A Review Panel assessments

Assessment
Type

Determined at 1st Conference

Determined at 2nd Conference

Determined at 3rd Conference

Additional Fees

Physical
Examiner

Psychiatric Examiner

Certificate
Writer

Panel
Chair

Non-complex

$1230

$2050

$2460

$410

$820

$1025

$410

Complex

$1640

$2460

$2870

Same Day Psychiatric Review Panel Assessment Fees per AssessmentFees (excluding GST) applicable for same day psychiatric Review Panel assessments

Assessment Type

Same Day Assessment

Panel Chair

Certificate Writer

Extra Reading Time (per hour)

Non-Complex

$2460

$410

$1025

$410

Complex

$2870

Additional Fees

Assessment

Additional Item

Description

Amount

All Assessments

Neuropsychological assessment
(ABI protocol)

  • Screening assessment
  • Full assessment

$2050

$3280

Medical Assessor conferencing

  • Pro rata rate of $205 per hour

$205

Extra ‘minor’ impairment assessments

  • Minor skin or minor dental injuries

$205

Two or more applications

  • 1 hour equivalent

$410

Multiple treatment disputes

  • Up to 5 disputes
  • More than   5 disputes

$205

$410

Interpreter loading

  • Per medical assessment examination

$205

Surveillance imaging review

  • Pro rata rate of $205 per hour

$205

Unreasonably late attendance by claimant or interpreter

  • Requiring an extra 30 minutes or   more to complete medical assessment examination
  • Requiring additional appointment to   complete medical assessment examination

$205

$410

Travel time to conduct an examination

  • Pro rata rate of $205 per hour

$205

Travel to conduct an examination

  • Motor vehicle per kilometre rate

$0.66*

All Assessments (excluding Reviews)

Non-attendance or Late Cancellation

  • Notified with less than 1 weeks   notice
  • Notified with less than 72 hours   notice

$410

$820

Review Panel Assessments

Non-attendance or Late Cancellation

  • Physical examination/Assessor
  • Psychiatric examination/Assessor

$410

$820

Explanatory Notes for Medical Assessment Fees

  • Medical assessment fees are based on an hourly rate of $410 and include the Medical Assessor’s review of the file, examination and preparation of a certificate including reasons.
  • No additional fees are payable in relation to an obvious error application.
  • Additional fees may be paid in relation to an incomplete certificate.
  • Additional fees (above) are paid on the basis that the ‘additional item’ will incur additional time and therefore will be taken into account for any further request for additional fees.
  • A discretionary assessment fee at the hourly rate of $410 may be approved in accordance with the Medical Assessors Fee Schedule Additional Loadings Policy.
  • Travel expenses must be made using the current Dispute Resolution Services Medical Assessor payment request and in accordance with the current SIRA Medical Assessors and Reviews Panel Assessors Travel Expenses Policy.
  • *Travel expenses are based on the annual Treasury Circular – Review of Meal, Travelling and other Allowances.

Permanent Impairment Assessments – physical and psychiatric

Non-Complex Fee

  • 1 or 2 body systems referred for assessment (there may be more than one injury in each body system).  For example, a soft tissue injury to the cervical, thoracic, lumbar spine and shoulders is non-complex because it involves 2 body systems – Spine and Upper Limb.
  • The review of documents should not take more than one hour.

Complex Fee

  • More than 2 body systems referred for assessment.
  • Multiple injuries within 1 body system. For example, separate finger, wrist and shoulder injuries (bilateral injuries do not constitute a complex case).
  • Medical assessment examination of the claimant is likely to take more than one hour for physical or up to two hours for psychiatric cases.
  • A large quantity of documentation is provided which is likely to take more than one hour to review.

Treatment Assessments

Non-Complex Fee

  • Assessment of several treatment disputes which relate to the same injury. For example, physiotherapy and arthroscopy disputes in a knee injury – single analysis of the current status and need for further intervention in relation to a knee injury only or massage therapy, CT scan and need for ongoing review by an orthopaedic specialist in relation to a soft tissue injury of the spine - all decisions in this case flow from a single analysis of the status and need for further intervention in relation to the spinal injury.
  • The review of documents should not take more than one hour.

Complex Fee

  • Medical assessment examination of the claimant is likely to take longer than one hour.
  • A large quantity of documentation is provided, which is likely to require more than one hour to review.

Further Assessments

  • A complex fee is allocated to all further assessments.

Occupational Therapy Treatment Assessments

Non-Complex Fee

  • Medical assessment examination of the claimant takes no longer than two hours.
  • Documentation is not likely to require more than one hour to review.
  • The Assessor is required to certify 1 or 2 separate periods of care.

Complex Fee

  • Medical assessment examination of the claimant is likely to take longer than two hours.
  • A large quantity of documentation is provided, which is likely to require more than one hour to review.

ABI Assessments

  • The complex ABI (Acquired Brain Injury) fee applies where the Assessor is asked to examine an ABI injury in addition to more than 2 other body systems.

Medical Review Panel Assessments

  • 1st teleconference - 3 hours (non-complex fee) or 4 hours (complex fee) spent by each Panel Assessor where the determination is made at the 1st teleconference.
  • 2nd teleconference - 2 additional hours for all Panel Assessors where a 2nd teleconference is required.
  • 3rd teleconference - 1 additional hour for all Panel Assessors where a 3rd teleconference is required.

Same Day Psychiatric Review Panel Assessments

  • Fees cover conferences and medical assessment examination conducted on the same day per assessment.
  • Fees allow for 6 hours (non-complex fee) and 7 hours (complex fee) spent by each Panel Assessor for pre-reading, conferencing, medical assessment examination and later certificate editing.