Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Amendment Regulations (No 2) 1999

  • revoked
  • Accident Insurance (Insurer's Liability to Pay Cost of Treatment) Amendment Regulations (No 2) 1999: revoked, on 1 April 2004, pursuant to regulation 20(1) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003 (SR 2003/388).

Reprint as at 1 April 2004

Accident Insurance (Insurer’s Liability to Pay Cost of Treatment) Amendment Regulations (No 2) 1999

(SR 1999/352)

Accident Insurance (Insurer’s Liability to Pay Cost of Treatment) Amendment Regulations (No 2) 1999: revoked, on 1 April 2004, pursuant to regulation 20(1) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003 (SR 2003/388).

Note

Changes authorised by subpart 2 of Part 2 of the Legislation Act 2012 have been made in this eprint. See the notes at the end of this eprint for further details.

These regulations are administered by the Department of Labour.

PURSUANT to section 402 of the Accident Insurance Act 1998, His Excellency the Governor-General, acting by and with the advice and consent of the Executive Council, makes the following regulations.

1 Title and commencement

(1)

These regulations may be cited as the Accident Insurance (Insurer’s Liability to Pay Cost of Treatment) Amendment Regulations (No 2) 1999, and are part of the Accident Insurance (Insurer’s Liability to Pay Cost of Treatment) Regulations 19991 (“the principal regulations”).

(2)

Regulation 2(2) comes into force on 11 November 1999.

(3)

The rest of these regulations come into force on 15 October 1999.

2 Interpretation

(1)

Regulation 2 of the principal regulations is amended by revoking the definition of registered specialist, and substituting the following definitions:

Recognised branch of medicine means any of the following branches or sub-branches of medicine

(a)

Anaesthetics:

(b)

Dermatology:

(c)

Diagnostic Radiology:

(d)

Emergency Medicine:

(e)

Internal Medicine:

(f)

Internal Medicine—Occupational Medicine:

(g)

Internal Medicine—Rehabilitation Medicine:

(h)

Obstetrics and Gynaecology:

(i)

Ophthalmology:

(j)

Orthopaedic Surgery:

(k)

Otolaryngology:

(l)

Paediatrics:

(m)

Pathology:

(n)

Psychological Medicine or Psychiatry:

(o)

Public Health Medicine:

(p)

Radiotherapy:

(q)

Surgery:

(r)

Surgery—Cardiothoracic Surgery:

(s)

Surgery—General Surgery:

(t)

Surgery—Neurosurgery:

(u)

Surgery—Paediatric Surgery:

(v)

Surgery—Plastic Surgery:

(w)

Surgery—Urology:

(x)

Venereology:

Registered specialist means a registered medical practitioner who holds vocational registration (within the meaning of the Medical Practitioners Act 1995) in at least 1 recognised branch of medicine:.

(2)

Regulation 2 of the principal regulations is amended by revoking the definition of recognised branch of medicine, and substituting the following definition:

Recognised branch of medicine means any of the following branches of medicine

(a)

Anaesthetics:

(b)

Cardiothoracic Surgery:

(c)

Dermatology:

(d)

Diagnostic Radiology:

(e)

Emergency Medicine:

(f)

General Surgery:

(g)

Internal Medicine:

(h)

Neurosurgery:

(i)

Obstetrics and Gynaecology:

(j)

Occupational Medicine:

(k)

Ophthalmology:

(l)

Orthopaedic Surgery:

(m)

Otolaryngology Head and Neck Surgery:

(n)

Paediatric Surgery:

(o)

Paediatrics:

(p)

Pathology:

(q)

Plastic and Reconstructive Surgery:

(r)

Psychological Medicine or Psychiatry:

(s)

Public Health Medicine:

(t)

Radiation Oncology:

(u)

Rehabilitation Medicine:

(v)

Sexual Health Medicine:

(w)

Urology:

(x)

Venereology:.

3 Dentists’ costs

Regulation 7(4) of the principal regulations is amended by omitting the expression “25%”, and substituting the expression “75%”.

4 Registered medical practitioners’ costs

(1)

Regulation 10 of the principal regulations is amended by inserting, after subclause (1), the following subclause:

(1A)

This regulation applies if the insured visits, or is visited by, a registered medical practitioner who either—

(a)

Is not a registered specialist; or

(b)

Is a registered specialist but, during the consultation, is not practising within a recognised branch of medicine in respect of which he or she holds vocational registration.

(2)

Regulation 10(2) of the principal regulations is amended by omitting the words “If the insured visits, or is visited by, a registered medical practitioner,”, and substituting the words “If this regulation applies,”.

(3)

Regulation 10(5) of the principal regulations is amended by inserting, after the word “practitioner”, the expression “referred to in subclause (1A)”.

5 Registered specialists’ costs

The principal regulations are amended by inserting, after regulation 10, the following regulation:

10A

(1)

This regulation relates to the treatments under the heading “Registered Specialists’ Costs”.

(2)

This regulation applies if the insured visits, or is visited by, a registered medical practitioner who—

(a)

Is a registered specialist; and

(b)

During the consultation, is practising within a recognised branch of medicine in respect of which he or she holds vocational registration.

(3)

If this regulation applies, the insurer is liable to pay—

(a)

The following rate for a first consultation that the insured has:

(i)

$97.55, if the consultation was with a registered specialist who, during the consultation, was practising within any of the following recognised branches of medicine:

(A)

Internal Medicine:

(B)

Neurosurgery:

(C)

Occupational Medicine:

(D)

Paediatrics:

(E)

Psychological Medicine or Psychiatry:

(F)

Rehabilitation Medicine; or

(ii)

$76.50, if the consultation was with a registered specialist who, during the consultation, was practising within any other recognised branch of medicine; and

(b)

$38.25, for any later consultation that the insured has with a registered specialist; and

(c)

The amount specified in the Schedule for any treatment the insured is given.

(4)

If the insured is given both a treatment and a more comprehensive treatment at the same visit, the insurer is liable to pay only the cost of the more comprehensive treatment.

(5)

If the insured is given 2 or more separate treatments at the same visit, the insurer is liable to pay—

(a)

The amount specified in the Schedule for the more or most expensive treatment the insured is given; and

(b)

50% of the amount specified in the Schedule for each other treatment the insured is given.

6 Specified treatment providers’ costs

Regulation 11(2) of the principal regulations is amended by omitting the expression “206”, and substituting the expression “249”.

7 Schedule amended

The Schedule of the principal regulations is amended by revoking items 206 and 207 and the heading immediately above item 206, and substituting the headings, sub-headings, and items set out in the Schedule.

Schedule Substituted headings, sub headings, and items

Reg 7

REGISTERED SPECIALISTS COSTS
Repair recent wound
206.Not exceeding 7 cm, superficial143.45
207.Not exceeding 7 cm, deeper tissue191.25
208.Exceeding 7 cm, superficial239.10
209.Exceeding 7 cm, deeper tissue286.90
Fractures (closed reduction)
210.Phlanges95.65
211.Metacarpals, excluding Bennetts172.15
212.Metatarsals133.90
213.Bennetts248.65
214.Carpal bones124.30
215.Colles229.50
216.Radius and ulna—shafts277.30
217.Radius—head and neck248.65
218.Humerus277.30
219.Talus—neck258.20
220.Calcaneus258.20
221.Other tarsals162.60
222.Ankle—fracture dislocation, Potts401.65
223.Tibia and fibula—shaft459.00
224.—upper end401.65
225.—involving joint traction468.55
226.—femur, any site, with/without traction707.65
Haematoma, abscess, or other infection
227.Small—aspiration23.95
228.Large—incision and drainage (local anaesthetic)114.15
229.—incision and drainage (general anaesthetic)124.30
Foreign body, removal of
230.Under local anaesthetic90.90
231.Under general anaesthetic200.80
232.From cornea or scelera62.20
233.From ear, other than by simple syringing95.65
234.From muscle, tendon, or other deep tissue286.90
235.From nose, other than by simple probing114.75
236.From throat, additional fee95.65
Dislocations (closed reduction)
237.Elbow, wrist, thumb and fingers with strapping/splint191.25
238.Shoulder114.75
239.Patella162.60
240.Hip229.50
Plaster
241.Upper limb—above elbow143.45
242.—below elbow124.30
243.Lower limb—above knee172.15
244.—below knee143.45
Other
245.Aspiration of joint23.95
246.Amputation of all or part of 1 digit210.40
247.Extensor tendon, primary repair334.70
248.Nail, simple removal of95.65
SPECIFIED TREATMENT PROVIDER COSTS
249.All treatment19.00
250.X ray services provided by chiropractor (maximum of 2 films per insured per personal injury)15.30 .
per film

MARIE SHROFF,

Clerk of the Executive Council.

Explanatory note

This note is not part of the regulations, but is intended to indicate their general effect.

These regulations amend the Accident Insurance (Insurer’s Liability to Pay Cost of Treatment) Regulations 1999 (the principal regulations). Regulation 2(2) comes into force on 11 November 1999, and the rest of these regulations come into force on 15 October 1999.

Regulation 2(1) substitutes in regulation 2 of the principal regulations definitions of recognised branch of medicine and registered specialist. Regulation 2(2) amends the definition of recognised branch of medicine because of changes, made by the Medical Practitioners (Vocational Registration) Order 1999, to the branches and sub-branches of medicine for which vocational registration may be granted under the Medical Practitioners Act 1995.

Regulation 3 amends regulation 7(4) of the principal regulations so that, if an insured is given treatment on a tooth that has previously been heavily restored, and no insurer was liable to pay for the previous restoration, the insurer is liable to pay not 25% but 75% of the amount specified for the treatment in the Schedule of the principal regulations. This corrects an error in the original regulations.

Regulation 4 amends regulation 10 of the principal regulations so that it applies only to visits to or by registered medical practitioners who either—

(a)

Are not registered specialists; or

(b)

Are registered specialists but, during the consultation, are not practising in a recognised branch of medicine in respect of which they hold vocational registration.

Regulation 5 inserts in the principal regulations new regulation 10A. New regulation 10A sets out insurer’s liability to pay registered specialists’ costs. The Schedule of the principal regulations (as amended by regulation 7) sets out the amounts payable for any specified treatment the insured is given by a registered specialist.

Regulation 6 effects a consequential amendment.

Issued under the authority of the Legislation Act 2012.

Date of notification in Gazette: 14 October 1999.

Eprint notes
1 General

This is an eprint of the Accident Insurance (Insurer’s Liability to Pay Cost of Treatment) Amendment Regulations (No 2) 1999 that incorporates all the amendments to those regulations as at the date of the last amendment to them.

2 About this eprint

This eprint is not an official version of the legislation under section 18 of the Legislation Act 2012.

3 Amendments incorporated in this eprint

Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003 (SR 2003/388): regulation 20(1)

1 SR 1999/104