Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003

Reprint as at 1 July 2015

Coat of Arms of New Zealand

Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003

(SR 2003/388)

Regulations name: amended, on 19 June 2013, pursuant to regulation 4(2) of the Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2013 (SR 2013/138).

Dame Sian Elias, Administrator of the Government

Order in Council

At Wellington this 15th day of December 2003

Present:
Her Excellency the Administrator of the Government in Council

Note

Changes authorised by subpart 2 of Part 2 of the Legislation Act 2012 have been made in this official reprint.

Note 4 at the end of this reprint provides a list of the amendments incorporated.

These regulations are administered by the Ministry of Business, Innovation, and Employment.

Pursuant to sections 324 and 349(1)(f) of the Injury Prevention, Rehabilitation, and Compensation Act 2001, Her Excellency the Administrator of the Government, acting on the advice and with the consent of the Executive Council, makes the following regulations.

Regulations

1 Title

These regulations are the Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003.

Regulation 1: amended, on 19 June 2013, by regulation 4(2) of the Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2013 (SR 2013/138).

2 Commencement

These regulations come into force on 1 April 2004.

3 Interpretation

In these regulations, unless the context otherwise requires,—

Corporation

(a)

means the Accident Compensation Corporation continued by section 259 of the Act; and

(b)

includes insurers

elective surgery

(a)

means any surgery required in respect of a personal injury; but

(b)

does not include—

(i)

an acute treatment; or

(ii)

a public health acute service; or

(iii)

treatment

insurer has the same meaning as in section 341 of the Act

public health acute services has the same meaning as in regulation 4 of the Injury Prevention, Rehabilitation, and Compensation (Public Health Acute Services) Regulations 2002

radiologist means a medical practitioner who holds a licence, appropriate to the treatment for which payment is sought, under the Radiation Protection Act 1965

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

scope of practice has the same meaning as in section 5(1) of the Health Practitioners Competence Assurance Act 2003

specialist means a medical practitioner whose scope of practice includes 1 or more recognised branches of medicine

specified treatment provider means an acupuncturist, chiropractor, occupational therapist, osteopath, physiotherapist, podiatrist, or speech therapist.

Regulation 3 Act: amended, on 3 March 2010, pursuant to section 5(1)(b) of the Accident Compensation Amendment Act 2010 (2010 No 1).

Regulation 3 nurse: revoked, on 19 September 2004, by regulation 3(1) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

Regulation 3 radiologist: amended, on 19 September 2004, by regulation 3(2) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

Regulation 3 registered specialist: revoked, on 19 September 2004, by regulation 3(3) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

Regulation 3 scope of practice: inserted, on 19 September 2004, by regulation 3(3) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

Regulation 3 specialist: inserted, on 19 September 2004, by regulation 3(3) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

Regulation 3 vocational registration: revoked, on 19 September 2004, by regulation 3(4) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

4 What hourly rate means

(1)

If an hourly rate is specified in these regulations, the Corporation is liable to pay the appropriate proportion of the hourly rate for the part of an hour during which a claimant received direct treatment.

(2)

Despite subclause (1), the Corporation is liable to pay a proportion of the hourly rate under regulation 13(5)(b) only after the claimant has received the first 30 minutes of direct treatment.

(3)

For the purposes of this regulation, and regulation 5, direct treatment means the time during which a treatment provider is directly applying his or her expertise to a claimant’s treatment.

5 Limitations on hourly rate

(1)

This regulation applies if a treatment provider—

(a)

elects to receive an hourly rate under these regulations for payment for his or her services to a claimant; or

(b)

receives an hourly rate under these regulations for payment for his or her services to a claimant.

(2)

For any particular hour during which a treatment provider is treating claimants, the Corporation is liable to pay for no more than a total of 60 minutes of treatment at the relevant hourly rate despite,—

(a)

the number of claimants that the treatment provider may have directly treated in succession in that hour; or

(b)

the number of claimants that the treatment provider may have directly treated at the same time in that hour.

Liability to pay or contribute to cost of treatment

6 Liability of insurer for cost of treatment

(1)

The amount that an insurer is liable to pay under clause 1(2)(b) of Schedule 1 of the Accident Insurance Act 1998 (as continued by section 342(2) of the Act), for treatment other than elective surgery, is calculated by—

(a)

determining the amount that the treatment provider who treated the claimant charges for treating personal injuries of the kind suffered by the claimant; and

(b)

determining the amount that is payable under these regulations for treatment; and

(c)

selecting the lesser of the amounts under paragraphs (a) and (b).

(2)

For the purposes of subclause (1)(b), the amounts that are payable under these regulations are in—

(a)

column 3 of the Schedule of these regulations, which specifies the amount payable for the treatment specified in column 2; and

(b)

regulations 9 to 17,—

(i)

some of which prescribe amounts that are payable without reference to the Schedule; and

(ii)

some of which modify the amounts specified in column 3 of the Schedule.

(3)

The amount that an insurer is liable to pay under clause 1(2) of Schedule 1 of the Accident Insurance Act 1998 (as continued by section 342(2) of the Act) for elective surgery is calculated under regulation 18.

7 Liability of Corporation for cost of treatment

(1)

For the purposes of clause 1(1)(b) of Schedule 1 of the Act, the amounts that the Corporation is liable to pay under these regulations (for other than elective surgery) are in—

(a)

column 3 of the Schedule, which specifies the amount payable for the treatment specified in column 2; and

(b)

regulations 9 to 17,—

(i)

some of which prescribe amounts that are payable without reference to the Schedule; and

(ii)

some of which modify the amounts specified in column 3 of the Schedule.

(2)

The amount that the Corporation is liable to pay under clause 1(1)(b) of Schedule 1 of the Act for elective surgery is calculated under regulation 18.

(3)

For the purposes of subclause (1), Corporation does not include insurers.

8 Corporation not liable for cost of public health acute service

(1)

The Corporation is not liable to pay a claimant for a public health acute service that—

(a)

the claimant receives; or

(b)

the claimant does not receive, but is entitled to receive.

(2)

Subclause (1) applies even if the public health acute service is—

(a)

a treatment of a kind to which regulation 6 or regulation 7 applies; or

(b)

elective surgery of a kind to which regulation 18 applies.

9 Counsellors’ costs

(1)

This regulation applies to the treatments specified in the Schedule under the heading “Counsellors’ costs”.

(2)

The Corporation is liable to pay—

(a)

$92.18 an hour for the treatment specified in item C1; and

(b)

$72.28 an hour for the treatment specified in item C2.

(3)

Despite regulation 4(3), the Corporation is liable to pay only for treatment provided on a face-to-face basis.

(4)

However, the Corporation is liable to pay for 1 session of treatment provided on other than a face-to-face basis if the treatment is provided because a claimant needs it urgently for a mental injury the claimant suffered in the circumstances described in section 21 of the Act.

Regulation 9(2)(a): amended, on 1 April 2014, by regulation 4(1) of the Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2014 (LI 2014/31).

Regulation 9(2)(b): amended, on 1 April 2014, by regulation 4(2) of the Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2014 (LI 2014/31).

10 Dentists’ costs

(1)

This regulation applies to the treatments specified in the Schedule under the heading “Dentists’ costs”.

(2)

The Corporation is liable to pay,—

(a)

for a claimant less than 18 years old at the time the claimant receives a treatment,—

(i)

the amount specified under the subheading “Claimants under 18 years old”, if the treatment is specified under the subheading; or

(ii)

the amount specified elsewhere under the heading, if the treatment is not specified under the subheading referred to in subparagraph (i); and

(b)

for any other claimant, the amount specified for the treatment other than under the subheading “Claimants under 18 years old”.

(3)

However, if at the same visit the claimant receives a treatment and a more comprehensive treatment for the same injury, the Corporation is liable to pay only the amount specified for the more comprehensive treatment.

(4)

If the claimant receives a treatment on a tooth that has previously been heavily restored, and the Corporation was not liable to pay for the previous restoration, the Corporation is liable to pay 75% of the amount specified for the treatment.

(5)

If the claimant receives a treatment on a tooth that has previously been crowned, and the Corporation was not liable to pay for the previous crowning, the Corporation is liable to pay 50% of the amount specified for the treatment.

11 Hyperbaric oxygen treatment costs

(1)

This regulation applies to the treatments specified in the Schedule under the heading “Hyperbaric oxygen treatment costs”.

(2)

If a claimant receives a treatment, the Corporation is liable to pay—

(a)

$51.93 an hour for the use of a hyperbaric oxygen chamber; plus

(b)

the amount specified for the treatment.

(3)

For the purposes of subclause (2)(a),—

(a)

the Corporation is liable to pay the appropriate proportion for the part of an hour during which a chamber is used; and

(b)

regulation 4 does not apply.

Regulation 11(2)(a): amended, on 1 April 2014, by regulation 5 of the Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2014 (LI 2014/31).

12 Radiologists’ costs

(1)

This regulation applies to the treatments specified in the Schedule under the heading “Radiologists’ costs”.

(2)

If a claimant receives treatment from a radiologist, the Corporation is liable to pay—

(a)

the amount specified for the treatment, if the radiologist’s scope of practice includes the branch of medicine known as diagnostic radiology; or

(b)

in any other case, 60% of the amount specified for the treatment.

Regulation 12(2)(a): amended, on 19 September 2004, by regulation 4 of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

13 Medical practitioners’ costs

(1)

This regulation applies if—

(a)

a claimant visits or is visited by a medical practitioner who—

(i)

is not a specialist; or

(ii)

is a specialist but during the visit is not practising within a recognised branch of medicine included in his or her scope of practice; and

(b)

any treatment received by the claimant during the visit is specified in the Schedule under the heading Medical practitioners’, nurses’, and nurse practitioners’ costs”.

(2)

For each visit the Corporation is liable to pay—

(a)

either—

(i)

$54.85, if the claimant is under 13 years old when the visit takes place; or

(ii)

$30.85, if the claimant is 13 years old or over when the visit takes place; plus

(b)

the amount specified for any treatment the claimant receives.

(3)

If the claimant receives 2 or more treatments at the same visit, for different injuries, the Corporation is liable to pay—

(a)

the amount specified for the more or most expensive treatment the claimant receives; plus

(b)

50% of the amount specified for each other treatment the claimant receives.

(4)

However, if at the same visit the claimant receives a treatment and a more comprehensive treatment for the same injury, the Corporation is liable to pay only the amount specified for the more comprehensive treatment.

(5)

If the practitioner travels to the claimant and the claimant receives emergency treatment, the Corporation is liable to pay—

(a)

a travelling fee at the rate of 73 cents per kilometre (if in the same circumstances the cost of travel would be payable under the New Zealand Public Health and Disability Act 2000); plus

(b)

$42.49 an hour if the Corporation is liable to pay a travelling fee under paragraph (a); plus

(c)

the amount payable under subclause (2).

(6)

The amount that the Corporation is liable to pay for treatment under this regulation includes a contribution to the cost of the practitioner using the most effective treatment materials available to the practitioner, having regard to the nature of the claimant’s personal injury.

(7)

This regulation is subject to regulation 15.

Regulation 13 heading: amended, on 19 September 2004, by regulation 5(1) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

Regulation 13(1)(a): amended, on 19 September 2004, by regulation 5(2) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

Regulation 13(1)(a)(i): amended, on 19 September 2004, by regulation 5(2) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

Regulation 13(1)(a)(ii): amended, on 19 September 2004, by regulation 5(2) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

Regulation 13(1)(a)(ii): amended, on 19 September 2004, by regulation 5(3) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

Regulation 13(1)(b): amended, on 1 April 2012, by regulation 4(1) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2012 (SR 2012/11).

Regulation 13(1)(b): amended, on 19 September 2004, by regulation 5(4) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

Regulation 13(2)(a): replaced, on 1 July 2015, by regulation 4 of the Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2015 (LI 2015/81).

Regulation 13(5)(a): amended, on 1 July 2012, by regulation 11(3) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2012 (SR 2012/11).

Regulation 13(5)(b): amended, on 1 July 2012, by regulation 11(4) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2012 (SR 2012/11).

14 Nurses’ costs

(1)

This regulation applies if—

(a)

a claimant visits or is visited by a nurse; and

(b)

any treatment received by the claimant during the visit is specified in the Schedule under the heading Medical practitioners’, nurses’, and nurse practitioners’ costs”.

(2)

For each visit the Corporation is liable to pay—

(a)

either—

(i)

$19.45, if the claimant is under 13 years old when the visit takes place; or

(ii)

$14.45, if the claimant is 13 years old or over when the visit takes place; plus

(b)

the amount specified for any treatment the claimant receives.

(3)

If the claimant receives 2 or more treatments at the same visit, for different injuries, the Corporation is liable to pay—

(a)

the amount specified for the more or most expensive treatment the claimant receives; plus

(b)

50% of the amount specified for each other treatment the claimant receives.

(4)

However, if at the same visit the claimant receives a treatment and a more comprehensive treatment for the same injury, the Corporation is liable to pay only the amount specified for the more comprehensive treatment.

(5)

The amount that the Corporation is liable to pay for treatment under this regulation includes a contribution to the cost of the nurse using the most effective treatment materials available to the nurse, having regard to the nature of the claimant’s personal injury.

(6)

This regulation is subject to regulation 15.

Regulation 14(1)(b): amended, on 1 April 2012, by regulation 5(1) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2012 (SR 2012/11).

Regulation 14(1)(b): amended, on 19 September 2004, by regulation 6 of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

Regulation 14(2)(a): replaced, on 1 July 2015, by regulation 5 of the Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2015 (LI 2015/81).

15 Medical practitioners’ and nurses’ costs for combined treatment

(1)

This regulation applies if—

(a)

a claimant visits or is visited by—

(i)

a nurse; and

(ii)

a medical practitioner described in regulation 13(1)(a); and

(b)

any treatment received by the claimant during the visit is specified in the Schedule under the heading Medical practitioners’, nurses’, and nurse practitioners’ costs”.

(2)

For each combined visit the Corporation is liable to pay—

(a)

either—

(i)

$57.73, if the claimant is under 13 years old when the visit takes place; or

(ii)

$33.73, if the claimant is 13 years old or over when the visit takes place; plus

(b)

the amount specified for any treatment the claimant receives.

(3)

If the claimant receives 2 or more treatments at the same combined visit, for different injuries, and the nurse and the medical practitioner worked together on each treatment, the Corporation is liable to pay—

(a)

the amount specified for the more or most expensive treatment the claimant receives; plus

(b)

50% of the amount specified for each other treatment the claimant receives.

(4)

If the claimant receives 2 or more treatments at the same combined visit, for different injuries, and the nurse and the medical practitioner worked separately on each treatment, the Corporation is liable to pay—

(a)

to the nurse—

(i)

the amount specified for the more or most expensive treatment the claimant receives from the nurse; plus

(ii)

50% of the amount specified for any other treatment the claimant receives from the nurse; and

(b)

to the medical practitioner—

(i)

the amount specified for the more or most expensive treatment the claimant receives from the medical practitioner; plus

(ii)

50% of the amount specified for any other treatment the claimant receives from the medical practitioner.

(5)

However, if at the same combined visit the claimant receives a treatment and a more comprehensive treatment for the same injury, the Corporation is liable to pay only the amount specified for the more comprehensive treatment.

(6)

The amount that the Corporation is liable to pay for treatment under this regulation includes a contribution to the cost of the nurse and the medical practitioner using the most effective treatment materials available to the nurse and medical practitioner, having regard to the nature of the claimant’s personal injury.

(7)

To avoid doubt, if the Corporation is liable to pay a nurse or a medical practitioner for a visit under this regulation, the Corporation is not liable, in relation to the visit, to pay the nurse or medical practitioner—

(a)

more than once for any treatment that the claimant receives; or

(b)

under any of the provisions contained in regulation 13 or regulation 14.

Regulation 15 heading: amended, on 19 September 2004, by regulation 7(1) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

Regulation 15(1)(a)(ii): amended, on 19 September 2004, by regulation 7(2) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

Regulation 15(1)(b): amended, on 1 April 2012, by regulation 6(1) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2012 (SR 2012/11).

Regulation 15(1)(b): amended, on 19 September 2004, by regulation 7(3) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

Regulation 15(2)(a): replaced, on 1 July 2015, by regulation 6 of the Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2015 (LI 2015/81).

Regulation 15(3): amended, on 19 September 2004, by regulation 7(4) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

Regulation 15(4): amended, on 19 September 2004, by regulation 7(5) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

Regulation 15(4)(b): amended, on 19 September 2004, by regulation 7(5) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

Regulation 15(4)(b)(i): amended, on 19 September 2004, by regulation 7(5) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

Regulation 15(4)(b)(ii): amended, on 19 September 2004, by regulation 7(5) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

Regulation 15(6): amended, on 19 September 2004, by regulation 7(6) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

Regulation 15(7): amended, on 19 September 2004, by regulation 7(7) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

15A Nurse practitioners’ costs

(1)

This regulation applies if—

(a)

a claimant visits or is visited by a nurse practitioner; and

(b)

any treatment received by the claimant during the visit is specified in the Schedule under the heading Medical practitioners’, nurses’, and nurse practitioners’ costs.

(2)

For each visit the Corporation is liable to pay—

(a)

either—

(i)

$50.45, if the claimant is under 13 years old when the visit takes place; or

(ii)

$26.45, if the claimant is 13 years old or over when the visit takes place; plus

(b)

the amount specified for any treatment the claimant receives.

(3)

If the claimant receives 2 or more treatments at the same visit, for different injuries, the Corporation is liable to pay—

(a)

the amount specified for the most expensive treatment the claimant receives; plus

(b)

50% of the amount specified for each other treatment the claimant receives.

(4)

However, if at the same visit the claimant receives a treatment and a more comprehensive treatment for the same injury, the Corporation is liable to pay only the amount specified for the more comprehensive treatment.

(5)

The amount that the Corporation is liable to pay for the treatment under this regulation includes a contribution to the cost of the nurse practitioner using the most effective treatment materials available to the nurse practitioner having regard to the nature of the claimant’s personal injury.

Regulation 15A: inserted, on 1 April 2012, by regulation 7 of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2012 (SR 2012/11).

Regulation 15A(2)(a): replaced, on 1 July 2015, by regulation 7 of the Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2015 (LI 2015/81).

16 Specialists’ costs

(1)

This regulation applies if—

(a)

a claimant visits or is visited by a medical practitioner who—

(i)

is a specialist; and

(ii)

during the visit, is practising within a recognised branch of medicine included in his or her scope of practice; and

(b)

any treatment received by the claimant during the visit is specified in the Schedule under the heading Specialists’ costs”.

(2)

For the first visit that the claimant has, the Corporation is liable to pay—

(a)

either—

(i)

$92.18, if the visit was with a specialist 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)

$72.28, if the visit was with a specialist practising within any other recognised branch of medicine; plus

(b)

the amount specified for any treatment the claimant receives.

(3)

For each further visit that the claimant has with the specialist, in relation to the same injury, the Corporation is liable to pay—

(a)

$36.14; plus

(b)

the amount specified for any treatment the claimant receives.

(4)

If the claimant receives 2 or more treatments at the same visit, the Corporation is liable to pay—

(a)

the amount specified for the more or most expensive treatment the claimant receives; plus

(b)

50% of the amount specified for each other treatment the claimant receives.

(5)

However, if at the same visit the claimant receives a treatment and a more comprehensive treatment for the same injury, the Corporation is liable to pay only the amount specified for the more comprehensive treatment.

Regulation 16 heading: amended, on 19 September 2004, by regulation 8(1) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

Regulation 16(1)(a): amended, on 19 September 2004, by regulation 8(2) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

Regulation 16(1)(a)(i): amended, on 19 September 2004, by regulation 8(2) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

Regulation 16(1)(a)(ii): amended, on 19 September 2004, by regulation 8(3) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

Regulation 16(1)(b): amended, on 19 September 2004, by regulation 8(4) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2004 (SR 2004/318).

Regulation 16(2)(a)(i): amended, on 1 April 2014, by regulation 10(1) of the Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2014 (LI 2014/31).

Regulation 16(2)(a)(ii): amended, on 1 April 2014, by regulation 10(2) of the Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2014 (LI 2014/31).

Regulation 16(3)(a): amended, on 1 April 2014, by regulation 10(3) of the Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2014 (LI 2014/31).

17 Specified treatment providers’ costs

(1)

This regulation applies to the treatments specified in the Schedule under the heading “Specified treatment providers’ costs”.

(2)

A treatment provider may elect not to be paid the amount specified in item TMT for any treatment that a claimant receives by giving the Corporation a written notice of election.

(3)

If the Corporation receives a notice of election, the Corporation is liable to pay the lesser of—

(a)

$56.76 an hour; or

(b)

the rate per hour the provider would have charged the claimant for treating personal injuries of the kind suffered by the claimant.

(4)

The provider may revoke an election under subclause (2) by giving the Corporation a written notice of revocation, but may give another written notice of election only if the Corporation first gives written consent allowing the provider to make a re-election.

Regulation 17(3)(a): amended, on 1 April 2014, by regulation 11 of the Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2014 (LI 2014/31).

18 Elective surgery costs

(1)

This regulation applies if the Corporation is liable to pay for elective surgery for a claimant.

(2)

The Corporation may nominate a provider to perform the surgery (nominated provider).

(3)

Subject to subclause (4), the claimant must then—

(a)

decide to accept the nominated provider; or

(b)

decide not to accept the nominated provider and choose a provider (chosen provider); or

(c)

choose a provider (because the Corporation has not nominated a provider under subclause (2)).

(4)

Before the claimant decides whether to accept the nominated provider, the Corporation must tell the claimant that the Corporation would be liable to pay the full cost of the surgery if it was performed by the nominated provider.

(5)

The Corporation is liable to pay the full cost of surgery under this regulation if it is performed by—

(a)

a district health board; or

(b)

a nominated provider; or

(c)

a provider described in subclause (3)(c).

(6)

The Corporation is liable to pay 60% of the amount that would have been payable under this regulation had the surgery been performed by the nominated provider, if—

(a)

the Corporation nominated a provider under subclause (2); and

(b)

the surgery is performed by the chosen provider; and

(c)

the chosen provider is not a district health board.

GST

19 GST excluded

All amounts specified or referred to in these regulations are exclusive of goods and services tax.

Regulation 19 heading: amended, on 1 July 2012, by regulation 17(1) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2012 (SR 2012/11).

Regulation 19: amended, on 1 July 2012, by regulation 17(2) of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2012 (SR 2012/11).

Revocations

20 Revocations

(2)

Despite subclause (1), the regulations continue to apply as if they had not been revoked for the purposes of determining the amount the Corporation is liable to pay for treatment received by a claimant at visits before 1 April 2004.

Schedule Costs of treatment

rr 6, 7, 9–17

Schedule: replaced, on 1 July 2012, by regulation 18 of the Injury Prevention, Rehabilitation, and Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2012 (SR 2012/11).

$
Counsellors’ costs
C1Consultation provided by a counsellor who is a specialist
C2Consultation provided by a counsellor
Dentists’ costs
Examination
DE1Dental consultation, including examination44.87
DE2Periodic oral examination or review28.86
DE3Extended initial examination (complex cases relating to dental implants, orthodontics, and advanced restorative work)—including study models and photographs and tomography123.91
Radiological examination and interpretation
DX1Periapical or bitewing film (each)22.43
DX2Occlusal (each)22.43
DX3Panorex58.64
DX4Other additional images (per treatment episode)8.85
DX7Acute sedation (IV only) (initial consultation only)154.88
Emergency temporary cover
DT1Emergency temporary cover43.46
General oral surgery
Extractions
DG1Extraction of permanent or rooted deciduous tooth per first tooth115.90
DG2Surgical removal of tooth (includes insertion and removal of sutures)185.86
DG4Extraction of subsequent permanent or deciduous tooth in same quadrant arch as for DG163.33
Surgery
DG5Management of lacerations by suturing per operative site120.81
DG7Incision and drainage abscess cellulitis136.29
DG8Excision of traumatic mucous cyst161.08
DG10Splint application or removal (for 3 splint units)92.93
DG11Cleaning of wound and removal of debris42.48
DG14Reduction of fractured alveolar process90.47
DG15Repositioning of displaced tooth (per tooth) or replacing avulsed tooth45.23
DG17Occlusal adjustment (simple)30.13
DG22Minor surgical operations not otherwise covered by this schedule129.74
DG23Provision of bite splints185.86
Restorative
DR1Amalgam 1 surface filling (including 2 fillings on the one surface)82.31
DR2Amalgam 2 surface filling (approximo-occlusal)107.66
DR3Complex amalgam restoration155.76
DR6Non-metallic simple fillings (including 2 fillings on the one surface)94.96
DR7Non-metallic filling (2 or more surfaces per tooth)126.64
DR8Rebonding tooth fragment or coronal portion85.13
DR9Complex reconstruction in composite resin, direct169.09
Prosthodontics
DP1Plastic denture (1 tooth—material of choice)474.07
DP2Each additional tooth (all dentures)21.24
DP5Metal-framed partial denture (1 tooth)1,085.64
DP7Transitional denture replacing missing tooth or teeth431.90
DP8Full upper or lower denture708.03
DP11Reline or rebase denture221.66
DP13Repair (all types)72.40
DP14Addition of tooth to existing denture (includes additional tooth)132.98
Crown and bridge
Inlay or onlay and veneers
DC3Indirect inlay or onlay270.33
DC6Porcelain veneer795.83
DC7Composite resin veneer173.46
DC8Post (wrought or pre-formed)92.93
DC9Composite or amalgam core111.52
DC11Cast post and core (metal or ceramic)213.12
Crowns
DC15All ceramic crown940.98
DC16Porcelain fused to metal crown904.86
DC17Cast gold crown (full and three-quarters)850.62
Bridges
DC19Maryland bridge655.64
DC20Composite bridge (per unit)216.83
DC25Re-cementing crown, bridge, veneer, or inlay32.57
DC26Non-composite bridge (on injured teeth that meet the requirement for a crown) (3 units)2,216.15
DC27Replacement of non-composite bridge2,651.59
Endodontics
DN1Pulpotomy or pulpectomy123.91
DN2Irrigation and dressing of root canal system125.77
DN3Complete preparation and obturation of root canal (per canal)—open or closed apex278.79
DN5Apicectomy and retrograde filling (per canal)271.42
DN6Removal of root filling (per canal)217.77
DN7Removal of post, post crown, or crown217.77
DN8Bleaching, 1 non-vital tooth (per treatment)154.88
DN9Pulp capping36.19
DN10Removal of fractured post or instrument217.77
DN11Repair of perforation217.77
DN13Negotiation of calcified canal (can be used with item DN3)217.77
Periodontics
DD1Gingivectomy103.77
DD2Crown lengthening (per tooth)216.83
DD4Subgingival curettage (per tooth)86.58
DD7Site preparation for dental implant316.65
DD8Placement of membrane339.26
DD9Substitute bone material135.70
Dental implants
DM1Resilient linings (tooth or teeth)65.14
DM2Fixture head impressions and copings (per fixture)348.31
DM3Dental implant crown (per single unit)1,085.66
DM4Dental stent and guide (per fixture)117.62
DM5Definitive abutment (per fixture)348.31
DM6Temporary abutment (per fixture)43.43
DM7Repairs to abutments (per fixture)75.36
Claimants under 18 years old
DY1Dental consultation, including examination58.42
DY14Temporary crown108.57
DY15Temporary bridge108.57
DY21Surgical decoronation379.98
DY22Removal of deciduous teeth26.55
Hyperbaric oxygen treatment costs
H1Neurological assay before recompression86.53
H2Neurological assay after recompression77.85
H3In-chamber treatment supervision, per hour90.46
H4Out-of-chamber treatment supervision, per hour44.34
Medical practitioners’, nurses’, and nurse practitioners’ costs
Burn or abrasion
MB1Treatment of burn not exceeding 4 cm²30.29
MB2Treatment of burn at single site exceeding 4 cm²59.64
MB3Treatment of significant abrasions not exceeding 4 cm² at single site30.30
MB4Treatment of significant abrasions exceeding 4 cm² at single site59.64
MB5Significant burns or abrasions (not including fractures) at multiple sites (exceeding 4 cm²): necessary wound cleaning, preparation, and dressing86.89
Dislocation
MD1Dislocation of finger or toe with splint or strapping35.09
MD2Dislocation of thumb: closed reduction and immobilisation98.34
MD3Dislocation of elbow with radiological confirmation: closed reduction and immobilisation91.08
MD4Dislocation of shoulder: closed reduction and collar and cuff immobilisation65.60
MD5Dislocation of patella: closed reduction and cast immobilisation156.09
Fracture
MF1Fractured finger or toe (proximal, middle, or distal phalanx): closed reduction and immobilisation35.09
MF2Fractured finger or toe (proximal, middle, or distal phalanx): requiring local anaesthetic48.52
MF3Fractured metatarsal: closed reduction (not requiring cast): closed reduction, immobilisation by strapping35.09
MF4Fractured metacarpal(s) hand: with or without local anaesthetic: immobilisation by strapping48.52
MF5Fractured carpal bone, including scaphoid: treatment by cast immobilisation, not requiring reduction109.29
MF6Fractured tarsal or metatarsal bones (excluding calcaneum or talus): treatment by cast immobilisation156.09
MF7Fractured calcaneum or talus: treatment by cast immobilisation156.09
MF8Fractured clavicle65.60
MF9Fractured distal radius and ulna: cast immobilisation not requiring reduction109.29
MF10Fractured distal radius and ulna requiring closed reduction, involving regional or other form of anaesthesia130.68
MF11Fractured shaft radius and ulna: treatment by cast immobilisation109.29
MF12Fractured distal humerus (supracondylar or condylar): by cast immobilisation109.29
MF13Fractured proximal or shaft humerus: immobilisation by collar and cuff or U-slab66.28
MF14Fractured shaft tibia, or fibula, or both: treatment by cast immobilisation with reduction156.09
MF15Fractured distal tibia or fibula, or both: treatment by cast immobilisation with reduction156.09
MF16Fractured fibula (without tibial fracture): immobilisation with soft tissue strapping66.28
Miscellaneous
MM1Abscess or haematoma: drainage with incision (with or without local anaesthetic agent)27.33
MM2Insertion of IV line for administration of IV medications or electrolytes or transfusion (if provided under local or national guideline approved by the Corporation)54.67
MM3Nail, simple removal of21.88
MM4Nail, removal of or wedge resection: requiring the use of digital anaesthesia91.08
MM5Removal of embedded or impacted foreign body from cornea or conjunctiva (with use of topical anaesthetic), or from auditory canal or nasal passages, or from skin or subcutaneous tissue with incision, or from rectum or vagina29.43
MM6Pinch skin graft68.34
MM7Dental anaesthetic25.53
MM8Epistaxis: arrest during episode by nasal cavity packing with or without cautery40.36
Open wound
MW1Closure of open wounds less than 2 cm: any necessary care and treatment, including cleaning and debriding, exploration, administration of anaesthetic, and dressing32.19
MW2Closure of open wound (or wounds) of skin and subcutaneous tissue or mucous membrane 2 cm to 7 cm long: any necessary care and treatment, including cleaning and debriding, exploration, administration of anaesthetic, and dressing61.41
MW3Closure of open wound (or wounds) of skin and subcutaneous tissue or mucous membrane exceeding 7 cm long: any necessary care and treatment, including cleaning and debriding, exploration, administration of anaesthetic, and dressing81.26
MW4Amputation of digit—including use of anaesthetic, debridement of bone and soft tissue, and closure of wound91.08
Soft tissue injury
MT1Simple soft tissue injuries: management of simple sprain of wrist, ankle, knee, elbow, or other soft tissue injury requiring crepe bandage or similar immobilisation not requiring formal strapping14.29
MT2Soft tissue injury (other than splinting of dislocated or fractured digit), unless specified elsewhere: application of plaster or padded splint or specific strapping within agreed guidelines (includes splinting of Achilles tendon injury and serious ankle sprains)66.28
MT3Aspiration of inflamed joint, tendon, bursa, or other subcutaneous tissue or space (with or without injection)32.16
MT4Extensor tendon, primary repair163.95
MT5Ruptured Achilles tendon: management by plaster immobilisation160.71
Radiologists’ costs
Extremities
RA01Sternum56.92
RA02Sterno-clavicular joints65.06
RA03Clavicle48.79
RA04Acromio-clavicular joints48.79
RA05Scapula48.79
RA06Shoulder52.86
RA07Humerus52.86
RA08Elbow joint44.73
RA09Forearm44.73
RA10Hand or wrist joint, or both44.73
RA11Wrist or hand for bone age44.73
RA15Upper limb (infant)52.86
RA21Sacro-iliac joints52.86
RA22Pelvis or both hips (1 projection)52.86
RA25Hip joint (more than 1 projection)56.92
RA26Femur52.86
RA27Knee joint48.79
RA28Knee joint (and intercondylar or axial)56.92
RA29Tibia and fibula48.79
RA30Ankle joint52.86
RA32Foot48.79
RA35Long legs (hips to ankles—including measurement)60.99
RA40Lower limb (infant)56.92
Head, neck, and spine
RB01Cervical spine60.99
RB02Thoracic spine56.92
RB03Lumbar spine including lumbosacral joint56.92
RB04Sacro-coccygeal spine52.86
RB08Spine (scoliosis views)60.99
RB10Skull56.92
RB12Nasal bones48.79
RB13Facial bones52.86
RB14Optic foramina44.73
RB16Auditory canals (plain films only)56.92
RB21Nasal sinuses44.73
RB22Nasopharynx52.86
RB23Mastoids (bilateral)56.92
RB24Larynx or trachea, or both48.79
RB31Upper teeth44.73
RB32Lower teeth44.73
RB33Mandible or OPG or lateral cephalogram60.99
RB34Temporo-mandibular joints60.99
RB35Salivary gland52.86
RB37Pharynx52.86
Chest, including breast
RC05Thoracic inlet52.86
RC06Chest (1 view)52.86
RC07Chest (more than 1 view)52.86
RC08Chest and thoracic cage65.06
RC09Chest and both oblique views65.06
Mammography
RC31Screening mammogram89.45
RC32Recall mammogram121.98
RC35Problem mammogram bilateral178.90
RC36Problem mammogram unilateral117.91
RC40Needle localisation239.89
RC41Galactogram239.89
RC45Breast aspiration biopsy239.89
RC46Breast biopsy with stereotaxis239.89
GI, GU, and obstetrics—no contrast modifiers permitted
Radiology
RD01Abdomen (1 projection)52.86
RD02Abdomen (2 or more projections)52.86
RD07Pelvimetry (1 view)52.86
RD08Pelvimetry (2 or more views)52.86
Screening
RD10Contrast swallow (oesophagus only)414.73
RD11Contrast study upper GI tract414.73
RD13Small bowel meal414.73
RD14Small bowel enema (enteroclysis)695.29
RD15Contrast enema414.73
RD20Dynamic proctogram414.73
RD30ERCP414.73
RD40IVP including plain film and tomography239.89
RD44Cystogram: retrograde or antegrade414.73
RD45Urethrogram414.73
RD46Micturating cysto-urethrogram414.73
RD47Ascending urethrogram414.73
Special procedures
RS42Tube injection239.89
RS43Dacrocystogram239.89
RS44Sialogram239.89
RS46Hysterosalpingogram414.73
RS61Myelogram cervical414.73
RS62Myelogram lumbar414.73
RS63Myelogram multilevel414.73
RS70Arthrogram239.89
RS71Arthrogram—upper limb239.89
RS73Arthrogram—lower limb239.89
Ultrasound
Abdomen and pelvis
RU01US abdomen126.05
RU02US abdomen and pelvis158.57
RU03US renal tracts117.91
RU04US abdominal aorta (without Doppler)117.91
RU06US pelvis (trans-abdominal only)117.91
Infants
RU10US infant head117.91
RU11US infant pylorus117.91
RU12US infant heart223.63
RU13US infant hips117.91
RU19US infant miscellaneous117.91
Various
RU20US thyroid or neck117.91
RU21US scrotum and testes117.91
RU22US breast117.91
RU23US veins166.71
RU24US eye117.91
RU25US chest117.91
RU27US injection or aspiration235.83
RU28US additional region85.39
RU29US miscellaneous117.91
Skeletal
RU30US shoulder166.71
RU31US musculo-skeletal126.05
RU32US foreign body localisation93.52
RU39US skeletal miscellaneous126.05
Intracavitary
RU40US prostate146.38
RU41US anus or rectum146.38
RU42US female pelvis (includes trans-vaginal and trans-abdominal, or trans-vaginal only)146.38
RU43US trans-oesophageal248.03
RU44US intraoperative248.03
RU49US intracavitary miscellaneous146.38
Vascular
RU51Duplex or Doppler of chest199.23
RU56Duplex or Doppler of additional limb (arterial or venous)158.57
Pregnancy
RU60US routine pregnancy less than 28 weeks126.05
RU61US problem pregnancy158.57
RU62US pregnancy exceeding 28 weeks158.57
RU64US with amniocentesis235.83
RU68US pregnancy—per extra foetus exceeding 160.99
Additional
RX24X-ray additional region44.73
RX25Domiciliary X-ray (in addition)85.39
Specialists’ costs
Repair recent wound
SR1Not exceeding 7 cm, superficial129.78
SR2Not exceeding 7 cm, deeper tissue173.03
SR3Exceeding 7 cm, superficial216.31
SR4Exceeding 7 cm, deeper tissue259.56
Fractures (closed reduction)
SF1Phalanges86.53
SF2Metacarpals, excluding Bennetts155.74
SF3Metatarsals121.14
SF4Bennetts224.95
SF5Carpal bones112.46
SF6Colles207.63
SF7Radius and ulna—shafts250.88
SF8Radius—head and neck224.95
SF9Humerus250.88
SF10Talus—neck233.60
SF11Calcaneus233.60
SF12Other tarsals147.10
SF13Ankle—fracture dislocation, Potts363.37
SF14Tibia and fibula—shaft415.26
SF15Tibia and fibula—upper end363.37
SF16Tibia and fibula—involving joint traction423.90
SF17Femur, any site, with or without traction640.22
Haematoma, abscess, or other infection
SH1Small—aspiration21.67
SH2Large—incision and drainage (local anaesthetic)103.28
SH3Large—incision and drainage (general anaesthetic)112.46
Foreign body, removal of
SB1Under local anaesthetic82.24
SB2Under general anaesthetic181.67
SB3From cornea or sclera56.27
SB4From ear, other than by simple syringing86.53
SB5From muscle, tendon, or other deep tissue259.56
SB6From nose, other than by simple probing103.82
SB7From throat, additional fee86.53
Dislocations (closed reduction)
SD1Elbow, wrist, thumb, and fingers with strapping or splint173.03
SD2Shoulder103.82
SD3Patella147.10
SD4Hip207.63
Plaster
SP1Upper limb—above elbow129.78
SP2Upper limb—below elbow112.46
SP3Lower limb—above knee155.74
SP4Lower limb—below knee129.78
Other
SM1Aspiration of joint21.67
SM2Amputation of all or part of 1 digit190.35
SM3Extensor tendon, primary repair302.81
SM4Nail, simple removal of86.53
Specified treatment providers’ costs
TMTAll treatment22.56
POD3Podiatry: abcess or haematoma: drainage with incision (with or without local anaesthetic agent)27.33
POD4Podiatry: nail, simple removal of21.88
POD5Podiatry: nail, wedge resection or removal of: requiring the use of digital anaesthesia91.08
XRAYX-ray services provided by chiropractor (maximum of 2 films per claimant per personal injury)13.84

Schedule: amended, on 1 April 2014, by regulation 12 of the Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) Amendment Regulations 2014 (LI 2014/31).

Diane Morcom,
Clerk of the Executive Council.

Issued under the authority of the Legislation Act 2012.

Date of notification in Gazette: 18 December 2003.

Reprints notes
1 General

This is a reprint of the Accident Compensation (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003 that incorporates all the amendments to those regulations as at the date of the last amendment to them.

2 Legal status

Reprints are presumed to correctly state, as at the date of the reprint, the law enacted by the principal enactment and by any amendments to that enactment. Section 18 of the Legislation Act 2012 provides that this reprint, published in electronic form, has the status of an official version under section 17 of that Act. A printed version of the reprint produced directly from this official electronic version also has official status.

3 Editorial and format changes

Editorial and format changes to reprints are made using the powers under sections 24 to 26 of the Legislation Act 2012. See also http://www.pco.parliament.govt.nz/editorial-conventions/.