OPERATIONAL ADVICE NO. 141
SECTION 29 - HOUSEHOLD AND ATTENDANT CARE SERVICES GUIDELINES
File Ref:88/1519
Contact:Greg Maizey
Phone:(02) 334-9824
State Managers
State Operations Managers
State Review Managers
State Executive Officers
General Managers
Group Managers
All operational staff
The purpose of this operational advice is to clarify the way in which section 29 of the Safety Rehabilitation and Compensation Act 1988 (“the Act”) is to be applied in relation to claims for household services . It should be read in conjunction with Operational Advice 130.
Sub-section 29(1) of the Act is not intended to restrict the amount payable in respect of household services to 50% of the cost of those services. It merely operates to restrict the maximum and minimum amounts of compensation that can be paid in those cases where an entitlement exists. If claims managers are satisfied that the services provided were reasonably required and the cost of providing those services was reasonable, then the full amount of the claim should be paid (subject, of course, to the statutory maximum).
When determining whether the services provided were reasonably required, claims managers should have regard to the matters specified in sub-section 29(2). Care should be taken, however, in those cases where the services were provided by a family member or friend. Whilst the claims manager may be satisfied that the services were reasonably required, it may well be that an allowance is not payable because the person providing the services may have provided them before the injury anyway and/or he or she might reasonably be expected to provide such services for the employee after the injury.
Where claims managers are satisfied that the services provided were reasonably required, but feel that the amount claimed in respect of those services was not reasonable (ie, was too high), the charges customarily made by “professionals” to provide similar services in the area where the employee lives should be used as a guide to determine the most reasonable amount of compensation payable. Once again, care should be taken where payment to a friend or relative is being considered. “Professionals” normally include an additional amount in their charges to cover the cost of their overheads. Friends or relatives would not usually have such overheads and therefore would not be entitiled to be paid at the full “professional” rate.
Having finally determined a reasonable amount payable, claims managers can then, if appropriate, exercise their discretion under section 29(1) to approve payment of an amount less than the amount claimed (remembering of course that the Act imposes a minimum payment of not less than 50% of the amount claimed ).
Obviously, this bottom limit will be of concern in cases where the amount claimed by the employee is so excessive that even a reduction of 50% is still higher than the amount of payment considered to be reasonable . In such cases, claims managers should still pay 50% of the initial claim but advise the employee that he or she is being overcharged for the service provided and that the amount approved in relation to future claims will be the amount Comcare Australia considers to be more reasonable in the circumstances.
Whilst this policy applies to all claims for household services that have been received since the commencement of the Act, ie. 1 December 1988, action need not be taken to search for, and identify, any “old” claims that may have been previously determined. However, if any of these claims come to the notice of claims managers, action should be taken to further consider them.
Antoinette le Marchant
General Manager
Business Development and Customer Service Division
18 June 1993