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22.1.2 Issues for the Delegate to consider

  • The treating doctor, specialist or allied health provider should initiate requests for all prior approval treatment (that not covered by the Treatment Authority).
  • Clients seeking medical approval should be directed to ask their treating practitioner to contact DVA.
  • The procedure should be directly related to the client's existing liability.
  • Where an extension of liability is requested, ensure that the extension is valid and determine for how long the extension will be valid.
  • Is it apparent how the prior approval treatment will benefit the client? What are the expected outcomes of treatment?
  • Do you require written reports prior to considering the request?
  • Is the cost reasonable? How do you benchmark this?
  • Has the client received similar prior approval treatment recently and if so how did they benefit and why is repeat prior approval treatment necessary?
  • Has a similar request been declined and do the same reasons for exist for this request?
  • Do you need to seek advice from staff or an adviser with health qualifications before you make a decision?
  • Do you have enough information from all relevant parties to make an informed decision?