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24.1.1 Treatment Approval
- All treatment must be accompanied by a current referral by the treating doctor.
- Treatment will only be approved for conditions for which the client has accepted liability.
- Treatment Authority will exist for clients to receive physiotherapy treatment, as long as there is a valid referral for that treatment, and it is provided for accepted condition/s only.
- In instances where a progress report has been requested, the maximum payable fee should not exceed the cost of a standard consultation. Progress reports should be brief and in dot point form and should identify functional outcomes.
- It is expected that practitioners be able to identify functional outcomes in the management of DVA clients and be able to provide clinical evidence that the functional goals are being met.
When requests for treatment are denied this is a reviewable decision under S62 of the SRCA. The determination must be in writing to the claimant and must include reasons for the decision as well as a statement that the determination can be reconsidered if the employee or claimant is dissatisfied with the determination. The medical provider supplying the treatment that we are not paying for also needs to be advised. If a Departmental medical advisor has been asked to comment on the case and recommends that treatment be declined, their written comments are to be placed on the client's E-file, as well as paper file, reflecting that recommendation. A note in Defcare should also be made.