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24.2.1 Treatment Approvals
- All requests for treatment must be accompanied by a current referral by the treating doctor.
- Treatment will only be approved for conditions for which the clients has accepted liability.
- Treatment Authority will exist for clients to receive Chiropractic/Osteopathic/Naturopathic treatment, as long as there is a valid referral for that treatment, and it is provided for accepted condition/s only.
- Naturopathic treatments will only be approved where the same clinical effect cannot be gained with treatment offered by other registered allied health practitioners.
- A progress report should not be paid for unless specifically requested by the Delegate. 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. The Delegate may be satisfied with a verbal report from the treating practitioner in lieu of a written report and the outcome should always be noted on Defcare.
- 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 need 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, and paper file, reflecting that recommendation. A note in Defcare should also be made.