Under s16 we pay the cost of medical treatment that was “reasonable” for the employee to obtain in the circumstances. In keeping with that fairly broad and open framework, whether by accidental loss, normal wear and tear, abnormal circumstances or whatever if there is a reasonable medical need for the client to replace the hearing aid then we would consider that to be “reasonable” medical treatment. Essentially the issue is does the claimant clinically require a hearing aid as a result of the compensable condition and do t — he — y already have a hearing aid that satisfies the clinical need?
The amount we pay is such amount as we determine is appropriate in the circumstances. We should ensure we pay for the cost of a standard of hearing aid that is reasonably required to return the client to a reasonable functional level of hearing, not necessarily to the highest level possible.
We should also ensure that the hearing loss arising from ADF employment effectively contributes to the need for the hearing aid.
Where a replacement is required due to damage or loss we should obtain a Statutory Declaration as to how the damage or loss occurred, and in the case of loss, what reasonable efforts have been taken to find it. Only in circumstance of wilful damage or neglect would we consider not replacing the aid. All such cases should be discussed with National Office before a decision to reject the claim is made.
The underlying principles for the approval of hearing aids for RCG clients are that:
- the aid is necessary to improve the hearing to a reasonable functional level;
- the level of hearing loss arising from the ADF employment must contribute materially to the need for the hearing aid;
- the aid is clinically effective (considering the available evidence);
- be accepted clinical practice (considering the current professional opinion);
- be at the lowest cost that meets the objectives above (considering the cost of treatment against the expected gains).