Part 3 – Rules for Disputes about Eligibility for Participation

1.1This Part applies in relation to a Dispute or proceedings under Part 5 Division 1 and 2 of the Act.
1.2The LSA shall conduct itself as a Model Litigant in Dispute matters.

2.1A Dispute application must be made to the LSA In Writing and can be in the form of a letter or email, or submitted via the LSA website.
2.2The Dispute application must include:

2.3If the Dispute Applicant does not provide the above information, then the LSA may request that information is provided to the LSA before the Dispute application can proceed to assessment.
2.4The LSA will send an acknowledgement of the Dispute application In Writing to the sender within 14 Calendar Days of receipt.
2.5A copy of the Dispute application will be provided to any other interested party within 14 Calendar Days of receipt, after which time that party has 14 Calendar Days in which to apply to become a party to the Dispute and make a submission to the LSA on the Dispute application.
2.6Any information provided to the LSA may be shared with any other party to the Dispute.

3.1If the LSA is satisfied that further information or documentation is required in connection with the Dispute application, or is likely to assist in the resolution of the Dispute, the LSA may:
- 3.1.1request that the information be provided within a period of up to 28 Calendar Days; and
- 3.1.2process the Dispute application without the information, but only after the stated time above has passed for the submission of the information.
3.2The LSA may obtain any relevant information as required.
3.3The LSA may contact any of the Dispute Applicant’s treating health practitioners or Service Providers to clarify the issues in dispute or to assist with obtaining information relevant to the Dispute.
3.4At any stage during the Dispute, the LSA may contact any of the Dispute Applicant’s treating health practitioners about health or physical safety issues that the LSA considers are urgent or serious.

4.1All parties to a Dispute will:
- 4.1.1receive a copy of the Dispute application, and any other documents related to the Dispute submitted to the LSA;
- 4.1.2receive a copy of the LSA’s decision that is being disputed, and any documents related to that decision that were submitted to the LSA, including the Application Form to the Scheme (where relevant);
- 4.1.3have an opportunity to make a submission or submissions in relation to the Dispute; and
- 4.1.4receive the written determination issued by the Review Officer or Certificate issued by the Expert Review Panel In Writing (as relevant depending on Dispute type).

5.1Under section 34 of the Act, a Dispute can be made in relation to a relevant determination:
- 5.1.1a threshold determination under s 33 (1)(a) to (d) of the Act; or
- 5.1.2a determination of the LSA that results in the suspension of the participation of a person in the Scheme.
5.2A Dispute application must be received within six months of receipt of the LSA’s decision referred to in Rule 5.1 and, in accordance with section 34 of the Act, will be determined by a Review Officer.
5.3The LSA may reject any such request if the LSA is satisfied that the request:
- 5.3.1does not establish that it relates to a Dispute about threshold determination;
- 5.3.2has not been made by persons specified in section 33(2) of the Act.

6.1Under section 34 of the Act, a Review Officer is not bound by the rules of evidence and may adopt such procedures as the Review Officer thinks fit.
6.2Review Officers will provide all parties with the opportunity to make submissions in person or In Writing.
6.3The Review Officer must produce a determination In Writing with reasons for the decision outlined in plain English within 14 Calendar Days from completion of Review proceedings. The LSA will provide the parties with these reasons.
6.4Under section 35 of the Act such a determination of a Review Officer may be appealed to the South Australian Civil and Administrative Tribunal.

7.1A Dispute application must be received by the LSA within six months of receipt of the LSA’s decision on eligibility In Writing.
7.2Under section 36 of the Act Disputes relating to medical considerations on eligibility may be referred to an Expert Review Panel by the LSA, or by notice to the LSA given:
- 7.2.1by or on behalf of an Applicant; or
- 7.2.2by an insurer; or
- 7.2.3by the nominal defendant.

8.1An Expert Review Panel, consists of between one and three medical experts appointed by the Convenor under Schedule 1 of the Act.
8.2The Expert Review Panel’s procedures will be in accordance with Schedule 1 of the Act and the ERP Guidelines issued by the Minister.
8.3The LSA will provide secretariat services to an Expert Review Panel.
8.4The Expert Review Panel will give a Certificate as to its determination setting out the reasons for the determination.
8.5Further information on Expert Review Panels is found in Schedule 1 of the Act and on the LSA website.