Part 6 – Treatment and Rehabilitation

1.1This Part applies in relation to services under subsection 4(1) of the Act.
1.2The LSA will pay for the necessary and reasonable cost of treatment and Rehabilitation services for a Participant where those services relate to the Motor Vehicle Injury. Services should be provided by a qualified health professional.

2.1The LSA will pay for the necessary and reasonable costs of treatment and Rehabilitation services for a Participant where:
- 2.1.1there is clinical justification for services;
- 2.1.2there is evidence that the service is necessary and reasonable in relation to the Motor Vehicle Injury;
- 2.1.3the service is likely to be effective and achieve or maintain a measurable functional improvement; and
- 2.1.4the service promotes progress towards functional independence, participation and self-management.
2.2The LSA will pay for the necessary and reasonable costs of counselling services for immediate Family members or people who live with the Participant where the need for the services relates to the Participant’s Motor Vehicle Injury and will benefit the Participant.

3.1The LSA will pay or contribute to the necessary and reasonable cost of hearing related Assistive Technology and services, based on assessed need and, to the extent of the hearing impairment that is assessed by an ear, nose and throat specialist or other Appropriately Qualified Medical Specialist, the need is a direct result of the Motor Vehicle Accident.
3.2To determine whether a Participant’s need for hearing Assistive Technology is necessary and reasonable in the circumstances, the following information is relevant:
- 3.2.1information about pre-existing or subsequent medical conditions related to the hearing impairment that affect whether a treatment or Rehabilitation need is related to the Motor Vehicle Accident;
- 3.2.2information from an ear, nose and throat specialist or other Appropriately Qualified Medical Specialist as to the likely cause of the presenting hearing impairment need;
- 3.2.3if the Participant has pre- or co-existing medical conditions that may impact on their needs for or, in connection with, the hearing impairment; and
- 3.2.4clinical assessments and reports relating to the treatment of the hearing impairment.

4.1The LSA will pay for the necessary and reasonable cost of prescribed corrective spectacles or contact lenses, based on the assessed need and, to the extent of the impairment of vision that is assessed by an ophthalmologist, the need is as being a direct result of the Motor Vehicle Accident.
4.2To determine whether a Participant’s need for corrective spectacles or contact lenses is necessary and reasonable in the circumstances, the following information is relevant:
- 4.2.1information about pre-existing or subsequent medical conditions related to the vision impairment that affect whether a treatment or Rehabilitation need is related to the Motor Vehicle Accident;
- 4.2.2information from an ophthalmologist or other Appropriately Qualified Medical Specialist as to the likely cause of the presenting vision impairment need;
- 4.2.3if the Participant has pre- or co-existing medical conditions that may impact on their needs for or, in connection with, the vision impairment; and
- 4.2.4clinical assessments and reports relating to the treatment of the vision impairment.

5.1The LSA will not pay for treatment and Rehabilitation services not related to a Participant’s Motor Vehicle Injury. Exclusions include, but are not limited to:
- 5.1.1Treatment and Rehabilitation needs that are, in the course of ordinary circumstances, the responsibility of the State and Commonwealth Governments (or other jurisdictions/ schemes) as benefits available to the community (wholly or in part and not related to the Motor Vehicle Accident) and the Participant remains eligible.
- 5.1.2Treatment and Rehabilitation needs that are a result of ageing, other disabilities, injuries, conditions or events.
- 5.1.3Assistive Technology or services related to

a.Pre-existing or subsequent illness, disease or conditions.
b.Illness, disease or conditions that occur due to causes other than assessed by an Appropriately Qualified health professional as being the direct result of the Motor Vehicle Accident.
c.Illness, disease or conditions that develop gradually other than that assessed by an Appropriately Qualified health professional as being the direct result of the Motor Vehicle Accident.