Legislative Council Tuesday 19 March, 2019
Ms FORREST question to the LEADER of GOVERNMENT in the LEGISLATIVE COUNCIL, Mrs HISCUTT
With regards to payments of claims made to hospitals following an MAIB claim by MAIB;
1. Are the claims ever questioned by MAIB if the cost appears higher than other similar claims; and
2. How are claims assessed prior to payment by MAIB to ensure claims are not excessive as related to medical care required?
The MAIB assesses all claims in accordance with the provisions of the Motor Accidents (Compensation and Liabilities) Act 1973 (the Act) and the Motor Accidents (Compensation and Liabilities) Regulations 2010 (Regulations) prior to accepting the claim.
Once a claim is accepted, under the Act the MAIB is required to pay relevant benefits, including medical costs and disability allowances, to eligible claimants, where the claimant's personal injuries result directly from a motor accident. The MAIB responds to the requests of treatment providers and reimburses, or pays directly on behalf of the claimant, costs that are determined to be reasonable and necessarily incurred and are a direct result of the accident.
Invoices for treatment costs are reviewed for "reasonableness" with consideration given to a number of factors including:
• Is the treatment provided reasonable for the injuries sustained;
• Has the correct fee (industry and/or agreed rates) been applied for the treatment; and
• Are the dates and/or days (for hospital stays) correct and correspond with the claim.
The MAIB has a number of fee schedules and agreements for services provided to claimants (including a bed day fee rate for public hospitals, which covers a major portion of hospital services provided to MAIB claimants in Tasmania) and invoices received are reviewed against the schedules and agreements prior to payment.
If there are any concerns about the reasonableness of an invoice the MAIB will take steps to address them, such as requesting further information from the hospital or provider.