21 Aug 2001
On the evidence the court found a temporal and causal nexus: the 1995 finger injury was the precipitating event that led to a chronic pain disorder (a mental injury). Predisposing psychosocial factors do not disentitle the appellant. Therefore the somatoform pain disorder is an 'outcome' of the physical injury within s4 and cover must be extended.
18 Jul 2000
The 1998 Act and its Schedule 1 (s426(3)) do not have the necessary clear retrospective effect to create an entitlement to reimbursement for treatment provided in 1988; consequently the respondent had no statutory authority to pay or reimburse the appellant's 1988 psychiatric fees.
21 Jan 1999
The appellant failed to prove on the balance of probabilities that the advanced degenerative change at L3/4 was causally connected to the 1978 pelvic fracture; therefore entitlement to payment of private hospital treatment costs is denied despite the operation meeting Regulation 11(2) requirements, and the Corporation's decision is confirmed.
19 Nov 1998
The Act and the Dentists Costs Regulations form a statutory code that confines the Corporation's payment obligation to the amounts specified in the regulations' schedule; therefore the Corporation lacked power to pay more than $444.70 and its decision to decline the balance was lawful.
30 Jul 1998
The Corporation was entitled to refuse payment because the statutory payment scheme limits reimbursement for specialist orthodontic treatment to services provided by a 'registered specialist' under the Dental Specialists Costs Regulations and the treatment and provider here did not qualify, and the Dentists Costs Regulations did not cover the treatment; accordingly the revocation under s67A was effective and no entitlement arose under the Act.
27 Feb 1997
The statutory scheme and the regulations prescribe fixed maxima for contributions to private treatment costs and do not permit the Corporation or the court to exceed those prescribed amounts; representations by a case manager or in pamphlets do not bind the Corporation and cannot create an entitlement beyond the statutory limits; therefore the respondent's calculation complied with the Act and Regulations and the appeal must be dismissed.
2 May 1996
Appeal allowed: where a claimant reasonably could not obtain the Corporation's prior approval because the Corporation had not yet decided to accept cover, regulation 11 must be read to allow payment (i.e. an implied exception), and the appellant is entitled to have her claim for the remedial treatment dealt with and reimbursed in accordance with the regulations on that basis.
20 Mar 1995
The court found on the balance of probabilities that prior verbal approval was given by the Corporation; the Schedule requires prior approval but its other listed requirements (specialist request and specified supporting information) were capable of being waived; having given verbal prior approval the Corporation must be taken to have waived the remaining requirements and therefore is liable to pay the CT cost to the extent specified in the Schedule.