8 Sept 1999
The appeal is dismissed because Regulations 5 and 11 require prior approval as a precondition to payment, no applicable exception applied to the appellant's facts (complications arose after unapproved treatment and were not discovered during approved treatment), and there is no statutory power to award ex gratia payments; Walsh is binding authority.
10 Mar 1997
The appellant's domestic and caregiving duties fell within the Regulations' definition of principal economic activity and, on the medical evidence from the treating surgeon, immediate surgery was necessary to prevent strangulation and to restore the appellant's ability to perform those activities; therefore the review officer erred and the appeal succeeds.
6 Mar 1996
The regulations unambiguously required prior approval for the specialist procedure and private hospital treatment; the appellant did not obtain prior approval before the 24 April 1992 treatment and therefore the Corporation was not liable to reimburse; representations in brochure or alleged promises did not override the regulatory requirement and no discretion existed to grant relief, so the appeal must be dismissed.
16 May 1995
Regulation 11's prior approval requirement must be read to permit an emergency exception to avoid absurdity; because the appellant faced an emergency and the treatment was necessary to restore him to his principal economic activity, the Corporation's refusal was revoked and it must pay the private hospital costs according to the regulatory scales.
1 Aug 1994
The regulations unambiguously require prior approval for procedures in Part 2 performed in private hospitals and do not grant the Corporation discretion to pay where prior approval has not been obtained; therefore the appellant is not entitled to reimbursement for the specialist/private hospital procedure, although consultation fees may be payable under separate GP regulations.