Payment for Individuals Sample Clauses

Payment for Individuals involved in a motor vehicle accident that was initially assessed as being eligible for compensation but is subsequently declined eligibility Where claims may have been submitted by the medical practitioner directly to the Motor Vehicle Accident appointed compulsory third party insurer and the episode of care is deemed unclaimable or is rejected by the insurer. The health service will approve payment of any fee-for-service inpatient claim relating to that episode of care, subject to verification through a copy of the rejection letter from the insurer, or in a single vehicle accident through the notes made at the time by the medical practitioner or the South Australian Ambulance Service. The rates to be paid are as per this agreement. Payment will not be made for any claims:  where ‘fault’ cannot be determined (eg a multiple vehicle accident where the matter should be referred to the insurer to determine who was the driver at fault)  if patient chooses to voluntarily waive their right to compensation  if a patient fails to submit a claim to an insurer where compensation would be claimable A claim form needs to be completed and the supporting documentation provided whenever a claim is made. Country Health SA would encourage all medical practitioners to utilise the option to submit claims via the bulk claim process – refer 4.6.2

Payment for Individuals involved in a motor vehicle accident that was initially assessed as being eligible for compensation but is subsequently declined eligibility