--- title: "Check which forum can review a refusal to fund treatment" url: "https://ailawframework.com/practice/personal-injury-and-compensation/check-which-forum-can-review-a-refusal-to-fund-treatment" type: "task" site: "AI Law Framework" id: "A21-WC20261023-12" practice_area: "Personal Injury & Compensation (workers compensation, CTP/TAC, medical negligence)" tier: "yellow" lawyer_review: "required" last_reviewed: "2026-10-25" --- # Check which forum can review a refusal to fund treatment > From the treatment refusal and the claim decision, using a firm-controlled tool, name the forum the opened pages allow for that kind of refusal and any time limit they state. Do not decide that the treatment is payable. Canonical page: https://ailawframework.com/practice/personal-injury-and-compensation/check-which-forum-can-review-a-refusal-to-fund-treatment Last reviewed: 2026-10-25 Site index for agents: https://ailawframework.com/llms.txt ## Key facts | Fact | Value | | --- | --- | | Practice area | [Personal Injury & Compensation (workers compensation, CTP/TAC, medical negligence)](https://ailawframework.com/practice/personal-injury-and-compensation.md) | | Human involvement | Yellow: Lawyer and AI draft together | | How AI is used | From the treatment refusal and the claim decision, using a firm-controlled tool, name the forum the opened pages allow for that kind of refusal and any time limit they state. Do not decide that the treatment is payable. | | What the lawyer must review | Decide whether the refusal can be reviewed, and in which forum. Do not send a Queensland procedure refusal to the Regulator if the page says it is not reviewable. Confirm the New South Wales treatment test in the regulation before quoting the new words. Health and wage records stay in a firm-controlled tool. Apply ASCR r 9, APP 11, and the notifiable-breach test. | | Written for / versions | 3 jurisdiction versions below | ## Checking plan **Source-by-source verification** The lawyer checks the output against the file and the linked sources before it is used or sent. - What the AI does: From the treatment refusal and the claim decision, using a firm-controlled tool, name the forum the opened pages allow for that kind of refusal and any time limit they state. Do not decide that the treatment is payable. - What the lawyer does: Decide whether the refusal can be reviewed, and in which forum. Do not send a Queensland procedure refusal to the Regulator if the page says it is not reviewable. Confirm the New South Wales treatment test in the regulation before quoting the new words. Health and wage records stay in a firm-controlled tool. Apply ASCR r 9, APP 11, and the notifiable-breach test. - Who reviews: Lawyer competent in statutory workers compensation - Basis: Checked against the linked sources on 23 October 2026. Confirm the current instrument before reliance. - Why: The level reflects what the work is, the consequence of an error, and how much the lawyer must check on every file. ## Checks the lawyer makes 1. Classify the letter as a claim rejection, a suspension, or a refusal to fund one procedure. The forum can differ. 2. In Queensland, do not lodge a Regulator review of a refusal to fund a particular procedure on the strength of this page. 3. In Victoria, diarise 60 days for conciliation where the letter is a decision on the claim. 4. Do not quote 'reasonable and necessary' as the New South Wales test until the lawyer has opened Part 4A of the regulation. ## Notes - Part 4A clause 8P of the Workers Compensation Regulation 2016, in the version current from 1 October 2026, states the reasonable-and-necessary rules for section 60(2C)(a). The part does not state a domestic-assistance test or a rule that existing claims keep the former words. - Domestic-assistance dollar thresholds were not opened and are not stated. - If health or wage records leave the firm-controlled tool, decide whether a Privacy Act 1988 (Cth) breach is notifiable. ## Sources - [Workplace Injury Commission: conciliation](https://www.wic.vic.gov.au/conciliation) (checked 2026-10-23) - [Workplace Injury Commission: arbitration](https://www.wic.vic.gov.au/arbitration) (checked 2026-10-23) - [WorkSafe Queensland: independent review of insurer decisions](https://www.worksafe.qld.gov.au/workers-compensation/independent-review-of-insurer-decisions) (checked 2026-10-23) - [SIRA: psychological injuries, guidance for insurers](https://www.sira.nsw.gov.au/workers-compensation/psychological-injuries-guidance-for-insurers) (checked 2026-10-23) - [Personal Injury Commission: medical disputes](https://www.pi.nsw.gov.au/types-of-disputes/workers-compensation/medical-pathways) (checked 2026-10-23) - [By Lawyers: NSW workers compensation changes from 1 October 2026](https://bylawyers.com.au/news/articles/nsw-workers-compensation-changes-from-1-october-20/) (checked 2026-10-23) - [SIRA: provisional payments](https://www.sira.nsw.gov.au/workers-compensation-claims-guide/glossary/p/provisional-payments) (checked 2026-10-23) ## Forms and precedents for this task | Form or precedent | Kind | AI level | Summary | | --- | --- | --- | --- | | [Complaint to the Independent Review Office about a workers compensation or CTP insurer](https://ailawframework.com/precedents/personal-injury-and-compensation/nsw-iro-insurer-complaint.md) | Letter | Yellow | Letter for a complaint to the New South Wales Independent Review Office about a workers compensation insurer or a CTP insurer, with the two pathways kept apart. | | [Covering letter for a Workplace Injury Commission conciliation application](https://ailawframework.com/precedents/personal-injury-and-compensation/vic-wic-conciliation-covering-letter.md) | Letter | Yellow | Covering letter sent with a Workplace Injury Commission Application for Conciliation. The worker or an authorised helper completes the form, and the tool does not sign it. | Signed-in accounts can read the full text of each one. ## Jurisdiction versions | Jurisdiction | Level | | --- | --- | | [New South Wales](https://ailawframework.com/practice/personal-injury-and-compensation/check-which-forum-can-review-a-refusal-to-fund-treatment/new-south-wales.md) | Yellow | | [Queensland](https://ailawframework.com/practice/personal-injury-and-compensation/check-which-forum-can-review-a-refusal-to-fund-treatment/queensland.md) | Yellow | | [Victoria](https://ailawframework.com/practice/personal-injury-and-compensation/check-which-forum-can-review-a-refusal-to-fund-treatment/victoria.md) | Yellow | *Practice guidance for planning and review. Confirm current primary sources and the requirements of the actual matter. This is general information, not legal advice.*