What is provided by the Lifetime Care and Support Scheme?
The Lifetime Care and Support Authority (the Authority) pays for the reasonable and necessary treatment, rehabilitation and care services of participants in the Lifetime Care and Support Scheme (the Scheme).
As a participant in the Scheme, the Authority will provide you with treatment, rehabilitation and care services that result from your motor accident injury. The Authority cannot pay for treatment, rehabilitation and care services that are not a result of this injury.
What is treatment, rehabilitation and care?
Treatment, rehabilitation and care is defined in Part 6(2) of the Motor Accidents (Lifetime Care and Support) Act 2006 (the Act) to include:
- medical treatment, including pharmaceuticals
- dental treatment
- rehabilitation
- ambulance transportation
- respite care
- attendant care services
- domestic assistance
- aids and appliances
- artificial members (limbs), eyes and teeth
- educational and vocational training
- home and transport modification
- workplace and educational facility modifications.
The Lifetime Care and Support Guidelines also include information about specific areas of treatment, rehabilitation and care.
Prior approval
All treatment, rehabilitation and care services require prior approval. This means the Authority has to approve requests for services before you have them. It is important to know that if you go ahead and pay for treatment, rehabilitation and care services without getting approval first, you may not be reimbursed and may end up having to pay for them yourself. Talk to your LTCS coordinator for more information.
"Reasonable and necessary"
The Authority will pay your reasonable and necessary treatment, rehabilitation and care services as a result of your injury from the motor accident. This is decided on a case by case basis, and means you will get what you need - not things that are simply nice to have.
What is not paid for?
Listed below are examples of some services and items that the Authority cannot pay for:
- services for medical conditions you had before the motor accident;
- treatment, rehabilitation or medical services not related to your injury from the motor accident, such as general GP visits or vitamins to maintain your health;
- loss of wages or other weekly benefits while you are in hospital or in rehabilitation;
- items that were lost or damaged in the motor accident;
- assistance to keep your business open, such as paying for temporary staff to do your job;
- general household items such as standard furniture, linen, household appliances, storage and whitegoods;
- costs to stay as an inpatient in a hospital or rehabilitation unit that are already included in the charges the Authority pays;
- extra expenses that you might incur in hospital or rehabilitation such as additional food, laundry, newspapers and magazines;
- payments for large capital items such as houses and cars; and
- treatment, rehabilitation and care services for other members of your family.
There may be other examples that are not listed above. If you are not sure about whether something is regarded as treatment, rehabilitation and care, contact your LTCS Coordinator.