Glossary
Pre-approval
The insurer's approval of a workplace-rehabilitation service and its cost before that service is delivered.
Also called: prior approval · insurer approval
Definition
Pre-approval is the insurer's agreement to fund a specific workplace-rehabilitation service, at an agreed cost, before the service is provided. Under the NSW workers compensation scheme, workplace rehabilitation providers seek approval for services against SIRA's fee framework, so funding is confirmed in advance rather than assumed. Pre-approval settles the funding before the service. For approved services under the scheme, there is no cost to the worker, because the insurer pays. It also gives the employer and insurer clear visibility of what is being delivered and why.
In practice
Before Nexus delivers a service, it seeks the insurer's pre-approval, setting out the service, the reason and the cost against the scheme framework. This keeps funding confirmed in advance and, for approved services, means nothing for the worker to pay. Pre-approval also documents each step for the insurer, so the claim record stays clear.