Glossary
Reasonable and necessary treatment
The standard an insurer applies when deciding which treatment and services it will fund for an injury.
Also called: reasonably necessary treatment
Definition
Reasonable and necessary treatment (more precisely, 'reasonably necessary' treatment) is the test a NSW workers compensation insurer applies when deciding what it will fund as a result of a work injury. In weighing whether a service is reasonably necessary, relevant factors include the appropriateness of the treatment, alternatives available, cost, and its likely effectiveness. Some services require pre-approval before the insurer will fund them, while certain categories do not. The same standard governs the treatment, care and related services the scheme covers, including approved workplace rehabilitation services.
In practice
This standard is often behind whether a particular service is approved and funded, and pre-approval can affect timing. Workplace rehabilitation is one of the services an insurer approves under it; where a worker meets the criteria, the insurer pays, and the worker pays nothing for approved services. Nexus coordinates the return-to-work services within scope and liaises with the treating doctor, who directs the medical treatment while the insurer decides what to fund.