Does Not Meet Criteria

1. Legend Healthcare professional Agent VWA Restricted Consultation: Application Process Healthcare professional completes a Restricted ConsultationApplication Form and faxes it to the managing VWA Agent (see below). Completion of the Restricted Consultation Application Form is payable using the relevant professional item codes. • Injury Management Advisor (IMA) reviews the application and determines whether the injury meets the diagnostic criteria: • Moderate to Severe Acquired Brain Injury • Spinal Cord Injury • Extensive Burns • Multiple Orthopaedic Fractures • Limb Amputations • Crush Injuries • Other Severe Injuries ‘On Merit’ Does Not Meet Criteria Does or May Meet Criteria Healthcare professional is informed in writing that the application is denied. Treatment for claims which do not meet the criteria for restricted consultations should be billed under the standard consultation item number. A member from the VWA Clinical Panel reviews the application to determine whether the injury meets the criteria and meets the principles of the VWA Clinical Framework for the delivery of health services to injured workers. Application denied. Healthcare professional informed in writing. Treatment for claims which do not meet the criteria for restricted consultations should be billed under the standard consultation item number. Application approved for the specified number of services over a period of time. Healthcare professional and Agent informed in writing. If the healthcare professional disagrees with the decision, they may appeal directly to the VWA Clinical Services Branch Fax: (03) 9641 1927 Two members of the VWA Clinical Panel review the application and will contact the provider by phone. Healthcare professional is informed in writing of the outcome of the appeal. VWA Agents: Allianz Fax: (03) 8615 8054 Cambridge Fax: (03) 9947 3318 GBS Fax: (03) 9297 9155 CGU Fax: (03) 8630 1086 QBE Fax: (03) 9246 2431