Social Welfare Consolidation Act 2005 section 86

Cost of medical care

Section 86 deals with the payment of medical care costs from the Social Insurance Fund for insured persons who suffer work-related injuries or occupational diseases.

• Medical care costs reasonably and necessarily incurred due to an insured injury or disease may be paid from the Social Insurance Fund, but only where not covered by the Health Acts, Mental Health Acts, or treatment benefit regulations.
• Payments are capped at the amount that would have applied had the person used available public health services, and for hospital in-patients, at the maximum charges under the Health Act 1970 or Mental Treatment Act 1945.
• Claimants may be required to undergo a medical examination to verify the necessity and relevance of the care to the injury or disease, and failure to comply means no payment will be made.
• Medical care covered includes GP and specialist care, nursing, pharmaceuticals, prosthetics, dental and optical treatment, allied health professional services, and transport to medical appointments.