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Psychiatrist reccommends....Do I have too?? If I choose to use alternative therapies will I loose compensation �

#21 User is offline   redsquare74ucys 

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Posted 04 December 2007 - 12:15 PM

View Postflowers, on Dec 4 2007, 12:28 PM, said:

Waiting in the stable for the Knacker? :wub:


Ykies! :ph34r:
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#22 User is offline   redsquare74ucys 

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  Posted 04 December 2007 - 12:16 PM

View Postflowers, on Dec 4 2007, 12:28 PM, said:

Waiting in the stable for the Knacker? :wub:


Ykies! :ph34r:
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#23 User is offline   waddie 

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Posted 04 December 2007 - 12:21 PM

Schedule 1, clause 57 - Corporation not to assess entitlement until it receives medical certificate as to stability of claimant's condition

(1)The Corporation must not assess the claimant's entitlement to lump sum compensation until the earlier of the following:
(a)the Corporation receives a certificate from a … medical practitioner indicating that—
(i)the claimant's condition resulting from the personal injury has stabilised; and
(ii)it is likely that there is permanent impairment resulting from the personal injury; or

(b)after 2 years have passed since the date of the personal injury, the Corporation receives a certificate from a … medical practitioner indicating that—
(i)the claimant's condition resulting from the personal injury has not stabilised; but
(ii)it is likely that there is permanent impairment resulting from the personal injury.

(2)If the claimant is under 16 years of age and has cover for personal injury that is a mental injury, the Corporation must not assess the claimant's entitlement to lump sum compensation for the mental injury until the claimant turns 16 years of age, unless the Corporation is satisfied that there are compelling reasons for assessing the claimant's entitlement earlier.

(3)A certificate provided under subclause (1) in respect of personal injury that is mental injury must—

(a)state that it is likely that permanent impairment has arisen from the mental injury; and
(b)be provided by a medical practitioner who is suitably qualified (to the Corporation's satisfaction) to assess mental injury.



Basically, if the medical practioner's opinion that treatment is likely to result in a reduction in impairment, then ACC would not be required to assess the impairment until the treatment had been provided. If you decline the treatment then the result is the assessment will not take place until you do, or 2 years has passed since the date of the personal injury (for a mental injury that is the day you first receive treatment for the mental injury) and a medical practitioner who is suitably qualified (to the Corporation's satisfaction) to assess mental injury state that it is likely that permanent impairment has arisen from the mental injury.
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#24 User is offline   redsquare74ucys 

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  Posted 04 December 2007 - 10:26 PM

Basically, if the medical practioner's opinion that treatment is likely to result in a reduction in impairment, then ACC would not be required to assess the impairment until the treatment had been provided. If you decline the treatment then the result is the assessment will not take place until you do, or 2 years has passed since the date of the personal injury (for a mental injury that is the day you first receive treatment for the mental injury) and a medical practitioner who is suitably qualified (to the Corporation's satisfaction) to assess mental injury state that it is likely that permanent impairment has arisen from the mental injury.
[/quote]

Ooooou, I love to hear you talking in clauses and sub-clauses. :D

I'm guessing they mean first treated by someone suitably qualified to the Corporation's satisfaction. If so the first visit would have been back in Nov '06 to an ACC counsellor. Prior to that I was only seeing a "standard" psychologist via our public health system. Bugger. Drags it out a bit doesn't it.
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#25 User is offline   doppelganger 

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Posted 04 December 2007 - 10:44 PM

they have to come under these sections

``treatment provider''—

(a)means an acupuncturist, audiologist, chiropractor, counsellor, dentist, medical laboratory technologist, nurse, occupational therapist, optometrist, osteopath, physiotherapist, podiatrist, . . . medical practitioner, or speech therapist; and

(b)includes a member of any occupational group included in the definition of ``treatment provider'' by regulations made under section 322

322.Regulations relating to definitions—

(1)The Governor-General may, on the recommendation of the Minister, by Order in Council, make regulations—

(a)defining ``acute admission'' for the purposes of this Act:

(b)defining ``counsellor'' for the purposes of this Act:

©defining ``impairment'' for the purposes of this Act:

(d)prescribing a place of education for the purposes of this Act:

(e)adding an occupational group, or part of an occupational group, to the definition of ``registered health professional'' in section 6(1), and defining that group or part by reference to membership of or registration with a particular body or in some other way:

(f)adding an occupational group, or part of an occupational group, to the definition of ``treatment provider'' in section 6(1), and defining that group or part by reference to membership of or registration with a particular body or in some other way:

(g)Repealed.

(2)The Governor-General may, on the recommendation of the Minister and the Minister of Health, by Order in Council, make regulations defining ``public health acute services'' for the purposes of this Act.

(3)The Minister may not make any recommendation under subsection (1) or subsection (2) without first consulting the persons or organisations the Minister considers appropriate, having regard to the subject-matter of the proposed regulations.

Cf 1998 No 114 s 399

so did the they come under one of those.
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#26 User is offline   waddie 

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Posted 04 December 2007 - 11:08 PM

View Postredsquare74ucys, on Dec 4 2007, 10:26 PM, said:

Basically, if the medical practioner's opinion that treatment is likely to result in a reduction in impairment, then ACC would not be required to assess the impairment until the treatment had been provided. If you decline the treatment then the result is the assessment will not take place until you do, or 2 years has passed since the date of the personal injury (for a mental injury that is the day you first receive treatment for the mental injury) and a medical practitioner who is suitably qualified (to the Corporation's satisfaction) to assess mental injury state that it is likely that permanent impairment has arisen from the mental injury.
Ooooou, I love to hear you talking in clauses and sub-clauses. :D

I'm guessing they mean first treated by someone suitably qualified to the Corporation's satisfaction. If so the first visit would have been back in Nov '06 to an ACC counsellor. Prior to that I was only seeing a "standard" psychologist via our public health system. Bugger. Drags it out a bit doesn't it.


Redsquare74ucy - Doppelganger's onto it. The date of your injury is the date your first received treatment from a treatment provider (it doesn't have to be an "ACC approved or contracted provider" treatment provider). Just one that comes within the definition in Doppelganger's posting. Basically they have top be registered with the occupations national body, for example a chiropractor has to be registered with the Chiroprators Association, doctors with the Medical Council etc Councillors with there National Body etc.

If it has been 2 years since you first received treatment, then all that is required is a suitably qualified medical practitioner to state that there is likely to be permanent impairment for ACC to carry out the lump sum assessment. (well thats my understanding but my brain is fairly tired at present).
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#27 User is offline   redsquare74ucys 

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Posted 07 December 2007 - 10:37 AM

Thanks D.G. and Waddie,

This knowledge may change things quite dramatically. I have three seperate claims lodged under the one main claim number, two qualify for lump sum, one is back in 1987 so that is for the IA. (*I think*).

Am hoping that they will pay just the one lump sum at this time so I can get my alternative treatments.

Cheers Guys.
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#28 User is offline   waddie 

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Posted 07 December 2007 - 10:50 AM

redsquares, independence allowance has a different set of criteria, it only has to be 1 year (lump sum 2years) and the there has to be impairment (as opposed permanent impairment). The reason is the IA can be reassessed if impairment reduces, therefore payment reduce accordingly, whereas once the lump sum is paid it cannot be reduced, hence it needs to be a permanent impairment.

If a IA is paid then it is from the date the claim was lodged, so the backdating can often result in an amount greater than the current lump sum provisions and the other benefit is that it is also ongoing (subject to a reassessment as the result of improvemnt) and can also be capitalised for a 5 year period into the future.

Either way, neither compensate for the real cost of the impairment but we must be greatful for the crumbs that fall from ACC's table.

NB: The above is off the top of my head, it may pay to check the exact wording of the legislation. the IA comes under the 1998 Act, schedule 1, got to much happening to look it up post it. can access it through ACC's web-site.
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#29 User is offline   doppelganger 

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Posted 07 December 2007 - 05:11 PM

Here is the section for the IA

326.Regulations relating to lump sum compensation—

(1)For the purposes of Part 3 of Schedule 1, the Governor-General may, on the recommendation of the Minister, by Order in Council, make regulations specifying when a claimant's condition is to be regarded as stabilised for the purposes of clause 57 of Schedule 1.

(2)The Governor-General may, on the recommendation of the Minister, by Order in Council, make regulations for the purposes of Part 3 of Schedule 1 to give effect to those provisions, including regulations that—

(a)refer to, or incorporate by reference, in whole or in part, the American Medical Association Guides to the Evaluation of Permanent Impairment:

(b)refer to, or incorporate by reference, guides, frameworks, or other standards:

©prescribe an assessment tool that in itself may refer to, or incorporate by reference, in whole or in part, any thing referred to in paragraph (a) or paragraph (b):

(d)do any combination of the things referred to in paragraphs (a) or (b) or ©:

(e)amend the lump sum compensation amounts payable under clause 56 of Schedule 1

(f)prescribe calculations and rules for determining the combined effect of personal injury for a claimant who has suffered more than 1 personal injury, for the purposes of clause 59(5) of Schedule 1:

(g)prescribe calculations and rules for adjusting the whole-person impairment score of a claimant to take into account the effect of injuries suffered before 1 April 2002:

(h)prescribe the scale of lump sum compensation amounts payable in respect of different degrees of whole-person impairment under clauses 56 and 60 of Schedule 1 so that the amount increases exponentially or otherwise as the degree of impairment increases:

(i)prescribe such other matters as may be desirable to enable the assessment, calculation, and payment of lump sums.

(3)The Minister must not make any recommendation under subsection (1) or subsection (2) without first consulting the persons or organisations that the Minister considers appropriate, having regard to the subject-matter of the proposed regulations.

(4)Any material referred to or incorporated by reference in regulations under this section forms part of the regulations for all purposes. However, any amendment made to the material after the commencement of the regulations does not have effect until regulations have been made incorporating the amendment into the regulations.

(5)The Corporation must allow a claimant to inspect any material referred to or incorporated by reference in regulations under this section. The inspection must be free of charge and take place at 1 of the Corporation's offices.




[377.Independence allowance for personal injury suffered before 1 July 1999—

(1)On the commencement of this section, sections 441 and 442 of the Accident Insurance Act 1998 cease to have effect.

(2)A person who suffered personal injury before 1 July 1999 is entitled to be assessed for an independence allowance under Part 4 of Schedule 1 of the Accident Insurance Act 1998, irrespective of when the claim for cover for the personal injury was or is lodged, subject to the modifications set out in subsection (3).

(3)The modifications are that—

(a)any assessment or reassessment must be done on the basis of whole-person impairment for the combined effect of all injuries suffered before 1 July 1999 for which the person has cover; and

(b)the percentage of impairment for which any lump sum compensation was received under section 119 of the Accident Compensation Act 1972 or section 78 of the Accident Compensation Act 1982, or both, must be deducted from the percentage of combined whole-person impairment assessed in accordance with paragraph (a); and

©the independence allowance based on the first assessment is payable as from,—

(i)in the case of a person who has received lump sum compensation under section 119 of the Accident Compensation Act 1972 or section 78 of the Accident Compensation Act 1982, or both, the date of the application for an independence allowance; or

(ii)in any other case, the later of the date on which the claim for cover was lodged or 1 July 1992.]


378.Personal injury suffered on or after 1 July 1999 and before 1 April 2002—

(1)The provisions of Part 4 of Schedule 1 of the Accident Insurance Act 1998 continue to apply to personal injury suffered on or after 1 July 1999 and before 1 April 2002, irrespective of when the claim for cover in respect of that personal injury was or is lodged.

(2)The amounts referred to in clause 62(1) of Schedule 1 of the Accident Insurance Act 1998, as adjusted under section 103 of that Act, must be adjusted in accordance with section 388.

(3)Despite section 339, for the purposes of this section, section 403 of the Accident Insurance Act 1998 continues to apply as if subsection (2) were repealed, and the following subsection were substituted:

``(2)The Governor-General may, on the recommendation of the Minister, by Order in Council, make regulations for the purposes of clauses 60 and 61 of Schedule 1 that—

``(a)refer to, or incorporate by reference, in whole or in part, the American Medical Association Guides to the Evaluation of Permanent Impairment:

``(b)refer to, or incorporate by reference, guides, frameworks, or other standards:

``©prescribe an assessment tool that in itself may refer to, or incorporate by reference, in whole or in part, anything referred to in paragraph (a) or paragraph (b):

``(d)do any of a combination of things referred to in paragraph (a) or paragraph (b) or paragraph ©.''

379.Payment of independence allowance to claimant outside New Zealand—

(1)The Corporation [must not] pay an independence allowance to a claimant outside New Zealand unless his or her condition has been assessed for the purposes of the Accident Rehabilitation and Compensation Insurance Act 1992 or the Accident Insurance Act 1998 by a person approved for the purpose by the Corporation.

(2)If an independence allowance is payable outside New Zealand and the claimant's continuing right to receive that allowance is to be assessed, the Corporation [is not required to] meet—

(a)any costs incurred by the claimant overseas; or

(b)any costs relating to the return of the claimant to New Zealand for assessment.

Lump sum compensation under former Acts

380.Lump sum compensation under former Acts—

(1)Lump sum compensation previously payable under the Accident Compensation Act 1972 or the Accident Compensation Act 1982 is payable if—

(a)a claim for the lump sum compensation in respect of the personal injury was lodged before 1 October 1992; and

(b)a decision made by the Corporation before 1 July 1995—

(i)was made under section 119 or section 120 of the Accident Compensation Act 1972 or section 78 or section 79 of the Accident Compensation Act 1982; and

(ii)is subject to a valid late application for review or appeal by the claimant.

(2)If the claim for cover was accepted by the Corporation as 1 claim, despite there being several incidents to which the personal injury might have been attributable, the only additional lump sum compensation that may be paid in relation to the claim is an amount up to the balance of the maximum that was payable under section 120 of the Accident Compensation Act 1972 or section 79 of the Accident Compensation Act 1982 for 1 claim, irrespective of the number of incidents involved.

(3)Subsection (2) is subject to subsection (1).


60.Payment of lump sum compensation for permanent impairment—

(1)The Corporation determines an amount of lump sum compensation based on an assessment of whole-person impairment under clause 59 and regulations under clause 56.

(2)Any amount derived under subclause (1) has deducted from it any lump sum compensation for permanent impairment received previously under this Part, as adjusted under subclause (3).

(3)If a claimant has received lump sum compensation for permanent impairment previously under this Part, the amount received previously must be adjusted for the purposes of subclause (2) in the manner provided in section 116.

(4)The Corporation must notify the claimant of—

(a)the assessed degree of whole-person impairment; and

(b)the amount of lump sum compensation payable, if any.

61.Reassessment of entitlement to lump sum compensation—

(1)Clauses 54 to 60 apply to reassessments under this clause.

(2)The Corporation must arrange for an assessor to reassess a claimant if—

(a)the claimant was assessed after the Corporation received a certificate under clause 57(1)(b) and before the Corporation received a certificate under clause 57(1)(a); and

(b)the Corporation then receives a certificate under clause 57(1)(a).

(3)A reassessment under subclause (2) is not a reassessment for the purposes of subclause (7).

(4)The Corporation must arrange for an assessor to reassess a claimant who produces to the Corporation a certificate from a . . . medical practitioner indicating that the claimant's permanent impairment is likely to have increased since the date of assessment.

(5)Subclause (4) is subject to subclauses (6) and (7).

(6)A certificate provided under subclause (4) in respect of personal injury that is mental injury must be provided by a . . . medical practitioner who is suitably qualified (to the Corporation's satisfaction) to assess mental injury.

(7)A claimant is not entitled to more than 1 reassessment under subclause (4) in any 12-month period.

Independence Allowance 1998 Act
441 INDEPENDENCE ALLOWANCE
(1) Subsection (2) applies to—
(a) A person to whom section 27(1) of the Accident Rehabilitation and Compensation Insurance Amendment Act (No. 2) 1996 applies and who was not reassessed under section 54A of the Accident Rehabilitation and Compensation Insurance Act 1992 before 1 July 1999:
(b) A person who, immediately before 1 July 1999, was receiving or was entitled to receive an independence allowance under section 54 of the Accident Rehabilitation and Compensation Insurance Act 1992:
© A person who suffered a personal injury before 1 July 1999 and did not apply for an independence allowance before 1 July 1999.
[S 441(1) amended by No 66 of 1999, s 3(1), by substituting in para © "apply for an independence allowance before 1 July 1999" for "claim an independence allowance"; effective 1 July 1999.]
(2) Such a person is entitled to receive an independence allowance on and after 1 July 1999 under Part 4 of Schedule 1, as modified by—
(a) Subsection (3); and
(b) Section 442(2)(a) and (b), if the person is a person to whom section 442(2) applies.
[S 441(2) amended by No 66 of 1999, s 3(2), by substituting "by—" for "by this section" and inserting para (a) and (b); effective 1 July 1999.]
(3) The modifications made by this subsection are as follows:
(a) Such a person may not lodge a claim for an independence allowance under Part 4 of Schedule 1 for any injuries suffered before 1 July 1999:
(b) A person described in subsection (1)(a) receives the rate of independence allowance payable on 30 June 1997 as adjusted by section 71 of the Accident Rehabilitation and Compensation Insurance Act 1992 or section 460:
© Any assessment under clause 60 of Schedule 1, or reassessment under clause 61 of Schedule 1, must be done on the basis of whole-person impairment for the combined effect of all his or her personal injuries covered by the former Acts, and only 1 independence allowance is payable for all those injuries:
(d) As soon as practicable after 1 July 1999 the manager must require a person described in subsection (1)(a) to be reassessed in accordance with paragraph ©.
[S 441(3) amended by No 66 of 1999, s 3(3), by inserting "made by this subsection"; effective 1 July 1999.]
442 ENTITLEMENT TO INDEPENDENCE ALLOWANCE OF PERSONS WHO RECEIVED LUMP SUMS UNDER FORMER ACTS AND SUFFER FURTHER IMPAIRMENT
(1) Subsection (2) applies to a person who received a payment for personal injury by accident under section 119 of the Accident Compensation Act 1972 or section 78 of the Accident Compensation Act 1982.
[S 442(1) substituted by No 66 of 1999, s 3(4), effective 1 July 1999. Former s 442(1) read:
"(1) Subsection (2) applies to a person who—
(a) Suffered personal injury by accident within the meaning of the Accident Compensation Act 1972 or the Accident Compensation Act 1982 before 1 July 1992; and
(b) Received a payment for the personal injury under section 119 of the Accident Compensation Act 1972 or section 78 of the Accident Compensation Act 1982; and
© On or after 1 July 1992 suffered an increased degree of permanent loss or impairment of bodily function resulting from the personal injury."]
(2) Such a person may apply under section 441 for an independence allowance under Part 4 of Schedule 1. That Part applies subject to the following modifications:
(a) The independence allowance must be calculated by deducting, from any whole-person impairment assessed under clause 60 of Schedule 1, or reassessed under clause 61 of Schedule 1, any percentage permanent loss or impairment of bodily function for which any payment was made under section 119 of the Accident Compensation Act 1972 or section 78 of the Accident Compensation Act 1982:
(b) An independence allowance payable as the result of an assessment under clause 60 of Schedule 1 is payable from the date of the application for it.
[S 442(2) amended by No 66 of 1999, s 3(5), (6) and (7), by (i) inserting "under section 441"; (ii) substituting in para (a) "clause 60 of Schedule 1, or reassessed under clause 61 of Schedule 1" for "Part 4 of Schedule 1"; and (iii) substituting para (b); effective 1 July 1999. Former para (b) read:
"(b) The independence allowance is payable from the date of the application for it."]

PART 4 — INDEPENDENCE ALLOWANCE
58 Independence allowance
58(1) The insurer is liable to pay the insured an independence allowance at the rate set in clause 62, if—
(a) The insured has suffered personal injury for which he or she has cover; and
(b) An assessment carried out under clause 60 establishes that that personal injury, for which the insured lodged the claim for cover, has resulted in a degree of whole-person impairment of 10% or more,—
but this subclause is subject to subclause (2).
58(2) The insurer is not liable to pay the insured any amount of independence allowance in excess of 100% whole-person impairment for mental injuries—
(a) That he or she has cover for under section 40; but
(b) That together are over 100% whole-person impairment.
59 Insurer not to assess entitlement until it receives medical certificate as to stability of insured's condition
59(1) The insurer must not assess the insured's entitlement to an independence allowance until the earlier of the following:
(a) The insurer receives a certificate from a registered medical practitioner indicating that—
(i) The insured's condition resulting from the personal injury has stabilised; and
(ii) It is likely that there is impairment resulting from the personal injury; or
(b) After 52 weeks have passed since the date of the personal injury, the insurer receives a certificate from a registered medical practitioner indicating that—
(i) The insured's condition resulting from the personal injury has not stabilised; but
(ii) It is likely that there is impairment resulting from the personal injury.
59(2) The insurer is liable to pay for the reasonable costs associated with the provision of a certificate under subclause (1).
60 Assessment of entitlement to independence allowance
60(1) The insurer must appoint, and pay, as many assessors as it considers necessary to do assessments under this clause.
60(2) An assessor assesses the insured's s percentage of whole-person impairment arising from each claim that is referred to the assessor for assessment.
60(3) An assessor must do the assessment after the insurer receives a certificate under clause 59(1).
60(4) In doing an assessment under this clause, an assessor must—
(a) Use the American Medical Association Guides to the Evaluation of Permanent Impairment (Fourth Edition) (subject to any regulations made under section 403(2)); and
(b) Exclude from the assessment any impairment that does not result from the personal injury for which the insured lodged the claim for cover.
60(5) The insurer must notify the insured of—
(a) The assessed degree of whole-person impairment; and
(b) The rate of independence allowance payable, if any.
60(6) The insurer must pay the reasonable costs associated with the assessment.
61 Reassessment of entitlement to independence allowance
61(1) Clauses 58 to 60 apply to reassessments under this clause.
61(2) The insurer must arrange for an assessor to reassess an insured if—
(a) The insured was assessed after the insurer received a certificate under clause 59(1)(b) and before the insurer received a certificate under clause 59(1)(a); and
(b) The insurer then receives a certificate under clause 59(1)(a).
A reassessment under this subclause is not a reassessment for the purposes of subclause (4) or subclause (6).
61(3) The insurer must arrange for an assessor to reassess an insured who produces to the insurer a certificate from a registered medical practitioner indicating that the insured's impairment may have increased since the date of assessment, but this subclause is subject to subclause (4).
61(4) An insured is not entitled to more than 1 reassessment under subclause (3) in any 12 month period.
61(5) The insurer must arrange for an assessor to reassess an insured if the insurer has a certificate from a registered medical practitioner indicating that the insured's impairment may have decreased since the date of assessment, but this subclause is subject to subclause (6).
61(6) An insured is not required to undergo more than l reassessment under subclause (5) in any 5 year period.
62 Weekly rates of independence allowance
62(1) An independence allowance is payable at the weekly rates set out in the following table:
62(2) The amounts specified in subclause (1) must be adjusted in the manner provided in section 103.
63 Payment of independence allowance
The following provisions apply to the payment of an independence allowance:
(a) The insurer is not liable to pay an independence allowance for any period before 1 July 1992:
(b) The insurer is liable to pay the independence allowance on and from the date on which the insured lodged the claim for cover for the personal injury from which the impairment results:
© The insurer is liable to pay the independence allowance quarterly in advance for any period after the completion of the assessment of the degree of impairment:
(d) The insurer must not take any action to recover the whole or any part of a quarterly payment of an independence allowance in respect of a quarter in which—
(i) The insured's impairment decreases; or
(ii) The insured's entitlement to an independence allowance ceases:
(e) An adjustment to the level of entitlement of the independence allowance necessitated by a reassessment under clause 61 takes effect on and from the date of the next quarterly payment:
(f) The insured's entitlement to an independence allowance he or she was receiving at the date of his or her death ceases on that date.

Read it all through before going tonext step.
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