Limitation of obligation for medical treatment

Where under these Regulations a person is required to submit himself to medical treatment he shall not forfeit or be disqualified for any benefit for refusal to undergo a surgical operation not being one of a minor character. 110 Social Security FIRST SCHEDULE [Regulations 40 and 44] RATES OF INJURY BENEFIT AND DISABLEMENT BENEFIT RATE OF INJURY BENEFIT 91 of 1991. 1. The weekly rate of injury benefit shall be eighty percent of the average insurable earnings of the insured persons and the amount payable for any day of incapacity shall be oneseventh of the weekly rate. 131 of 2000. AMOUNT OF DISABLEMENT GRANT 2. The amount of disablement grant shall be a lump sum equal to two hundred and sixty times the average insurable earnings times the degree of disablement. RATE OF DISABLEMENT PENSION 3. The weekly rate of disablement pension– (a) if the degree of disablement is assessed at one hundred per cent, shall be sixty per cent of the average insurable earnings of the insured person; (b) if the degree of disablement is assessed at more than twenty–four per cent but less than one hundred per cent, shall be a weekly rate equal to sixty per cent of the average insurable earnings times the degree of disablement as assessed: 91 of 1991. Provided that the minimum weekly rate of disablement pension in the circumstances described under 89 of 1998. Social Security 111 subparagraphs (a) and (b) above shall not be less than fortyseven dollars. AVERAGE INSURABLE EARNINGS 4. For the purposes of this Schedule, the expression “average insurable earnings” means– (a) where four or more contributions have been paid in respect of the person concerned before the relevant accident, the sum of the weekly earnings on which the last four contributions were paid dividend by four; (b) where sub–paragraph (a) does not apply but two or three contributions were paid in respect of the person concerned before the relevant accident, the sum of the earnings on which the contributions were paid dividend by two or three as the case may be; (c) where by reason of the shortness of the period during which the person concerned was employed before the relevant accident neither subparagraph (a) nor subparagraph (b) above applies, the average of the earnings on the basis of which four contributions were paid immediately before the relevant accident in respect of a person of similar earning capacity engaged in employment of the same nature and grade with the same employer, or if there is no such person with the same employer, with another employer in similar circumstances: Provided that where the actual average earnings in accordance with this paragraph of an employed person who has received retirement benefit under these Regulations 112 Social Security exceed seventy–five dollars per week, the average insurable earnings of such person shall be deemed to be seventy–five dollars per week. Meaning of “assessed” 5. In this Schedule “assessed” means, in relation to the degree of disablement, assessed in accordance with Regulation 43. Social Security 113 SECOND SCHEDULE [REGULATION 43] PRESCRIBED DEGREES OF DISABLEMENT COLUMN (1) COLUMN (2) Description of Injury Degree of disablement per cent 1. Loss of both hands or amputation at higher sites 100 2. Loss of a hand or a foot 100 3. Double amputation through leg or thigh, or amputation through leg or thigh on one side and loss of other foot 100 4. Loss of sight to such an extent as to render the claimant unable to perform any work for which eyesight is essential 100 5. Very severe facial disfiguration 100 6. Absolute deafness 100 7. Forequarter or hindquarter amputation 100 8. Total paralysis 100 114 Social Security 9. Loss of remaining eye by one–eyed person 100 10. Loss of remaining leg by one–legged person Amputation cases – upper limbs (either arm) 11. Amputation through shoulder joint 90 12. Amputation below shoulder with stump less than 20.5 centimetres from tip of acromion 80 13. Amputation from 20.5 centimetres from tip of acromion to less than 11.5 centimetres below tip of olecranon 14. Loss of a hand or of the thumb and four fingers of one hand or amputation from 11.5 centimetres below tip of olecranon 15. Loss of thumb 30 16. Loss of thumb and its metacarpal bone 40 17. Loss of four fingers of one hand 50 18. Loss of three fingers of one hand 30 19. Loss of two fingers of one hand 20 Social Security 115 20. Loss of terminal phalnax of thumb 20 Amputation cases – lower limbs 21. Amputation of both feet resulting in endbearing stumps 90 22 Amputation through both feet proximal to the metatarso–phalangeal joint 80 23. Loss of all toes of both feet through the metatarso–phalangeal joint 40 24. Loss of all toes of both feet proximal to the proximal inter–phalangeal joint 30 25. Loss of all toes of both feet distal to the proximal inter–phalangeal joint 20 26. Amputation at hip 90 27. Amputation below hip with stump not exceeding 13 centimetres in length measured from tip of greater trochanter 80 28. Amputation below hip and above knee with stump exceeding 13 centimetres in length measured from tip of great troch–anter, or at knee not resulting in end–bearing stump 70 116 Social Security 29. Amputation at knee resulting in end–bearing stump or below knee with stump not exceeding 9 centimetres 30. Amputation below knee with stump exceeding 9 centimetres but not exceeding 13 centimetres 50 31. Amputation below knee with stump exceeding 13 centimetres 40 32. Amputation of one foot resulting in endbearing stump 30 33. Amputation through one foot proximal to the metatarso–phalangeal joint 30 34. Loss of all toes of one foot through the metatarso–phalangeal joint 20 Other injuries 35. Loss of one eye, without complications, the other being normal 40 36. Loss of vision of one eye, without complications or disfigurement of eye ball, the other being normal Loss of: A. Fingers of right or left hand Index finger Social Security 117 37. Whole 14 38. Two phalanges 11 Loss of: 39. One phalanx 9 40. Guillotine amputation of tip without loss of bone 5 Middle finger 41. Whole 12 42. Two phalanges 9 43. One phalanx 7 44. Guillotine amputation of tip without loss of bone 4 Ring or little finger 45. Whole 7 46. Two phalanges 6 118 Social Security 47. One phalanx 5 48. Guillotine amputation of tip without loss of bone 2 B Toe of right or Left foot Great toe 49. Through metatarso–phalangeal joint 14 50. Part with some loss of bone 3 Any other toe 51. Through metatarso–phalangeal joint 3 52. Part, with some loss of bone 1 Two toes of one foot, excluding great toe 53. Through metatarso–phalangeal joint 5 54. Part, with some loss of bone 2 Three toes of one foot, excluding great toe 55. Through metatarso–phalangeal joint 6 Social Security 119 56. Part with some loss of bone 3 Four toes of one foot excluding great toe 57. Through metatarso–phalangeal joint 19 58. Part with some loss of bone 3 120 Social Security THIRD SCHEDULE [Regulation 58] LIST OF PRESCRIBED DISEASES AND INJURIES AND THE OCCUPATIONS FOR WHICH THEY ARE PRESCRIBED COLUMN (1) COLUMN (2) Description of Disease or Injury Nature of Occupation 1. Poisoning byAny occupation involving: The use or handling of, exposure to the fumes, dust or vapour of lead or a substance containing lead or a compound of lead. (1) Lead (2) Phosphorus The use or handling of, exposure to the fumes, dust or vapour of phosphorus, or a compound of phosphorus or a substance containing phosphorus. (3) Arsenic The use or handling of, exposure to the fumes, dust or vapour of arsenic, or a compound of arsenic or a substance containing arsenic. (4) Mercury The use or handling of, exposure to the fumes, dust or vapour of mercury, or a compound of mercury or a substance containing mercury. (5) Benzine or a homologue The use or handling of, exposure to the fumes of, or a vapour containing benzine or any of its homologues. Social Security 121 (6) Organic phosphates The use or handling of organic phosphates for the destruction of pests or vermin. Work in the forest or the manipulation of "poison wood" or any process in or incidental to the Manufacture of articles therefrom (7) Metopium brownei ("Black poison wood") or Cameraria belizensis stand ("savanna white poison wood") (8) Carbon monoxide gas Any process involving the use of – (i) dynamite and gunpowder for blasting in sub– terranean galleries; (ii) illuminating gas; (iii) power or producer gas; (iv) blast furnaces, furnaces and stoves for the burning of charcoal, coke and other fuel; (v) gas engines. (9) Carbon dioxide gas Any process involving blasting, the manufacture of mineral waters, fermenting in breweries and the formation of lime in lime kilns. Any process involving the production, liberation or use of halogen derivatives of hydrocarbons of the aliphatic series. (10) The halogen derivatives of hydrocarbones in the alip– hatic series. 2. Anthrax Any occupation involving:the handling of wool, hair, bristles, hides or skins or other animal products or residues, or contact with animals infected with anthrax. 122 Social Security 3. Glanders Contact with equine animals or their carcasses. 4. (a) Ulceration of the corneal surface of the eye (b) Localised new growth of the skin, papillomatous or keratotic The use or handling of, or exposure to tar, pitch, bitumen mineral oil (including paraffin) soot or any compound, product, or residue of any of these substances. (c) Epitheliomatous cancer or ulceration of the skin due in any case to tar, pitch, bitumen mineral oil (including paraffin–soot or any compound, product or residue of any of these substances. (d) Contact dermatitis due in any case to fertilizers, cement, waste chemi– cals, tar, pitch, bitumen, mineral oil (including paraffin), soot or any other compound, product or residue of these substances1 5. Inflamation, ulceration or malignant disease of the skin or subcutaneous tissues or of the bones or leukaemia or anaemia of the aplastic type, due to X–rays, ionising particles, radium or other radio–active substances. Exposure to X–rays, ionising particles, radium, or other radioactive substances or other forms of radiant energy 6. Inflation or ulceration of the skin or of the mucous membrance of the upper respiratory passages or mouth produced by dust, liquid or vapour (including the condition Exposure to dust, liquid or vapour. 1 This Schedule was amended by S.I. 108 of 1992 Social Security 123 known as chlor–acne, but excluding chrome ulceration. Manual labour causing severe or prolonged friction or pressure on the knee 7. Subcutaneous cellulitis of acute bursitis arising at or about the knee (Beat )(knee) 8. Subcutaneous cellulitis of the hand (Beat hand) Manual labour causing severe or prolonged friction or pressure on the hand. 9. Subcutaneous cellulitis of acute bursitis arising at or about the elbow Manual labour causing severe or prolonged friction or pressure at or about the elbow. 10. Inflammation of the synovial lining of the wrist joint and tendon sheaves Manual labour or frequent repeated movements of the hand or wrist. 11. [Repealed by S.I. 108 of 1999.] 12. Tuberculosis Any occupation involving close and frequent contact with a source or sources of tuberculosis infection by reason of employment: (a) in the medical treatment or nursing of a person or persons suffering from tuberculosis or in a service ancillary to such treatment or nursing: (b) in attendance upon a person or persons suffering from tuberculosis where the need for such attendance arises by reason of physical or mental infirmity; (c) as a research worker engaged in research in connection with tuberculosis; 124 Social Security (d) as a laboratory worker, pathologist or postmortem worker, where the occupation involves working with material which is a source of tuberculous infection, or in any occupation ancillary to such employment. 13. Dermatitis of the hand The sectionising and peeling by hand of citrusfruit. 14. Non–infective dermatitis of external origin (including chrome ulceration of the skin but excluding dermatitis due to ionising particles or electro– magnetic radiations other than radiant heat) Exposure to dust, liquid or vapour or any other external agent capable of irritating the skin (including friction or heat but excluding ionising particles or electromagnetic radiations other than radiant heat). 15. Brucellosis Contact with bovine animals, sheep and goats, infected by brucella organisms, their carcasses or parts thereof or their untreated products, or with laboratory specimens or vaccines of or containing brucella organisms, by reason of employment – (a) as a farm worker; (b) as a veterinary worker; (c) as a slaughterhouse worker; (d) as a laboratory worker; or (e) in any other work relating to the care, treatment, examination or handling of such animals, carcasses or parts thereof, or products including untreated milk. 16. Infectious hepatitis Any occupation involving close and frequent contact with source or sources of infectious hepatitis by reason of employment Social Security 125 (a) in the medical treatment or nursing of a person or persons suffering from infectious hepatitis or in a service ancillary to such treatment or nursing; (b) as a research worker engaged in research in connection with hepatitis; (c) as a laboratory worker, pathologist or postmortem worker, where the occupation involves working with material which is a source of hepatitis infection, or in any occupation ancillary to such employment. 17. Typhoid Any occupation involving close and frequent contact with a source of typhoid infection by reason of employment – (a) in the medical treatment or nursing of a person or persons suffering from typhoid fever or in a service ancillary to such treatment or nursing; (b) as a research worker engaged in research in connection with typhoid; (c) as a laboratory worker (including pathologist) or post–mortem worker where the occupation involves working with material which is a source of typhoid infection, or in any occupation ancillary to such employment 18. (a) Infection by leptospira icterohaemorrhagiae Work in places which are or are liable to be infected by rats; (b) Infection by leptospira cani– cola work at dogs kennels or the care or handling of dogs. Exposure to dust of mouldy hay or other mouldy vegetable produce by reason or employment 19. Pulmonary disease due to the inhalation of the dust of mouldy hay 126 Social Security (a) in agriculture, horticulture or forestry; or other mouldy vegetable produce and characterised by symptoms and signs attributable to a reaction in the peripheral part of the bronchopulmonary system, and giving rise to a defect in gas exchange (Farmer's Lung). (b) loading or unloading or handling in storage such as hay or other vegetable produce; or (c) handling bagasse. Handling, loading, and unloading cement. Construction industry and ancillary work places. Pulmonary disease due to inhalation of cement dust (cementosis)1 1 This Schedule has been Amended by Act. 108 of 1992 Social Security 127 FOURTH SCHEDULE [Regulation 48] I AUTHORISATION OF APPROVED PRIVATE MEDICAL PRACTITIONERS AND FACILITIES TO PROVIDE MEDICAL TREATMENT TO INSURED PERSONS WHO SUFFER FROM PRESCRIBED DISEASE OR INJURY ARISING FROM THEIR INSURABLE EMPLOYMENT 1. The Board shall be the purchaser of the medical treatment services provided to an insured person pursuant to Regulation 48 (1) of these Regulations. 2. Subject to the provisions of Regulation 48 of these Regulations and this Schedule, an insured person may seek medical treatment from any of the following medical treatment providers; namely– (a) Government or Private General Medical Practitioners; (b) Government or Private Medical or Surgical Specialists; (c) Government or Private Dental Practitioners; (d) Government or Private Physical Therapists; (e) Government or Private Pharmacies; (f) Government or Private Diagnostic or Imaging Services; 128 Social Security (g) Government or Private Laboratories; (h) Government or Private Hospitals or Clinics. 3.–The Board shall, subject to Regulations 48 and 58 of these Regulations and this Schedule, honour all payments for the treatment of prescribed diseases and/or injuries arising from an insured person’s insurable employment. 4.–Private medical practitioners or facilities providing medical treatment to insured persons pursuant to Regulation 48 and this Schedule shall: (a) in the case of private medical practitioners, be registered under the Medical Practitioners Registration Act and in possession of a valid practising certificate; CAP. 318. (b) in the case of private medical facilities, be accredited and recognised by the Ministry of Health; (c) first apply to the Board for registration by the Board as providers of medical treatment to insured persons pursuant to Regulation 48 and this Schedule; (d) first agree to the terms and conditions set out by the General Manager of the Board for participating in the provision of the medical treatment services to insured persons. 5. Government medical facilities and institutions referred to in subparagraphs (e) to (h) of paragraph 2 of this Schedule shall automatically upon the commencement of these Regulations be medical treatment providers. 6. Subject to Regulation 48(2), the Board will make payment to any Government pharmacy, or to any private pharmacy Social Security 129 which qualifies to dispense medications to insured persons pursuant to Regulation 48, for all medications dispensed in accordance with a prescription duly issued by an approved medical practitioner, dental practitioner, or a medical or surgical specialist, but payments for medications dispensed to an insured person without the requisite medical prescription shall only be allowed with the prior written approval of the Board, given by an officer of the Board designated in that behalf. 7. Subject to Regulation 48(2), the Board will make payment to any Government laboratory, or to any private laboratory which qualifies to offer laboratory examinations and tests to insured persons pursuant to Regulation 48, for all laboratory examinations and tests issued by such laboratory to an insured person on the recommendations of an approved registered medical practitioner, dental practitioner or a medical or surgical specialist, but payment for examinations and tests which are not recommended as aforesaid shall only be allowed with the prior written approval of the Board, given by an officer of the Board designated in that behalf. 8. Subject to Regulation 48(2), the Board will make payment to any Government diagnostic service facility, or to any approved diagnostic service provider, for all diagnostic services offered to an insured person on the recommendations of an approved registered medical practitioner, dental practitioner or a medical or surgical specialist, but payment for diagnostic services not recommended as aforesaid shall only be allowed with the prior written approval of the Board, given by an officer of the Board designated in that behalf. 9. Subject to Regulation 48(2), the Board will make payment for inpatient hospitalization services for insured persons requiring it due to prescribed disease or injury arising from the insurable employment. Payment for such services shall include payment for accommodation and meals at standard ward level rates, physician and nursing services, surgery, drugs and related preparations when administered in the 130 Social Security hospital, as well as laboratory and diagnostic services offered in the hospital, use of an operating room, anaesthetic facilities, surgical equipment and necessary supplies and equipment. The Board shall also make payment for outpatient fees for medical consultations required after hospitalisation. 10. The Board may cancel the approval given to any private medical provider referred to in paragraph 2 of this Schedule because of any unethical behaviour of such medical provider. II REFERRAL PROCEDURES A. FIRST CONSULTATION 11. All employees suffering a job–related prescribed disease or injury in the workplace shall consult a general medical practitioner in the first instance for evaluation, treatment and/or referral. 12. In cases where no general medical practitioner is available, any medical personnel may perform initial evaluation of the injured or sick person and then refer the insured person as deemed necessary to a specialist or to a general medical practitioner. 13. The employer or his representative, or the insured person, shall be responsible for paying for the first consultation but shall be reimbursed by the Board after confirmation that the prescribed disease or injury occurred at the workplace. 14. Subject to these Regulations, follow–up consultations shall require a purchase order from the Board. 15. Where the cause for first consultation is a job–related prescribed disease, the insured person shall present a purchase order from the Board. A medical report will be Social Security 131 required by the Board to substantiate the claim. If in the course of an examination the physician examining an insured person determines that the insured person’s prescribed disease is job–related in accordance with Regulation 58 and the Third Schedule hereto, the examiner will treat or refer the patient and provide the Board with a written medical report of his findings. 16. When on examination a general medical practitioner determines that the prescribed disease or injury is minor, he will prescribe treatment and follow–up consultation to the insured person. 17. Minor prescribed diseases or injuries will include those that– (a) are minimal injuries, not involving dental or maxillo-facial injuries or injuries to the cornea or the sclera; (b) do not involve injuries to tendons, ligaments and bones; (c) do not require hospitalization for their treatment; (d) may be resolved within a period of two weeks; or (e) require minimal diagnostic services (laboratory, X–rays, ultra–sonogram, (USG), etc.). 18. A general medical practitioner may order basic, relevant laboratory tests, X–rays and USG studies to aid in his diagnosis and determination as to whether to treat or refer the insured person. 132 Social Security 19. When upon assessment, the general medical practitioner determines that the insured person cannot be treated or does not fall within the categories specified in paragraph 17 above, he shall refer the insured person to a specialist registered with the Board pursuant to Regulation 48 of these Regulations for further treatment and examination. 20. Where additional services have been provided by the general medical practitioner, these shall be paid by the Board. 21. The general medical practitioner shall charge the Board, except in the case of a first consultation, for his services and shall for this purpose submit a purchase order of the Board, together with written medical reports when required (these may be required at a later date by the Board). Payments shall be made by the Board within five working days. B. REFERRAL TO A MEDICAL OR SURGICAL SPECIALIST 22. A general medical practitioner may refer a person to a medical or surgical specialist and such specialist shall evaluate, treat or refer for hospitalisation the insured person referred to him. 23. Upon referral under paragraph 22 of this Schedule, the insured person shall either present to the medical or surgical specialist a purchase order from the Board, or at his option elect to pay the expenses related to the treatment and claim reimbursement from the Board: Provided that in the case of emergency referrals, the employer or his representative shall be responsible for the payment and shall be reimbursed by the Board after confirmation that the prescribed disease or injury occurred at the workplace. Social Security 133 24. Upon receiving a person referred to him pursuant to paragraph 22 of this Schedule, the medical or surgical specialist shall thenceforth be the principal medical doctor of the referred person, unless he further refers such person to another specialist. 25. Where the prescribed disease or injury cannot be treated in Belize, it shall be the duty of the medical or surgical specialist to inform the Board without undue delay, but specialists shall as far as possible exhaust all possible treatment services available in Belize before informing the Board that treatment is not available in Belize. 26. Where the medical or surgical specialist considers it necessary, the insured person may be referred to a physical therapist for treatment. 27. Where the medical or surgical specialist considers it necessary, the insured person may be hospitalised for treatment; and the specialist may continue acting as the insured person’s principal medical doctor. 28. Where the medical or surgical specialist acting as Principal Medical doctor considers it necessary, he may refer the insured person to a consultant medical or surgical specialist who shall assist him in the diagnosis and treatment of the insured person. For purposes of payment by the Board, a written request by the medical or surgical specialist to the consultant shall suffice if the insured person is hospitalised, but in cases of ambulatory insured persons, the medical or surgical specialist shall first advise the Board in writing before referring the insured person to the consultant, and a purchase order from the Board shall be issued thereafter to cover the cost of treatment. 29. In the case of ambulatory insured persons referred to in paragraph 28 of this Schedule, the consultant medical or surgical specialist shall charge the Board for his services and for this purpose shall attach a written certificate of the 134 Social Security referring specialist or the purchase order of the Board, as the case may be, together with written medical reports of the insured person. The Board shall make payment to the consultant within five working days after receipt of the consultant’s invoice. In the case of hospitalized insured persons referred to in paragraph 28 above, the consultant shall submit his invoice to the hospital or clinic which in turn shall submit such invoice to the Board for payment. C. REFERRAL TO A DENTAL SPECIALIST 30. An approved general dental practitioner shall evaluate, treat, refer or hospitalize an insured person referred to him by an approved medical practitioner, medical or surgical specialist, or the Board. 31. In normal circumstances, the insured person seeking treatment shall present to the approved general dental practitioner a purchase order from the Board, but in cases of emergency the insured person or his employer or the employer’s representative shall make payment for such treatment and claim a refund for the treatment expenses from the Board, after confirmation that the prescribed disease or injury occurred at the work place. 32. A dental practitioner may attend to an insured person as an ambulatory patient or as a hospitalized patient upon the written request of the medical doctor treating the insured person. 33. An approved general dental practitioner may perform urgent dental treatment required for teeth extractions, suturing of wounds in oral cavity, and reduction of fractures. 34. Where an approved general dental practitioner is of the opinion that maxillo–facial surgery is necessary, or that a dental specialist is required in a specific case, he shall refer the insured person to a surgical or dental specialist and inform Social Security 135 the doctor who referred the insured person to him accordingly. 35. Where an approved general dental practitioner is of the opinion that the treatment of an insured person requires prosthesis, or special procedures and services such as root canal treatment, or orthodoncy in order to re–establish the adequate functioning of the mouth, and he is further of the opinion that such treatment is not of an urgent nature, he shall first submit to the Board an evaluation and cost estimate of the treatment for prior approval by the Board before performing the treatment or referring the insured person to a specialist dental practitioner. 36. In the case of ambulatory insured persons referred to an approved general dental practitioner, the practitioner shall charge his services to the Board, and for purposes of payment shall attach to his invoice a written certificate from the referring doctor or a purchase order from the Board together with the written medical reports’ of the insured person. In the case of hospitalized insured persons, the approved general dental practitioner shall submit his invoice to the hospital, which in turn shall forward the invoice to the Board for payment. Payment shall be made within five working days. D. REFERRAL TO A PHYSICAL THERAPIST 37. An approved medical doctor may refer an insured person under treatment for a prescribed disease or injury to an approved physical therapist, and the therapist shall evaluate the condition of the insured person. 38. An approved physical therapist may upon the request of an approved medical doctor attend to an insured person suffering from a prescribed disease or injury as an ambulatory patient or as a hospitalized patient. 136 Social Security 39.–After initially attending to an ambulatory insured person referred to him pursuant to paragraphs 37 or 38 of this Schedule, the approved physical therapist shall make an evaluation based on his observations and the comments of the medical doctor who referred the ambulatory insured person, and immediately thereafter design a plan of treatment and a cost estimate for such treatment which shall be approved by the medical doctor and referred by the doctor to the Board for prior approval before the treatment programme begins. 40. On the completion of the treatment programme, the approved physical therapist shall refer the insured person back to his medical doctor for evaluation. 41. In cases where the insured person is hospitalized, the medical doctor may request an approved physical therapist to attend to the insured person, and the Board shall meet the cost of treatment provided by the approved physical therapist. 42. In cases of ambulatory insured persons, the approved physical therapist shall make an invoice payable by the Board, and for the purposes of payment shall attach thereto the written request of the referring medical doctor, or the purchase order of the Board, together with written progress reports of the patient when required (these may be required by the Board at a later date). In cases of hospitalized insured persons, the physical therapist shall make an invoice payable by the Board, and submit it to the hospital, which in turn shall submit it to the Board for payment. Payment shall be made within five working days after receipt of the invoice. E. PHARMACIES 43. An approved pharmacy may dispense medications to an insured person under treatment for a prescribed disease or injury in the following circumstances and using the following procedures; namelySocial Security 137 (a) the prescription shall be written by any of the medical personnel referred to in subparagraphs (a) to (c) of paragraph 2 of this Schedule; (b) the prescription forms shall be in triplicate, duly signed, and with the official seal and address of the medical personnel referred to in paragraph (a) above who issued the prescription; (c) each of the three prescription forms shall bear a caption that it is issued under the “Belize Social Security Board Injury Benefits Schedule”; (d) of the three copies, one copy shall be given by the pharmacist to the insured person, one copy shall be retained on record by the pharmacy and the original copy shall be submitted together with the pharmacy’s invoice to the Board for payment purposes. 44. Bills for medications dispensed by approved pharmacies within hospitals shall be submitted to the Board by the hospital upon the discharge of the insured person. 45. Payments shall be made by the Board within five working days of the receipt of the pharmacy’s invoice by the Board. F. DIAGNOSTIC SERVICES 46. An approved provider of diagnostic services may provide such services to insured persons under treatment from a prescribed disease or injury under the following circumstances and using the following procedures; namely: 138 Social Security (a) the diagnostic services shall be done on the written request of any of the medical personnel referred to in subparagraphs (a) to (c) of paragraph 2 of this Schedule; (b) diagnostic services may be performed for insured persons treated as ambulatory or hospitalized patients; (c) a requisition form for the diagnostic services shall be in duplicate and written by any of the medical personnel referred to in paragraph (a) above requesting such services, duly signed, and with the official seal and address of the medical personnel requesting such services; (d) each of the two requisition forms shall bear a caption that it is issued under the “Belize Social Security Board Injury Benefits Scheme”; (e) a copy of the requisition form shall be retained by the diagnostic service provider on record, and the original thereof shall be submitted together with the providers’ invoice to the Board for payment purposes. 47. Bills for diagnostic services performed by diagnostic service providers within hospitals shall be submitted to the Board by the hospital upon the discharge of the insured person. 48. Payments shall be made by the Board within five working days of the receipt of the providers’ invoice by the Board. Social Security 139 G. LABORATORIES 49. An approved laboratory may perform diagnostic services requested by the medical personnel referred to in subparagraphs (a) to (c) of paragraph 2 of this Schedule in respect of insured persons under treatment for prescribed diseases or injuries under the following circumstances and in accordance with the following procedures; namely– (a) diagnostic services may be performed for insured persons who are treated as ambulatory or hospitalized patients; (b) a written requisition form in duplicate shall be signed by the medical personnel referred to in subparagraphs (a) to (c) of paragraph 2 of this Schedule requesting the diagnostic services and each form shall be duly signed, have the official seal and address of the medical personnel requesting the services and provide that it is issued under the “Belize Social Security Board Injury Benefits Schedule”. (c) the original requisition form shall be submitted to the Board together with the diagnostic service providers invoice for payment purposes, and the duplicate shall be retained by the provider on record. 50. Bills for laboratory services performed within hospitals shall be submitted to the Board by the hospital upon the discharge of the insured person. 51. Payments shall be made by the Board within five working days of the receipt of the provider’s invoice by the Board. 140 Social Security H. HOSPITALIZATION 52. An insured person suffering from a prescribed disease or injury arising from his insurable employment may be hospitalized and attended to by any of the medical personnel referred to in paragraph 2 of this Schedule and, when so attended, the attending medical doctor shall be the principal treatment doctor of the insured person during and after hospitalization, and for referrals relating to diagnostic and rehabilitation services, unless stated otherwise by the doctor or the insured person. 53. Upon discharge of the insured person from hospital, the Board shall pay for the treatment services offered to the insured person, including payments to treating specialists and other consultants. Such payments shall be made within five working days after the receipt by the Board of the medical providers’ invoice. I. CHOICE OF PROVIDERS 54. The choice of medical providers shall primarily be the responsibility of the insured person, acting on the advice of his treating specialist or medical practitioner. J. GENERAL 55. All other services, medications, etc., which may be required by the insured person but are not specifically authorised by the medical practitioner shall require the prior written approval of the Board, and the Board may in appropriate cases refuse to make payment where the Board’s prior written authorization was not obtained.