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Investigation of a Claim
Last amended: 7 November 2012
What is the purpose of investigation?
Investigation of a claim is a significant part of the determination process because it establishes the basis on which a decision is made. As service pension and income support supplement are income support (welfare) payments, it is the duty of the officer processing the claim, to ensure that claimants receive the full benefits permitted by the VEA, and that these are made available with the minimum of delay.
Investigation of a proper claim
If a person makes a proper claim an investigation is to be made into the matters to which the claim relates. In investigating a claim, it is necessary to gather sufficient evidence or documents to enable the decision-maker to determine the claim. The information gathering process need not be exhaustive.
Where there are barriers to a person being able to provide original documents or certified copies to support a claim, a delegate may decide that uncertified copies can be submitted. This is consistent with the department's corporate plan which states that we assess the risk of non-compliance and differentiate our response by taking individual circumstances into account. The delegate must be reasonably satisfied that, on the balance of probabilities, the copies are true copies of an original, that they have not been altered, and that they accurately reflect a pensioner's circumstances.
Once a proper claim is lodged, the Secretary will investigate the claim and submit the claim to the Commission for investigation and determination.
Investigation of a disability pension application
Investigation and processing of disability pension, increase in disability pension, war widow's/widower's or orphan's pension claims can take up to three months or longer. This time is required to:
- get service documents from the Department of Defence if it is a first time claim,
- allow the department to gather further information about the veteran's personal and medical histories if necessary, and
- conduct further medical examinations, if necessary, for people claiming disability pension, or an increase in disability pension.
Delegates should refer to Commission Guidelines for Psychiatric compensation claims available in the Reference Library.
The fee schedule for Psychiatrists for the preparation of reports for compensation claims is available on the internet at http://www.dva.gov.au/service_providers/Fee_schedules/Pages/psych.aspx
Payment of expenses
A person required to attend an interview or examination in connection with a claim may be paid prescribed travelling or accommodation expenses.
Refusal to undergo medical examination
Where a claimant refuses to undergo a medical examination or provide information for the investigation of the claim, the Commission can defer consideration of the claim if they believe that the examination or information is likely to affect the determination. Consideration of the claim can be deferred until the claimant undergoes the examination or provides the information. If the claimant does not comply after six months from the date they were notified of the deferral, the claim is deemed to be refused.