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220.127.116.11 Interim Transitional cases
An initial interim transitional determination is processed in the same manner as a determination based on a person with stable conditions with the exception of the applicable lifestyle factor to be used.
Where interim compensation has been paid and the client is being reassessed due to the stabilisation of all of their conditions (i.e. under section 75(4)), the relevant PI claim date to be used for the purposes of determining which VEA and/or SRCA conditions (and related payments) are included and/or excluded from the assessment is, the date of the last MRCA PI claim:(i.e. the date of the most recent PI claim that resulted in an assessment, immediately preceding the section 75(4) reassessment). Refer to the example in Chapter 5.8.6 of this manual for further clarification on what is considered the last MRCA PI claim for these purposes.
For the purposes of transitional PI claims, this means that the PI claim date, which is used to determine what VEA and/or SRCA conditions and related payments are included and/or excluded from the calculation, is the date of the initial interim PI claim. However, if the client has lodged further PI claims since the initial interim PI claim which have resulted in an assessment, the PI claim date to be used for the purposes of determining which VEA and/or SRCA conditions (and related payments) are included and/or excluded from the assessment, is the date of the last MRCA PI claim preceding the s75(4) determination
For example, a transitional client lodges a PI claim on 13 July 2011 which results in payment of interim compensation due to one condition being unstable. On 26 March 2012, the client lodges another PI claim based on new conditions which results in an additional payment of interim compensation. The client lodges a further PI claim on 18 September 2012 based on a worsening of existing conditions but does not meet the required impairment point threshold for payment of additional interim compensation. On 9 December 2012, all of the client’s conditions stabilise and a reassessment is undertaken under section 75(4). For the purposes of determining what VEA and/SRCA conditions and related payments are included/excluded in the reassessment, the last MRCA PI claim date is 26 March 2012.
Please note that where interim PI has been paid, the client is not required to lodge a claim in order for their impairment to be reassessed upon stabilisation of their conditions (see Chapter 5.8.6 for more information on this).