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20.6.1 Medical certificate/opinion quality checklist

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A medical opinion should never be rejected lightly. However delegates should certainly consider seeking further or alternate information where, for instance:

  • the terms of a medical certificate are directly contradicted by documented work performance in a rehabilitation work trial, or some other documented activity (i.e. published sporting results)
  • the report or certificate is internally inconsistent (i.e. self contradictory) and/or is anomalous with respect to other medical opinions on file
  • a medical report is written in an emotive way and discusses irrelevant matters that suggest the author has adopted an advocate's role rather than that of an objective medical assessor
  • the report's findings on medical fact, conflicts with what the same medical assessor has written in relation to that client's case for a VEA pension
  • the medical data and observations contained in the report conflicts markedly with what other medical assessors have found, i.e. is contrary to assessments conducted for insurance or Centrelink purposes
  • medical opinion is not based on first hand information or on a medical examination conducted by the author
  • an advocate supports an initial request for incapacity payments with a report by a medical examiner who is not the treating specialist nor the treating GP
  • the medical report purporting to support the request for weekly payment is not current i.e. it is much older than the claimed period of incapacity
  • the report (Note: Not a simple certificate) is an almost word-for-word 'cut and paste' copy of reports received from the same practitioner, but in relation to other clients (and/or other conditions!)

This is not an exhaustive list. In fact a delegate may challenge a medical opinion and/or seek another opinion on any reasonable ground. This may include the perception that that current medical examiner has been treating the client and certifying the incapacity over some considerable time without apparent change, and although there are no specific problems with that advice or treatment, a second opinion would be prudent.