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20.7.4 Medical Certification between standard review points


For intermittent periods between standard review points (at which point we would have a specialist opinion) a certificate from a qualified medical practitioner is satisfactory.

For ongoing continuous incapacity, supported by specialist medical opinion, no further certification is required until the next scheduled specialist review. Reviews for ongoing continuous Incapacity, once a specialist medical opinion has been initially received, can be completed by the client's treating GP.

Where the client is participating in a Rehabilitation plan the responsibility for obtaining any further medical certification lies with the Rehabilitation Coordinator.

In keeping with the Department's Compliance Model, clients should be given every assistance in meeting their obligations before any action is taken to remove benefits.

Current practices surrounding the provision of advanced warning to clients that their medical certificates are soon to expire (and that a new certificate is required for any subsequent period of incapacity) vary from state to state.  The procedure below aims to ensure a nationally consistent process to remind incapacity clients of their compliance obligations to provide medical certification for periods of incapacity.

Determination letters issued in respect of each period of incapacity should:

  • Be clear that incapacity payments are made on the basis of finite periods in line with medical certification;
  • Ensure that the end date is clearly stated and highlighted using bold text;
  • Include the date by which a new certificate is to be supplied to DVA in time to continue payments if required; and
  • Delegates should ensure these dates are consistent with PMKeyS cut off times.

A system-generated task appears in Defcare 28 days before a client's current period of incapacity is due to expire.  Where the client is in receipt of ongoing incapacity payments, they are to be contacted via telephone and reminded of the requirement to provide new medical certification to enable the payment of incapacity benefits beyond the existing period.  If the client has been sent an SMS reminder, and the medical certificate has not been received, the telephone contact should take place two weeks after the SMS was sent. The resubmit date in the Task should be adjusted to reflect this.

Where attempts have been made to telephone the client, but these have proven unsuccessful, a reminder letter is to be sent, requesting the provision of a further medical certificate in time for incapacity payments to continue without interruption.

This timeframe should allow a client to provide the required documentation in time for incapacity payments to continue without interruption.

It is important that payments are ceased where the client does not provide the required certification by the end date specified both in the original determination and reminder letters. Failure to cease payments in these circumstances will result in an overpayment.

These steps are to be followed for all cases and will be of particular value in cases where the client is providing less frequent certification over longer periods of time.  In these situations there is an increased risk that the client will forget to provide appropriate documentation within the timeframe required.