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20.7.5 Ongoing General Review (26 pay period review)

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Treating Specialist report is required to confirm/reconfirm the incapacity.

Exceptions to this rule are:

  • There is no treating specialist, there is no active treatment plan, where for whatever reason the treating specialist is not suitable or able to provide medical evidence or the circumstances of the claim are particularly complex or contentious. In these circumstances, a report by an independent specialist is appropriate.
  • Where we already have contemporary credible specialist medical opinion covering the ongoing incapacity (based on previously advised specialist review date).
  • Where there is an ongoing current rehabilitation plan (RTW plan).
    Where the client is participating in a Rehabilitation plan the responsibility for obtaining any further medical certification lies with the Rehabilitation Coordinator.
  • Where the client has been assessed to be Chronically Incapacitated Category A or B (see reference below).