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50.6 1st General Review (client has reached 6 cumulative pay periods)

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If not already provided since the commencement of incapacity payments, a treating specialist report is required to confirm the incapacity. Exceptions to this rule are:

  • Where there is an ongoing current rehabilitation plan (return to work (RTW) plan).
  • Where the client is participating in a Rehabilitation plan the responsibility for obtaining any further medical certification lies with the Rehabilitation Coordinator.
  • 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 from an independent specialist is appropriate.

 

An Ongoing Payee Incapacity Checklist is to be completed at this stage and a copy put on the file.  This checklist asks a variety of questions aimed at ensuring the client is entitled to Incapacity, is being paid at the correct rate, has been referred to or assessed for Rehabilitation, has an end date in PMKeyS, and that we have up to date information. With regard to the question about the Review of Compensation Payments, it is not mandatory to send the review form to the client at the first general review if the client is actively engaged with DVA, and the relevant up to date information necessary to complete the review is available on the file.

 

For instance, during this 12 week time, DVA have sought rank and pay group confirmation from Defence via SAM, correct the Commonwealth Superannuation Corporation entitlement confirmation from the Commonwealth Superannuation Corporation, employment and education details (if required) have been obtained from the client or via the rehabilitation process.  Dependant details may not be necessary to complete this review.  Delegates are to document answers to the ongoing payee checklist justifying their responses, particularly if they have established there is not a requirement to action one or more of the questions.