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11.3.2 Choosing a doctor to advise the Delegate

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DVA engages Contracted Medical Advisors (CMA) to assist in the timely consideration of claims. 

 

CMA advice can and should be used where appropriate. Depending on the circumstances, it may be sufficient to disallow a claim if the weight of all available evidence led the delegate to conclude that there was no liability.

 

Note that, for the purposes of establishing the diagnosis and causation of a disease, the opinion of a medical specialist – i.e. a specialist in the medical field relating to the disease – is to be sought in preference to a General Practitioner. Reports from General Practitioners provided by the client and forwarded with the claim form in disease cases, should be noted but are not usually accepted as definitive.

Furthermore, in most cases, the medical opinion of the client's treating medical specialist is (at least initially) to be sought in preference to other (i.e. consultant) specialist medical opinion.

 

This is because the various appeal forums (AAT, Federal Court) generally give greater credence to the opinion of a specialist who has seen the client over a period of time and for the purposes of treatment, rather than a consultant who has seen the person only once and only for the purposes of writing a report.

 

In the case of a client who is still serving, and as a rare exception to this general rule, it may be sufficient to address the standard 'liability questionnaire' to GPs within the ADF Health Service unit responsible for that client's case management. (Note: This applies to cases when there has been as yet no specialist involvement.)

 

This is particularly valuable in cases where there is little delay between injury or onset of a disease and the claim for compensation. In that case, the current treating ADF doctor is likely to be the person to whom the symptoms were first reported, and may have further information relating to the circumstances surrounding causation.

 

Nevertheless, where the ADF Health Service has already referred a serving member to a consultant medical specialist, the liability questions should be referred to that specialist for response, i.e. rather than to the GP-staffed Health Service. Note that since the MRCA came into effect on 1 July 2004 all injuries sustained as a result of service since that time will come under that Act resulting in most claims under the SRCA in respect of an injury being already some years' old.

 

Where the member has discharged, the Delegate should usually address the liability questions to the current (i.e. civilian) treating specialist.

 

However, this does not mean that the Delegate may not also refer to a specialist consulted by the ADF whilst the member was still serving. Indeed, in some circumstances clarification of the medical reports current at the time of injury or onset of the disease, may be vital to the outcome of the case.

 

However, it frequently happens that a client does not have a treating specialist. Also, but more rarely, there may be a treating specialist but the Delegate may be unsatisfied with that doctor's response. In either case, the Delegate may need further medical advice to make an informed decision on liability.