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13.3.2 Making a decision to suspend benefits
attend medical or other assessments of their capacity to undertake a rehabilitation program when DVA requests that they do so; and
fully participate and cooperate in their rehabilitation program.
If the client fails to meet these obligations without reasonable excuse, their compensation payments may be suspended. The client’s entitlements to medical treatment will not be affected, even if the compensation payments are suspended.
Suspension of compensation payments should be an option of last resort and should only take place where all reasonable steps have been taken to resolve the issue of non-compliance with the rehabilitation process.
It is important that the Rehabilitation Coordinator takes a whole-of-person approach when working to resolve issues of non-compliance. This includes being aware of other issues that may be impacting on the client’s willingness to undertake a rehabilitation assessment or their ability to participate in their rehabilitation program in a positive way. For example, the client may have lodged a claim for permanent impairment payments, which is taking some time to resolve, and may be impacting on their ability to focus positively on working towards their rehabilitation goals, or to engage positively with the department. Where there are concerns raised about a client’s participation in the rehabilitation program, it is important that the Rehabilitation Coordinator develops a clear understanding of the client’s circumstances by:
- liaising with members of the compensation teams who are managing any outstanding claims that the client has lodged;
- liaising with the client’s treating health professionals to build a more complete understanding of the client’s circumstances;
- liaising with the client’s rehabilitation provider to gain an understanding of "where the client is at" and why there are issues with participation in their rehabilitation program; and
- discussing any concerns that they have directly with the client, to gain an understanding of the issues that the client is concerned about.
Where a client presents a reason for their non-compliance, the Rehabilitation Coordinator must consider whether the client had a reasonable excuse for their failure for meet their obligations. Any reasons provided by the client should be acknowledged, and if not considered valid, a warning letter with clear information as to why the reason is not considered valid, and the potential consequences of their non-compliance must be sent to the client.
It is mandatory that R&C ISH standard letters are used when communicating with clients about potential non-compliance. Letters generated from R&C ISH will automatically attach to the client’s UIN folder in TRIM.
If a decision is made to suspend compensation entitlements, this must be communicated to the client in writing, outlining the reasons for the decision. It is mandatory that R&C ISH standard letters are used when communicating with clients about non-compliance with their rehabilitation participation. Letters generated from R&C ISH will automatically attach to the client’s UIN folder in TRIM.
The power to suspend compensation payments (but not access to treatment) due to non-compliance is delegated to different APS levels under the MRCA and SRCA. It is vital that the determination letter to the client is signed by a DVA delegate at the appropriate APS level.
Section 2.9.2 of the Rehabilitation Policy Library explains who has the power to suspend a client's compensation payments under sections 50(1) and 52(1) of the MRCA.
Section 2.9.1 of the Rehabilitation Policy Library explains who has the power to suspend compensation payments under sections 36 and 37 of the SRCA.
The incapacity delegate will receive an alert through R&C ISH when a plan is closed due to non-compliance. It is essential that the Rehabilitation Coordinator liaise with the client’s compensation delegates, particularly the incapacity delegate, to ensure that they are fully aware of any actions that must be taken.
Reinstatement of compensation payments
Once a decision is made to suspend compensation entitlements, a client loses the right to claim retrospective entitlements for the period of suspension. Entitlements can only be reinstated on and from the date upon which the person actually becomes compliant with their rehabilitation obligations.
A determination to reinstate benefits following suspension must be provided, by the incapacity delegate, to the client in writing, outlining the reasons for the determination. Delegates are asked to refer to information in chapter 11.2 of the Incapacity Policy Manual for specific information about reinstatement about incapacity payments. Section 2.9.2 of the Rehabilitation Policy Library explains who has the power to reinstate a client's compensation payments under the MRCA.
It is essential that all actions are clearly documented in R&C ISH and any relevant documentation is uploaded as an attachment to the client’s R&C ISH case.
The importance of thorough and complete documentation is imperative in this process. If an activity is not documented it will be seen as not having occurred. The chain of evidence is broken and the activity cannot be substantiated. It is mandatory that R&C ISH standard letters are used when communicating with clients about suspension and reinstatement of compensation payments. Letters generated from R&C ISH will automatically attach to the client’s UIN folder in TRIM and any other relevant correspondence should be uploaded as an attachment to the client’s R&C ISH case.