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9.13 Streamlined access to incapacity payments
Streamlined access to incapacity payments
The streamlined access to incapacity payments initiative was a 2017/18 Budget measure. It will ensure that veterans with mental health conditions accepted under the Military Rehabilitation and Compensation Act 2004 (MRCA) are provided with income replacement compensation as soon as possible should they be unable to continue to work due to their mental health conditions. This measure includes ongoing access (for up to 12 months) to rehabilitation services enabling a smoother transition when veterans find themselves in and out of employment or they need to reduce their hours of work because of their accepted DVA conditions.
At present, a client’s rehabilitation plan generally remains open for a period of approximately three months after the client returns to work as a result of participating in a vocational rehabilitation plan. This ensures that support is available, should the client experience any difficulties in managing their employment role. This period is flexible, and dependent on the individual client’s needs and circumstances.
During this period of monitoring, a new claim for incapacity payments is not required if the client needs to cease their employment or reduce their hours, because of their accepted conditions. Rather, the Rehabilitation Coordinator will liaise with the client’s incapacity claims manager to ensure that incapacity payments can be reactivated.
The streamlined access to incapacity payments measure
The streamlined access to incapacity payments measure extends the period of rehabilitation assistance and monitoring for specific clients:
- who have secured employment after participating in a DVA rehabilitation plan; and
- may be particularly vulnerable to experiencing difficulties in managing and maintaining employment because of mental health conditions for which DVA has accepted liability under the MRCA; and
- would benefit from additional support as they test their ability to return to, and maintain employment.
It is not intended that all clients with episodic mental health conditions will be automatically eligible for support under this measure.
Through this initiative, specific clients who may be at risk of moving in and out of employment may be considered for a continuation of their rehabilitation plan up to a maximum of 12 months. This will enable their incapacity payments to be quickly recommenced if their capacity for employment is affected by a change in the symptoms of their accepted mental health condition(s). This ongoing rehabilitation assistance enables a smoother transition in and out of work because income replacement will be provided as soon as possible if the client needs to leave, pause, or reduce the hours of their employment due to the episodic nature of their accepted mental health condition(s).
Intent of the initiative
The streamlined access to incapacity payments initiative is intended to provide increased support to clients who are testing their ability to return to work, or concerned that they may experience financial stress if they need to leave their employment because of their accepted mental health conditions. This initiative is guided by evidence about the health benefits of good work, which stresses that employment is as much part of a person’s recovery from injury, as it is a positive outcome of rehabilitation. Many of DVA’s rehabilitation success stories highlight how important work has been in helping veterans get their life back on track after a service related injury or disease.
The streamlined access to incapacity payments initiative is designed to support clients who have accepted an offer of employment. It is expected that rehabilitation providers will have been diligent in ensuring that the client has the best opportunity to be successful in their return to work and that the rehabilitation provider and the client have worked together to ensure that there is a good match between the client’s needs, skills, expectations and experience and the job that they have been offered. This helps to ensure that the client has the best possible chance of their return to work being sustainable. Issues that should be worked through as a starting point include:
- the client’s attitude to their employer (e.g. are there trust issues, how health literate the employer is, are they aware of how military culture can impact on the person’s interactions/expectations in a work place, their willingness to provide assistive equipment or other modifications);
- the likelihood that the client will experience a level of job satisfaction from a personal perspective from their employment role;
- the client’s ability to perform work tasks and develop skills to enable them to fulfil their work role (including both the client’s and the employer’s perspective);
- the client’s individual needs/ values – look at what they are, if they are they being met, if they can be met in that work role, or with that employer; and
- the potential impact of any changes in the client’s condition(s) which may result in a work, health and safety risk for the client and/or their workmates.
If there are any concerns about any of these issues, then it is expected that the client and the rehabilitation provider will discuss these in detail, and develop strategies for managing any potential difficulties that may arise. Undertaking this process may help to resolve whether a particular job is a suitable option, or whether it may be better for the client to be looking for an alternate role or employer. It is acknowledged that this process is part of a business as usual approach for a client who is participating in a vocational rehabilitation plan. However, these highlighted issues have the potential to create greater difficulties for clients who may be hesitant to return to employment because of their concerns about their mental health.
The next step is to identify what support the client may require when they return to employment. If a rehabilitation provider is concerned about the client’s capacity to manage their work role and/or believes that they may require additional support for a longer period, then they can be considered for the streamlined access to incapacity payments initiative.
Who may be provided with streamlined access to incapacity payments?
Clients with accepted mental health conditions under the MRCA are eligible for this additional support. Rehabilitation providers are therefore expected to check this, before they recommend a client for this additional support, or discuss this initiative with the client.
There are no barriers to a client being able to participate in the streamlined access to incapacity payments initiative on more than one occasion.
There are many individual differences in the way that mental health conditions impact on a person’s life. For example, having a particular diagnosed condition may manifest in an episodic flare of mental health symptoms for some clients which impacts on their ability to manage in a workplace. In contrast, another client with the same condition(s), who has developed a range of strategies and skills to manage their symptoms effectively may not require a break from their employment. Therefore, rather than this initiative applying to all clients with mental health conditions, a ‘flag’ system has been developed, to identify issues that may place a client at risk of effectively managing employment, because of the impact of their mental health conditions. These ‘flags’ for clients are noted below and include, but are not limited to:
- reduced cognitive function (including concerns about the person’s ability to process information and effectively undertake tasks required for their work role);
- interpersonal function (including a likely reduced ability to work collaboratively as a member of a team, or to manage any conflict in a workplace , a lack of coping strategies, or limited supports that a person may have available to them);
- medication and drug use (e.g. is the person struggling to find the right combination of medication to stabilise their symptoms, are they requiring maximum levels of medication to be able to function in a work role, are they experiencing side effects which may impact on their work role);
- affect/mood (including reduced energy level, decreased motivation, increased pain levels, a lack of resilience, and concerns about work goal orientation and commitment);
- personal confidence (including a lack of confidence for the specific work role and for returning to work generally);
- personal defensiveness (including a sense of injustice, or concerns about condition stigma);
- health literacy (including concerns about the client’s understanding of their personal health conditions, management of their symptoms and the course of the condition);
- lifestyle balance (including sleep issues, social isolation and a lack of positive recreation activities or other commitments which may make it challenging for them to be able to maintain a healthy lifestyle which includes work);
- whether the client has co-morbidities, including non-accepted conditions, which may add to the complexity of managing their employment obligations;
- the client’s attitude to the behaviour of supervisors and co-workers – indicating concerns about their ability to maintain positive working relationships with others; and
- the client’s current capacity to work in a team – do their behaviour/actions match what is expected in the workplace, their style of interaction in the workplace, the client’s relationship problem solving skills etc.
Where a client has an accepted mental health condition, and the rehabilitation provider and the client identify any issues in the above flags that are likely to make them vulnerable in an employment setting, then they are expected to discuss this with the Rehabilitation Coordinator.
Early identification of these flags and pro-active management of issues is more likely to result in the client better handling their situation and recovering sooner. Identifying these issues quickly can also enable whole-of-person rehabilitation support to be provided, which may help the client to overcome some of their concerns about managing their work role. For example, brief intervention counselling to assist the person to develop strategies to manage their pain more effectively may give them confidence to be able to manage pain or discomfort in a workplace.
DVA’s expectations of clients accessing support through this initiative
It is important that clients accessing additional rehabilitation support are:
- motivated and ready to attempt a return to employment;
- willing to continue to participate in whole-of-person rehabilitation activities approved under their extended rehabilitation plan that may assist in making their return to work more sustainable;
- happy to be contacted by their rehabilitation provider on a regular basis while their extended rehabilitation plan remains open;
- agreeable to their rehabilitation provider contacting their health providers, and/or their employer to seek information about issues where it is appropriate for them to do so, try to resolve difficulties with their employment role, or access documents from their employer to ensure that their incapacity payments can recommence as quickly as possible if they need to reduce their hours or cease employment;
- prepared to address issues that may arise during their employment, and being proactive in seeking out and using strategies that may help them to remain in employment for as long as they are able to;
- committed to contacting their rehabilitation provider as soon as they begin to experience difficulties in their work role, or relationships with employers or co-workers, or a change in their mental health symptoms;
- agreeable to visiting their GP, psychologist, psychiatrist or other appropriate medical specialist if they begin to experience an increase in the symptoms of their accepted mental health conditions;
- prepared to access appropriate treatment during the period that they are away from work, or working reduced hours; and
- willing to contact their rehabilitation provider when they are comfortable for their extended rehabilitation plan to be closed, as they feel that they are managing their employment effectively.
Participation in the streamlined access to incapacity payments initiative is voluntary and clients can decide that they would like to withdraw from the initiative at any time. However, clients participating in this initiative will be expected to continue to participate in activities on their rehabilitation plan that focus on building on their capacity to sustain long term employment. As the client will be managing their employment obligations at the same time, adjusting to changes to routine and could potentially be under time pressures that they are not used to, it is important that these activities are not too onerous, and that participation in rehabilitation activities can be realistically achieved. A rehabilitation plan for a client participating in this initiative would therefore be expected to be less complex and include fewer activities relative to other clients.
If a client withdraws from the initiative, the rehabilitation provider is expected to provide a rehabilitation closure report for the Rehabilitation Coordinator explaining that the client has chosen to withdraw.
There are no barriers to a client being able to participate in the streamlined access to incapacity payments initiative on more than one occasion. This may occur, for example, where a client’s extended rehabilitation plan has closed after 12 months, and the client has been successfully maintaining their employment role, but an unexpected life crisis means that their capacity for employment diminishes. In this case, if the person approaches DVA for support because they are very concerned about returning to employment again, then the Rehabilitation Coordinator will be expected to consider whether another extended rehabilitation plan would be an appropriate option for the client upon their return to work.
DVA’s expectations of rehabilitation providers
DVA has clear expectations of rehabilitation providers who are managing clients accessing streamlined access to incapacity payments. These include:
- the need to provide clear evidence about why the client would benefit from streamlined access to incapacity payments;
- that the provider will identify and communicate the particular risk factors that apply for the individual client and how the client and the provider will work together to address these risks;
- the need to provide evidence that the client has agreed to the rehabilitation provider maintaining contact with them on a regular basis, together with a plan for how this contact will be maintained;
- the need to provide evidence of agreement from the client that they will alert their rehabilitation provider as soon as they begin to experience difficulties in managing employment because of their accepted conditions;
- the need to provide evidence that clear and SMART goals have been identified on the extended rehabilitation plan and that both the client and the provider are actively engaged in a meaningful rehabilitation program to overcome barriers to the person meeting their rehabilitation goals;
- a commitment to using the GAS and all other standard DVA documents during the extended rehabilitation plan;
- ensuring that the DVA Rehabilitation Coordinator is informed as quickly as possible if the client begins to experience difficulties in employment that may lead to incapacity payments needing to be recommenced;
- maintaining contact with the DVA Rehabilitation Coordinator at agreed time periods and providing meaningful updates on the client’s rehabilitation plan;
- ensuring that a whole-of-person approach is always utilised, so that barriers to rehabilitation and employment can be pro-actively addressed;
- keeping in touch with the client’s treating health professionals and employer as appropriate, particularly when the client is experiencing difficulties in employment;
- using their judgement about whether, with the client’s permission, they may need to contact the client’s employer to access evidence of their current rate of pay if they have needed to reduce their hours of work, or a separation certificate if the client has needed to cease employment,if the client is too unwell to be able to do so; and
- a commitment to informing the DVA Rehabilitation Coordinator as soon as possible when the client is effectively managing their employment role, and has requested that their rehabilitation plan be closed.
Expectations of Rehabilitation Coordinators
It is essential that a client receiving support through the streamlined access to incapacity payments initiative is not deemed with an ability to earn while their extended rehabilitation plan remains open. This is because to do so, would create barriers to the person’s incapacity payments being reinstated as quickly and as easily as possible. Clients participating in this initiative can be identified through file notes and comments in the client’s rehabilitation case and their incapacity case in R&C ISH. Further information about how participants in this program are identified in R&C ISH can be found in the Rehabilitation Procedures Library.
It is important that the client’s Rehabilitation Coordinator and the client’s incapacity delegate communicate regularly and that the incapacity delegate is immediately notified when a client needs to reduce, pause or cease their employment due to an increase in the symptoms of their mental health condition(s). This will prevent any unnecessary delays in incapacity payments being recommenced.
Rehabilitation Coordinators are expected to ensure that value for money is being achieved during the extended rehabilitation program and that the provider is actively engaged and providing meaningful support to the client. If a Rehabilitation Coordinator has any concerns about the rehabilitation provider’s recommendation that a specific client be provided with an extended rehabilitation plan, then it is strongly suggested that they discuss the case with a DVA Rehabilitation Adviser, to help determine a way forward.
Rehabilitation Coordinators are expected to ensure that a whole-of-person rehabilitation approach is being utilised during the extended rehabilitation program. If a client needs to reduce their hours or work, access sick leave, or cease employment, their rehabilitation plan may move to focusing on medical management and/or psychosocial rehabilitation activities once their acute symptoms have diminished. This helps to ensure that the client is working towards overcoming barriers to their rehabilitation, which includes barriers to them remaining in employment.
This means for example, that it would be reasonable for an exercise program, healthy cooking course, dietician support or similar activities to be included on the extended rehabilitation plan, if a client’s physical health and weight gain is impacting on their ability to sustain employment. Another example is that short anger management, stress management, mindfulness, meditation or yoga courses may be included on a rehabilitation plan to assist clients to develop strategies to manage stress in their workplace. Likewise, short drama courses, public speaking or other similar courses could be included on the rehabilitation plan if the client is having difficulty in communicating in a work place. A flexible approach will be required, with each case to be considered on its merits, being mindful that non-accepted conditions are likely to impact on the client’s ability to sustain employment.
As the client starts to recover, and their symptoms reduce, then vocational rehabilitation activities can recommence.
What documentation is required to enable incapacity payments to recommence?
The streamlined access to incapacity payments initiative provides additional rehabilitation support for clients who are vulnerable to moving in and out of employment due to their accepted mental health conditions. However, it is also important that clients continue to access appropriate treatment and support from their treating health professionals, to ensure that any flare in symptoms can be managed as quickly as possible.
For this reason, DVA expects that a client who is accessing support through the streamlined access to rehabilitation program will visit their GP, psychiatrist, psychologist or other appropriate health provider when they begin to experience difficulties in managing their employment responsibilities. A medical certificate from their treating health professional will provide the assurance that DVA requires that the client has needed to reduce their hours of employment, or cease their employment because of their accepted mental health condition(s). A GP certificate will be regarded as being sufficient. The client may either provide this certificate to their rehabilitation provider for forwarding to DVA, or provide it directly to their DVA Rehabilitation Coordinator.
Where the person remains in employment at a reduced number of hours, it is important that DVA has evidence of the client’s current rate of pay, as this will ensure that the correct rate of incapacity payments is paid, and will reduce the risk of overpayments. If the person has completely ceased employment, an employment separation certificate will be required before incapacity payments can be reinstated. If the client is having difficulty accessing these documents, the rehabilitation provider can assist and ensure that they are forwarded to the client’s DVA Rehabilitation Coordinator. The Rehabilitation Coordinator will then liaise with the client’s incapacity claims manager so that incapacity payments can recommence as quickly as possible.