5.8.1 Eligibility criteria for interim permanent impairment payments

An interim payment of permanent impairment (PI) compensation can be made under section 75 of the MRCA where:

• the person suffers an impairment as a result of one or more accepted conditions,
• the impairment is likely to continue indefinitely (i.e. is permanent), 
• the impairment is not yet stable (i.e. likely to improve),
• It is anticipated that compensation will be payable under section 68 or 71 (i.e. the condition is expected to stabilise in the future),
• final assessment of the degree of impairment cannot currently be determined because one or more of the accepted conditions are not stable,
• assessment of the degree of impairment upon stabilisation can be estimated and is at least the minimum threshold for payment.

Assessment for an interim payment will apply mainly in cases undergoing active treatment that is expected to result in significant improvement in the impairment.  Whilst the final outcome of the treatment may not yet be known, permanent impairment points at the completion of treatment can be estimated. 

It is important to obtain all of the relevant information required for the correct assessment of permanent impairment compensation up front to avoid having to seek a supplementary report.  This will require asking specific questions of the assessing medical practitioner in the first instance.  If this fails to provide the information required to determine an interim payment then efforts should be made to seek this information by requesting a follow-up supplementary report or by requesting clarification from a DVA Contracted Medical Adviser (CMA). 

5.8.1.1 Interim permanent impairment payments for clients with certain mental health conditions

For clients claiming PI for the first time with posttraumatic stress disorder (PTSD), depressive disorder, anxiety disorder, substance use disorder or alcohol use disorder with a current level of impairment of 10 points or more, but who are not yet stable, an interim compensation payment must be offered based on a level of impairment at a minimum of 10 points.

An interim compensation payment can be offered at a higher degree of impairment if appropriate i.e. when the medical evidence indicates that the condition would stabilise at a level of impairment more than 10 points.

The interim 10 impairment point minimum assigned to the person’s PTSD, depressive disorder, anxiety disorder, substance use disorder or alcohol use disorder condition/s should be combined with points from any other conditions assessed.

If a person receives an interim payment but the final degree of their impairment stabilises below the interim PI rating, the person’s final impairment point rating remains as previously determined. Any interim payment amount that is more than the person would have received as their final payment amount is not considered an overpayment and will not be recovered.

This policy should only be applied to clients who have not previously received MRCA PI compensation.

Example 1.

In this case, because the PTSD condition is not yet stable, a determination under section 68 is not possible. Interim compensation is instead determined under section 75 based on 20 impairment points plus the appropriate lifestyle rating (generally the bottom of the shaded area).　 A review date is set for 6 months to assess the stability of the PTSD.

Example 2.

In this case, because the PTSD condition is not yet stable, an assessment under section 68 is not possible. Interim compensation is instead determined under section 75 based on 10 impairment points plus the appropriate lifestyle rating (generally the bottom of the shaded area).　 A review date is set for 6 months to assess the stability of the PTSD.

Example 3.

In this case, because the PTSD condition is not yet stable, an assessment under section 68 is not possible. Interim compensation is instead determined under section 75 based on 10 impairment points plus the appropriate lifestyle rating (generally the bottom of the shaded area).　 A review date is set for 6 months to assess the stability of the PTSD.

If the PTSD condition does eventually improve to less than 10 points the interim PI payment amount is not considered an overpayment and is not recovered.

In this case, because the PTSD is not yet stable, an assessment under section 68 is not possible. Interim compensation is instead determined under section 75 based on 10 impairment points. Although there is no evidence to suggest what the final level of impairment of the PTSD might be, because this condition is included in the policy applicable to clients with certain mental health conditions the minimum impairment points assigned to the PTSD is 10. Interim compensation is determined based on 23 impairment points plus the appropriate lifestyle rating (generally the bottom of the shaded area). A review date is set for 6 months to assess the stability of the depressive disorder.

Even though the client would have met the minimum points for interim payment required from the permanent and stable conditions alone (hearing loss and thoracolumbar spine disc disruption), 10 points is still included in the calculation in recognition of the PTSD.

5.8.1.2 Information required would include (but not necessarily be limited to);

1. Status of each of the assessed conditions for permanence and stability,
2. Identification of current level of impairment,
3. Identification of any current or scheduled treatment that is expected to improve the condition/s,
4. If not stable, an estimated timeframe when treatment is expected to be complete and impairment is therefore expected to stabilise,
5. An estimation of the final points for the condition/s at completion of treatment and/or stabilisation of condition.

It is important to note that for transition MRCA PI cases, it may be a MRCA or SRCA condition that is not yet stable resulting in an interim MRCA PI outcome. VEA conditions do not need to be stable to result in a disability pension payment, therefore the stability of VEA accepted conditions in a transition MRCA PI case is not relevant.