MILITARY REHABILITATION AND COMPENSATION SCHEME POLICY INSTRUCTION  - NUMBER 7

Subject: Rehabilitation

Background

The provisions for rehabilitation are contained in Chapter 3 of the Military Rehabilitation and Compensation Act 2004 (MRCA). Section 38 of the MRCA states: 'The aim of rehabilitation is to maximise the potential to restore a person who has an impairment, or an incapacity for service or work, as a result of a service injury or disease to at least the same physical and psychological state, and at least the same social, vocational and educational status, as he or she had before the injury or disease.' The provisions of the MRCA are complemented by the document 'Principles and Protocols guiding rehabilitation'.  A copy of this is attached.

What is rehabilitation

Rehabilitation is the managed process of assisting members and former members with accepted conditions to return to their pre-injury potential physically, psychologically and vocationally. The rehabilitation process is a holistic approach having regard to the member or former member's psychological, physical, social and vocational make-up and can include medical treatment, vocational rehabilitation and psychosocial rehabilitation.

Types of rehabilitation

There are three types of rehabilitation: Medical rehabilitation is the use of treatment measures to restore or maximise the person's physical and psychological function. Vocational rehabilitation is the managed process that provides an appropriate level of assistance, based on assessed needs, necessary to achieve a meaningful and sustainable paid employment outcome, at a similar status to pre-injury/disease. Psychosocial rehabilitation is the use of rehabilitation measures aimed at restoring or maximising the person's function in the community by providing appropriate behavioural and social skills for living in the community.

Who is the Rehabilitation Authority?

The Rehabilitation Authority is as follows: For a serving member of the Permanent Force or a Reserve member on Continuous Full-time Service who has NOT been identified as 'likely to be medically discharge' – the Service Chief Everyone else – the Military Rehabilitation and Compensation Commission

When should a claim be referred for a  rehabilitation assessment

You should consider referral for a rehabilitation assessment when the member or former member: is being medically discharged from the ADF, is requesting incapacity payments, has been on incapacity payments for an extended period, has requested assistance to return to work, has submitted a medical certificate stating that they are able to return to work on suitable duties, has stated that they are unable to continue in their current employment due to their compensable injury, has requested household services or attendant care, has been identified as requiring modifications, aids or appliances, has requested a gym program, requires a coordinated package of physical and psychosocial assistance. When the person is a member of the Permanent Forces or a member of the Reserve on Continuous Full-time Service, who has not been identified for medical discharge, you should advise the Service Rehabilitation Delegate of his or her respective Service Chief, as they are the person's Rehabilitation Authority. All others, should be referred to the Rehabilitation Coordinator in the MCRS Office of the State in which the claimant lives. The following information should be included in this referral: Copies of all medical reports Records of all conversations with the claimant A copy of the Needs Assessment Copies of all letters to the claimant. Note: The following refers to former members and part-time reservists.  This group also includes cadets and declared members. Note:  A screening tool to assist you in identifying those people who may require a rehabilitation assessment is currently being developed by the  Rehabilitation Policy Section.  This is expected to be available for trialing early in 2006.

What will happen

Where the former member or part-time reservist's requirement for rehabilitation has been identified as part of the 'Needs Assessment', and he or she has agreed to that assessment, or he/she has requested rehabilitation, then a rehabilitation assessment must be conducted. Where the former member or part-time reservist has been referred for rehabilitation outside the 'Needs Assessment' the Rehabilitation Coordinator will assess the member or former member's situation and determine whether or not to proceed with a rehabilitation assessment. The Rehabilitation Coordinator will refer the claimant to a suitably qualified or experienced professional to measure the capacity and need for the person to participate in the rehabilitation. The major objectives of the rehabilitation assessment are: to assess the capability of the claimant to undertake a rehabilitation program, identify the rehabilitation needs if the assessor is recommending a rehabilitation program, to provide guidelines for a possible return to work. Once the initial assessment is completed the Rehabilitation Coordinator will assess the recommendation and decide whether or not to proceed with the rehabilitation program.  Where the decision is to proceed with the Rehabilitation program a determination under S51 will be made.

What is a rehabilitation plan

A rehabilitation plan is a document that describes or summarises the rehabilitation program of activities. These are the activities which aim to restore or maximise the injured person's physical and psychological functioning in normal daily environments of work, family and community. The plan outlines the rehabilitation goals and objectives, responsibilities, services, timeframes and costs which have been developed jointly between the injured person, the service provider, the rehabilitation coordinator and the treating doctor/allied health professionals. All details have regard to medical recommendations. The plan addresses the injured person's rehabilitation needs that have been identified in a rehabilitation assessment report and may typically include one or a combination of services such as: Vocational services aimed at returning the person to suitable employment; Psychosocial activities which focus on re-engaging the injured person with their normal support and social networks; Household services and attendant care services; The provision of rehabilitation aids and appliances, and Alterations to the injured person's home, workplace or motor vehicle.

What happens when a former member or part-time reservist requires Household Services

Straightforward requests for household services, eg where someone living on his own is unable to mow his lawn because of a broken leg, may not require assessment by an occupational therapist or other qualified professional.  These may be processed by the MRCA delegate.  However, the claim should be supported by evidence of the person's  incapacity to perform the required activity such as a report from the GP or other treating specialist. When a request for household services requires an assessment by an occupational therapist or another suitably qualified person the claim must be referred to the Rehabilitation Coordinator for processing through incorporation into a Non-Return to Work (NRTW) rehabilitation plan.

What happens when a former member or part-time reservist requires Attendant Care Services

Any request for, or consideration of, provision of attendant care services must be undertaken in conjunction with an assessment that fully identifies the former member or reservist's requirements.  An occupational therapist or other suitably qualified person (eg the treating specialist) must carry out the assessment. All claims for attendant care services must be referred to the Rehabilitation Coordinator for assessment as part of a rehabilitation plan. Where there is no Return to Work (RTW) rehabilitation plan in place or being developed, then the Rehabilitation Coordinator must create a NRTW case.

What happens when a former member or part time reservist requires Aids and Appliances

Requests for aids and appliances must be referred to the Rehabilitation Coordinator, who will refer the member or former member to be assessed for their capacity for rehabilitation.

When does medical treatment become rehabilitation

Many activities that fall within the definition of medical treatment will also be provided under the umbrella of medical rehabilitation. This medical treatment can include the provision/repair of medical aids and appliances.  However, to become rehabilitation, the medical treatment activities must be provided as part of an overall rehabilitation program. Provision of medical treatment is provided under Chapter 6 of the MRCA until such time as the person is referred to a rehabilitation coordinator, an assessment is undertaken under section 44 and a determination is made under section 51.

What happens when a serving member, who has not been identified for medical discharge, requires these services

If rehabilitation is identified as part of the 'Needs Assessment' the Service Rehabilitation Delegate, through the Executive Officer Joint Health Support Agency, should be advised.  The identified need should be included in any advice documentation.  The Service Delegate will advise the MRCC delegate of the outcome of the rehabilitation assessment and of any subsequent rehabilitation plan, if one is undertaken. Where a serving member has a rehabilitation plan developed, the Service Delegate will advise the MRCC.  The plan may include identified needs that are the responsibility of the MRCC (ie aids and appliances under sections 54 to 59). If it does, the MRCC delegate may organise provision of those benefits. Where the serving member is assessed as not being capable of rehabilitation by the Service Delegate, but requires benefits such as aids and appliances, the member should then be referred to the MCRS Rehabilitation Coordinator so that a NRTW plan may be developed and benefits provided through that process.

Mark Johnson

Branch Head

Military Compensation

     December 2005
Principles Guiding Rehabilitation under the MRCA

(Italics are quotes from the Act)

1. The aim of rehabilitation is to maximise the potential to restore a person who has an impairment, or an incapacity for service or work, as a result of a service injury or disease to at least the same physical and psychological state, and at least the same social, vocational and educational status, as he or she had before the injury or disease.

Section 38

2. A person can be considered for rehabilitation where the Military Rehabilitation and Compensation Commission (the Commission) has accepted liability for an injury or disease, which causes incapacity for work, or caused impairment that requires medical or social rehabilitation.

3. If the Commission has accepted liability for a person's injury or disease that person can request an assessment for suitability to undertake rehabilitation and that request must be complied with.

4. The Commission can determine that a person undertakes a rehabilitation program having regard to the following:

• any written report in respect of the person under subsection 46 (3);
• any reduction in the future liability of the Commonwealth to pay or provide compensation if the program is undertaken;
• cost of the program;
• any improvements in the person's opportunity to be engaged in work after completing the program;
• the person's attitude to the program;
• the relative merits of any alternative and appropriate rehabilitation program; and
• any other matter the rehabilitation authority considers relevant.

Subsection 51 (2)

5. Any reference to written reports or relevant material in the Act, may include reports provided from the person's principal treating practitioner and any other report provided by the claimant in respect of both assessments of the person's capacity for rehabilitation and the development of the rehabilitation program.

6. The rehabilitation program can include vocational and social rehabilitation.

7. Persons with suitable qualifications or expertise in rehabilitation will assess a person's capacity for rehabilitation and where applicable provide guidance on the type of program the person should undertake.

8. If a person fails to undertake a rehabilitation assessment or program without reasonable excuse the Commission may suspend the persons right to compensation (but not treatment).

9. Rehabilitation will be coordinated, integrated and adequately resourced to achieve effective outcomes.

10. Relevant incapacity payments (income replacement) are payable whilst a person is undertaking a rehabilitation program and they are unfit for work.

11. All determinations relating to rehabilitation, with the exception of a determination relating to the suspension of compensation for refusing or failing to undergo a rehabilitation examination, or refusing or failing to undertake a rehabilitation program, are original decisions and subject to review and appeal.

Protocols of Rehabilitation under the MRCA

Rehabilitation Screening

1. Where a person seeks a payment for impairment or incapacity for work a delegate will consider whether that person should undertake an assessment of capacity to undertake rehabilitation.

2. Where it is considered that such an assessment should be undertaken a written determination must be made.

3. A person may request an assessment of their capacity for rehabilitation at any time.

Rehabilitation Assessment

4. Persons who have requested an assessment, or where it has been determined that such an assessment is required, will be referred for a professional and comprehensive assessment.

5. The assessment will be undertaken by suitably qualified or experienced professionals in the field of medical, psychological and vocational rehabilitation to measure the capacity and needs of the person to participate in the rehabilitation.

6. The suitably qualified or experienced professional who will perform the rehabilitation assessment is determined by the rehabilitation authority from a list of approved providers.  Persons, Ex-Service and Defence organisations may nominate any person or provider to be considered for approval to the Military Rehabilitation and Compensation Commission.

7. In the event that a dispute arises between a client and the approved provider performing the rehabilitation assessment, the Department will endeavour to resolve the issues.  If the issues cannot be resolved the Department undertakes to use its best endeavours to assign another approved provider to conduct the rehabilitation assessment.

8. The vocational assessment and rehabilitation consists of or includes any one or more of the following:

• assessment of transferable skills;
• functional capacity assessment;
• workplace assessment;
• vocational counselling and training;
• review of medical factors;
• training in resume preparation, job-seeker skills and job placement; and
• provision of workplace aids and equipment.

Subsection 41 (1)

A vocational assessment will also include an assessment of employability taking into account age, capability and labour market conditions.

9. Vocational training and education is generally provided to return a person to the workforce at a level to which they are accustomed.  If, in order to regain employment, the assessment determines that education or training to a higher level, including tertiary, is required to achieve reasonable likelihood of a return to the workforce, and such provision could reasonably be expected to be cost effective, training or education to that level will be considered.

10. Matters to be considered when determining cost effectiveness include:

• Cost of the training or education, including where applicable HECS;
• Additional reduction in future liability that would be attributable to the studies; and
• Improvement in work opportunities and capacity to obtain paid employment.

11. Where a person will benefit from social rehabilitation a rehabilitation plan will list the services aimed at restoring or maximising a person's function in the community by providing appropriate behavioural and basic training skills for living and participating in a community setting.

12. The prime factor when considering what, if any, non-vocational measures will be implemented will be the recommendations from the rehabilitation assessment and the attitude of the person towards rehabilitation aimed at achieving quality of life outcomes.

Rehabilitation Plan

13. A rehabilitation program will only be developed if the person has undergone an assessment of their capacity for rehabilitation by a suitably qualified person.

14. The rehabilitation program will be described by a rehabilitation plan that will list the services that will be provided, the time period covered under the plan and the likely outcome at the completion of the plan.

15. All parties to the plan, which includes, at a minimum, the person's case manager, an approved provider and the person will be consulted during the preparation of the plan.  This will enable each party to sign up to the plan. The consultation will include providing the person with information and options to allow them to make informed decisions.

16. The rehabilitation program  means a program that consists of or includes any one or more of the following:

• medical dental, psychiatric and hospital services (whether on an in-patient or outpatient basis);
• physical training and exercise;
• physiotherapy;
• occupational therapy;
• vocational assessment and rehabilitation
• counselling;
• psycho-social training.

Subsection 41 (1)

Social rehabilitation could include such measures as referral to community support services, attendant care services, psychosocial counselling, basic skills training, fitness and exercise regimes and drug and alcohol management programs.

17. The plan will include an outline for the coordination arrangements for each of the rehabilitation services.

18. Rehabilitation plans are subject to review, as requested, to ensure they remain relevant to the person's needs.

19. If it is decided that the rehabilitation program should cease or vary another assessment is required.

Rehabilitation Services

20. Services, including assessment, are to be provided by approved providers only.  These will be:

• providers approved for the purposes of the Safety, Rehabilitation and Compensation Act 1988; and
• providers with appropriate skills and expertise approved by the Commission.

21. Rehabilitation services will be provided to ensure that the most cost-effective outcome is achieved for both the person and the Commonwealth.

22. The delivery of the services will be coordinated to ensure they are delivered in an effective and timely manner.

Rehabilitation Delivery Costs

23. The Commonwealth will meet the cost of all rehabilitation activities approved by a delegate.  This includes examinations, assessments, aids, appliances and other activities included in a plan.

24. Where a person is incapacitated for work due to a combination of compensable and non-compensable conditions, or being medically discharged due to a non-compensable condition, the Commission will consider paying for rehabilitation costs of the non-compensable injuries if it has the potential to be cost effective in facilitating a return to work.

25. If there is a requirement to travel to undertake a rehabilitation examination, then the Commonwealth will pay compensation for any costs reasonably incurred in that journey.  If the person is also required to stay in accommodation in the area as a result of the journey then compensation for all reasonable costs will be paid.

26. In determining the amount  payable, the rehabilitation authority will have regard to:

(a) the means of transport available to the person for the journey; and

(b) the route or routes by which the person could have travelled: and

(c) the accommodation available to the person

Section 48

Deeming a person able to earn income.

27. Where a person fails to accept an offer of suitable employment, fails to begin or continue such employment or fails to undertake rehabilitation or a retraining program as a condition of obtaining suitable work without reasonable excuse the person can be deemed to be earning the amount that they would have received but for their failure.

28. If a person fails to seek suitable work they can also be deemed to be earning an amount that they could reasonably be expected to earn, having regard to the labour market.  If the person can show genuine yet unsuccessful attempts to obtain employment they will not be “deemed” when suitable employment is not possible.

29. The processes and requirement to communicate with a person prior to a determination to suspend compensation will be the same as current processes in place under the Safety, Rehabilitation and Compensation Act 1988.  These processes ensure that the person has an opportunity to provide the rehabilitation authority with evidence of reasonable excuse for their inability to undertake a rehabilitation program.

30. Suitable work for a person means work for which the person is suited having regard to the following:

1. the person's age, experience, training, language and other skills;
2. the person's suitability for rehabilitation or vocational retraining;
3. if work is available in a place that would require the person to change his or her place of residence – whether it is reasonable to expect the person to change his or her residence;
4. any other relevant matter.

Section 5

Assistance in Finding Work

31. Where a person's injury or disease results in an incapacity for work the rehabilitation authority must take all reasonable steps to assist the person to find suitable work in the civilian workforce.  This requirement does not apply while the person is a full-time member of the ADF.

32. If liability for the injury or disease ceases the requirement to provide assistance in finding suitable work also ceases.

Review

33. A person's capacity for rehabilitation may vary from time to time depending on their medical status. This may mean that a person not previously able to undertake rehabilitation due to medical factors may subsequently be able to do so.  Alternatively a person in a rehabilitation program may no longer be able to continue that program due to medical factors.

34. Reviews of treatment provision and rehabilitation will continue to be relevant in post working age years.  A person may at any time request that the Commission undertake a review to ensure that they are receiving the most appropriate level of rehabilitative services.  The review may cover appropriate levels of medical treatment, social rehabilitation services and vocational programs and services.

35. The frequency of reviews will be determined taking account of advice from treating physicians and specialists, and as appropriate as specified in a rehabilitation plan. Up to the age at which incapacity payments would normally cease, the Commission will at a minimum, undertake a review at least every 5 years, including consideration of whether appropriate treatment and services are being provided.  Where a principal treating practitioner states that a review must be undertaken with particular care, in such circumstances, a review will not be undertaken without first contacting the treating practitioner. A review may be undertaken on the papers.

36. The Commission or a person can at any time seek a review of services being provided.

37. Where a person's capacity for work changes following a medical review, a review of their rehabilitation capacity should also be undertaken.  This would involve the person undergoing an assessment for rehabilitation.

38. All aspects of a rehabilitation plan, including the selection of provider are subject to review.

39. A person's appeal rights are determined as set out in the diagram below.

40. A person has the right to be accompanied by a person of their choice, including a family member, an ex-service organisation or service representative, or a legal representative to interviews and in phone conversations relating to any aspect of their claim including at reconsideration and appeal.  The only exceptions are VRB proceedings which are non- adversarial and legal representation is not permitted.

41. Legal Aid may be available in respect of AAT matters, subject to relevant Legal Aid guidelines and priorities including merit and/or means testing for eligibility.

42. Determinations relating to the suspension of compensation for refusing or failing to undergo a rehabilitation examination, or refusing or failing to undertake a rehabilitation program are not “original determinations” and are not subject to either reconsideration or review by the Veterans' Review Board or the Administrative Appeals Tribunal.  These decisions can only be appealed on a matter of law to the Federal Court.  All other determinations concerning rehabilitation are “original determinations” and are subject to merit review.

Interaction with the Transition Management Service (TMS)

43. Interaction between the TMS Coordinator and the Rehabilitation Coordinator is necessary to ensure discharging members are aware of and thus able to utilise all benefits available to them through MRCS and their ADF discharge entitlements.  Discharging members have a variety of entitlements through the ADF's Career Transition Assistance Scheme (CTAS) ie. Training, resume preparation, job seeking and on the job training.

44. There are discharging members who will require additional rehabilitation assistance through the MRCB to achieve their goal of returning to suitable employment and/or coping with activities of daily living. The TMS coordinator is required to liaise with the DVA rehabilitation team and to refer those clients who require additional MRCB rehabilitation intervention.

Review of the administration of the rehabilitation provisions

45. A forum comprising representatives of the ex-service and Defence force communities and the MRC Commission will meet at least annually to review the experience of the administration of the Rehabilitation clauses in the Act.

Office of the Principal Adviser, Rehabilitation

10 September 2004