20.7.9 Examples relating to 'first ever' medical certification of incapacity

First example

For instance, consider the case of a reservist who falls and breaks his collar bone during a reserves camp, is given emergency treatment and strapping etc. in the emergency room of a hospital and is released to the care of his GP. He is obviously incapacitated for his civilian work as a factory process worker but it is anticipated that the break will heal without complication. Functionality sufficient for civilian employment purposes will return in three to five weeks. In this case, only the GP certificate of incapacity is required to initiate the weekly payments. No specialist orthopaedic intervention would be necessary and the delegate should therefore not insist on a specialist opinion on incapacity.

However, if incapacity were to continue beyond this expected period – i.e. the GP continued to write incapacity certificates two to three months after the accident – the delegate should commission a specialist review of the case. Remember there will be a system generated task prompting such a review after 6 pays. Alternatively, if there was some early suggestion that damage may be more widespread or there were complications (i.e. of the shoulder joint, for this example) which may prolong incapacity, a delegate should seek that specialist advice sooner rather than later.

This does not mean that payment for current, obvious incapacity can not be at least initiated on the basis of a GP certificate. Such urgent payments should not be deferred pending necessary specialist follow-up, which may take some time to organise.

Second example

On the other hand, consider a case where a client has had liability admitted for an in-service aggravation of a pre-existing degenerative back condition. Liability for this condition was accepted over fifteen years ago. Subsequently, he discharged to become an agricultural labourer and has had no further contact with DVA  until he recently lodged this first ever request for incapacity payments. He alleges that his current, severe back condition is linked to the aggravation fifteen years ago. Also that his currently incapacitating leg condition is a consequence of his back condition. He presents only a GP certificate to support his assertions of incapacity.

In such circumstances, it is obvious that the connection between the accepted back injury, the current back complaint and the new leg complaint are critical to the case for incapacity payments. However, judging the nexus between injury and the current (alleged) incapacity lies within the expertise of a medical specialist (i.e. orthopaedic surgeon, rheumatologist, etc.) not a GP. In this example, the delegate should not make any determination about incapacity payments – even one purporting to be an 'interim' payment – unless or until an appropriate specialist confirms that incapacity for work is attributable to the compensable injury.