1.4.2 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 to a rehabilitation provider for a professional and comprehensive assessment.

5. The rehabilitation assessment is a comprehensive investigation undertaken by a suitably qualified or experienced professional in the field of medical management, psychological and vocational rehabilitation to measure the capacity and needs of the person.

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.

7.  In the event that a dispute arises between a person 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. Subsection 41(1) of the MRCA defines that: "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
• the provision of workplace aids and equipment."

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

9. Vocational training and education is generally provided to return a person to the workforce to at least the level of the person's former employment. If, in order to regain employment, the rehabilitation assessment determines that education or training to a higher level, including tertiary studies, is required to achieve reasonable likelihood of a return to the workforce, and such assistance is considered to be appropriate and cost effective, training or education to that level will be considered.

10. Matters that must be considered when determining the cost effectiveness of further education include:

• the person's rehabilitation goals and the primary focus of their current rehabilitation plan;
• the person's current medical status, previous educational qualifications, employment history, training undertaken through their defence role, and current job opportunities available to them;
• the cost of the training or education, including where applicable HECS - HELP;
• the type of course and the fee structure that applies to that course;
• access to suitable training institutions/courses or opportunities in the person's local area;
• local, regional and state labour market factors and employment opportunities which may impact on the client's future employability;
• the potential to assist the client towards a sustainable return to work and therefore financial self sufficiency and to help reduce future Commonwealth liability for ongoing payment of compensation;
• the client's ability to cope with the pressures and demands of study and the likelyhood of them successfully meeting the course requirements;
• the client's commitment to self-manage their study, and if required seek assistance from the university support systems and their rehabilitation provider when needed; and
• the potential to assist the client to achieve the health benefits of being actively engaged in meaningful employment.

Further education will only be supported when the client is undertaking a vocational rehabilitation plan and working towards a return to work goal.

Further information about retraining and further education can be found in section 9.8 in this library.

11. It is important, as part of a whole-of-person approach to rehabilitation, that psychosocial rehabilitation is always considered. The aim of psychosocial rehabilitation is to assist a person to maximise their functioning in the community, manage their life circumstances as effectively as possible, and to work towards a fulfilling an meaningful future by providing appropriate behavioural and basic training skills for living and participating in a community setting.

Rehabilitation Plan

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

13. The rehabilitation program will be described by a rehabilitation plan. It will list the goals that both the client and the provider believe to be achievable, as well as provide an indication of how difficult the client perceives these goals will be to achieve. It will list the services that will be provided, the time period covered under the plan and the expected outcome at the completion of the plan.

14. All parties to the plan, which includes, at a minimum, the person's rehabilitation coordinator (delegate), an approved rehabilitation provider and the person will be consulted during the preparation of the plan. This will enable each party to commit to the plan and goals within the plan. The consultation will include providing the person with information and options to allow them to make informed decisions. Please refer to Goal Attainment Scaling in Chapter 15 in this library for detailed instructions on how to develop a plan.

15. DVA's whole of person approach to rehabilitation means that support and services can have a primary focus on:

• vocational rehabilitation;
• psychosocial rehabilitation; or
• medical management rehabilitation.

Rehabilitation support is tailored to each client's individual circumstances. It is likely that a rehabilitation plan may include activities across each of these three areas.

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

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

18. Any major changes to a rehabilitation plan, including closure of the plan, must be based on discussions between the client, their treatment doctor (if appropriate) and the rehabilitation provider, and be agreed by the rehabilitation coordinator.

Rehabilitation services

19. Rehabilitation services, including assessment, are to be provided by approved rehabilitation providers only.

Approved rehabilitation providers are:

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

20. The delivery of the services will be coordinated to ensure they are delivered in an efficient and and timely manner and are appropriate to the client's current needs and circumstances.

Rehabilitation delivery costs

21. The Commonwealth will meet the cost of all rehabilitation activities approved by a rehabilitation coordinator (delegate). This includes examinations, assessments, aids, appliances (where they cannot be provided through the Rehabilitation Appliances Program) and other activities included in a plan. Treatment costs, including nursing care costs, cannot be met through a rehabilitation plan.

22. 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 improved functioning and a return to work outcome.

23. 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.

24. Section 48 of the MRCA describes that when: "determining the amount payable, the rehabilitation authority must 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."

Further information about travel to undertake a rehabilitation assessment can be found in section 9.1 of the MRCA policy manual and chapter 90 of the SRCA general handbook.

Deeming a person able to earn income

25. Where a person fails to accept an offer of suitable employment, or fails to begin or continue such employment, without reasonable excuse, the person can be deemed to be earning the amount that they would have received if they had been in this employment.

26. If a person fails to seek suitable work as part of an agreed vocational rehabilitation plan, 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.

     Section 5 of the MRCA defines: "suitable work for a person means work for which the person is suited having regard to the following:

• (a) the person's age, experience, training, language and other skills;
• (b) the person's suitability for rehabilitation or vocational retraining;
• (c) 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;
• (d) any other relevant matter."

27. Discussions must always occur between the person's rehabilitation coordinator, and their incapacity delegate, before a deeming decision is made.

Assistance in finding work

28. Where a person's injury or disease results in an incapacity for work, the rehabilitation authority, through the rehabilitation provider and the rehabilitation coordinator, must take all reasonable steps to assist the person to find suitable work in the civilian workforce. 

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

Review

30. 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.

It is important that the person's rehabilitation provider is proactive in informing the rehabilitation coordinator of any changes to the client's circumstances that are creating barriers to them participating in their rehabilitation program. The rehabilitation coordinator must liaise with the client's incapacity delegate to ensure that the client is able to access their correct entitlements if they are not able to participate in employment or rehabilitation for a period of time.

31. The provision and review of treatment 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 must consider whether appropriate levels of household services, attendant care services, assistance with motor vehicle modifications, medical management, psychosocial and vocational rehabilitation programs and services are being provided.

32. The frequency of reviews will be determined taking account of advice from treating physicians and specialists, and 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. A more regular review cycle is highly recommended. Where a principal treating practitioner states that a review must be undertaken with particular care, the rehabilitation coordinator or the incapacity delegate must first contact the treating practitioner. In this case, a file review may be more appropriate. It is vital that the incapacity delegate and the rehabilitation coordinator communicate regularly to better manage activities that are being undertaken regarding the client.

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

34. Where a person's capacity for work changes following a medical review, a reassessment of their rehabilitation capacity should also be undertaken. This would involve the person undergoing an assessment for rehabilitation. The incapacity delegate and the rehabilitation coordinator must work together in a coordinated way in this circumstance and ensure that each is aware of activities being undertaken regarding the client.

Appeal mechanisms

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

36. Further information about a person's appeal rights can be found in section 13.4 in this library.

37. A person has the right to be accompanied by a person of their choice, including a family member, an ex-service organisation or ADF 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.

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

39. 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 Review 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 ADF Rehabilitation Program

40. While an ADF member is still serving, the Chief of the Defence Force is their rehabilitation authority. For members of the Permanent Forces and Reservists on continuous full time service (CFTS), rehabilitation support is provided through the ADF Rehabilitation Program (ADFRP). For all other Reservists, rehabilitation support is provided through the Rehabilitation for Reservists Program (R4R). Interaction between the ADFRP/R4R and DVA is necessary to ensure ADF members are aware of and able to utilise all services and support available to them from DVA. This includes compensation, household services, attendant care services, rehabilitation aids and appliances and DVA's motor vehicle assistance schemes. 

Permanent force members and Reservists on CFTS also have access to a variety of entitlements through the ADF's Career Transition Assistance Scheme (CTAS), including training, resume preparation, job seeking and on-the-job training.

41. It is important that timely support is provided to members who are in the process of separating from the ADF to ensure that there is a smooth transition of rehabilitation authority from the Chief of the Defence Force to the MRCC. Interaction between the member's ADFRP Rehabilitation Consultant/R4R Case Manager and the DVA location who will be managing their ongoing rehabilitation is vital. Wherever possible, DVA is required to continue rehabilitation activities that have been approved by the ADFRP/R4R, and to continue to have the person's plan managed by the same rehabilitation provider.

Further information about the ADF rehabilitation programs can be found in Chapter 4.1 in this library.