8.3 Investigating a claim for attendant care services

Making a claim for attendant care services

A claim is required to access attendant care services. The attendant care claim form (form D1351) is available through the DVA website. 

Claims must be supported by documentary evidence from the client’s treating doctor, or other suitably qualified medical or allied health professional. The claim form must confirm attendant care services are reasonably required due to a service-related condition for which liability has been accepted.

Assessment for attendant care services

Once the claim form is received, the DVA delegate will refer the client to a suitably qualified health practitioner for an Activities of Daily Living (ADL) Assessment. This assessment provides evidence for the delegate to consider when making their determination about whether attendant care services are reasonably required. The legislative matters delegates are required to consider when making this determination are referenced in section 8.4 in this library.

As part of the assessment, consideration should be given to whether aids and appliances available through the Rehabilitation Appliances Program may help to assist the client to independently manage their personal care needs. 

Where a delegate is not satisfied they have sufficient information to make a determination, they can:

• request further information from the client or a health practitioner; or
• request a further assessment by an independent and qualified medical professional or rehabilitation service provider with specialist skills. An example is an Occupational Therapist specialising in mental health.

Approval period

The provision of attendant care services for a short period of time may be relatively common for persons who are recovering from surgery or similar treatment for an accepted service injury or disease.

However, where a client has permanent, significant or complex injuries, ongoing attendant care services may be required.

Regular reviews are required to ensure that delegates have a good understanding of the client’s current circumstances and needs.

The approval period should be appropriate for the client’s individual circumstances. 

Determinations

A formal determination is required for all attendant care claims. 

The determination must:

• reference the legislative requirements a delegate is required to consider (listed in section 8.4 in this library);
• include details about the type and level of attendant care services being approved; and
• specify the period of approval. 

Once attendant care services are approved, the client is responsible for sourcing a provider and managing all of the interactions with that provider. More information about the responsibilities of DVA and clients can be found in section 8.6 in this library.

Statutory limit

The amount of compensation payable for attendant care services is capped by a legislated statutory limit. This limit is indexed on 1 July each year, by reference to the Consumer Price Index. Details of the maximum attendant care limits are available on the attendant care pages of the DVA website. 

Where a determination has been made that the veteran meets the Catastrophic Injury criteria, attendant care services can be approved to meet the client’s assessed needs, without reference to the legislated statutory limit. 

Note: The statutory limits for attendant care services and household services are mutually exclusive. 

Personal care services from other programs or organisations

Personal care services from another organisation or program will:

• impact a client’s reasonable requirement for attendant care services; and
• impact the type and level of services that may be provided through the DVA Attendant Care Program.

Nursing care needs

Clients who require nursing services, or have complex or high care needs, may also be eligible for clinical services accessed through the DVA Community Nursing Program.

The Community Nursing Program can provide both personal care and nursing services. 

Any personal care services provided through the Community Nursing Program will impact a client’s reasonable requirement for personal care through the Attendant Care Program. 

Veterans’ Home Care Program

Personal care services through the Veterans’ Home Care (VHC) Program can be considered to fill any gaps in service provision when:

• the client holds a Veteran Gold Card or a Veteran White Card for an accepted service-related injury or condition; and
• the required services cannot be provided using the Safety, Rehabilitation and Compensation (Defence-related Claims) Act 1988 (DRCA) and Military Rehabilitation and Compensation Act 2004 (MRCA) provisions, as the need is not related to the client’s accepted conditions; and

• the VHC assessment confirms the client is eligible; and 

• the VHC assessment confirms that the services can be provided.

Further information about VHC can be found on the DVA website.

Payments of a similar nature

Attendant Allowance under the Veterans’ Entitlements Act 1986 (VEA)

Attendant Allowance is paid under the VEA to support veterans with the costs of employing an attendant to assist with activities of daily living. The allowance is payable to veterans with conditions accepted under the VEA including blindness, amputations and injuries to the cerebro-spinal system.

Clients should not be receiving, or being paid to access, the same services under different Acts. Therefore, where clients receiving Attendant Allowance request attendant care services under the MRCA or DRCA, delegates must be satisfied these services are reasonably required because of the client’s MRCA/DRCA accepted conditions.

Carer Payment under the Social Security Act 1991

Receiving a Carer Payment from Centrelink does not preclude eligibility for attendant care services under the MRCA or DRCA. However, attendant care payments may impact income support payments, including those paid by Centrelink.

Provision of attendant care services outside Australia

The same decision-making principles and processes should be followed where a client living overseas claims attendant care services. Supporting evidence from a treating doctor, specialist or allied health provider, is still required. 

Information about reimbursements for attendant care services payments for clients living overseas can be found in section 8.6 in this library.