B32/1995 RELEVANT DOCUMENTARY MEDICAL EVIDENCE OBTAINED FOR VETERANS' REVIEW BOARD (VRB) - PAYMENT OF UNPAID PROVIDER ACCOUNTS

DATE OF ISSUE:  2 MAY 1995

RELEVANT DOCUMENTARY MEDICAL EVIDENCE OBTAINED FOR VETERANS' REVIEW BOARD (VRB) - PAYMENT OF UNPAID PROVIDER ACCOUNTS

Purpose

This Departmental Instruction concerns the cost of “relevant documentary medical evidence” obtained by applicants to the VRB.  It sets out payment arrangements where an applicant has an unpaid account or invoice for the evidence.

Background

2.Departmental Instruction B21/94 indicates the intention that payment should be made directly to the provider of additional medical evidence if the applicant has not already paid the account.

3.The legislation to give effect to this benefit, Section 170A, did not make specific provision for payments to providers.  Consequently there has been some doubt as to whether such direct payments can be made.

4.Clarification of this aspect has been obtained from the Department's Legal Advisings Group.  Their advice is that the provider can be paid directly.  This is not feasible however, as payments are made through the Financial Accounting System (FAS), and direct payment to the provider would mean losing the capacity to monitor payments of this benefit.  Further advice from Legal Advisings Group has confirmed that the VRB applicant can be paid directly and that it is not necessary for the applicant to have paid the account.

5.Consequently, based on the legal obligation between the applicant who requested the medical report and provider of the report, the following arrangements will apply where there is an outstanding account for additional evidence.

Procedural

6.It is necessary under Section 170A(5)(a) for an applicant to lodge a claim form (D7256) which will be processed according to Departmental Instruction B16/95.

7.After a decision is made to meet some or all of the cost of the “relevant documentary medical evidence” payment will be made to the applicant whether he or she has already paid for the evidence or not.  The onus will then be on the applicant to settle the account with the provider.  By making all payments directly to the applicant, the record of benefits paid will be complete for future reference.

8.Where an account is unpaid, the butt attached to the cheque should note, for example “VRB additional evidence from Dr .....”.  An applicant may simply endorse the cheque to the provider by writing on its back “Please pay Dr .....” and adding their signature.  Alternatively the applicant may bank the cheque and make other arrangements for paying the provider.

9.It is stressed that in these cases the Department has no direct obligation to the provider and consequently it must not enter into any enquiries from the provider.  Should such an enquiry be received the provider is to be referred directly to the applicant.

10.If State Offices know of cases where contrary advice has been given the VRB applicants should be contacted.

W R MAXWELL

HEAD

COMPENSATION DIVISION