B16/1995 MEDICAL REPORTS OBTAINED FOR VETERANS' REVIEW BOARD (VRB) - REIMBURSEMENT OF APPLICANTS' COSTS

DATE OF ISSUE:    14 MARCH 1995

MEDICAL REPORTS OBTAINED FOR VETERANS' REVIEW BOARD (VRB) - REIMBURSEMENT OF APPLICANTS' COSTS

Purpose

The purpose of this Departmental Instruction is to notify that the Veterans' Entitlements Act 1986 (VEA) has been amended to enable applicants to the VRB to be reimbursed:

• for the costs of "relevant documentary medical evidence" obtained after the primary decision to be reviewed, and

• for reasonable travelling expenses incurred in obtaining such evidence.

2.The amendment received Royal Assent on 16 December 1994 and is effective from 1 July 1994.

3.The relevant sections of the VEA will be:

• reimbursement of relevant documentary medical evidence - s. 170A.

• reimbursement for reasonable travelling expenses - s. 170B

• advance of travelling expenses - s. 170C

Background

4.In its report presented to the Minister on 18 March 1994, the Veterans' Compensation Review Committee (Baume Committee) found that there was evidence of supporting medical reports being withheld at the primary and VRB levels until the cost could be met at the AAT.  This was despite the fact that if the evidence had been produced earlier the case could have been decided sooner, without incurring the costs of appeals.

5.The introduction of this change to the VEA is in response to a Baume Committee recommendation.  It will enable reimbursement of the cost of relevant documentary medical evidence up to an aggregate total of $425 for each condition that is the subject of review.  This reimbursement applies for all VRB reviews, including assessment.

6.Reimbursement of reasonable travel costs may also be made for the purpose of obtaining such evidence.

Procedural

Reimbursement of Relevant Documentary Medical Evidence

7.The term "relevant documentary medical evidence" has the meaning given in subsection 133 of the VEA, ie:

"'relevant documentary medical evidence', in relation to an application, means certificates, reports or other documents from:

(a) a medical practitioner; or

(b) a hospital, or similar institution, in which the applicant has received medical treatment;

concerning a medical condition of the veteran and reasonably used in support of the application.".

8.The requirements for reimbursement are:

• a right of review exists;

• an application for review has been made to the VRB;

• the relevant documentary medical evidence must have been obtained after the date of notification of the associated primary decision;

• the original relevant documentary medical evidence must be submitted to the VRB and is relevant to a review pending before the VRB;

• the relevant documentary medical evidence must be relevant to the condition that is subject to review;

• original receipts are to be supplied with the application;

• the application for reimbursement must be made within 3 months after the relevant documentary medical evidence was submitted to the VRB (or if the evidence was submitted to the VRB before 1 January 1995 the claim must be lodged before 1 April 1995).

9.It will not be necessary for an application to the VRB to be successful, or even determined, before a claim for reimbursement of relevant documentary medical evidence may be considered.  The withdrawal of a VRB application will not be a barrier to reimbursement but the relevant documentary medical evidence must have been submitted to the VRB.

10.In most cases it will be obvious whether the additional evidence relates to the condition that is the subject of the VRB application.  If in doubt, the advice of a DMO should be sought.

11.There is no allowance for reimbursing applicants for the costs incurred in arranging for medical witnesses to personally attend hearings of the VRB to present medical evidence on their behalf.

12.There is no provision for advances or prepayment of this benefit.

13.Payment will be made through FAS.  The delegate will compare the claim details with the CMS to ascertain that a VRB claim has been lodged for the condition shown in the documentary medical evidence.  FAS records are to include the condition for which the claim was made.  There is provision on the FAS "AMD" screen to include a full description of the condition for which the relevant documentary medical evidence relates and the amount paid in reimbursements.  For record purposes and the possible payment of travel expenses, all necessary claims details are to be entered on this screen.  This will also enable staff to monitor the $425 amount.

14.Reimbursement of relevant documentary medical evidence costs will be made through FAS against subprogram 1.2. (Benefits compensation)  The account number codes to be used are:

Assessment Cases

NSW 1262-24491

VIC 1153-24491

QLD 1114-24491

SA 1255-24491

WA 1356-24491

TAS 1157-24491

Entitlement Cases

NSW 1262-24492

VIC 1153-24492

QLD 1114-24492

SA 1255-24492

WA 1356-24492

TAS 1157-24492

15.Applications are to be processed through State Offices and are to be made on a newly created form, D7526.  Any documentary medical evidence supplied with the claim is to be forwarded to the VRB.

16.The reimbursement of a maximum of $425 is per condition that is subject to review.  Where the relevant documentary medical evidence covers more than one condition an itemised account should be provided.

17.Reimbursement of documentary medical evidence cannot be paid if another authority is to cover costs (e.g.  private health insurance).  If partial costs are met by another authority this department can pay the difference up to the $425.

Future Action

Reimbursement of Associated Travel Expenses

18.If an applicant has had to travel to obtain relevant documentary medical evidence associated with the VRB claim the applicant is, under s.170B(1), entitled to be paid the prescribed travelling expenses.  The new legislation provides for payment of travelling expenses as prescribed by Regulation.  This requires creating a new Veterans' Entitlements Regulation.  Until the Regulation is approved reimbursement of travel expenses cannot be made.  A further Departmental Instruction will be issued when the Regulation is approved.

CCPS

19.CCPS is in the process of being amended and this new legislation will be reflected in advices in the next version of CCPS.

12 Month Review of Medical Reports

20.An examination will be conducted in about 12 months to check the quality of reports submitted and that the provider of the relevant documentary medical evidence is not overcharging.

Specialist Medical Review Council (SMRC)

21.The amended legislation also includes provision for reimbursement of relevant documentary medical evidence and associated travel costs for applicants to the SMRC for review of a Statement of Principle.

22.A separate Departmental Instruction will be issued to cover this aspect of the legislation.

W R MAXWELL

A/G NATIONAL PROGRAM DIRECTOR

BENEFITS