Purpose

The purpose of this Departmental Instruction is to provide legislation and policy information and procedural guidelines.  This information is provided with regards to the 1999/2000 Budget Initiative that changes the permanent incapacity for work eligibility criteria for:

• Invalidity Service Pension (ISP); and
• Invalidity Income Support Supplement (I-ISS).

R J HAY

BRANCH HEAD

INCOME SUPPORT

Introduction

From 1 January 2000, the 1999/2000 Budget introduced changes to the eligibility criteria for the assessment of permanent incapacity for work for:

• Invalidity Service Pension (ISP); and
• Invalidity Income Support Supplement (I-ISS).

Old rules

Prior to 1 January 2000, a person was considered to be permanently incapacitated for work if:

• the degree of permanent incapacity was 85% or more; or
• the person was permanently blind in both eyes.

Subjectivity

The 85% component of the criteria is subjective and open to broad interpretation.  This makes it difficult for both the treating doctor and the decision-maker to arrive at an objective assessment of permanent incapacity for work.

Aim of change

The aim of the initiative is to make the assessment of eligibility for permanent incapacity for work more objective.  This will be achieved by aligning the assessment of permanent incapacity for:

• ISP, with the Special Rate of Disability Pension (i.e Totally and Permanently Incapacitated- T&PI); and
• I-ISS, with the Disability Support Pension (DSP) paid by Centrelink.

Commencement date

Changes to the permanent incapacity for work eligibility criteria for ISP commence on 1 January 2000.

ISP rules

For ISP purposes, a person is permanently incapacitated for work if:

• the person is permanently blind in both eyes; or
• the person is a veteran to whom section 24 of the VEA applies (special rate pension); or
• the person has an impairment that, if deemed to be an injury or disease for the Guide to the Assessment of Rates of Veterans' Pensions, would rate 40 or more in Table 18.1 of that Guide; and
• solely because of the incapacity, the person is permanently unable to work for periods adding up to more than 8 hours per week; and
• the Repatriation Commission regards the incapacity as permanent.

Who is affected

The new criteria will apply to claims lodged from 1 January 2000.

Note: existing recipients will not have their eligibility re-assessed under the new rules.  Similarly, formal claims for ISP lodged prior to 1 January 2000, will be determined under the old rules, as will section 57 reviews lodged after 1 January 2000 where the original determination was made under the old rules.

Commencement date

Changes to the permanent incapacity for work eligibility criteria for I-ISS commence on 1 January 2000.

I-ISS rules

For I-ISS purposes, a person is permanently incapacitated for work if:

• the person is permanently blind in both eyes; or
• the person has a physical, intellectual or psychiatric impairment that results in 20 points or more under the Impairment Tables in Schedule 1B of the Social Security Act 1991; and
• the Commission is satisfied that solely because of the impairment, the person cannot work for the following 2 years.

Work definition

For I-ISS purposes, work means work that:

• is undertaken for at least 30 hours a week at award wages or above; and
• exists in Australia even if not, for a particular person, in the locally accessible labour market.

Who is affected

The new criteria will apply to claims lodged from 1 January 2000.

Note:  existing recipients will not have their eligibility re-assessed under the new rules.  Similarly, formal claims for I-ISS lodged prior to 1 January 2000, will be determined under the old rules, as will section 57 reviews lodged after 1 January 2000 where the original determination was made under the old rules.

Changes to VEA

ISP and I-ISS related changes to the Veterans' Entitlements Act 1986 (VEA), were effected in the Veterans' Affairs Legislation Amendment Act, No. 171, 1999.  The Act received Royal Assent on 10 December 1999.

More information: http://scaleplus.law.gov.au/html/comact/10/6083/t — op.htm

ISP changes

Changes to the VEA in relation to ISP include:

• Repeal of permanent incapacity for work criteria in subsection 37(2).
• New section 37AA provides for Commission to specify the new criteria in a written determination (i.e. disallowable instrument).

• New section 37AAA provides for continued eligibility for ISP for 7 years, if the person ceases to be permanently incapacitated for work while participating in the Veterans' Vocational Rehabilitation Scheme.

More information: refer 'Disal — l — owa — b — le Instruments' section.

I-ISS changes

Changes to the VEA in relation to I-ISS include:

• Repeal of permanent incapacity for work criteria in subsection 45A(3).

• New section 45AA provides for Commission to specify the new criteria in a written determination (i.e. disallowable instrument).

More information: refer 'Disallowable Instruments' section.

Fringe Benefits changes

Changes to the VEA in relation to Fringe Benefits (i.e. Pensioner Concession Card) mean that if a person is receiving ISP, and they cease to be eligible because they are working more than 8 hours per week, they remain eligible for fringe benefits.

More information: refer 'Disallowable Instruments' section.

Summary

There are 3 Disallowable Instruments that set out the circumstances in which a person:

1. is permanently incapacitated for work in order to be eligible for ISP;
2. is permanently incapacitated for work in order to be eligible for I-ISS;
3. continues to be eligible for fringe benefits.

ISP

The Veterans' Entitlements (Invalidity Service Pension – Permanent Incapacity for Work) Determination 1999 sets out the circumstances in which a person is permanently incapacitated for work in order to be eligible for ISP.  The circumstances are outlined at Section 1.2, 'New Permanent Incapacity Criteria for ISP'.

I-ISS

The Veterans' Entitlements (Income Support Supplement – Permanent Incapacity for Work) Determination 1999 sets out the circumstances in which a person is permanently incapacitated for work in order to be eligible for I-ISS.  The circumstances are outlined at Section 1.3, 'New Permanent Incapacity Criteria for I-ISS'.

Fringe benefits

The Veterans' Entitlements (Continued Fringe Benefits) Determination 1999 sets out the circumstances in which an ISP recipient continues to be eligible for fringe benefits.  Where the ISP recipient starts working for more than 8 hours per week, eligibility for fringe benefits is continued for:

• 12 months; or

• until the person stops working for more than 8 hours per week,

whichever occurs first.

Online viewing

The 3 disallowable instruments will be available on CLIK.

Summary

The Veterans' Affairs Legislation (Permanent Incapacity – Transitional) Regulations 199, no. 358 set out the rules relating to determining claims and applications for review, lodged prior to 1 January 2000.  The Regulations also provide for 'grandfathering' of existing ISP and I-ISS recipients.

More information: http://scaleplus.law.gov.au/html/numrul/17/8561/top.htm

Grandfathering

The Regulations provide for a person receiving ISP or I-ISS prior to               1 January 2000, to remain eligible under the old rules (i.e. grandfathering).  Note: if eligibility is lost on or after 1 January 2000, any reapplication for a determination on the permanent incapacity for work would be assessed under the new rules.  If payability is lost, but not eligibility, any reapplication for a determination on the permanent incapacity for work would be assessed under the old rules.

Claims

The Regulations provide for a formal claim made prior to 1 January 2000 to be determined in accordance with the old rules, even if determined on or after 1 January 2000.

Note: Where an informal claim is lodged prior to 1 January 2000 but the formal claim is lodged on or after 1 January 2000 the claim is determined under the new rules.  In this scenario, payment may be backdated to the date of the informal claim, of course providing the formal claim is made within 3 months of the informal claim.

Reviews (appeals)

If a primary determination is made under the old rules, and a request for review:

1. of the primary decision is received; or
2. is made to the AAT; or
3. is made to a higher court,

the Regulations allow for the review decision or the decision of the court to be made under the old rules.

Summary

The Repatriation Commission has provided policy directives on the following, for ISP purposes:

• definition of work;
• definition of manifest;
• medical assessment protocol.

Definition of work

A definition of 'work' was sought from Commission.  The model used by Disability Compensation in relation to Special Rate (T&PI) was adopted (section 28 VEA and Commission Guidelines CM 5011 of 10 June 1999 refer).  A summary of the salient points is below.

For ISP purposes, work means work that:

• a person with the veteran's skills, qualifications and experience might reasonably undertake, possibly with retraining; and
• is actually undertaken and is not uncommon in the Australian work force; and
• is of a kind for which award wages are, or could reasonably be expected to be, paid.

Work in this context is not necessarily limited to:

• the particular type of job that the veteran has previously undertaken; or

• work readily available to the veteran at this time or in the veteran's local area.

Note: factors to consider in determining ability to work for invalidity ISS can be found on at the following link:

www.facs.gov.au/guide/ssguide/36270.htm

Definition of manifest

A definition of 'manifest' was sought from Commission.  This definition was sought in order to minimise the number of veterans being sent to medical examinations if it is clearly not necessary.  Commission approved the following definition:

Manifest means that the veteran clearly and obviously meets the invalidity service pension eligibility criteria according to paragraph 37(1)(c) of the VEA, based on the presenting medical evidence available to the Department and that no additional medical assessment or work capacity test is required for the decision-maker to form an opinion regarding 'permanently incapacitated'.

Medical assessment protocol

To provide decision makers with the discretion to use an independent medical service provider if it is required in order to make a decision, Commission approved the following Medical Assessment Protocol:

1. As part of the new claim application, the veteran's treating doctor provides an initial diagnosis.
2. As a matter of course, the veteran undergoes a medical assessment to ascertain GARP impairment points and/or whether they pass or fail the work test.
3. Independent medical assessment may be required if:

• the veteran is in receipt of Newstart (recipients have to declare that they are fit and able to work, and willing to look for work, therefore this may suggest that they are capable of working 8 hours per week);
• the veteran is still employed, with a retirement date in the future (e.g. voluntary redundancy cases);
• the veteran has travelled some distance to visit a doctor (this might suggest that the veteran is seeking a more favourable medical assessment);
• the Disability Pension model for diagnosing Psychiatric conditions is not satisfied.  'Diagnostic Guidelines for Psychiatric Assessment and Reports' and the 'Second Opinion Protocol for Psychiatric Cases' provide guidelines on the provision of psychiatric reports that are of a suitable standard for DVA purposes.  These documents can be accessed via: Start\Departmental\Applications\CCPS\CCPS Research Library. →
• the new claim application raises other medical questions.

Summary of process

The ISP claim process from inquiry to permanent incapacity for work determination can be broken into the following steps

1. Receive inquiry

6. Calculate impairment points

2. Send & receive new claim kit

7. Determine work test result

3. Register the case

8. Finalise case

4. Diagnose

9. Make decision

5. Send & receive GARP and work test forms

10. Advise veteran

More detail

Each step is discussed in the following table

Step

Action

1

Inquiry is received and D0501 Preliminary Details form is completed (according to State practice)

2

Send:

• Covering letter
• D0503 Claim for Service Pension by a veteran or mariner
• D0569 Invalidity Details form
• Reply paid envelope (according to State practice)

Receive completed:

• D0503
• D0569

3

Register veteran on MAGPIES

Register claim on MAGPIES

Note: if TPI, Blind, Manifest or Able to work, claim can be fast tracked to finalisation and decision- go to Step 8.

4

Enter treating doctor diagnosis on MAGPIES by using International Classification of Diseases

Note: if calculating points for a psychiatric condition, diagnosis made by a non-specialist, must be confirmed by a psychiatrist.

5

Send Doctor:

• Covering letter
• Schedule of fees
• GARP medical assessment forms
• D0570 Work test questionnaire

Note: in some cases it may only be necessary to send the D0570.  For example, where there are already 40 impairment points on file.

Send Veteran:

• Covering letter (veteran to make appointment with doctor)
• D0803 Claim for travelling expenses (according to State practice)

Receive completed:

• GARP medical assessment forms

• D0570 Work test questionnaire

6

Calculate GARP impairment points using MAGPIES

7

Determine Work test result and record decision on MAGPIES

8

Finalise the case using MAGPIES

9

Make decision to accept or reject claim.

Record decision for file on D0572 PI Determination Sheet.

10

Advise veteran in writing of decision

More info

Click on these hyperlinks for more information relating to these procedures.

2.3 Forms- ISP

2.5 Standard Letters- ISP

3.2 MAGPIES Cheat Sheet

Summary of process

The I-ISS claim process from inquiry to determination can be broken into the following steps

1. Receive inquiry

4. Determine eligibility/make decision

2. Send & receive new claim kit

5. Finalise case

3. Register the case on CMS

6. Advise claimant

More detail

Each step is discussed in the following table

Step

Action

1

Inquiry is received and D0501 Preliminary Details form is completed (according to State practice)

2

Send claimant:

• Covering letter including paragraph advising claimant to make an appointment with approved Centrelink medical assessment service provider
• D0529 Claim for Income Support Supplement by a War Widow or Widower
• D0571 Medical and Work Details form
• Reply paid envelope (according to State practice)
• Attachment containing list of Centrelink approved medical assessment service providers

Send doctor:

• Covering letter
• Schedule of fees

Receive completed:

• D0529
• D0571

3

ISS claim registered on CMS and PIPS PC

4

Make decision to accept or reject claim- includes PI aspect based on the information provided in the D0571 Medical and Work Details form as completed by the Centrelink approved doctor

5

Finalise the case on PIPS PC

6

Advise claimant in writing of decision

More info

Click on these hyperlinks for more information relating to these procedures.

2.4 Forms- I-ISS

2.6 Standard Letters- I-ISS

Summary

A number of forms were either created or modified for ISP.  They include:

• Preliminary Details form (D0501)
• Claim for Service Pension by a veteran or mariner (D0503)
• Invalidity Details (D0569)
• GARP medical assessment forms
• Work test questionnaire (D0570)
• Schedule of fees
• Combined Impairment Assessment report
• PI determination sheet (D0572)

D0501

The service pension Preliminary Details form D0501 has been modified to allow Special Rate (T&PI) and Blind cases to be easily identified.  This will allow these cases to be fast tracked to finalisation and decision.

Available on: Online Forms.  Hyperlink to Online Forms: http://internet-mirror/factsheets/default.htm

D0503

The Claim for Service Pension by a veteran or mariner D0503 has been modified to allow Special Rate (T&PI) and Blind cases to be easily identified.  This will allow these cases to be fast tracked to finalisation and decision.

Available on: Online Forms

D0569

The old Invalidity Details D512 has been replaced with a new Invalidity Details form D0569.  The new form provides space for a diagnosis from the treating doctor.

Available on: Online Forms

GARP forms

MAGPIES will generate the GARP medical assessment forms for the treating doctor to complete.  The answers on these forms will be entered into MAGPIES to arrive at an impairment point calculation.

Available on: MAGPIES

Note: the GARP forms should be stamped with the 'return to Income Support' stamp available in each State.  This will ensure the forms are returned to Income Support.

D0570

The Work Test Questionnaire D570 is a new form that is completed by the treating doctor, at the same time as the GARP forms.

Available on: Online Forms

Schedule of fees

A schedule of fees has been developed to advise the doctor how much they will be paid for their service (consultation and report).  The schedule of fees should be sent to the doctor with the GARP and Work Test forms.

Available on: MS Word- word document emailed to all contacts

CIA

The Combined Impairment Assessment (CIA) report is generated by MAGPIES and provides information about the GARP assessment.  The following table shows when to put the CIA on file and when to send it to the veteran.

Available on: MAGPIES

IF claim is...

THEN...

granted

place copy of CIA on file.

rejected

place copy of CIA on file; and

send copy of CIA to veteran, with rejection letter.

Note: if the claim is rejected only due to failure of the work test (i.e. 40 or more GARP impairment points were obtained), the CIA report would not be sent to the veteran.

D0572

A Permanent Incapacity Determination sheet has been developed to record the details of the permanent incapacity for work decision.

Available on:  Online Forms

Summary

A number of forms were either created or modified for I-ISS.  They include:

• Preliminary Details form (D0501)
• D0529 Claim for ISS by a war widow or widower
• D0571 Medical and Work Details
• Schedule of Fees

D0501

Refer to 2.3 F — o — rms- ISP.

D0529

The Claim for Income Support Supplement by a War Widow or Widower D0529 has been modified to identify claimants who are blind, so they can be fast tracked to finalisation and decision.

Available on: Online Forms

D0571

The Medical and Work Details form D0571 has been developed to obtain a medical assessment and work ability details from the Centrelink approved medical assessment service provider.  The Centrelink approved doctor will also provide the impairment point rating on this form.

Available on: Online forms

Schedule of fees

A schedule of fees has been developed to advise the Centrelink doctor how much they will be paid for their service and/or reports.  The schedule of fees should be sent with the Medical and Work Details form.

Available on: MS Word- word document emailed to all contacts

Summary

A number of standard letters were created.  They include:

• Cover letter for Doctor (informal claim)
• Cover letter for Doctor (formal claim)
• Cover letter for Veteran
• New Claim Reject- Not PI

Doctor cover letter (informal)

A covering letter has been developed to go to the treating doctor with the GARP forms, Work Test questionnaire and schedule of fees.  This letter is sent if the veteran is sent to a medical assessment on the strength of an informal claim for ISP.

Available on: IS Standard Letters, Clinical

Doctor cover letter (formal)

A covering letter has been developed to go to the treating doctor with the GARP forms, Work Test questionnaire and schedule of fees.  This letter is sent when the veteran is sent to a medical assessment after lodging a formal claim for ISP.

Available on: IS Standard Letters, Clinical

Veteran cover letter

A covering letter has been developed to go to the veteran after lodging a claim.  The letter advises the veteran to make an appointment with their treating doctor to undergo medical assessment for the purposes of determining permanent incapacity for work.

Available on: IS Standard Letters, Clinical

New claim reject

A new letter has been developed for claims that are rejected.  This letter allows the decision-maker to choose rejection reasons from a list of options.  The CIA report would be sent with this letter if a CIA report has been produced.

Available on: IS Standard Letters, New Clm

Summary

New standard letters were created.  They include:

• ISS New Claim Reject

• ISS covering letter, claim already lodged
• ISS covering letter, claim not lodged
• ISS letter to Doctor

New claim reject

A new letter has been developed for claims that are rejected.  This letter allows the decision maker to choose rejection reasons from a list of options.

Available on: IS Standard Letters, New Clm

Cover letter claim already lodged

If a claim form has already been lodged, this covering letter is used to advise the claimant to make an appointment with a Centrelink medical assessment service provider.

Available on: IS Standard Letters, Clinical

Cover letter claim not lodged

The new claim kit contains a covering letter that advises the claimant to make an appointment with a Centrelink medical assessment service provider when they are ready to lodge their new claim.

Available on: IS Standard Letters, Clinical

Letter to Doctor

This letter is sent to the doctor with the Schedule of Fees that tells the Doctor how much they will paid for completing the D0571, Medical and Work Details form.

Available on: IS Standard Letters, Clinical

Changes to auto advice

An existing automatic advice is generated for new grants of ISP and I-ISS.  Changes to the grant and obligation paragraphs of the letter will take effect for cases eligible under the new rules after the 'Y2K freeze' is lifted and DOE system changes are implemented.  This is expected to be in late April 2000.

Veterans eligible under the old rules will receive the old paragraphs as applicable.

Y&YP insert

The You and Your Pension booklet is sent with all new grant advices, as formal advice of obligations.  A one page insert has been developed for inclusion with the booklet.  The insert amends the ISP and I-ISS obligations in the booklet.  The new insert should be included with hard copies of the booklet until such time as the booklet is reprinted.

Note: the ISP and I-ISS obligations in the electronic DVA web-site version of Y&YP have been updated.

New system

A permanent incapacity computer system for ISP has been developed with 3 main functions:

1. generate GARP medical assessment forms;
2. calculate GARP impairment points; and
3. record permanent incapacity for work decisions (i.e. eligibility).

MAGPIES

The name of the new system is MAGPIES.  MAGPIES stands for Medical Assessment GARP Permanent Incapacity Eligibility System.

Stand-alone

MAGPIES is a stand-alone computer system.  This means it does not 'talk to' or update any other DVA computer systems.

Access

MAGPIES is accessed through the Start menu and is found under:

• Departmental\Applications\MAGPIES- Production; or

• Departmental\Applications\MAGPIES- Training.

The production version is the 'live' version for processing cases.  The training version is intended for training and practising on etc.

Flight Guide

The MAGPIES Flight Guide is the system manual for MAGPIES.  It is on the DVA intranet and is found at the following link:

http://sharepoint/programsandprojects/systemguides/magpiesflightguide/Pages/MAGPIES%20Flight%20Guide.aspx

I-ISS

MAGPIES is not used to calculate impairment points for I-ISS cases.  The Centrelink Medical Assessment Service Provider will provide impairment points for I-ISS cases on the D0 — 5 — 71 form.

Cheat sheet

A short, practical guide to using MAGPIES is included here.  It is intended as a familiarisation tool for new users.  It is not likely to be needed long term.

Step

Action

Enter veteran personal details

File/New File

Register claim

File/New Case

Select fast track option

Assessment Options (double click)

Finalise Case

Case/Finalise

Step

Action

Enter veteran personal details

File/New File

Register claim

File/New Case

Diagnose

Subject of Claim (double click), Add, Diagnose

Select GARP forms

Impairment Form Categories (double click), Impairment Forms (right click), Classify Forms, select body system

Generate GARP forms

Impairment Form Categories (select), click on red book, Case Print Queue (right click), Print Correspondence, Unaddressed Attachments (select), Print

Select body system to calculate points under

Assessment Sections (double click), Assessment Procedures (right click), Classify Assessment, select body system

Calculate points

Assessment Options (double click), None of the Above (select option), Calculate impairment points using GARP V (select option); Calculate impairment pts (GARPV) (double click), Select blue text line, Assess, answer questions as required

Generate CIA report

Assessment Options (double click), Calculate impairment pts (GARPV) (double click), Report, Combined Impairment Report (select), Report

Enter Work Test result

Assessment Options (double click), Work Test (double click), answer questions

Finalise case

Case/Finalise Case