C03/1998 CLAIMS ASSESSORS TO ADDRESS ALL CAUSES OF DEATH WHEN DECIDING A CLAIMF ROR WAR WIDOW(ER)S PENSION

Part

Function

1

Gives the reason and background to this instruction.

2

Clarifies the status of death certificates in deciding the causes of death.

3

States the need to investigate all possible causes of death, including the claimant's contention.

4

States the need to address the claimant's contention and all possible causes of death in reasons for decision.

Purpose

The instruction states the requirement for Claims Assessors to address all causes of death contained on a death certificate or contended by the claimant when deciding a claim for War Widow's pension.

The instruction also clarifies the status of death certificates in considering evidence.

Issue raised by Legacy

Legacy representatives consistently raise this issue at consultative forums.  The essence of their complaint is that some Claims Assessors rigidly confine their investigations to the primary cause of death as shown in the first section of death certificates.

They also point to a lack of consistency.  They give other instances where Claims Assessors have stated that a cause shown on a death certificate is not a cause because they have medical opinion to the contrary.

Inconsistency noted in sampling exercise

The death cases sampling exercise carried out last year also pointed to inconsistency amongst Claims Assessors in investigating and determining the causes of death.

Death certificates are one piece of evidence

In the majority of cases the cause of death as shown on a death certificate is common ground and no further investigation is required to establish a cause.  The information used by the Claims Assessors that is contained on the death certificate about the cause of death is not an issue.

However, this is not always the case.

Although the Bureau of Statistics issues guidelines for Medical Officers to complete death certificates, our experience shows that the quality of the information recorded on death certificates varies considerably.

In some cases the certificate merely states the terminal event (eg pneumonia) without reference to the underlying disease process.  In the other extreme, the certificate may list all of a person's medical ailments without clearly indicating which ones were causal in the death.

In the final analysis the information contained on the death certificate constitutes no more than a medical opinion on the cause of death.  Consequently, death certificates can only be treated as one of the possible sources of evidence in deciding the causes of death for a particular claim.

‘Rules' cannot apply to death certificates

Because of the variable quality of death certificates, Claims Assessors must not attempt to apply a set of rules in interpreting death certificates.  For instance, no rule can be made that for a cause to be accepted, the cause must appear in the first or second sections of the certificate.

Decide each case on its merits

Each case must be decided on its own merits and depends on the entirety of the evidence available.  Death certificates form part of this evidence on which the Claims Assessor decides the cause of death.

A claimant's contention about a cause of death cannot be disregarded simply on the basis that the contended cause is not included on the death certificate.

All causes to be investigated

Claims Assessors must investigate all causes of death that are shown on a death certificate before rejecting a claim.

The results of investigations must be clearly recorded on the claimant's file.

Claimant's contention to be investigated

In cases where the claimant has contended a cause of death that is not included on the death certificate, this contention must also be investigated and additional evidence sought to establish if it has a basis in fact.

At a minimum, medical opinion about the contended cause should be obtained in such a case.  Preferably, the claimant's representative should be contacted to discuss the basis of the contention and be asked about the sources of evidence on which the contention is based.

The Claims Assessor may be required to investigate the matter further by obtaining clinical or hospital notes, autopsy reports, etc, depending on what evidence is available.  The Claims Assessor may need to consult with a Medical Officer in deciding what avenue to pursue.

Care in accepting contributory causes

It is also important to note that all disabilities contained on a death certificate should not automatically be accepted as having causally contributed to the death.

Such a circumstance might arise where there is evidence that a major disability has caused the death (such as a cancer), but the death certificate also lists other unrelated or minor disabilities as contributory causes (such as hypertension which the medical history shows as controlled).

In this circumstance a medical opinion should be sought about the cause of death.  Before making a decision it may be necessary to obtain further details of the veteran's medical history and treatment in the time leading to the death.  Again, each case needs to be considered on its merits.

Requirement for reject reasons

In preparing reasons for decisions when rejecting a claim for pension in respect of a veteran's death, Claims Assessors must:

• Show that they have considered all of the disabilities included on a death certificate.

• Show that they have considered the claimant's contention.

• State what they consider to be the causes of death.

• Refer to the evidence that leads to their conclusion.

System changes

System changes will be made that will require Claims Assessors to clearly identify their findings on causes of death in reasons for decision.