No Certificate

If no certificate has been received, the claim must still be registered.  This then provides Comcare with a record of how many claims of this type are being lodged.

Once the claim has been registered, a standard letter should be issued, to advise the employee that no further action will be taken with his or her claim until a medical certificate has been received.

Effectively, this means that there will be a small number of claims left on PRACSYS with a determination status of 'N' (non compliant).  However the Act indicates no further action is required for non-compliant claims.

The claim should simply be filed away in the file bays.

There are mandatory and non-compliant fields in 'Create Claim' (CCLM.CC).

Mandatory fields are those that must be completed for a claim to be recognised as registered by PRACSYS.  As there are very few of these on the system, this means claim details can be entered using minimal information.

There are three sets of non-compliant fields on PRACSYS.  The legal term has already been discussed above.

However, non-compliance also relates to some information that needs to be supplied by both the employer (such as their customer and Cost Centre numbers) and employee (rehabilitation and incapacity details) before a claim can be determined.

This means that while a claim may be registered using minimal information, it must satisfy the compliance test before it may then be determined.

If non-compliant, the employee may need to be sent a letter advising that certain details are missing, and that no further action will be taken with the claim until the information is provided.

To issue this letter, the function 'Issue Standard Letter' under the General Facilities Menu (ASSL.GF), and letter ID 'CMIV01E' should be used.

If the required details are later received to make the claim compliant, the claim record should be updated on PRACSYS.  As the claim has already been created on the system, new details will need to be added through the amend process.

To do this, the 'Amend Claim' (ACLM.CM) function in the Claims Management menu should be selected.  Once the function is selected, any missing 'compliant' detailswill be highlighted in bright pink.

Once information is added the claim may be determined (the 'N' determination

This is because an historical record needs to be kept of employer and Cost Centre changes.  It is all a crucial part of ensuring that payment and reimbursement of benefits and allocation of premiums for employers are accurately recorded and maintained.