12.7.5 Interim transitional cases

An initial interim transitional determination is processed in the same manner as a determination based on a person with stable conditions with the exception of the applicable lifestyle factor to be used. Generally the bottom lifestyle rating of the shaded area will be applied. For more information about interim payments please see chapter 5.8 of the MRCA PI Policy Manual.

Reassessment of an interim transitional PI claim

Where interim PI has been paid, the client is not required to lodge a claim in order for their impairment to be reassessed (under section 75(4)) upon stabilisation of their conditions (see Chapter 5.8.6 for more information on this).

What is the relevant date for including VEA and or DRCA conditions (and related payments)?

Where a person is being reassessed (due to stabilisation of their conditions) following interim compensation being paid, the most recent PI claim date preceding the section 75(4) assessment (i.e. finalising an interim) is the relevant date for the purposes of determining which VEA and/or DRCA conditions (and related payments) to include or exclude in the assessment.

For the purpose of considering the VEA and/or DRCA conditions (and related payments), the delegate should ask the following question:

Has the person lodged any further MRCA PI claims since the initial PI claim was made resulting in the interim determination?

• If no, the relevant date is the date of the initial PI claim, or
• If yes, the relevant date is the date of the last MRCA PI claim preceding the 75(4) assessment.

Refer to the example in Chapter 5.8.6 of this manual for further clarification on what is considered the last MRCA PI claim for these purposes.

Example

For example, a transitional client lodges a PI claim on 13 July 2011 which results in payment of interim compensation due to one condition being unstable. On 26 March 2012, the client lodges another PI claim based on new conditions which results in an additional payment of interim compensation. The client lodges a further PI claim on 18 September 2012 based on a worsening of existing conditions but does not meet the required impairment point threshold for payment of additional interim compensation. On 9 December 2012, all of the client’s conditions stabilise and a reassessment is undertaken under section 75(4). For the purposes of determining what VEA and/DRCA conditions and related payments are included/excluded in the reassessment, the last MRCA PI claim date is 26 March 2012.