8.10 Catastrophic Injury Provisions

Catastrophic Injury (and Disease) Provisions

for Household Services and Attendant Care Services

 

Policy Statement

This policy allows members and former members of the Australian Defence Force (ADF) whose condition/s meet the definition of catastrophic injury (or disease) under the DRCA or the MRCA to receive Household Services and/or Attendant Care Services to a level reasonably required, without regard to the statutory limits that would ordinarily apply to these services.

Services funded through Catastrophic Injury Provisions remain subject to DVA’s Household Services Policy and Attendant Care Policy.

Authority

This policy provides support under the Military Rehabilitation and Compensation Act 2004 (MRCA) and the Safety, Rehabilitation and Compensation (Defence-related Claims) Act 1988 (DRCA).

Legislative authority is given under the Military Rehabilitation and Compensation (Catastrophic Injury or Disease) Determination 2018 and the Safety, Rehabilitation and Compensation (Defence-related Claims) (Catastrophic Injury) Rules 2018 (‘the Catastrophic Injury and Disease provisions’).

This policy is informed by Comcare’s Safety, Rehabilitation and Compensation Act 1988 (SRCA), and the Safety, Rehabilitation and Compensation (Catastrophic Injury) Rules 2018.

Background

In 2017, Comcare introduced catastrophic injury provisions into the Safety, Rehabilitation and Compensation Act 1988 (SRCA).  The provisions are used to enable support to clients under the National Insurance Injury Scheme (NIIS).

These provisions were replicated in the Safety, Rehabilitation and Compensation (Defence-related Claims) Act 1988 (DRCA), which was passed in October 2017 and subsequently utilised by DVA in place of the SRCA.  Following this, catastrophic injury provisions were incorporated into the Military, Rehabilitation and Compensation Act 2004 (MRCA), which were passed by Parliament in March 2018.

The implementation of this policy ensures that the provision for Household Services and Attendant Care services for clients under the MRCA and DRCA are equivalent to civilians with coverage under the SRCA.

Intent

A Catastrophic Injury determination provides clients with access to Household Services and/or Attendant Care services on a needs basis, subject to assessment, without regard to the weekly statutory limit.  The determination does not guarantee a higher level of these services will be required by the client or funded by DVA.

Household Services and Attendant Care Services funded through Catastrophic Injury Provisions remain subject to DVA’s Household Services Policy and Attendant Care Policy – see ‘Related Policy and Legislation’ section of this page for more information.

Services that do not fall within scope of either Attendant Care or Household Services cannot be funded through Catastrophic Injury Provisions.  Even where a person has a catastrophic injury or disease determined, funding for relevant treatment, medical or allied health services should continue to be met though the DVA health card arrangements or mainstream services, as appropriate.

Catastrophic Injury Provisions do not provide coverage for clients without MRCA and/or DRCA accepted conditions. This includes those with entitlement solely derived from:

Eligibility

For the purpose of MRCA and DRCA, a client can be considered to have a “catastrophic injury” if both of the following conditions are satisfied:

  1. The MRCA and/or DRCA injury results in an impairment assessed by a FIMTM credentialed medical or health care professional at a score of 5 or less on any of the items on the FIMTM score sheet; and
  2. The Commission is satisfied that according to criteria provided in the relevant instrument, the injury is:
    1. A catastrophic nerve injury; or
    2. A catastrophic brain injury (additional assessments may be required); or
    3. A catastrophic amputation injury; or
    4. A catastrophic burn injury; or
    5. A catastrophic blindness injury.

The Catastrophic Injury Provisions Instruments under MRCA and DRCA provide detail on the scope of each condition type, or presenting issues for the purpose of eligibility.  The conditions are based on the minimum benchmarks for eligibility to catastrophic traumatic injuries for the workplace accidents stream of the NIIS, and are also equivalent to those contained in the motor vehicle accidents stream of the NIIS.

It is noted that what may be defined as a ‘catastrophic’ injury by one agency (such as Department of Defence) can vary from the definition applied for this policy.  Conditions that are not within scope of the conditions of a catastrophic injury or disease (as per the legislative instrument) are excluded from being considered.

To be eligible for Catastrophic Injury provisions, a formal determination must be made in writing by a Commission Delegate and communicated to the client.  Any formal decision made by a Commission Delegate regarding the outcome of a catastrophic injury claim must be evidence-based as outlined in the Catastrophic Injury Guidelines.

Formal determinations must be made by Delegates with appropriate delegation authority.

Related Policies, Legislation and Information

Policy
Internal Guidelines
  • Catastrophic Injury Guidelines
  • Household Services Guidelines
  • Attendant Care Guidelines
  • Delegations registers for MRCC and RC
External Guidelines
Legislation
DVA website

Source URL: https://clik.dva.gov.au/rehabilitation-policy-library/8-attendant-care/810-catastrophic-injury-provisions

Last amended