Delegates must record all previous permanent impairment payments to ensure clients are not overpaid and debts incurred.

Locating previous DRCA permanent impairment payments

To find DRCA permanent impairment previous payments for the claimed condition delegates must first check ISH records.

Previous payments made in Defcare may also appear in ISH on at the bottom of the Permanent impairment history.

The break up of s24 and s27 will not show on this screen in ISH for Defcare payments.

The correct break up of previous payments is necessary to record the previous payments accurately in ISH. See also the ISH step by step guides for DRCA permanent impairment.

For previous DRCA permanent impairment payments post 2017/2018 found in ISH take the following steps:

1. Check the ISH Permanent impairment history screen to see all previous payments:

2. Find the condition that you are investigating and record all previous payments for the same condition:

For DRCA permanent impairment payments between 2000 and prior to 2018 in ISH search DEFCARE by taking the following steps:

1. On Claims/Cases overview screen – look at the condition under review to see that a previous DRCA PI payment was made:

2. To ensure the correct amounts under s24 are recorded – double click on the actual bolded words of the condition/case to get to the cases screen:

3. Click on the permanent impairment tab:

4. Scroll down to the decision that accepted and paid compensation to see the corresponding s24 and s27 amounts as well as the date of the decision.

In the example below there is also a ‘DVA clear red. Amount’ recorded. This is due to VEA offsetting that was applied.

This amount should not be deducted in previous payments as the Offsetting team will consider this as part of their calculations for DRCA permanent impairment assessments.

5. To obtain the break up between the Part A and Part B of Section 27 for transposing to ISH, click on the Process view tab:

6. Click on the plus ‘+’ signs for permanent impairment.

The plus sign for the corresponding claim where then payment was made (in this example it was the claim dated 02/01/2014) then the plus sign for ‘register – PI claim’ then double click on the ‘investigate’ icon:

7. This screen will appear – double click on the sentence that says ‘The report has been generated’. Double click here to review the document (s):

8. This will generate a 2 page report which outlines the payment made under s24, as well as parts A and B of s27.

Ignore any ‘deduction amounts’ as this will be related to either VEA offsetting or previous debts/overpayments and do not form the reflection of the DRCA PI compensation amount that was payable for that condition at that time.

The Offsetting team will be aware of any previous deductions when they undertake their calculations.

Any DRCA PI payments made prior to 2000 will not appear in DEFCARE.

The paper DRCA files in CM9 must be reviewed to ensure no previous payments have been made.

If delegates are unsure about whether the client received previous DRCA permanent impairments, the DRCA files saved in CM9 should be consulted.

Recording previous payments in ISH

Ensure that all previous payments for the condition under investigation are all transposed into the appropriate screens in ISH. In the medical impairment screen for DRCA permanent impairment cases:

This chapter describes the actions delegates need to take when assessing the level of permanent impairment under the DRCA.

The standard procedures must be applied if the decision is to reject the claim.

Consider which appropriate Act under the DRCA to apply

Delegates must ensure they have a sound understanding of policy and legislation as to the meaning of ‘permanent’ under the DRCA.

Medical evidence and/or liability decisions can be carefully considered to determine the date a condition became permanent.

The term ‘permanent’ is different to ‘stable’ and has differing implications under DRCA permanent impairment assessments.

If the delegate is satisfied that the condition being assessed became permanent prior to 1 December 1988, this condition must be assessed under the 1930 Act or the 1971 Act depending on when the delegate is satisfied the condition became permanent.

If assessment is under the 1930 or 1971 Act medical evidence must indicate the body region/type and confirm the impairment is permanent and stable at a percentage of loss of efficient use (LOEU). These types of assessments do not include compensation for a non-economic loss (NEL) component.

Delegates should record reasons for being satisfied that the condition became permanent prior to 1 December 1988 in R&C ISH as a case note or on the medical impairment screen.

Functional medical assessment

The functional medical assessment refers to the impairment to the function of a body region caused by an accepted condition.

The tables under Part 2 of the ‘Guide to the Assessment of the Degree of Permanent Impairment, commonly referred to as the ‘PIG’ tables are consulted when determining the percentage of whole person impairment (WPI).

These tables are available in ISH under the ‘medical impairment’ screen.

Delegates assess the level of impairment using available medical evidence. If required, assistance to interpret medical evidence is available from DVA medical adviser compensation (MACs) via ISH.

Ensure the medical practitioner has used the correct table and has assessed the impairment within the range permitted by the relevant table.

Delegates must be satisfied the impairment assessed is from the accepted condition/s only and should go back to the same assessing medical practitioner asking specific questions to assist in determining the level of impairment if required.

Consider whether medical evidence supports that the condition under investigation has been overtaken by other conditions. If this is the case delegates must ensure previous payments for any overtaken conditions are recorded in the current R&C ISH assessment.

Combined whole person impairment (CWPI)

When conducting the functional medical assessment in R&C ISH, delegates should consider whether the condition under investigation constitutes a combined whole person impairment (CWPI) and affects differing body regions. R&C ISH automatically calculates CWPI.

Delegates must record notes in R&C ISH which justifies functional medical assessment and attach relevant medical evidence to ISH.

Non-economic loss scores

Non-economic loss (NEL) deals with the effects of the impairment on a client’s life or lifestyle in relation to pain and suffering, loss of amenities, loss of expectation of life, and other losses of a non-economic nature.

NEL is a subjective concept and delegates must consider the self-reported scores in conjunction with medical evidence carefully and determine what NEL the client suffered as a result of the specific injury being assessed.

NEL scores are done on a case-by-case basis and will rest on the evidence provided to determine the claim.

NEL scores must not be:

• reduced unless there is clear evidence to support this, and only once the veteran has been provided an opportunity to clarify or respond to delegate’s concerns with the self-assigned NEL score
• offset against the scores determined for a separate injury
• based on a delegates opinion.

NEL assessments are not required when:

• the client is deceased
• the assessment is an interim assessment
• 1971 Act or 1930 Act impairments where the claim for NEL is lodged on or after 7 December 2000.

The NEL questionnaire

The NEL questionnaire provides clients with an opportunity to express how a condition affects different aspects of their lifestyle.

A new NEL questionnaire should be completed for each different condition.

Where the client has not provided sufficient comments or justification for selecting a NEL score, they must be given further opportunity to provide information, especially if a NEL score is being amended.

Calculations

The amount of NEL compensation payable is divided into 2 equal amounts, a Part A and Part B.

Part A is pre-determined by the level of whole person impairment (WPI) determined for the injury under section 24.

Example:

A client who’s injury causes 10% WPI under section 24 will also be entitled to 10% of the maximum rate payable under section 27 Part A.

Part B is determined based on the level of impact the injury has on the client’s lifestyle. Delegates are required to determine the scores in each section by carefully considering the clients NEL questionnaire, along with any other relevant evidence.

Example:

A client claims PI for their accepted lumbar spondylosis. In the NEL questionnaire they self-assesses recreation activities at a score of three and describes an inability to continue playing golf and go fishing.

The delegate considers the clients score in conjunction with medical reports before accepting this score.

NEL assessments must not:

• exceed the maximum score of five in each table, for each separate injury
• be based on assumptions
• be made using a ridged instruction or ‘blanket rules’
• be ‘offset’ against the scores determined for a separate injury
• be determined in reference to ‘the functional capacity of a normal healthy person.

At times, there may be an ‘overlap’ between the NEL being assessed and a NEL that the claimant has received in respect to a separate injury. In these instances, the delegate must use the evidence before them to make a determination as to the NEL suffered by the client for the injury that they are assessing.

Other factors, including an injury for which PI compensation has already been paid, must be excluded from the determination.

This should, in practice, draw a distinction between any NEL that has resulted from the injury being assessed and NEL that has resulted from a separate/previous injury. It may be necessary for the client to explain the lifestyle loss associated with each injury to assist with decision-making.

Delegates can consider the appropriateness of a NEL score for subsequent injuries where there is clear medical or other relevant evidence confirms that a lifestyle effect has already been taken into account as part of a NEL for a previous injury.

Example:

A client claims PI for their accepted left shoulder rotator cuff injury and left wrist carpal tunnel injury. In both NEL questionnaires the client self-assesses recreation and leisure activities at a score of 2 and states they are no longer able to play guitar as a result of both injuries.

The delegate accepts the score of 2 for the wrist injury and makes a decision accordingly.

Before making a determination on the shoulder injury, the delegate contacts the client requesting additional information about how the shoulder injury causes a loss of recreation and leisure activities independent to the loss caused by the left wrist.

Providing the client an opportunity to support the two separate scores ensures procedural fairness and natural justice.

The client provides additional information, explaining how the shoulder injury prevents them from playing guitar, but also tennis and attending boxing classes as frequently as was once enjoyed.

The delegate is able to be satisfied that the loss caused by the left shoulder is different to the loss caused by the left wrist.

Therefore the delegate is open to determine a score of 2 for the recreation and leisure activities section for both the left shoulder and the left wrist independently.

This would not be providing compensation twice for the same effects on the client’s lifestyle.

Interim assessments

If medical evidence supports the condition being assessed is permanent but not yet stable, delegates can consider an interim assessment if the impairment meets the normal minimum criteria of impairment levels to warrant a payment.

Delegates must obtain the following before proceeding with an interim assessment:

• A written request from the client asking for an interim assessment for the condition being assessed.
• Medical evidence confirming the condition is permanent but not yet stable.
• Medical evidence confirming that the client’s impairment will remain at least at 10% WPI for new assessments, or increased by at least 10% WPI (since the previous DRCA PI compensation payment was made) after any treatment undertaken.

For further information refer to:

• CLIK - DRCA policy manual - Permanent impairment handbook - 4.3 Interim payment of compensation for permanent impairment [4][1]
• CLIK - DRCA policy manual - Permanent impairment handbook - 1.2 lump sum compensation for losses under the 1930 and 1971 Acts [5][2]
• CLIK - DRCA policy manual - Permanent impairment handbook - 3.3.2 Importance of date permanent [6] [3]
• CLIK - DRCA policy manual - Permanent impairment handbook - 3.3.2.1 When should an old Act injury be assessed under the 1988 Act?
• CLIK - DRCA policy manual - Permanent impairment handbook - 5.3 tables 1-13 of the approved guide [8][5]
• CLIK - DRCA policy manual - Permanent impairment handbook - 5.4.1 Combined whole person impairment (CWPI) [9] [6]
• CLIK - DRCA policy manual - Permanent impairment handbook - 5.1.1 'Approved Guide' - S4(1) [10] [7]
• CLIK - DRCA policy manual - Permanent impairment handbook - 2. Legislation - 2.5 Compensation for Non-economic loss [ [12]
• CLIK - DRCA policy manual - Permanent impairment handbook - 3. Concepts - 3.5 Non-economic loss [13][9]
• CLIK - DRCA policy manual - Permanent impairment handbook - 5.7 Calculation of entitlement for non-economic loss [14] [10]
• CLIK - DRCA policy manual - Permanent impairment handbook - 5.8 NEL tables 1-5 and questionnaire 
• C:IL - Compensation Claims Procedures - Communication Procedures - Contacting clients regarding negative decisions
• Businessline - Policy clarification for non-economic loss (NEL) assessments under the DRCA 20 March 2023 [17] – (CM9# 23291776E).

This chapter outlines procedures that need to be undertaken to calculate and determine the amount of permanent impairment (PI) compensation payable under the DRCA.

Offsetting procedures

If client is in receipt of VEA disability compensation payment (DCP) delegates must send an offsetting clearance request as follows:

1. Generate the approved offsetting clearance in R&C ISH.
2. Fill in any incomplete details and then email it directly to offsetting@dva.gov.au    
3. Save the sent email to CM9 as a record of when it was sent in case there is a need to follow up with Offsetting team at a later date.

R&C ISH will automatically generate a task to follow up receipt of VEA offsetting.

Delegates should arrange contact the claimant or their representative to provide an update on the progress of the claim at this point and alert them to possibility of significant delays experienced for offsetting clearances to be returned. This will aid in managing the client’s expectations and keeping them informed of the progress of their claim.

Delegates must wait for the response from Offsetting team before proceeding further with the claim.

The response from the Offsetting team will include:

• an estimate of the effects/deduction amount to the lump sum DRCA PI compensation amount
• the effects/deduction amount to the fortnightly VEA disability compensation payment (previously known as VEA disability pension). This estimate will include a deadline date whereby the estimated calculation will expire.

Debts/overpayments

Check departmental records for outstanding debts. Outstanding debts are generally recorded in VIEW. Details of debts may also be recorded in R&C ISH, Defcare and the client’s UIN container in CM9.

Determine the current amount of the outstanding debt and whether this amount is recoverable from DRCA permanent impairment lump sum payment.

Finalise calculation

R&C ISH automatically calculates the amount of PI compensation payable once all information has been input.

Delegates must ensure that:

• all previous payments are recorded accurately
• systems are checked to confirm whether there are any outstanding debts
• any offsetting amounts have been input.

Generate offer letter

When a delegate is satisfied that the client is entitled to a DRCA PI compensation payment, the offer of compensation letter is sent.

This will automatically include an election form and bank account details form.

The offer letter should include the delegate’s reasons for their decision including detailed reasons for reducing any self assessed non-economic (NEL) scores.

Delegates will email or post (if client requests post) the letter to client/advocate/CCS/legal representative/legal representative of deceased estate and should save the sent email to CM9.

Delegates should ensure that they advise client of any offsetting implications and that any debts will be recovered from DRCA permanent impairment payment (if applicable).

Completed election form

The election form provides the client with 3 options:

• accepting the offer of compensation
• rejecting the offer (if the effects to the VEA disability compensation payment are too great)
• suing the Commonwealth.

Clients must indicate their choice on the election form.

Once the completed election form and bank account details form has been returned, the delegate can finalise the determination and process the compensation payment.

All documents must be saved in CM9.

Client accepts offer

Client rejects offer or sues the Commonwealth

A client may decide not to accept the offer of compensation, either due to effect to their VEA DCP or because they are choosing to sue the Commonwealth.

Make the most appropriate choice in R&C ISH such as rejecting the claim due to those reasons and generate appropriate correspondence in R&C ISH.

Delegates must ensure the reasons for the client not accepting the offer of compensation are recorded in R&C ISH.

Client does not make an election

Where all attempts to contact the client and ascertain their election choice have failed, delegates may exercise discretion to proceed with payment.

It would not be appropriate to make a payment without considering DCP offsetting implications. If the PI compensation results in DCP offsetting, the claim should be case-conferenced before a decision is made as to whether to pay the PI compensation.

Where a delegate decides to proceed with the PI payment the following steps should be applied:

Finalising a claim with no bank account details

Bank account details are not required to finalise a PI claim in ISH. Where the PI claim is finalised in ISH without bank account details, the claim will go into awaiting payment, and will be paid once bank account details are provided.

If a client dies and the estate or appropriate beneficiary cannot be properly identified, the PI compensation cannot be paid to another person.

In these instances it is appropriate for the delegate to determine the PI lump sum compensation is payable to the estate without dispersing the funds to an account. The funds are then held by the MRCC.

For further information refer to:

• CLIK - Compensation claims procedures - Compensation offsetting and manual payments procedures (current) - 1.1 Offsetting introduction [24] [2]
• CLIK - Compensation claims procedures - Compensation offsetting and manual payments procedures - 2.3 DRCA clearances [25] [3]
• CLIK - Compensation claims procedures - Compensation offsetting and manual payments procedures - 4.1 Processing disability claims affected by section 25A [26] [4]
• CLIK - Compensation claims procedures - Permanent impairment - Debts/overpayments [27] [5]
• CLIK – DRCA Permanent Impairment Handbook chapter 6.1 Determination, Payment & Interest payable [28].