You are here
7.19 Claims Awaiting Coroner's Findings
Last amended: 1 April 2020
VEA and MRCA death compensation claims may be determined in the absence of a death certificate where certain criteria are met and certain alternative evidence is available.
Only in cases where all the following factors exist can a death compensation determination be considered without a finalised death certificate showing outcomes of a coronial investigation:
- The case is one to which the VEA or MRCA applies;
- The case has been referred to the Coroner;
- There is expected to be a significant delay (three months or more after death) in the finalisation of the Coroner’s investigation;
- The cause of death is not contentious (e.g. it is known that the death was from an overdose, or the circumstances clearly indicate suicide and the coroner is investigating systemic issues rather than the circumstances);
- There is a clear link between an accepted condition and/or service and the cause of death (e.g., for the overdose example above, substance abuse disorder is an accepted condition);
- There is no suspicion of outside involvement (such as possible homicide) or other factors unrelated to service being the primary contribution to the death; AND
- There is sufficient evidence to appropriately determine the cause of death and the appropriate SoP (see Required Evidence).
Where a case meets the above criteria, a determination can still only be made where there is sufficient evidence for the Delegate to make a decision according to the relevant standard. The minimum evidence required is:
- Unambiguous authoritative information relating to cause of death (reporting by families and or social media should not be considered sufficient in and of itself);
- An interim death certificate, or statement from a treating physician indicating death has occurred has been obtained by DVA;
- Autopsy and/or pathology reports have been obtained by DVA and are sufficient to determine cause and circumstances of the death;
- Any police reports or Inspector-General of the Australian Defence Force (IGADF) reports detailing the circumstances of the death have been obtained (if applicable);
- Advice from the coroner as to the expected delay in provision of the final coronial report has been received. If greater than a specified minimum period (3 months from date of death) then the application of the guideline can proceed;
- An opinion from a senior Contracted Medical Adviser regarding cause of death on the basis of the above evidence has been obtained.
Automatic Grant Cases
As cause of death is not required to be established for automatic grant cases (eg the deceased was in receipt of TPI or 80+ points under MRCA), it is proposed that the minimum evidence requirement in automatic grant cases is an interim death certificate or notice from the treating physician confirming the death has occurred.
Before any determination under this policy is finalised:
- the case must be escalated to the Chief Health Officer (or their delegate) for review of the medical evidence and,
- final approval to proceed should be obtained from the FAS Client Benefits Division.
Should a decision be made in advance of a Coroner’s findings, it will be important to ensure appropriate messaging to the family. This messaging should be clear that the decision is being made in advance of the final Coroner’s report, that the Coroner’s findings will be definitive and that the decision may be subject to review when the final Coroner’s report is handed down (including the possibility of payments ceasing or recovery of a lump-sum under MRCA if a decision is revoked).
Any determination made on the basis of this guideline should be compulsorily reviewed under S 31(4) of the VEA or S 347 of the MRCA once the final coroner’s findings are handed down, to review whether the decision remains correct, to see whether an alternate finding should be made on cause of death and to determine whether it is still appropriate for liability to be accepted.
It is expected that most decisions will remain the same on review. However in cases where the decision is altered and revoked, the following approach should be taken:
- For fortnightly payments: where the initial decision granting payment was made based on information provided in good faith and correctly applying the relevant guidelines, it would be appropriate not to recover any fortnightly payments which have already been made on the basis of the initial decision (which would have been correct on the evidence available at the time of determination). Payments should be cancelled from the time of the revocation.
- For lump sum payments: all altered decisions involving lump sum payments should be referred to senior management for case by case consideration. Should recovery be required, this should exclude an amount calculated to cover the period during which the initial decision was valid.