At any time during the life of an Incapacity claim, delegates may decide that medical review is appropriate to confirm ongoing Incapacity and/or a clients potential to benefit from a rehabilitation program. This may be at the very beginning of a new Incapacity claim or a new period of Incapacity, or it may be at some stage during long term Incapacity.
When arranging medical reviews delegates should take into account whether the person has a treating Specialist or General Practitioner who they consult regularly. In the first instance it is preferable to obtain a report from the person's treating Specialist, or General Practitioner if there is no treating Specialist. If the circumstances of the case warrant it, a review by an independent Specialist may be desirable. When arranging an assessment by an independent Specialist consideration should be given to client's ability to attend and consideration for travel arrangements particularly for rural and/or remote clients. Clients should be given sufficient notice about an appointment where possible to allow time for them to confirm their attendance and/or have it changed to a more suitable date or time. There are standard letters in DEFC — ARE and CADET for this purpose.
If a client fails to attend an appointment arranged by DVA, there will be an account for non-attendance. We should pay the account to the provider as normal but then write to the client (there is a standard letter in DEFCARE) and advise them they may be liable to pay the non-attendance fee unless they can provide us with a reasonable cause as to why they did not attend.
Under Section 57 of the SRCA, if a client refuses or fails, without reasonable excuse, to undergo an examination their rights to compensation can be suspended until the examination takes place. This means all benefits are ceased including Incapacity payment, rehabilitation and treatment, and these are not recommenced until aft — er the examination takes place.
If an appointment is made by a client or their legal representative and DVA do not use the information contained in the resultant report then there is no responsibility for DVA to pay for the appointment or the report. If, on the other hand, the report is used or relied upon when making a decision about the claim (or to overturn the decision at reconsideration), then the cost of the appointment and report should be reimbursed to the client and/or their lawyer. This needs to be considered on a case by case basis and if there is any doubt it should be discussed with a tea — m leader or assistant director.