No. 11 Treatment Paths

Purpose

The purpose of this instruction is to clarify the treatment entitlement of persons with 60 or more impairment points and the import of section 281 of the Military Rehabilitation and Compensation Act 2004 (MRCA).

Background

The treatment provisions in the MRCA reflect a combination of those found in the Safety Rehabilitation and Compensation Act 1988 (SRCA) and the Veterans' Entitlements Act 1986 (VEA).

The SRCA type provisions allow for the payment/reimbursement of reasonable costs incurred in the treatment of an injury or disease, for which liability has been accepted.

The White and Gold Card treatment provisions in the MRCA (the card system), which are based on the VEA arrangements, allow for treatment as provided for in the MRCA Treatment Principles.

Once a person claims compensation, the delegate must carry out a needs assessment under section 325, and then must determine, under section 327, whether the claimant should have their treatment costs reimbursed or whether they should be issued with a White Card.

Section 327

Section 327 states:

If the Commission conducts an assessment of a person's needs

under section 325 in relation to a claim for compensation, the

Commission must make a written determination specifying that either section 271 or 280 applies to the person.

This provision does not take account of the fact that the claimant could either:

have an impairment rating of 60 or more impairment points, in which case treatment is automatically provided under section 281 of the MRCA; or

still be a serving Permanent Force member of the ADF or reservist on CFTS, in which case treatment is usually provided by the Department of Defence under section 58F of the Defence Force Regulations 1952 (the Defence Regulations).

Treatment under MRCA for serving members of the ADF

Sections 272 and 279 allow for the provision of treatment under the MRCA for serving ADF personnel, where the Military Rehabilitation and Compensation Commission (MRCC) determines, on advice from the member's  service chief that it is appropriate to do so.  This is expected to occur in transition to medical discharge.  In all other cases, serving members are provided with treatment for injuries or diseases under the Defence Regulations.

Section 327 will be amended so that a determination by Commission concerning an appropriate treatment path is only required where there is a requirement to determine a path under sections 271 or 280 (ie no requirement to determine a path if the person is still serving or as assessed at more than 60 impairment points).

Section 327

Section 327 states:

If the Commission conducts an assessment of a person's needs

under section 325 in relation to a claim for compensation, the

Commission must make a written determination specifying that either section 271 or 280 applies to the person.

This provision does not take account of the fact that the claimant could either:

have an impairment rating of 60 or more impairment points, in which case treatment is automatically provided under section 281 of the MRCA; or

still be a serving Permanent Force member of the ADF or reservist on CFTS, in which case treatment is usually provided by the Department of Defence under section 58F of the Defence Force Regulations 1952 (the Defence Regulations).

Section 281

Section 281 of the MRCA states:

(1) A person is entitled to be provided with treatment under this Part for any injury or disease of the person if:

(a) the Commission has determined under Part 2 of Chapter 4

(permanent impairment) that an impairment resulting from

one or more service injuries or diseases suffered by the

person constitutes 60 or more impairment points; and

(b) the person's impairment continues to constitute 60 or more

impairment points; and

(c) the treatment is provided to the person after the determination under Part 2 of Chapter 4 is made.

Note 1: Compensation might be payable in respect of treatment obtained before the Commission determines that the person is entitled to treatment (see section 273).

Note 2: A person who ceases to be entitled to treatment under this section

might still be entitled to treatment under section 282.

(2) However, if the person is only suffering from a single aggravated

injury or disease, then the person is only entitled to be provided

with the treatment if the impairment resulting from the aggravation

or material contribution constitutes, and continues to constitute, 60

or more impairment points.

Thus if a claimant's impairment is assessed at 60 or more impairment points, section 281 automatically applies.

Example

A member is injured while serving in February 2005 and his injuries result in paraplegia.  Liability is accepted under the MRCA in July 2005.  However, because the member is still serving he receives treatment from the ADF under the Defence Regulations, including the provision of appliances and pharmaceuticals.  His condition stabilizes and the member's claim for permanent impairment is accepted. He is assessed at 70 impairment points.  He is discharged in April 2006.  Section 281 automatically applies and the member is issued with a Gold Card for any treatment after discharge.

Contact

Any queries concerning this instruction should be addressed to Brenda Franklin on extension 16426.