What to do I do when there is conflicting information?
Review the CLIK Compensation Claims Procedure guidance on Weighing up evidence | CLIK
The clients and/or representatives are requesting that you seek new medical evidence (despite there being sufficient evidence on file for a decision to be made). How do I manage this?
The most appropriate course of action will depend on the individual circumstances of the claim.
Medical reports, Imaging, Clinical notes, Claimant reports not submitted with the claim.
Previous Claims Assessments and Appeal Decisions – These documents, which may include assessment under other Acts, can help clarify how certain evidence was interpreted previously and identify how new evidence may fill a gap or change the overall assessment.
Statutory Declarations - Sworn statements from the claimant or others involved, providing factual details about the injury and its impact.
Medical Reports
These include Diagnostic Assessment forms completed by the treating or assessing doctor, as well as other reports and information provided specifically in relation to the claim. These reports help assess if the injury was sustained or aggravated during service.
Service Medical Records and other relevant Defence Documents
These records provide a detailed history of the claimant’s health and duties during service and help establish a link between the injury or condition and their service.
Determine the claim based on available information
It is open to Incapacity delegates to determine Incapacity claims based on the available evidence, if the evidence allows them to be satisfied that the relevant DRCA provisions have been met.
Another question to ask is: How can I make the s58 process work to finalise an old claim where the client has completely disengaged?
It may be appropriate for the other claims to be reassigned to the holding bay in the following scenarios. This action should only be taken once the s58 process has been followed including consideration if the claim can be determined.
Determine the claim based on available information
It is open for PI delegates to determine PI claims based on the available evidence.
The general rule of thumb is to ask:
Determine the claim based on available information
It may be appropriate for an IL claim to be determined in the following scenarios. This action should only be taken once the s58 process has been followed.
Before determining a claim based on available information, consider if:
Refer to the R&C ISH - Assign Claim – QRG (CM9: 17294879E) for instructions on how to reassign claims.
Requested information received |
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This overarching process details the minimum standard of contact required when requesting information which only the client can provide.
Clients can request an extension of time to provide requested information. Delegates should accommodate all reasonable requests.
If granted:
