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 s330 process has been followed.

Refer to the R&C ISH - Assign Claim – QRG (CM9: 17294879E) for instructions on how to reassign claims.

1. Determine the claim based on available information

Where possible, claims should be determined based on available evidence. The things that need to be considered will depend on the claim type. Determining the claim finalises the claim in the system and gives the client their right of appeal.

This overarching process details the minimum standard of contact required when requesting information which only the client can provide. 

• Clear case notes MUST be added at each step to outline the next action needed 

Clients can request an extension of time to provide requested information. Delegates should accommodate all reasonable requests. 

If granted:

The policy contained in this manual relates to Household Services and Attendant Care services under both the Military Rehabilitation and Compensation Act 2004 (MRCA) and the Safety, Rehabilitation and Compensation (Defence-related Claims) Act 1988 (DRCA).
 

When investigating and determining a claim, decision makers must consider and weigh up the relevant evidence before them.

Whole Person Impairment (WPI) of the fingers and toes is assessed using Tables 16-1, 16-2 and 16-3 of the AMA Guide for the fingers and Table 17-14 of the AMA Guide for the toes. These tables are complex in nature and often require specialist opinion to determine the impairment.

Form D9484 asks clinicians to indicate the loss of active range of movement (ROM) for the thumb and/or finger, for example, “loss of less than half normal range” etc.