Last amended: 28 March 2013
It is the duty of all delegates to determine all claims for compensation in an accurate and timely manner. The accuracy of determinations is not negotiable. No compromise can be accepted in the degree of care and diligence in deciding any entitlement under the Act. Claims assessors should always aim to meet the targets for time taken to process of 75 days for the VEA and 120 days for the SRCA and MRCA. Where possible, the assessment of claims should commence as soon as possible after receipt and the regular ongoing management of those claims conducted in a reasonable timeframe. To achieve this it is important that both the claims assessors and their managers closely monitor the claims that are received and on hand to ensure a good awareness of the status of claims and circumstances of the clients. The principles to be applied to claims processing to assist in achieving this goal are as follows;
In some cases however, the urgency associated with the matter means that a claim must be dealt with ahead of older claims and significant attention needs to be given to obtaining the necessary information to make a determination. This is a judgement call for the delegate and/or the manager based on the degree of personal distress, financial hardship and medical or rehabilitation concerns of the client.
Priorities need to be attributed by the claims assessor and their manager, and based on the circumstances of the claim at the time of receipt and allocation. These priorities will need to be regularly reviewed during the progress of the claim where changes to the claimant's circumstances may provide a greater urgency. This regular review can be conducted as part of the case conferencing process between claims assessors and their team leader or Director/Manager.
Effort should always be made to ensure the determination of claims within the target period. To ensure this, the commencement of the assessment of the claim must occur within 7 days of assignment to a claims assessor. In some cases claims may take longer to determine due to a number of factors such as non-availability of relevant information or being held within ongoing backlogs. However, claims that have encountered difficulty during assessment must be highlighted as part of a regular case conferencing process. It is during this process that claims nearing the target for processing may be raised to a higher priority.
The other principle in determining any priority is the needs of the client. All clients will have differing needs and expectations, but some clients' circumstances will involve a greater urgency than others. These may be based on the requirement to meet financial/medical/mental health/rehabilitation needs and to alleviate immediate distress so that the client's circumstances and requirement for benefits are met. Guidance on the circumstances in which a claim may be considered as a higher priority is detailed below. In some cases the client's circumstances can change over the course of consideration of a claim. Claims assessors must be aware of the changing circumstances of a client and, if required, reassess the priority for consideration of the claim.
Initially the priority will be assessed through the process of initial assessment of the claim and assignment to a claims assessor. However, the urgency of a claim can change in the process of determination and so the support of team leaders or the regular case conferencing process should be used to ensure that the correct priorities are regularly reviewed and identified.
The following provides guidance on the circumstances that may result in a claims assessor determining that a claim needs to be considered as a higher priority.
Some of the cases handled by the Client Liaison Unit and/or Case Co-ordinators will be considered under this priority, but it should be noted that these are potentially high profile cases as well.
It is important to take into consideration whether the member is being medically discharged and /or has chosen to have their separation from the ADF Held-In-Abeyance (HIA) pending determination of liability for the compensation claim. If HIA has been chosen, the financial hardship prospect is not as great as previously with the separation held until DVA have determined liability. However, if a member elects to be HIA and fails to submit their claim and/or is obstructive in the claims process, then the ADF may elect to separate the member regardless of the claim status. Also for the purpose of appeals ADF members will not be HI — A.
Part of the consideration with this priority should take into account the commencement/continuation of medical treatment and an appropriate rehabilitation program particularly vocational rehabilitation.
The recommendation that the member's compensation claim be highlighted as a priority for consideration by DVA will be passed to the ADF decision maker as part of the review of the person's employment status, or as part of the ongoing management and review of wounded, injured and ill members. The recommendation will be accompanied by a Defence WebForm which contains the following:
Links
[1] https://clik.dva.gov.au/user/login?destination=node/20132%23comment-form
[2] https://clik.dva.gov.au/user/login?destination=node/20216%23comment-form
[3] https://clik.dva.gov.au/user/login?destination=node/20479%23comment-form
[4] https://clik.dva.gov.au/user/login?destination=node/20371%23comment-form