Section 61 of the SRCA requires that a decision on liability must be issued as a written determination informing the client, at a minimum:
a) the terms of the determination (i.e. meaning whether the claim has been accepted or rejected etc. and, if accepted, from what date); and
b) the reasons for the determination (in all instances, Delegates are required to explain the reason for making a particular decision. In cases where liability is found, the reasons need only be fairly brief, referring to the medical and/or other evidence on which the decision to find liability was based. However, in those cases where the claim has been disallowed, the reasons must necessarily be comprehensive, bearing in mind the likelihood of a request for reconsideration and possible review by the AAT or Federal Court.)
c) a statement to the effect that the claimant may, if dissatisfied with the determination, request a reconsideration of the determination under subsection 62(2).
Delegates should issue Determinations as provided in the Defcare Standard Letter suite. There are separate Liability Determination letters for either acceptance or denial of liability. Those letters are templates only which are designed and intended to be modified to suit the circumstances of the particular case. However, they should not be changed in ways that alter the three statutory requirements referred to above.
A clear audit trail of reasons for the decision should be recorded in all cases in either the Investigation Notes within the Initial Liability Support Module or in the determination issued to the client or their representative.
It is RCG policy to give clients who are to receive an adverse decision, advance warning of that likely outcome. The purpose of that policy is to give that client the opportunity to submit new evidence in the light of your interpretation of the evidence (or the lack of it).
While it is generally not necessary to give advance notice if you are going to determine in the client’s favour, thought should be given to the client and the nature of their claim when deciding if advance notice is appropriate.
The suggested means of giving this advance warning is for the Delegate to phone the client and discuss the case, the proposed decision and the reasons for that decision. If the client acquiesces to the adverse finding, or alternatively is unable or unwilling to produce further evidence or make any further submission etc., you may then determine the matter as planned.
Note: You should keep a full record of this conversation. This record should appear on both Defcare and the document file.
Where the client asserts that he/she can and will submit more evidence or argument, you should send a letter acknowledging that conversation and allowing a further 28 days to make that submission, after which you will make a decision based on the evidence you then have. There is an appropriate letter in Defcare Standard Correspondence templates, adapt it as needed.
Where you can not contact the client by phone, or you consider that it is not advisable to do so, you should simply issue the '28 day letter' briefly outlining how you would decide the matter at the present state of evidence. The letter should give a brief outline of the reasons for the proposed decision and invite further input within the 28 days.
Where subsequent to advice of the proposed decision the client contacts you and asserts that it will take more than 28 days to obtain the evidence he/she has in mind (i.e. a new medical report, perhaps) you should normally grant a further extension.
However, this is at your discretion. If you consider that person is being unreasonable and obstructive and/or there is no prospect of further relevant information, you have no obligation to grant a further extension. This would also apply where the client is insisting on seeking information you have already said is irrelevant and can not alter your determination.
Exceptions to the warning/28 day rule may occur where the case is decided on matters other than the quality or quantity of evidence, i.e. no amount of additional evidence could change the outcome. For instance where the claimant was not an employee of the ADF (e.g. was a Defence contractor assisting overseas forces etc.) or the claimed condition did not have coverage (e.g. PTSD asserted by the client to have originated with Vietnam operational service.)
Section 61 of the SRCA requires a determination to be 'served' (i.e. dispatched to the client) 'as soon as practicable' after the decision is made.
In fact, in the RCG context, there is no reason why the date of Determination can not also be the date that Determination is dispatched to the client.
Furthermore, once the Delegate has arrived at a decision based on the evidence, the only reason for delay should be to await the client's response to a warning of impending adverse decision (see 3.2 [5] above). In those cases where the client has not made a further submission within the 28 days allowed, the Delegate should determine the matter promptly.
Links
[1] https://clik.dva.gov.au/user/login?destination=node/20224%23comment-form
[2] https://clik.dva.gov.au/user/login?destination=node/20222%23comment-form
[3] https://clik.dva.gov.au/user/login?destination=node/20377%23comment-form
[4] https://clik.dva.gov.au/user/login?destination=node/20127%23comment-form
[5] https://clik.dva.gov.au/military-compensation-srca-manuals-and-resources-library/liability-handbook/ch-3-determinations-liability/32-natural-justice-considerations-and-prior-warning-adverse-decisions