When requests for treatment are denied this is a reviewable decision under S62 of the SRCA. The determination must be in writing to the claimant and must include reasons for the decision as well as a statement that the determination can be reconsidered if the employee or claimant is dissatisfied with the determination. The medical provider supplying the treatment that we are not paying for also needs to be advised. If a Departmental medical advisor has been asked to comment on the case and recommends that treatment be declined, their written comments are to be placed on the client's E-file, as well as paper file, reflecting that recommendation. A note in Defcare should also be made.
Physiotherapy treatment should aim at providing functional outcomes for the client. These outcomes should be identifiable and form part of the practitioner's treatment plan.
When requests for treatment are denied this is a reviewable decision under S62 of the SRCA. The determination must be in writing to the claimant and must include reasons for the decision as well as a statement that the determination can be reconsidered if the employee or claimant is dissatisfied with the determination. The medical provider supplying the treatment that we are not paying for also need to be advised. If a Departmental medical advisor has been asked to comment on the case and recommends that treatment be declined their written comments are to be placed on the client's E-file, and paper file, reflecting that recommendation. A note in Defcare should also be made.
Chiropractic, osteopathic or naturopathic treatment should aim at providing functional outcomes for the client. These outcomes should be identifiable and form part of the practitioner's treatment plan.
When requests for treatment are denied this is a reviewable decision under S62 of the SRCA. This must be in writing to the claimant and must include reasons for the decision. The medical provider supplying the treatment that we are not paying for also needs to be advised. If a Departmental medical advisor has been asked to comment on the case and recommends that treatment be declined, their written comments are to be placed on the client's E-file, and paper file, reflecting that recommendation. A note in Defcare should also be made.
RCG Medical Treatment |
All requests for footwear must be accompanied by a current recommendation from a podiatrist registered to prescribe footwear and a referral from the treating doctor.
Footwear will only be approved for conditions for which the clients has accepted liability and only where depth, custom made or specific footwear is necessary to accommodate a physical deformity.
Depth footwear may be prescribed for some corrective insoles or to accommodate forefoot abnormalities such as bunions, hammer toes, swelling etc.
Custom footwear is only prescribed for more complex problems such as severe physical deformities, arthritic changes or diabetic ulcerations. Custom footwear is a made to measure shoe provided by suppliers experienced in the manufacture of these shoes.
Requests for good walking shoes, boots or running shoes will NOT normally be considered. However, where the podiatrist recommends a specific type of shoe that is available “off the shelf” and the podiatrist is of the opinion that but for that particular shoe being available the claimant would need depth or custom footwear it should be considered. The podiatrist should be asked for reasons as to why this particular footwear mets the needs associated with the accepted condition. Delegates need to ensure that these requirements are met before meeting or reimbursing for the cost of the footwear. Specific footwear will generally be cheaper than either of the other options.
One pair of recommended footwear will be supplied initially. This may be reviewed at the discretion of the Delegate under appropriate professional advice. This may include corrective work boots if the client is currently employed. Replacement is not time based, but as required. The prescribing podiatrist will need to view the existing footwear to decide whether it can be altered, repaired or whether it needs to be replaced. On average, depth and custom footwear would be expected to last 2–3 years and specific footwear 1-2 years.
When requests for treatment are denied this is a reviewable decision under S62 of the SRCA. The determination must be in writing to the claimant and must include reasons for the decision as well as a statement that the determination can be reconsidered if the employee or claimant is dissatisfied with the determination. If appropriate the medical provider supplying the footwear that we are not paying for also need to be advised. If a Departmental medical advisor has been asked to comment on the case and recommends that the request be declined their written comments are to be placed on the client's E-file and paper file reflecting that recommendation. A note in Defcare should also be made.
RCG Medical Treatment |
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Many footwear problems can be addressed by the provision of orthotics or corrective insoles. Footwear will only be considered when other podiatry interventions are not sufficient to address a client's clinical need.
RCG Medical Treatment Update 02/06/06 23
Last amended: 20 September 2012
Delegates should be aware of the following policy regarding requests for massage therapy or the extension of long-term massage therapy services for SRCA clients.
For those SRCA clients receiving massage therapy for accepted conditions, the pre-approved provision (in line with their Treatment Authority) is where the massage therapy:
For existing SRCA clients seeking to extend a long term massage treatment program with non-allied health professionals, delegates are required to:
Last amended: 17 April 2013
Where a client is seeking massage therapy for the first time or a client is seeking an extension of their long-term massage therapy services, and their GP/specialist is supportive of alternative treatment with a focus on self management, the client will be offered assistance to transition to new treatment arrangements with the support of a DVA Injury Management Adviser (IMA).
The IMA may in certain cases initiate a physical rehabilitation program through an approved rehabilitation service provider with the necessary skills in physical rehabilitation to manage the goals of assisting the client to develop strategies to self manage their condition. The rehabilitation service provider will be expected to provide monthly progress reports on the client's progress in meeting the return to health goals identified in their program.
Such a program could include any one or combinations of the following:
Delegates must refer to the current policy guidelines in chapter 5.4 [16] of the Rehabilitation Guide when considering gymnasium-pool memberships and home based exercise programs for clients.
In circumstances where it is identified that alternate self managed treatment arrangements cannot be arranged in a timely manner, an existing client may be granted an interim extension of their massage therapy services. However, the extension can only be provided after the delegate has discussed the matter with the client, an IMA, the client's GP or treating specialist and any service providers involved in organising an appropriate assessment and transitioning arrangement.
The delegate should ensure that the client is made aware of the fact that the approval is deemed to be exceptional and lies outside the current guidelines and ongoing monitoring is to follow to regularly assess when it would be appropriate to transition the client from their existing provider arrangements to an alternate self managed treatment arrangement.
Last amended: 21 March 2013
These principles are specific to gymnasium-pool memberships only and apply to all SRCA clients and those MRCA clients who do not have a Repatriation Health Card. They also apply to those clients on a medical, vocational, or psychosocial rehabilitation program who are requesting a gymnasium - pool membership as part of their existing rehabilitation program. These policy guidelines must be considered and applied when a request for a gymnasium-pool membership is received.
Last amended: 5 September 2013
There are some items that, depending on the circumstances of the case, can be approved under either S16 [19] or S39 [20] of the SRCA. That is, the item may be considered either a medical aid or appliance or a rehabilitation aid or appliance. Guidelines about medical aids and appliances and rehabilitation aids and appliances can be found in chapter 10 [21] of the Rehabilitation Guide. This chapter also includes information about:
Under s16 we pay the cost of medical treatment that was “reasonable” for the employee to obtain in the circumstances. In keeping with that fairly broad and open framework, whether by accidental loss, normal wear and tear, abnormal circumstances or whatever if there is a reasonable medical need for the client to replace the hearing aid then we would consider that to be “reasonable” medical treatment. Essentially the issue is does the claimant clinically require a hearing aid as a result of the compensable condition and do they already have a hearing aid that satisfies the clinical need?
The amount we pay is such amount as we determine is appropriate in the circumstances. We should ensure we pay for the cost of a standard of hearing aid that is reasonably required to return the client to a reasonable functional level of hearing, not necessarily to the highest level possible.
We should also ensure that the hearing loss arising from ADF employment effectively contributes to the need for the hearing aid.
Where a replacement is required due to damage or loss we should obtain a Statutory Declaration as to how the damage or loss occurred, and in the case of loss, what reasonable efforts have been taken to find it. Only in circumstance of wilful damage or neglect would we consider not replacing the aid. All such cases should be discussed with National Office before a decision to reject the claim is made.
The underlying principles for the approval of hearing aids for RCG clients are that:
Links
[1] https://clik.dva.gov.au/user/login?destination=node/20567%23comment-form
[2] https://clik.dva.gov.au/user/login?destination=node/20540%23comment-form
[3] https://clik.dva.gov.au/user/login?destination=node/20578%23comment-form
[4] https://clik.dva.gov.au/user/login?destination=node/20533%23comment-form
[5] https://clik.dva.gov.au/user/login?destination=node/20552%23comment-form
[6] https://clik.dva.gov.au/user/login?destination=node/20528%23comment-form
[7] https://clik.dva.gov.au/user/login?destination=node/20563%23comment-form
[8] https://clik.dva.gov.au/user/login?destination=node/20558%23comment-form
[9] https://clik.dva.gov.au/user/login?destination=node/20569%23comment-form
[10] https://clik.dva.gov.au/user/login?destination=node/20573%23comment-form
[11] https://clik.dva.gov.au/military-compensation-srca-manuals-and-resources-library/medical-treatment-handbook/ch-24-guidelines-specific-treatment-approvals
[12] https://clik.dva.gov.au/user/login?destination=node/20562%23comment-form
[13] https://clik.dva.gov.au/user/login?destination=node/20548%23comment-form
[14] https://clik.dva.gov.au/user/login?destination=node/20586%23comment-form
[15] https://clik.dva.gov.au/user/login?destination=node/20530%23comment-form
[16] https://clik.dva.gov.au/rehabilitation-policy-library/5-medical-management-rehabilitation/54-other-types-medical-treatment-support
[17] https://clik.dva.gov.au/user/login?destination=node/20571%23comment-form
[18] https://clik.dva.gov.au/user/login?destination=node/20581%23comment-form
[19] clik://LEGIS/MRC-ACTS/SRCA/S16
[20] clik://LEGIS/MRC-ACTS/SRCA/S39
[21] https://clik.dva.gov.au/rehabilitation-policy-library/10-alterations-modifications-aids-appliances-and-motor-vehicle-assistance
[22] https://clik.dva.gov.au/user/login?destination=node/20580%23comment-form