Source: http://clik.dva.gov.au/print/book/export/html/19372
Timestamp: 2019-12-11 20:32:12
Document Index: 37936877

Matched Legal Cases: ['art 2', 'art 2', 'art 5', 'art-9', 'art-9', 'art-5', 'art-7']

﻿ Ch 5 Permanent Impairment
Home > Military Compensation MRCA Manuals and Resources Library > Policy Manual > Ch 5 Permanent Impairment
This chapter is provided for delegates investigating and determining compensation claims under the Military Rehabilitation and Compensation Act 2004 (the MRCA) for Permanent Impairment (PI) that results from accepted conditions (i.e. service injuries or service diseases). Part 2 of Chapter 4 of the MRCA [3] relates to claims for PI compensation.
Under section 325(2) of the MRCA, a needs assessment must be carried out for a client before a claim for compensation can be determined. Best practice for carrying out a needs assessment is outlined at chapter 2.3.4. [4] of the MRCA Policy Library. However, where a PI delegate is unsure if a needs assessment has been carried out, it is open to them to contact the client and carry out an assessment of the client's PI needs and record this accordingly. Alternatively, if the PI delegate is unable to contact the client, or is unsure about processing or determining the claim in these circumstances they can contact the Benefits and Payments Policy team for guidance or clarification.
“Impairment”, as defined by section 5 of the MRCA, in relation to a person “means the loss, the loss of the use, or the damage or malfunction, of any part of the person's body, of any bodily system or function, or of any part of such a system or function.” “Permanent Impairment” (PI) is not specifically defined by the MRCA. However, in setting out the criteria which must be met for the Commonwealth to be liable to pay PI payments for a service injury or disease, section 68 repeats the definition of this term used in section 4 of the Safety, Rehabilitation and Compensation Act 1988 (the SRCA). That is, an impairment “that is likely to continue indefinitely”.
The MRCA bases PI on a Whole Person Impairment (WPI) concept that is drawn from the American Medical Association's Guide. The Guide to Determining Impairment and Compensation (known as GARP M) is the guide approved by the Military Rehabilitation and Compensation Commission (the MRCC) under subsection 67(1) of the MRCA. GARP M is derivative of the Guide to the Assessment of Pensions Fifth Edition (known as GARP V) used to assess the extent of incapacity from war-caused or defence-caused injuries or diseases under the Veterans' Entitlements Act 1986 (the VEA).
Like GARP V, GARP M expresses the extent of medical impairment suffered by a person in impairment points (IPs) on a scale from 0 to 100. On this scale, zero IPs corresponds to no or negligible impairment from accepted conditions, and 100 IPs corresponds to death. Effectively, impairment points are percentages of WPI. GARP M also contains the same criteria as GARP V to be used in assessing the effect of a person's accepted conditions on the person's lifestyle. This is expressed in a numerical lifestyle rating from 0-7.
For specific information about the application of Chapter 3 of GARP for Spine and Limb conditions, please refer to Chapter 9.8.5 of the Compensation and Support Library. [5]
For specific information about the application of Chapter 10 of GARP for Sexual Function, Reproduction, and Breasts, please refer to Chapter 9.8.6 of the Compensation and Support Library. [6]
Under section 68 of MRCA [3], the Commonwealth is liable to pay PI compensation to a person if:
the condition has, or, if more than one condition has been accepted, all of the conditions have, stabilised.
More information on how a claim for PI compensation can be lodged can be found at Chapter 2.1.8 [8].
Successive PI claims during an appeal period – section 322 ‘same matter’
Broadly speaking, the intention of section 322 is to prohibit the making of multiple simultaneous claims, but does not necessarily preclude a person from making subsequent claims.
A client can make a PI claim for any new or aggravated condition/s other than the condition/s subject to a current appeal, or that are within the 12 month appeal period;
A client is not able to make a subsequent PI claim which relates to the same condition/s that have been previously determined and are either under active appeal or within the appeal period.
Section 68 of the MRCA operates, and is supplemented by section 71, to provide permanent impairment compensation with reference to the ‘whole of person impairment’ as a result of the accepted service-related injuries or diseases. The Act expressly contemplates that a person’s permanent impairment compensation would be adjusted where there are subsequent conditions accepted by the Commission. Therefore the same matter provisions are not designed to prevent a subsequent claim for PI compensation in respect of conditions that were not the subject of the initial compensation claim.
A client recently had liability accepted for osteoarthritis of the right knee and lumbar spondylosis, and subsequently submits a claim for compensation for permanent impairment. While an assessment is still ongoing for these 2 conditions, the client’s liability claim for posttraumatic stress disorder is accepted and submits a further claim for permanent impairment for the condition.
The claimant can submit a claim for permanent impairment for the posttraumatic stress disorder. Where the Commission has accepted liability for the condition, it then forms part of the ‘compensable conditions’ in section 68 of the MRCA, and the permanent impairment of the claimant would then be assessed on the basis of all three conditions.
A client submits a claim for permanent impairment for two accepted conditions, general anxiety disorder and sensorineural hearing loss. An assessment is made and the client is found to have 40 impairment points.A month following this determination, the client submits a claim for a PI with respect of a new condition, bilateral osteoarthritis for which liability was accepted after the initial PI determination.
The client is not prevented under section 322(4) from submitting a claim for additional permanent impairment compensation, because once liability for the new condition is accepted by the Commission, it constitutes ‘one or more additional service injuries or diseases of the person’ for the purposes of section 71 of the MRCA. The ‘person’s overall impairment’would then be assessed on the basis of all three conditions, and the amount of compensation would added together with the permanent impairment compensation for the ‘original compensable conditions’, up to the maximum prescribed by section 74.
Practically, the impairment points found in the original determination (i.e. 40 points) should be added to the impairment points awarded with respect of the new condition following an assessment to find the degree of impairment resulting from that condition.
A client submits a claim for permanent impairment for their accepted conditions, general anxiety disorder and sensorineural hearing loss.An assessment is made and the client is found to have 40 impairment points. The client lodges an appeal with respect of the determination with the VRB. Two months later, liability is accepted for a new condition, bilateral osteoarthritis and the client submits a claim for a PI with respect of the condition.
As above, the client is not prevented from submitting a claim for permanent impairment compensation with respect of the new condition. Section 71(1) will apply and the additional impairment from the additional service injury or disease should be assessed and compensated where the person meets the 5 point impairment threshold.
A client recently had liability accepted for lumbar spondylosis, hearing loss and tinnitus and subsequently submits a claim for compensation for permanent impairment. The claim is finalised and the person is offered compensation under section 68 with respect of the conditions. Six months later the client submits a further claim for permanent impairment compensation for the accepted conditions, during this period the client has not had liability accepted for any other service-related conditions.
The claimant is not entitled to claim for additional permanent impairment for the three accepted conditions. The same matter provisions apply here and the client is still within the 12 month appeal period with respect of the section 68 determination. The client will only be entitled to claim for additional compensation if liability is accepted for a new condition, or after the appeal period expires.
A client submits a claim for permanent impairment for the accepted condition of major depressive disorder.An assessment is made, and it is found the condition is permanent but not yet stable, so interim compensation is offered on the basis of 30 impairment points. The client lodges an appeal with respect of the determination with the VRB. Six months later, liability is accepted for two new conditions, rotator cuff syndrome of the left shoulder and subacromial bursitis of the left shoulder. The client submits a new claim for a PI with respect of the left shoulder conditions.
The previous interim determination of compensation will not preclude the assessment of additional compensation payable to the client, and they can make a valid claim for permanent impairment compensation with respect of their two newly accepted conditions.
The original interim determination and impairment points with respect of the major depressive will remain and is a matter for the VRB to consider.
Practically, where there is a permanent impairment with respect of the left shoulder conditions, the impairment points found in the original interim determination (i.e. 30 points) should be added to the impairment points awarded for the new conditions. Where the degree of impairment constitutes a 5 point increase overall, the person will have met threshold and be entitled to additional compensation. The calculation of compensation payable will be based on the difference of impairment between the 30 points and the new overall impairment rating with the inclusion of the left shoulder conditions. The delegate will able to award the amount of compensation payable by way of a further section 75 determination.
Section 69 of the MRC [3]A requires that PI compensation is not payable unless a person's WPI constitutes 10 IPs. IPs from more than one accepted condition can be combined to meet the 10 IP requirement. The impairments excepted from the 10 IP requirement are impairments of the fingers, the toes, the sense of taste and smell, and hearing loss. For these impairments section 69 of the MRCA requires that PI compensation is not payable unless WPI constitutes 5 IPs. IPs from more than one condition cannot be combined to meet the 5 IP requirement.
Under subsection 70(2) [11] of the MRCA [3], the amount of PI compensation payable in respect of an accepted aggravation of a pre-existing condition is the amount payable in respect of the IPs and lifestyle effects constituted solely by the aggravation.
Signs and Symptoms [12]
Should a claimant already be in receipt of or entitled to PI (including interim) compensation for an accepted condition or conditions and suffers another condition, additional PI compensation is payable under subsection 71(1) of the MRCA [3] to a person if:
liability has been accepted for the new condition(s);
a claim for PI compensation has been lodged in respect of the new accepted condition(s);
as a result of the accepted condition(s), the person's WPI has increased by 5 IPs;
Under subsection 71(2) [11] of the MRCA [3], if a person has been paid or is entitled to be paid PI (including interim) compensation and one or more of the accepted conditions deteriorates, additional compensation for PI may be paid if:
“Natural deterioration” means that a condition has become worse, not that it has been made worse (see Windeyer J in Federal Broom Co Pty Ltd v Semlitch (1964) [15] 110 CLR 639-640). In other words, it must be distinguished from aggravation, and includes a situation whereby a progressive condition increases in gravity by running its ordinary course.
Section 73 of the MRCA [3] requires the delegate to “have regard to” the following matters when deciding whether an impairment is likely to continue indefinitely:
the duration of the impairment;
the likelihood of improvement in the accepted conditions concerned;
whether the person has undertaken all reasonable rehabilitative treatment for the impairment; and
The use of this phrase gives a delegate some flexibility in the exercise of their judgment as to the permanence of an impairment. In making this judgement, it is necessary to consider each of the criteria. However, the relative weighting to be given to each criterion must be determined on the facts of each individual case.
When considering whether an impairment is likely to continue indefinitely the delegate should give consideration to duration of the impairment. The use of the word “indefinite” indicates that an impairment does not need to last forever to be considered “permanent”. Instead, it should be taken to refer to a period of time which, although undetermined, is substantial (McDonald v Director-General of Social Security [19](1984) [19] 6 ALD 6). In some cases, such as an amputation, the permanency of the impairment will be obvious. However, where such as a fracture of the limb, an impairment is known to be of a likely finite duration it should not be considered permanent. However, if such an impairment fails to resolve for a considerable period of time and the medical evidence suggests that long-term prognosis for resolution is poor, it may be appropriate to review the question of permanence.
When considering whether an impairment is likely to continue indefinitely the delegate should give consideration to whether the claimant has undertaken all reasonable rehabilitative treatment for that impairment. “Rehabilitative treatment” means any treatment, including surgery, designed to restore a person, as far as it can be, to the person's former health (see Smiths J in Dragojlovic v Director-General of Social Security [22](1984) [22] 1 FCR 307-308).
Firstly, the delegate should consider what, if any, reasonable rehabilitative treatment exists for the particular impairment? This is a question that should be answered on basis of advice received from a legally qualified medical practitioner whose expertise is appropriate to the particular impairment under consideration. Secondly, the delegate should consider whether the claimant has undertaken the reasonable rehabilitative treatment? These questions will assist the determination of whether the particular impairment under consideration is a permanent one (see Katz J in Filla v Comcare Australia [23] [2001] FCA 964).
This paragraph authorises the delegate to consider any other matters which may assist in determining whether an impairment is more likely than not to continue indefinitely. However, it is important to ensure that any such other factors are relevant to the client's particular situation and that there is adequate medical or other evidence to support the conclusion reached.
Stable - simply means it is unlikely to improve to any major degree. This should not be judged on the basis of possible improvement in impairment ratings
Permanent - means that the condition is not likely to resolve.
Essentially, it is a matter of medical evidence when an impairment becomes stable for the purposes of PI compensation. A delegate should rely, in particular, on medical opinion to establish a date when the impairment stabilised. However, the last date of any active (as opposed to palliative) treatment of the impairment may also be indicative of stabilisation, if that treatment is no longer required. In cases where the stability of an impairment is unclear, it may be appropriate to seek the advice of a Contracted Medical Advisor (CMA) in providing an opinion based on existing medical evidence or by liaising with the clients treating/assessing medical practitioner.
It is important to note that there is a difference between the date an impairment becomes stable and the date an impairment becomes permanent. An impairment may well be permanent (i.e. likely to continue indefinitely, or not likely to resolve) but not yet stable (i.e. further treatment is likely to provide an improvement in the impairment, such as a back injury where active treatment is being undertaken or surgery is scheduled).
In some cases impairment may be intermittent, that is, remain at a low or negligible level of impairment between discrete episodes of increased impairment. A sufferer of epilepsy who remains well between “fits” is a useful example. This does not necessarily mean that the impairment should not be considered stable. Many conditions will have periods where symptoms may be more or less severe, including fluctuations of symptoms or 'spikes' as part of their normal manifestation.
It will be medical opinion provided by the assessing medical practitioner or the CMA that will guide a decision around the permanence and stability of a condition.
In cases where the stability of a condition, the timeframe for follow-up, or an estimate of points post stabilisation is unclear, it may be appropriate to seek the assistance of a CMA in providing a medical opinion based on the available evidence, or to liaise with the clients treating medical practitioner for clarification via a supplementary report.
Client has an accepted condition of Major Depressive Disorder and has been receiving treatment for the past 6 months. The assessing medical practitioner states that the condition is permanent, and whilst treatment to date has been beneficial, further improvement is expected with ongoing treatment over the next 6 months. On the basis of this information the conditions is considered permanent but not yet stable, therefore interim compensation is appropriate with a review recommended for 6 months’ time. On review 6 months later the assessing medical practitioner states that despite a requirement for ongoing regular treatment and fluctuations in the condition as a result of ongoing life events such as stress at work and moving house, the condition is now considered to be stable as it is not expected to improve to any further major degree.
5.5.1 Unreasonable refusal to undertake medical treatment
There is a general rule of law that a claimant must not unreasonably refuse treatment that will lessen the degree of impairment they suffer (see Fazlic v Milingimbi Community Inc [27](1982) 150 CLR 345). This is known as the “doctrine of mitigation of damage” and should be applied to claims for PI compensation. Any assessment of the reasonableness or otherwise of a claimant's refusal of treatment must depend upon the claimant's state of knowledge at the relevant time. The delegate should decide, in light of the medical advice given to the claimant and all the circumstances known to the person, whether the person's refusal is unreasonable. Delegates may take into account many factors, including the risk of failure and the possible extent of benefit of the treatment, particularly when compared to the present position.
For example, the claimant may have a mental condition such as an anxiety state which leads to the refusal to undergo treatment. This would not necessarily be unreasonable. Practising members of certain religions may have an objection to undergoing certain medical procedures. Again, this might not be unreasonable. Personal experience of earlier treatment may lead to a refusal to undergo that treatment again. This could be considered reasonable in the circumstances. Similarly, the Courts have held that refusal to take psychotropic medication would not be considered unreasonable refusal.
5.5.2 Unreasonable refusal to attend a medical examination
Policy and procedure on responding to an unreasonable refusal to attend a medical examination for the purposes of a claim (including PI), is outlined in Chapter 2 Part 2.1.14 Medical Examinations - Overview [28]
5.5.2 Unreasonable refusal to undertake a rehabilitation program
Under section 52 of MRCA, a person's right to compensation may also be suspended where they fail or refuse to undertake a rehabilitation program, without reasonable excuse.
Non-compliance under MRCA can lead to suspension of compensation entitlements (with the exception of compensation for medical treatment). Compensation under the MRCA may include Permanent Impairment benefits, incapacity payment attendant care services and household care services.
The criteria for the payment of PI is not reliant on participation in a rehabilitation program, unlike incapacity payments which can be. Therefore it should be considered on a case-by-case basis and depending on the facts of the case, including the decision letter issued to the client advising them of the effects on their ongoing MRCA entitlements before determining if the PI compensation benefits should be suspended. Delegates should seek advice from the Benefits and Payments Policy team if a case arises and there are issues relating to the ongoing entitlement, or current assessment of a person’s entitlement to the PI compensation and a section 52 suspension has been determined.
Any decisions to suspend under Section 52 are determinations under the Rehabilitation provisions and will be determined by a Rehabilitation delegate. It is important to note, MRCA Section 345 states a determination under Section 50 or 52 is not an 'original determination' and therefore does not provide appeal rights.
Where a person receives an initial PI compensation payment under section 68 of the MRCA [3], the amount payable is calculated as follows:
assess WPI which results from the person's accepted conditions using GARP M;
ascertain the lifestyle effects of all accepted conditions using Chapter 22 of GARP M;
use Chapter 23 of GARP M to find the appropriate compensation factor for the combined impairment points and lifestyle rating; and
multiply the compensation factor by the current maximum MRCA periodic payment to calculate the gross weekly MRCA payment.
Note that section 69 of the MRCA requires that initial payment of PI compensation under section 68 can only be made when the impairment suffered by the person constitutes at least 10 impairment points (except in cases where the impairment relates to a loss of hearing, the loss, or the loss of the use of a finger or toe, or the loss of the sense of taste or smell, in which case it is 5 impairment points). The same also applies to compensation for “aggravations” under section 70 of the MRCA.
Where a person who has already received a PI compensation lump sum or is receiving periodic PI compensation payments claims additional compensation under section 71 of the MRCA [3], the additional amount payable is calculated as follows:
ascertain the lifestyle effects of all conditions using Chapter 22 of GARP M;
use Chapter 23 of GARP M to find the appropriate compensation factor for the combined impairment points and lifestyle rating;
multiply the compensation factor by the current maximum MRCA periodic payment to calculate the gross weekly MRCA payment; and
subtract from the gross weekly amount the weekly PI that the client is receiving or would be receiving if they had not converted their payment to a lump sum.
The remaining amount is the weekly amount of PI payable for the additional compensation.
Note that for “additional” compensation to be payable under section 71, the increase in the person's overall impairment rating from another service injury or disease (or the deterioration of an original condition) only needs to constitute 5 impairment points. The same also applies to additional compensation for “aggravations” under section 72 of the MRCA.
Note also that where a person's existing MRCA compensation for a cause of action has been subject to recovery based on receipt of compensation from another source for that same cause of action, the impairment - and therefore the impairment points - attributable to that condition still exist and must be taken into account for any future payment of additional compensation.
Gold Card eligibility where an impairment rating drops below 60 points
Section 281 of the MRCA states that a person is entitled to a Gold Card when assessed at 60 or more impairment points and where the impairment continues to constitute 60 or more impairment points.
When a person is reassessed under s71 and the reassessment results in a level of impairment falling below 60 points, it would be appropriate to consider the previous rating as being the continuing level of impairment for compensation and entitlement purpsoses. This will mean that the existing points can be assigned (allowing the Gold Card eligibility to remain unchanged) and the claim disallowed on the basis that there has not been an increase of 5 points.
Note that the information in this section applies only to payments made under sections 68 or 71 of the MRCA [3]. For date of effect provisions for interim permanent impairment payments, see 5.8 [33]
Under subsection 77(1) of the MRCA [3], if PI compensation is payable under section 68 of the MRCA for a single accepted condition, that compensation is payable from the later of:
the date the claim for liability was lodged; and
as a result of the accepted condition, the person has suffered an impairment; and
the accepted condition has stabilised; and
the requirements of section 69 (or section 70 for an aggravation) have been satisfied regarding the level of impairment.
5.7.1.1 Date compensation payable for more than one condition where person became entitled prior to 1 July 2013
If PI compensation is payable under section 68 of the MRCA for more than one accepted condition from a date prior to 1 July 2013, that compensation is payable from the later of:
the date the most recent claim for liability was lodged for one of the conditions; and
as a result of the accepted conditions, the person has suffered an impairment; and
all of the accepted conditions have stabilised; and
5.7.1.2 Date compensation payable for more than one condition where person became entitled on or after 1 July 2013
If PI compensation is payable under section 68 of the MRCA for more than one accepted condition and 5.7.1.1 does not apply because the date of effect is not earlier than 1 July 2013, the date that compensation is payable may vary for each of the conditions.
In such cases the date of effect for each condition to which section 68 applies is the later of:
the date liability for each condition was claimed; and
Example 1 Client claims liability and PI for a condition on 12 June 2013. On the date of the claim all of the criteria for payment of PI are met. Subsequently, on 5 July 2013, the client claims liability and PI for a second condition which is permanent and stable. It is assessed at 3 impairment points. The two claims are determined together in August 2013.
5.7.1.1 does not apply as the date of effect for payment of additional PI for these two conditions would, under the former rules, be in July 2013 . Therefore in this example there are two dates of effect. They are:
the first condition is payable from 1 July 2013 (the earliest date possible because the separate date of effect rules only apply from 1 July 2013); and
the second condition is payable from 5 July 2013.
Example 2 Client claims liability and PI for a condition on 12 June 2013. On the date of the claim all of the criteria for payment of PI under section 68 are met except that the number of impairment points (4) does not meet the threshold. Subsequently, on 7 July 2013 and before a determination has been made, a revised assessment of the level of impairment is received from the doctor. As of 5 July the condition is assessed at 10 impairment points. Another condition is claimed on 25 July. This condition meets all of the criteria so that when, in August, a determination on the two conditions is made, the dates of effect for the two conditions are:
the first condition is payable from 5 July 2013; and
the second condition is payable from 25 July 2013.
Example 3 Client claims liability and PI for a condition on 24 August 2013. On the date of the claim all of the criteria for payment of PI under section 68 are met. On 2 September 2013 the client claims a second condition which is not yet stable. However by the time the two conditions are determined in December the second condition has stabilised. The delegate determines that the second condition stabilised on 25 November 2013. The dates of effect for the two conditions are:
the first condition is payable from 24 August 2013; and
the second condition is payable from 25 November 2013
Note the MRCA specifies it is the section 319 claim for acceptance of liability that sets one of the dates under section 77, not the claim for PI compensation. This can be especially important when calculating arrears for a person who elects to take periodic payments.
Under subsection 77(2) of the MRCA [3], if additional PI compensation is payable under subsection 71(1) of the MRCA for a single accepted condition, that compensation is payable from the later of:
the date the claim for liability was lodged for the new condition; and
as a result of the new condition, the person suffers additional impairment; and
the increase in the person's overall impairment constitutes at least 5 impairment points (which includes aggravations under section 72) [11]; and
the new condition has stabilised.
5.7.2.1 Date additional compensation payable for more than one condition where person became entitled prior to 1 July 2013
If additional PI compensation is payable under section 71 of the MRCA for more than one accepted condition from a date prior to 1 July 2013, that compensation is payable from the later of:
the date the most recent claim for liability was lodged for one of the new conditions; and
as a result of the new conditions, the person suffers additional impairment; and
all of the new conditions have stabilised.
5.7.2.2 Date additional compensation payable for more than one condition where person became entitled on or after 1 July 2013
If additional PI compensation is payable under section 71 of the MRCA for more than one accepted condition and 5.7.2.1 does not apply because the date of effect is not earlier than 1 July 2013, the date that additional compensation is payable in respect of each of the conditions may vary.
In such cases the date of effect of the additional PI for each condition to which section 71(1) applies is the later of:
the date each condition was claimed; and
Note that the requirement for the increase in the overall impairment to constitute at least 5 impairment points can be met by the combination of several conditions. However, that criterion is not met by an individual condition that of itself is under the additional 5 point threshold, until the date it meets the threshold when combined with another condition (which is also likely to continue indefinitely and has stabilised).
Example 1 Client is in payment under section 68 for a number of accepted conditions. The client then claims liability and PI for a new condition on 12 June 2013. On the date of the claim all of the criteria for payment of additional PI are met. Subsequently, on 5 July 2013, the client claims another condition. As for the first condition, all criteria for payment of compensation under section 71 are met on the date of the claim for liability. The two claims are determined together in August 2013.
5.7.2.1 does not apply as the date of effect for payment of additional PI for these two conditions would, under the former rules, be in July 2013. Therefore in this example there are two dates of effect. They are:
Example 2 Client is in payment under section 68 for a number of accepted conditions. The client then claims liability and PI for a new condition on 13 August 2013. On the date of that claim all of the criteria for payment of additional PI under section 71 are met, except that the condition does not increase the whole person impairment by 5 impairment points. On 5 September 2013, the client claims liability and PI for another condition which is likely to continue indefinitely and is stable. All criteria are met on the date of the claim for liability and PI for the subsequent condition because the two conditions in combination increase the whole person impairment by more than 5 points. The two claims are determined together in October 2013.
The date of effect for the two conditions is 5 September 2013 because until combined with the subsequent condition, the condition claimed on 13 August 2013 did not meet the threshold required for payment of additional PI.
Example 3 Client is in payment under section 68 for a number of accepted conditions. Client claims liability and PI for an additional condition on 24 August 2013. On the date of the claim all of the criteria for payment of additional PI under section 71 are met. On 2 September 2013 the client claims a second additional condition which is not yet stable. However by the time the two conditions are determined in December the second condition has stabilised. The delegate determines that the second condition stabilised on 25 November 2013. The dates of effect for the two conditions are:
Under subsection 77(3) of the MRCA [3], if additional PI compensation is payable under subsection 71(2) of the MRCA for deterioration of a single accepted condition, that compensation is payable from the later of:
Provision to assess interim PI under the Military Rehabilitation and Compensation Act 2004 (MRCA) was adapted from the existing legislation and policy under the Safety, Rehabilitation and Compensation (Defence-related) Act 1988 (DRCA). Interim assessment was introduced under the DRCA to ensure that the possibility of entitlement to a permanent impairment payment does not impede the rehabilitation process.
Compensation for accepted conditions may be payable in the form of permanent impairment payments where an ongoing impairment is both permanent and stable, and is assessed as reaching a minimum level of impairment points.
Where an impairment is permanent but not yet stable, payment of interim permanent impairment compensation should be considered.
Many conditions will have periods where symptoms may be more or less severe, including fluctuations of symptoms or ‘spikes’ as part of their normal manifestation. This may be especially true of mental health conditions.
For clients with posttraumatic stress disorder (PTSD), depressive disorder, anxiety disorder, substance use disorder or alcohol use disorder with a current level of impairment of 10 points or more, but who are not yet stable, an interim compensation payment must be offered based on a level of impairment at a minimum of 10 points.
For PI assessment purposes the following definitions should be broadly considered ;
“Permanent” means that the condition is not likely to resolve.
“Stable” simply means it is unlikely to improve to any major degree. This should not be judged on the basis of possible improvement in impairment ratings.
An interim payment of permanent impairment (PI) compensation can be made under section 75 of the MRCA [3]where:
One of the criteria for payment of interim PI is that the impairment suffered by the person must constitute a minimum number of IPs. The number required varies according to the circumstances of each case and is the same threshold as is required under section 69 as explained at Chapter 5.2.1 [40]. Where additional compensation is being considered, and the outcome continues to be interim, the threshold points required is as per the criteria of s71(1) and s71(2), i.e. a 5 point increase.
Impairment point thresholds may be made up of a single interim condition, or contributed to by multiple conditions, one of which is interim. It is not necessary for the unstable condition alone to meet the threshold points, providing the overall points threshold will be met by the inclusion of all conditions being assessed including the interim condition.
For clients with posttraumatic stress disorder (PTSD), depressive disorder, anxiety disorder, substance use disorder or alcohol use disorder included in their assessment, the minimum number of IP’s will be considered to be reached if their current impairment from that condition/s is 10 points or more i.e. these clients will receive interim PI compensation at a minimum of 10 points.
thoracolumbar spine strain
Currently 20 but expected to improve to 10 with treatment over the next 6 months.
In this case, because the condition is not yet stable, an assessment under section 68 is not possible, therefore an assessment is undertaken under s75 for interim compensation for the accepted condition. As the final points at the end of treatment is expected to be 10, eligibility for interim permanent impairment compensation has been reached as it meets the minimum threshold for an initial claim of 10 points. Interim compensation is determined based on 10 interim impairment points plus the appropriate lifestyle rating (being generally the bottom of the shaded area). A review date is set for 6 months to assess the stability of the thoracolumbar spine strain.
Currently 50 but expected to improve to 30 with active treatment over the next 6 months.
Total Combined Interim Points
In this case, because one or more of the conditions is not yet stable, an assessment under section 68 is not possible, therefore an assessment is undertaken under s75 for interim compensation for all of the combined conditions. As the overall points at the end of any active treatment is expected to be 37, eligibility for interim permanent impairment compensation has been reached as it meet the minimum threshold for an initial claim of 10IP. Interim compensation is determined based on 37 interim impairment points plus the appropriate lifestyle rating (being generally the bottom of the shaded area).
Points previously determined s68
New points on reassessment
Currently 30 points but expected to be reduced to 20 points after surgery (spine)
35 (previously determined)
42 (current interim points)
In this case, because one or more of the conditions is not yet stable, an assessment under section 71 for additional compensation is not possible, therefore an assessment is undertaken under s75 for interim compensation for all of the combined conditions. As the overall points at the end of any active treatment is expected to be 42, eligibility for additional interim permanent impairment compensation has been reached as it meets the minimum threshold for an additional claim of 5IP. The claim for additional compensation is paid based on 42 impairment points plus the appropriate lifestyle rating (being generally the bottom of the shaded area), and taking into account previously paid PI compensation.
Under subsection 75(2) of the MRCA [3], the amount of interim compensation is the amount determined to be reasonable, based on an estimate of the final PI rating suffered by the claimant once the impairments have stabilised. When the estimated PI rating has been determined, the compensation factor is calculated, taking account both of the level of PI and the lifestyle rating.
Where interim PI is payable in respect of a PI claim, the lifestyle rating for the person's whole person impairment is determined using Chapter 22 of GARP M [43]
Note that for Step 1 there may be situations where no lifestyle rating has been determined. This would include:
a transitional case where the old injury or disease is a SRCA condition; and
where the MRCA client converted an interim PI payment to a lump sum prior to the inclusion of a lifestyle factor in interim PI from 1 July 2013.
If the client has completed option 1 (self-rated) or option 3 (questionnaire) these are to be ignored for interim PI lifestyle assessment.
A client claimed liability and PI for a service injury in November 2012. His specialist advised that the condition had not stabilised at the time of his claim so the delegate decided to pay him interim PI. As the determination of the amount payable was made prior to 1 July 2013, the calculation of his interim PI did not include a lifestyle effect. As his condition stabilised in May his PI was recalculated (including a lifestyle rating) and increased to his final payment rate with effect from the date of stabilisation in May. Because his condition had stabilised the instructions under “Optional methods of Assessment” in Chapter 22 of GARP M are applied to determine his lifestyle rating rather than the steps in 5.8.4 [45].
Once the impairment(s) for which interim compensation has been paid stabilises, PI compensation is recalculated at the final assessed rate (i.e. the weekly rate applicable at the date the final assessment is undertaken). If the final weekly rate of payment has increased by any amount (i.e. there is no minimum threshold to be met in these circumstances), the ongoing periodic payment to the claimant is increased by the difference between the two.
Where the available medical evidence indicates that the final level of impairment is not more than the previously assessed interim rating (i.e. in circumstances where the client's impairment has improved beyond the estimated level), it would appropriate to consider the existing interim rating as the final rating to enable the case to be finalised. This would be the continuing level of impairment for compensation purposes (i.e. reassessment thresholds would need to be met above the higher rating in accordance with s71).
If the final rating is below the interim rating, it will not be appropriate to consider a higher lifestyle rating as it can be argued that the lifestyle effects have already been compensated at the level determined as part of the previous interim assessment. In these scenarios, stability can be confirmed and the determination can indicate (where applicable) that no further compensation is payable. The claim can be considered finalised for the purposes of s75(4).
When an interim payment has been made as a lump sum, the amount of PI payable is calculated by converting the lump sum paid to a current weekly amount and subtracting this from the total weekly amount of PI payable at final assessment. The difference is the new weekly amount payable (which can be converted to a lump sum or taken as an ongoing weekly entitlement).
In either case, the new rate is subject to the rules for conversion to a lump sum set out in section 78 of the MRCA [3]as discussed below.
In cases where multiple impairments are being considered as part of the PI assessment (and interim compensation has previously been paid), a final amount of PI compensation becomes payable once all of the service injuries or diseases concerned have stabilised. If the final weekly rate of PI payment is greater than the weekly interim rate, the increase in the rate is backdated to the date on which the delegate is satisfied that all of the person's service injuries or diseases stabilised.
It is not uncommon for the finalisation of an interim claim under section 75(4) to coincide with the assessment of additional compensation for impairment under s71. Where this happens the outcome should be one of a total combined whole person impairment as this is the most beneficial outcome for the client. If the s71 condition/s meet the 5 point threshold then the date of effect will be the same as in other s71 circumstances. If the s71 conditions do not meet the 5 point threshold, they are instead included as part of the s75(4) finalisation. The date of effect for these cases will be the date all of the conditions contributing to the WPI have stabilised.
An interim claim initially determined under section 75 with a total WPI rating of 25 points for a combination of hearing loss and lumbar spondylosis is being finalised. The overall final WPI rating for these two conditions is now 28 points. At the same time, impairment for a new service injury of right knee osteoarthritis has been assessed at 10 points. The date of effect for the increase from 25 to 28 points for the finalisation of the interim conditions is the date both the hearing loss and lumbar spondylosis are considered stable. The date of effect for the additional 10 points for the new condition is the latter of the date of the IL claim for the osteoarthritis or the date the osteoarthritis became permanent and stable.
However, if the WPI rating of the new condition of right knee osteoarthritis did not meet the increase of 5 impairment points on its own, the points would be added to the overall WPI total along with the finalisation of the interim conditions, with an effective date when all of the person’s service injuries or diseases have stabilised.
5.8.6.1 Date of effect for interim payments – single conditions
Where a determination is made that interim PI is payable in respect of a single condition the PI is payable from the later of:
the date the impairment suffered by the person:
where the claim for PI constituted 10 IPs (or 5 for those conditions that require a lower threshold);
where the claimant has previous compensable conditions under the MRCA – contributed at least 5 additional impairment points to the person’s overall impairment rating.
5.8.6.2 Date of effect for interim payments – multiple conditions
Where a determination is made that interim PI is payable in respect of multiple conditions the PI for each condition may be payable from different dates because the date of effect for each condition is the later of
the date the claim for liability for that condition was lodged; and
the date the impairment suffered by the person as a result of that condition (either separately or in conjunction with another condition):
where the claim for PI was made prior to 1 July 2013 – constituted 10 IPs;
where the claim for PI was made on or after 1 July 2013 and the claimant has no previous compensable conditions under the MRCA – constituted 10 IPs;
where the claim for PI was made on or after 1 July 2013 and the claimant has previous compensable conditions under the MRCA – contributed at least 5 additional impairment points to the person’s overall impairment rating.
Client is receiving PI for several stable conditions. On 12 September 2013 he claims PI for one new condition. Medical advice is that whilst the condition is permanent it is not yet stable and that at the time of the claim for PI it increased this person’s overall impairment rating by more than 5 impairment points. The delegate decides to pay him interim PI. The date of effect for payment of the interim PI is the date of claim on 12 September 2013.
Each offer of interim compensation requires a new offer/determination and optional choice to take a lump sum or part lump sum payment. The default payment method is periodic compensation paid fortnightly which should automatically be processed after a specified time (usually 21-30 days from determination date) set out by the delegate in the determination letter (noting the s389 choice). Under section 78 of the MRCA [3], a person may be entitled to choose to convert all or part of the periodic compensation payable to a lump sum. This could potentially lead to a situation where someone receives a combination of periodic and lump sum payments if more than one interim offer is made.
Section 389 of the MRCA provides that a member or former member to whom PI compensation is payable, but who has not been paid any PI compensation, can institute an action for damages against the Commonwealth or a potentially liable member at common law. See part 5.14 "Claimants Pursing Common Law Action [48]" for more information.
The following examples demonstrate the effect of multiple interim payments on a person's entitlements based on a single accepted impairment. The examples are based on the following set of information:
Calculation (warlike/non-warlike)
0.159 x $275.86 = $43.86 per week
0.265 x $286.07 = $75.81 per week
0.509 x $292.08 = $148.67 per week
Example 1 – Male choosing lump sum, periodic, periodic
A = 0.159 x $275.86 = $43.86 per week
$43.86 x 1232.4 = $54,053.06 lump sum
Takes lump sum of $54,053.06
B = 0.265 x $286.07 = $75.81 per week
A1 (current equivalent of Interim A payment) = 0.159 x $286.07 = $45.49 per week
$75.81 (B) - $45.49 (A1) = $30.32 per week
Takes periodic payment of $30.32 per week
Final = 0.509 x $292.08 = $148.67 per week
A2 (current equivalent of Interim A payment) = 0.159 x $292.08 = $46.44
$148.67 (final) – $46.44 (A2) = $102.23 per week
Takes new periodic payment of $102.23 per week
In this example (1), the current weekly equivalent of the lump sum taken at Interim A is subtracted before the final calculation of weekly payments.
Example 2 – Male choosing periodic, lump sum, periodic
Takes periodic payment of $43.86
A1 = 0.159 x $286.07 = $45.49 per week
$30.32 x 1218.1 = $36,932.79
Takes lump sum of $36,932.79 and continues periodic payment of $43.86 (indexed) per week
($30.32 ? $286.07) x $292.08 = $30.96 (current equivalent of $30.32)
$148.67 (final) – $30.96 = $117.71 per week
Takes new periodic payment of $117.71 per week
In this example (2), the weekly equivalent of the lump sum taken at Interim B is subtracted before the final calculation of weekly payments.
Example 3 – Male choosing lump sum, periodic, lump sum
A2 = 0.159 x $292.08 = $46.44
$148.67 (final) – $46.44 (A2) = $102.23
$102.23 x 1221.5 = $124,873.94
$124,873.94 – (52 weeks x $30.32) = $123,297.30
Takes lump sum of $123,297.30 ($124,873.94 minus Interim B already paid as periodic payments). Periodic payments will cease.
In this example (3), the weekly equivalent of the lump sum taken at Interim A is subtracted before the final calculation of weekly payments, which is converted to a lump sum. Also, the equivalent of the periodic payments paid for the 52 weeks between July 2009 & July 2010 is subtracted from the final lump sum calculation.
Example 4 – Male choosing periodic, periodic, lump sum
Takes new periodic payment of $75.81 per week
$148.67 (final) x 1221.5 = $181,600.41
$181,600.41 – (52 weeks x $43.86 (A) + 52 weeks x $75.81 (B)) = $175,377.57
Takes lump sum of $175,377.57 ($181,600.41 minus total of Interim A & B already paid as periodic payments). Periodic payments will cease
In this example (4), the final assessment of weekly payments is converted to a lump sum.
Example 5 – Male choosing periodic, lump sum, lump sum
$148.67 – $30.96= $117.71 per week
$117.71 x 1221.5 = $143,782.76
$143,782.76 – (52 weeks x $43.86 (A) + 52 weeks x $45.49 (1)) = $139,136.56
Takes lump sum of $139,136.56 ($143,782.76 minus the total of Interim A already paid as periodic payments). Periodic payments will cease
In this example (5), the current weekly equivalent of the lump sum taken at Interim B is subtracted from the final calculation of weekly payments, which is converted to a lump sum. The final lump sum calculation also takes account of the periodic payments which were paid for 52 weeks at the 2008-2009 rate and 52 weeks at the 2009-2010 rate.
Ceasing periodic payments: In examples 3, 4 and 5, the person's periodic payments effectively cease. This is due to the final amount being converted to a lump sum. The 'special circumstances' provision in section 78(4) would need to be used to allow the person to choose to convert to a lump sum all PI compensation payable to them that has not previously been converted to a lump sum.
This provides additional flexibility to the claimant, otherwise, the amount that could be converted would be limited to the difference between the interims paid and the final assessment.
Once the amount of PI compensation payable has been determined under section 74 of the MRCA [52], or the level of interim compensation has been determined under section 75 of the MRCA, section 76 and section 389 of the MRCA requires the delegate to advise the claimant in writing of:
the amount of weekly compensation to which they are entitled;
their choice to advise the MRCC if they intend to institute an action for damages against the Commonwealth or a potentially liable member at common law (s389 choice)
what percentage of the maximum weekly compensation they are to receive; and
their options for converting all or part to a lump sum.
On PI compensation becoming payable, a client is to be sent a Determination letter, with enclosed terms of decision. The letter shall draw attention to the operation of s389, which will usually be accompanied by an election form which allows the client to advise the DVA of their s389 choice. Whilst there is no legislative timeframe in relation to a choice under s389, claimants should be advised to let DVA know of any intention to institute action for damages by retuning the signed 'election form' clearly indicating their intentions. If the s389 election form is not received by the DVA within a reasonable timeframe, every reasonable effore should be made to contact the client to ensure they are aware of their choice under s389. See Chapter 5.14 "Claimants Pursing Common Law Action [53]" for more information.
Under s68, 71 & 75 of the MRCA, compensation is generally payable once a determination has been made that a person is eligible for that compensation (having regard to the requirements of s77). Other than the 'choice' under s78 (discussed below), there is no further positive action required on the part of the person of the compensation to be required to be paid. Legally a person can be put into payment without a positive indicatin in writing that they wish to receive compensation, however, in lieu of doing this within a strict non-statutory tiemframe, there is instead a responsibility on processing staff to follow-up with those clients who do not respond within a reasonable timeframe.
It is important to note that as long as the clients is still within the 6 month timeframe, they are still able to advise the MRCC that they elect to convert part or all of their compensation into a lump sum.
If interim payments have been made for a condition which has stabilised and if the new amount payable is greater than the amount of interim compensation which has been paid, section 76 requires the delegate to advise the claimant in writing:
of the difference between the two amounts; and
that the difference may be converted to a lump sum.
Each notice must specify the date on which it is given.
It is imperative that a claimant understands the impacts of their decision to convert permanent impairment periodic payments to a partial or whole lump sum. The financial impact of this decision on a client, will vary depending on the client's personal circumstances, and it should always be recommended that a client seeks financial and legal advice before making this decision.
It is also important to note that a decision to convert a weekly amount into a partial or whole lump sum under s78 is irrevocable and cannot be altered after it is made.
The legal personal representative of a deceased person is not entitled to choose to convert any percentage of a weekly amount that was payable to the deceased person to a lump sum.
The conversion of the weekly amount to a lump sum is based on a life expectancy table provided by the Australian Government Actuary. Adapted tables using data from the life expectancy tables are listed in the Military Compensation MRCA Manuals and Resources Library/Actuary Tables Used For Age Adjusting Lump Sum Payments. [57]
The table that contains factors for converting a weekly amount (under s68, 71 or 75(2)) to a lump sum under s78(5) of the MRCA where the election is made on or after 4 May 2015 can be found via the following link [57].
In order to elect a lump sum, section 78 [3] requires that:
it must be made within 6 months of the date the claimant receives the section 76 [3] notice.
http://www.rba.gov.au/statistics/tables/index.html#interest-rates [60]
If the link above does not work, go to http://www.rba.gov.au [61]. Once there, click onto “Statistics” located along the top of the screen. Click on ‘Economic and Financial Statistics”, and then "Statistical Tables" then scroll down to "Interest Rate" and click on "Interest Rates and Yields - Money Mark - Daily - F1".
5.12.1 Eligibility for additional compensation payments
Section 80 makes provision for severely impaired people to be considered for additional amounts of compensation, if maximum compensation is paid. Additional amount/s of compensation can be considered where all of the following criteria is met in relation to s80(1);
The impaired person has been paid, or is entitled to be paid MRCA PI (for transitional clients, they must meet the 5IP threshold requirement at step 2(a) of Chapter 25 of GARP M); and
The degree of impairment suffered constitutes 80 or more impairment points (for transitional clients this can be from a combination of MRCA, VEA and/or SRCA total impairment points as assessed at Step 1 of Chapter 25 of GARP M), and
Maximum compensation is paid i.e. the impaired person must be in receipt of the maximum weekly rate (this may be, or have been converted to a lump sum amount). For transitional clients this can also be as a result of SRCA, VEA and MRCA contribution.
Other eligibility requirements such as the Gold Card or SRDP which only requires the client reaching the total impairment rating threshold of 60 and 50 impairment points respectively, the eligibility for additional compensation under this provision requires more than meeting the threshold alone. The veteran must be assessed as 80 or more impairment points, and be paid at the maximum rate of compensation.
5.12.2 Eligibility for additional compensation
Once this criteria is met, section 80(2) specifies that the claimant is entitled to receive an additional lump sum payment for each person who is both a dependant of the impaired person and an eligible young person. The amount payable is indexed annually. The current amount can be found in the Comp and Support Library under current payment rates [63]. The applicable payment rate for the additional lump sum payment will be as of the date we determine compensation is payable and advise the client they are eligible for the payment.
This additional amount is payable for each person who was both an eligible young person and a dependant of the impaired person at the later of:
the date determined by the delegate to be the date that the claimant's impairment constituted at least 80 IPs; or
the date on which the claim for liability was made; or
where more than one injury or disease resulted in the person reaching 80 impairment points, the date on which the most recent claim for liability for one of those injuries or diseases was made.
For the purposes of s 80(2), a ‘dependant’ means any person mentioned in s 15(2) (for example, a child, spouse or other dependant of the impaired person) who is wholly or partly dependent on the impaired person, or would be but for that person’s relevant incapacity (s 15(1)). ‘Eligible young person’ means a person who is under 16 or certain persons who are 16 or more but under 25 (broadly, persons receiving full-time education and not engaged in full-time employment or work) (s 5)..
In summary, an impaired person is entitled to additional compensation under s 80 in respect of each depedent of that person, provided that the dependant is:
an eligible young person at the time referred to in s 80(2) (the ‘relevant time’) – broadly, the later of the date of determination by the Commission that the impairment threshold was met or the date a relevant claim was made under s 319 of the MRC Act; or
born alive after the ‘relevant time’ but conceived before that time (s 80(3)(a)); or
adopted on or after the ‘relevant time’ but in respect of whom adoption proceedings were begun before that time (s 80(3)(b)).
In a determination dated 25 June 2017, a client is advised they have 80 impairment points and is entitled to receive PI compensation at the maximum rate. The date at which they met the 80 point threshold was 1 April 2016. The date of effect for the purposes of PI compensation and calculating the arrears payable is from 1 April 2016. On 5 July 2018 DVA receives the relevant information required to establish each dependant meets the criteria of an eligible young person and processes the payment for additional lump sum/s to the client. The following dates apply for additional lump sum payment purposes:
1 April 2016 – the date the former member met 80 impairment points, is the date that the criteria for dependency and EYP must be met by any child, spouse or other dependant of the veteran; and
5 July 2018 – is the date utilised when determining the applicable rate of payment for the additional compensation under section 80 of MRCA. This date will also bethe date the payment is processed and paid to the veteran.
Therefore in this example, a child, spouse or other dependant of the veteran who meets the criteria for section 80 payment as at April 2016 will attract an additional lump sum payment payable to the veteran as at the rates in July 2018, being the 2018/19 indexed rate.
5.12.3 Other Dependants who meet the eligibility criteria of EYP
While most payments under section 80 will be paid due to the client having a child who is both a dependant and an eligible young person, it is possible for a wholly dependent partner or other dependant to also meet the eligibility criteria for a section 80 payment to be paid.
this will occur where, at the time of the veteran reaching the 80 point threshold and receiving compensation at the maximum rate, the veteran's partner or other dependant was under the age of 25, in full-time study, and not engaged in full-time work, while being financially dependent on the veteran.
5.12.4 Dependency in context
While guidance on dependency can be found elsewhere on CLIK (Chapter 7.5.2. [64] of this manual is useful), assessing dependency for s80 does not require establishment of a certain level of dependency to calculate a payment. An eligible young person is either financially dependent on, or not financially dependent on, the impaired person for the purposes of this payment.
Practically speaking, 'dependency' requires a consideration of the relationship of economic support between the impaired person and the eligible young person. A practical approach is to consider the financial contribution provided consistently over a period of time towards the total cost of the dependant in maintaining the necessities of life at the standard of living enjoyed. The simplest example is where a dependant relies on the impaired person for 100% of their economic support. In the s80 context, this would be seen as determinative.
However, a relationship of economic support may exist where the impaired person is only partially responsible for the economic support of the eligible young person. The Commission takes a lenient approach to these cases, such that, where an impaired person provided more than a token proportion of the total economic support provided from all sources to the eligible young person, the payment should be made.
This must be considered in the context of the individual case. For example, where an eligible young person receives $50 per week from his mother (the impaired person) before the 80+ point determination, but the eligible young person lives with his father and step-mother who are otherwise responsible for all economic support to the eligible young person, it would be unrealistic to suggest that the eligible young person is dependent economically on the impaired person.
The question to ask as a delegate is: “Would the eligible young person be impacted in a real sense if the economic support provided by the impaired person was no longer provided?”
Benefits and Payments policy are happy to consult on any borderline cases, but in line with the MRCA being a beneficial legislation, an interpretation that favours granting the benefit will usually be preferred.
5.12.5 Section 80(3) IVF consideration
The purpose of s 80 is to provide the impaired person with compensation to assist the person with the expenses associated with raising the children they have at the relevant time, as well as any child they might have (barring intervention of some kind) as a result of a pregnancy or adoption proceedings that commenced prior to the relevant time. The impaired person is not, however, entitled to assistance under s 80 in respect of any subsequent child they have where the child is conceived, or adoption proceedings commenced, after the relevant time.
Thus, there is a clear distinction between children of an impaired person who existed, or were on their way or growing into existence, at the relevant time, and children who might come later. The impaired person is entitled to compensation in respect of the former, but not in respect of the latter.
While the reason for this distinction is not made explicit in the MRC Act, it would seem to be because the impaired person should be taken to be compensated in respect of the circumstances they find themselves in at the relevant time (whether those circumstances include a child already born or a child on the way). In other words, it seems that the intention was that the impaired person not be placed in an inferior position merely because they have children or are expecting children (in the sense described above), which, at the relevant time, is a circumstance beyond their control.
It is of course a different situation where an impaired person chooses to have a child at a later date with the knowledge of their impairment (as the relevant circumstances are within the control of the impaired person). That is, the impaired person can be taken to comprehend the situation they are in at that time (including their financial situation), and the consequences of choosing to have a child (or additional children), and can make a decision accordingly.
Therefore, the Military Rehabilitation and Compensation Commission (MRCC) view of the meaning of ‘conceived’ in s 80(3)(a) of the MRC Act is the commencement of pregnancy, which, in the context of in-vitro fertilisation (IVF), broadly equates to implantation of the fertilised egg in the uterus. This interpretation is consistent with authority on the ordinary meaning of the term ‘conceived’, and is the most logical reading of the term for the purposes of s 80 of the MRCA. The MRCC made this determination based on advice from the Australian Government Solicitor (AGS).
There is a maximum amount of compensation that can be provided for the purposes of seeking financial and/or legal advice. See CLIK rates chart [63] for current amount under 'Reimbursement limits – Financial and legal advice compensation'. Delegates should feel comfortable paying/reimbursing any amount up to the maximum
Section 389 of the MRCA [3]provides that a member or former member to whom permanent impairment (PI) compensation is payable, but who has not been paid any PI compensation, can institute an action for damages against the Commonwealth or a potentially liable member for non-economic loss. This is commonly referred to as 'common law action'. The action is taken ‘in respect of a service injury or disease’. It is not the permanent impairment assessment that a person may take action against, but a single condition as distinct from other accepted conditions.
Instituting action for damages (common law action)
The amount of damages at common law is restricted to a maximum of $110,000, is not indexed and is for pain and suffering (non-economic loss) only. Compensation payments other than PI compensation such as incapacity payments and treatment will remain payable under the MRCA . If PI compensation has already been paid in respect of a specific service injury or disease, common law action cannot be taken in relation to that same service injury or disease.
Commencing compensation payment
Section 77 of the MRCA provides that once compensation is payable to a person, it becomes payable from a prescribed date and weekly arrears will continue to accrue from this date. There is no positive action required from a person to receive PI compensation. However, once compensation is paid to a person they no longer have the option to institute action for damages (for non-economic loss). For this reason it is important to ensure clients are provided with adequate information about the two options available to them at this point in the PI compensation process, and a suitable timeframe to decide what they prefer to do.
Notifying a client of their rights
There is no statutory timeframe attached to a s389 choice, a person may take as long as they rquire to decide if they wish to take the compensation amount calculated by DVA, or alternatively institute action for damages against the Commonwelath or a potentially liable member. Where no response has been received in relation to the s389 choice (i.e. where the election form has not been returned) it is appropriate for the delegate to make contact with the client with a view to identifying any difficulties the client may be having in reaching a decision. Delegates are encouraged to use their discretion to delay payment if there is no client contact, for example if the client is hospitalised or overseas, and doubt exists over the clients intentions to accept compensation. However, payments should not be delayed indefinitely and if after a reasonable time has elapsed and all practical efforts have been made to contact the client, then the client can be placed into periodic payment if this is considered reasonable.
While there is no legislative requirement for the claimant to advise that they intend to sue the Commonwealth, subsection 390(2) states that the claimant must advise the MRCC of a claim under common law not later than 7 days after the common law claim is lodged.
Any payments received via settlement of private insurance matters will not affect a client's entitlement to either permanent impairment or incapacity compensation under the MRCA and there is no requirement to “offset” these payments against any MRCA benefits (as occurs with payments for common law damages).
Refer to Chapter 2.2.9 [68] of the handbook “Claims” for more information on the definition of private insurance benefits and the basis for excluding them from the recovery provisions contained in the Act.
R&C ISH is a system designed to assist in determining all Rehabilitation and Compensation Claims. The Delegate Step by Step [72]guide will assist in recording Lifestyle ratings.
When calculating an interim impairment payment amount under subsection 75(2) of the MRCA [3], the Commission must allocate a lifestyle rating using the following methodology:
Delegates should accept a client self assessed rating unless there is evidence to indicate that it is a vast over or underestimation.
More ? [77]
Centrelink [78]
Last amended: 1 August 2011
From 28 April 2011, permanent impairment lump sum compensation must be paid directly to an account maintained by the claimant and not to a third party such as the claimant's legal representative. See also 11.7.1 [82] Payment into Bank Account etc.
Source URL (modified on 23/02/2016 - 9:02am): http://clik.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-5-permanent-impairment
[1] http://clik.dva.gov.au/user/login?destination=comment/reply/19372%23comment-form
[2] http://clik.dva.gov.au/user/login?destination=comment/reply/19352%23comment-form
[4] http://clik.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-2-claims/23-needs-assessments/234-conduct-needs-assessment
[5] http://clik.dva.gov.au/compensation-and-support-policy-library/part-9-principles-determining-pension-rate/98-guide-assessment-rates-veterans-pensions-garp/chapter-3-impairment-spine-and-limbs
[6] http://clik.dva.gov.au/compensation-and-support-policy-library/part-9-principles-determining-pension-rate/98-guide-assessment-rates-veterans-pensions-garp/986-garp-chapter-10
[7] http://clik.dva.gov.au/user/login?destination=comment/reply/19341%23comment-form
[8] http://clik.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-2-claims/21-making-claim/218-claims-compensation
[9] http://clik.dva.gov.au/user/login?destination=comment/reply/19375%23comment-form
[10] http://clik.dva.gov.au/user/login?destination=comment/reply/19360%23comment-form
[11] http://clik.dva.gov.au/service-eligibility-assistant-updates/all-determinations-order-date-signed-oldest-most-recent/determinations-under-mrca
[12] http://clik.dva.gov.au/tags/signs-and-symptoms
[13] http://clik.dva.gov.au/user/login?destination=comment/reply/19350%23comment-form
[14] http://clik.dva.gov.au/user/login?destination=comment/reply/19354%23comment-form
[15] http://www.austlii.edu.au/cgi-bin/sinodisp/au/cases/cth/HCA/1964/34.html?stem=0&amp;synonyms=0&amp;query=semlitch%201964
[16] http://clik.dva.gov.au/user/login?destination=comment/reply/19366%23comment-form
[17] http://clik.dva.gov.au/user/login?destination=comment/reply/19397%23comment-form
[18] http://clik.dva.gov.au/user/login?destination=comment/reply/19370%23comment-form
[19] http://www.austlii.edu.au/cgi-bin/sinodisp/au/cases/cth/FCA/1984/57.html?stem=0&amp;synonyms=0&amp;query=title(mcdonald%20and%20director-general%20of%20social%20security%201984%20)
[20] http://clik.dva.gov.au/user/login?destination=comment/reply/19338%23comment-form
[21] http://clik.dva.gov.au/user/login?destination=comment/reply/19383%23comment-form
[22] http://www.austlii.edu.au/cgi-bin/sinodisp/au/cases/cth/FCA/1984/6.html?stem=0&amp;synonyms=0&amp;query=Dragojlovic%201984
[23] http://www.austlii.edu.au/cgi-bin/sinodisp/au/cases/cth/FCA/2001/964.html?stem=0&amp;synonyms=0&amp;query=Filla
[24] http://clik.dva.gov.au/user/login?destination=comment/reply/19349%23comment-form
[25] http://clik.dva.gov.au/user/login?destination=comment/reply/19336%23comment-form
[26] http://clik.dva.gov.au/user/login?destination=comment/reply/19359%23comment-form
[27] http://www.austlii.edu.au/cgi-bin/sinodisp/au/cases/cth/HCA/1982/3.html?stem=0&amp;synonyms=0&amp;query=fazlic
[28] http://clik.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-2-claims/21-making-claim/2114-medical-examinations-overview
[29] http://clik.dva.gov.au/user/login?destination=comment/reply/19376%23comment-form
[30] http://clik.dva.gov.au/user/login?destination=comment/reply/19368%23comment-form
[31] http://clik.dva.gov.au/user/login?destination=comment/reply/19373%23comment-form
[32] http://clik.dva.gov.au/user/login?destination=comment/reply/19384%23comment-form
[33] http://clik.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-5-permanent-impairment/58-interim-permanent-impairment-compensation
[34] http://clik.dva.gov.au/user/login?destination=comment/reply/19339%23comment-form
[35] http://clik.dva.gov.au/user/login?destination=comment/reply/19351%23comment-form
[36] http://clik.dva.gov.au/user/login?destination=comment/reply/19381%23comment-form
[37] http://clik.dva.gov.au/user/login?destination=comment/reply/19392%23comment-form
[38] http://clik.dva.gov.au/user/login?destination=comment/reply/19379%23comment-form
[39] http://clik.dva.gov.au/user/login?destination=comment/reply/19358%23comment-form
[40] http://clik.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-5-permanent-impairment/52-entitlement-permanent-impairment-compensation/521-required-degrees-impairment
[41] http://clik.dva.gov.au/user/login?destination=comment/reply/19387%23comment-form
[42] http://clik.dva.gov.au/user/login?destination=comment/reply/19398%23comment-form
[43] https://www.legislation.gov.au/Series/F2016L01290
[44] http://clik.dva.gov.au/user/login?destination=comment/reply/19380%23comment-form
[45] http://clik.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-5-permanent-impairment/58-interim-permanent-impairment-compensation/584-determination-lifestyle-rating-where-interim-pi-payable
[46] http://clik.dva.gov.au/user/login?destination=comment/reply/19374%23comment-form
[47] http://clik.dva.gov.au/user/login?destination=comment/reply/19357%23comment-form
[48] http://clik.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-5-permanent-impairment/514-claimants-pursuing-common-law-action
[49] http://clik.dva.gov.au/user/login?destination=comment/reply/19342%23comment-form
[50] http://clik.dva.gov.au/user/login?destination=comment/reply/19395%23comment-form
[51] http://clik.dva.gov.au/user/login?destination=comment/reply/19356%23comment-form
[52] https://www.legislation.gov.au/Series/C2004A01285
[53] http://clik.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-5-permanent-impairment/510-advising-claimant
[54] http://clik.dva.gov.au/user/login?destination=comment/reply/19347%23comment-form
[55] http://clik.dva.gov.au/user/login?destination=comment/reply/19390%23comment-form
[56] http://clik.dva.gov.au/user/login?destination=comment/reply/19393%23comment-form
[57] http://clik.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/actuary-tables-used-age-adjusting-lump-sum-payments/conversion-factors-permanent-impairment-periodic-payments-lump-sums-where-election-lump-sum-made-or-after-4-may-2015
[58] http://clik.dva.gov.au/user/login?destination=comment/reply/19365%23comment-form
[59] http://clik.dva.gov.au/user/login?destination=comment/reply/19394%23comment-form
[60] http://www.rba.gov.au/statistics/tables/index.html#interest-rates
[61] http://www.rba.gov.au
[62] http://clik.dva.gov.au/user/login?destination=comment/reply/19389%23comment-form
[63] http://clik.dva.gov.au/compensation-and-support-reference-library/payment-rates/current-payment-rates
[64] http://clik.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-7-compensation-death/75-who-may-be-entitled-compensation-following-death-under-mrca/752-criterion-2-what-degree-dependency-did-person-who-meets-criterion-1-have-deceased
[65] http://clik.dva.gov.au/user/login?destination=comment/reply/19364%23comment-form
[66] http://clik.dva.gov.au/user/login?destination=comment/reply/19346%23comment-form
[67] http://clik.dva.gov.au/user/login?destination=comment/reply/19371%23comment-form
[68] http://clik.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-2-claims/22-determination-claims/229-receipt-private-insurance-benefits
[69] http://clik.dva.gov.au/user/login?destination=comment/reply/19378%23comment-form
[70] http://clik.dva.gov.au/user/login?destination=comment/reply/19382%23comment-form
[71] http://clik.dva.gov.au/user/login?destination=comment/reply/19367%23comment-form
[72] http://clik.dva.gov.au/military-compensation-reference-library/rc-ish-guides/mrca-permanent-impairment
[73] http://clik.dva.gov.au/user/login?destination=comment/reply/19388%23comment-form
[74] http://clik.dva.gov.au/user/login?destination=comment/reply/19353%23comment-form
[75] http://clik.dva.gov.au/user/login?destination=comment/reply/19363%23comment-form
[76] http://clik.dva.gov.au/user/login?destination=comment/reply/19386%23comment-form
[77] http://clik.dva.gov.au/compensation-and-support-policy-library/part-5-income-support-allowances-and-benefits/53-education-entry-payment-edep
[78] http://www.humanservices.gov.au/customer/dhs/centrelink
[79] http://clik.dva.gov.au/user/login?destination=comment/reply/19377%23comment-form
[80] http://clik.dva.gov.au/compensation-and-support-policy-library/part-7-common-allowances-and-benefits/74-clean-energy-payments
[81] http://clik.dva.gov.au/user/login?destination=comment/reply/19369%23comment-form
[82] http://clik.dva.gov.au/military-compensation-mrca-manuals-and-resources-library/policy-manual/ch-11-overpayments-miscellaneous-items/117-miscellaneous-items/1171-payment-bank-account-etc