Checking and actioning Employment Services Assessment (ESAt) reports 001-02320020

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Example

1

When an ESAt is upgraded to a JCA

Joe attends an ESAt interview after having supplied a medical certificate to Services Australia for a bad back. Joe has a history (over 18 months) of supplying medical certificates on and off for this back condition. The medical certificate states that it is a temporary exacerbation of a condition likely to persist for more than 2 years and that the symptoms include generalised lower back pain, referred pain to Joe's legs, and an inability to sit or stand for more than 10 minutes.

Joe gets up and down from the chair to stretch and change positions regularly throughout the assessment. Treatment is indicated to be non-steroidal anti-inflammatory drugs (NSAIDs), physiotherapy and exercise. Joe is also a little overweight. The doctor indicates on the certificate that Joe cannot undertake usual work or study, nor can Joe do more than 8 hours of work per week.

Joe tells the Assessor that these back problems started after a fall at work 5 years ago, but in the last couple of years, it has become worse. Joe says that surgery has been suggested, however there is just as much chance it will do damage as there is it will improve, so Joe is not keen to pursue it. Joe says the back condition affects everything, even when not suffering from a 'relapse'.

Joe's history of medical certificates along with a verbal history, current medical evidence, presentation at interview, and indication that the only treatment option may not be effective, means that it is likely Joe's situation will affect Joe's ability to work into the future and will in fact deteriorate.

Therefore, an upgrade to a JCA and the impact of Joe's condition assessed against the impairment tables would be appropriate. In this case, where medical certificates are the only evidence, contact with Joe's doctor would be needed.

An ESAt upgraded to a JCA will have a title of either:

• Employment Services Assessment Report, or
• Job Capacity Assessment Report (includes Employment Services Assessment)

If the ESAt report indicates medical eligibility for DSP and this is correctly recorded in the report, it is considered to be upgraded to a JCA.

When accepted, the report will display in Documents as ESAR and ESA on the Medical Condition (MC) screen.

Note: before a claim for Disability Support Pension (DSP) can be granted, a Disability Medical Assessment (DMA) will be required.

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Question

1

Question: When should an ESAt be upgraded to a Job Capacity Assessment (JCA)?

Answer: ESAt should be upgraded to a JCA when an Assessor has sufficient medical evidence to assign an Impairment Rating or determine manifest medical eligibility.

The report must meet one of the following sets of requirements:

• Requirements due to Impairment Rating - the report must show the following:
• Attracts an Impairment Rating of 20 points or more, for a condition(s) that is likely to persist for more than 2 years, and is diagnosed, reasonably treated and stabilised (DTS)
• Indicates a future work capacity of less than 15 hours per week with intervention in the next 2 years
• Has actively participated in a Program of Support (POS), or has a severe impairment and is exempt from the active participation in a POS requirement
  Note: if the active participation in a POS question is answered N, the Assessor will not be able to assess the DTS work capacity fields for this customer
• Requirements due to manifest medical eligibility - the report must show the following:
• Meets the manifest medical eligibility criteria (manifest indicator)
• Indicates a future work capacity of less than 15 hours per week with intervention in the next 2 years

A submitted ESAt report may have enough evidence to assess the job seeker as meeting all medical eligibility criteria for DSP, but the assessment is not upgraded. For example, the report indicates DSP medical eligibility is met in the Remarks or Assessment Summary, but there is no Impairment Rating or manifest indicator. If this occurs, staff should:

• review the report to identify the reason the Assessor did not upgrade the assessment
• contact the Assessor to discuss the reason the assessment was not upgraded
• accept or return the report as necessary

See an example of when an ESAt is upgraded to a JCA.

2

Question: What should happen after an upgraded ESAt is submitted?

Answer: After an upgraded ESAt has been submitted:

• the Assessor records a Potential DSP eligibility Fast Note so the ESAt is actioned as a priority
• the report is reviewed and accepted following normal procedures
• consider if the customer should be invited to claim Disability Support Pension (DSP)

Residence assessments in upgraded ESAt

Where an upgraded ESAt recommends:

• medical eligibility under the Impairment Tables: the residence section of the report defaults to This client has resided in Australia for: 10 years or more, regardless of the customer's residence status
• manifest medical eligibility: the residence section does not show in the report

If the customer claims DSP, the Medical Assessment (MAT) will consider the customer's residence and will assess where the customer's Continuing Inability to Work (CITW) occurred, if applicable.

Invite the customer to claim if both the following apply:

• they do not currently have a claim for DSP in progress
• they meet non-medical eligibility requirements for DSP including residential requirements

To invite to claim, see the Inviting a current income support customer to claim DSP table on the Assisted tab.

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Question: What is the process to return a report to Assessment Services?

Answer: If an error, inconsistency or quality issue is identified in an ESAt Report, before returning the report, refer the query to the Assessment Services Quality Team. See the Process page, Table 2 > Step 5 for more details on action required.

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Question: How is medical evidence referenced within the report?

Answer: Since 1 July 2011, original medical evidence must be referenced in an ESAt report to support all verified conditions within the report. Previous assessments can no longer be used to verify a condition. If medical evidence is not referenced and viewable in Document Tools/MIFE, return the report to the Assessor.

• All verified conditions (likely to persist for less than 2 years and conditions likely to persist for more than 2 years) must be referenced within the ESAt report
• For ESAt upgrades to JCA, all medical conditions recorded must be linked to one or more sources of original medical evidence to confirm the diagnosis

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Question: What is original evidence?

Answer: Original medical evidence refers to a medical report, medical certificate or other medical evidence such as a specialist report. This medical evidence must be a viewable document, which has been scanned to the job seeker record and cannot be an earlier ESAt or report or other document that refers to the original evidence. Assessors must reference the medical evidence used for the previous report or document, not the report or document itself.

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Question: What type of information is not required to be referenced within a report?

Answer: Test resources and other tools are not required to be referenced within the report. For example:

• Psychometric and physical assessment tools used in the preparation of a Specialist Assessment Report
• Depression Anxiety Stress Scales (DASS) used to determine the severity of depression
• Wechsler Adult Intelligence Scale (WAIS) reports