Inconsistencies in an Employment Services Assessment (ESAt) report 001-02320090

Staff may access the entire contents of the completed Employment Services Assessment (ESAt) electronically and may view and print the report as required. For example, to provide an explanation or undertake a formal review of a decision or other valid reasons.

After it is submitted to the decision maker by the Assessor, the ESAt report may require manual checking and actioning. If the report has noticeable inconsistencies, the decision maker will discuss the issue with a Subject Matter Expert (SME). Inconsistencies may include, but are not limited to:

• inconsistent work capacities (and rationale)
• incorrect or absent assessment of medical information
• incorrect or absent assessment of program of support requirements
• incomplete specialist assessment, including provision of specialist report
• incorrect application of impairment, including incorrect table (for upgraded ESAts only)
• the customer's functional impairment is not congruent with medical information. The functional impairment should reasonably align with the medical condition. (For upgraded ESAts only)

If the ESAt report cannot be accepted, return (reject) the report.

Assessment Services will:

• review the matter
• escalate recommendations to the Assistant Director and Director
• communicate to the Assistant Operations Support Manager for Disabilities the changes to be made, action taken and any progress made

If the Assistant Operations Support Manager for Disabilities disagrees with the outcome, the Assessment Services Team will refer as appropriate to the HPAU for advice and opinion.

If the HPAU and the Assessor have reached a single professional view, the outcome will be provided to the Assistant Operations Support Manager for Disabilities by the Assistant Director in Assessment Services.

When investigating a decision to provide an explanation to a customer. a SME must consider any new medical evidence provided to decide whether a new ESAt is required.

Significant new medical evidence may include:

• new medical evidence with information about a medical condition which significantly impacts the customer's ability to function, that was not assessed in the previous ESAt
• information about the customer's employment (for example, they are working regular full-time hours) that was not evident to the Assessor

When undertaking a formal review of a decision, an ARO may seek further information or clarification from a variety of sources. These include the customer, the HPAU, the customer's treating doctor or specialist, and the Assessor.

If an ARO seeks help from the HPAU, HPAU will ensure that a single agency view is provided.

The ARO may identify Assessor practice that has contributed to the decision. For example, if the ARO recognises the Assessor has not provided clear justification about the functional impact of the medical condition/s.

The ARO retains the final authority to make a decision based on available evidence in accordance with legislation.

CIS SMEs may seek assistance when making decisions about complex matters regarding impairment and work capacity for foreign pension, portability and agreement claim matters.

When a report is accepted, CIS Officers may identify inconsistencies within the report. These include but are not limited to:

• inconsistent work capacities (and rationale)
• incorrect or absent assessment of medical information
• incorrect or absent assessment of program of support requirements
• incomplete specialist assessment, including provision of specialist report
• incorrect application of impairment, including incorrect table (for upgraded ESAts only)
• the customer's functional impairment is not congruent with medical information. The functional impairment should reasonably align with the medical condition. (for upgraded ESAts only)

The matter will need to be forwarded to the Team Leader at CIS who will review the matter and forward it for review to the Assessment Services Quality team mailbox.

Assessment Services will:

• review the matter
• escalate recommendations to the Assistant Director and Director
• communicate to the Assistant Director of the relevant appeals team about changes that are required, the action taken and any progress made
• if appropriate, refer the matter to the HPAU for opinion and advice

Branch advocates may seek help from Assessment Services if:

• a customer has had a decision set aside by an ART first review on the basis of significant new medical evidence, or
• a customer submits new medical evidence in the course of an ART second review

These cases will be referred to the ASNAT.SUPPORT mailbox for action.

In all cases, the Assessor must liaise with HPAU to ensure that the conclusions expressed in their report about functional impairment and work capacity accurately represent the view of Services Australia. Assessment Services is required to respond within agreed timeframes to facilitate the tribunal timeframes.

Advocates may be made aware of detrimental findings or at review identify inconsistencies within the ESAt report. These include but are not limited to:

• inconsistent work capacities (and rationale)
• incorrect or absent assessment of medical information
• incorrect or absent assessment of program of support requirements
• incomplete specialist assessment, including provision of specialist report
• incorrect application of impairment, including incorrect table (for upgraded ESAts only)
• the customer's functional impairment is not congruent with medical information. The functional impairment should reasonably align with the medical condition. (for upgraded ESAts only)

The matter will need to be forwarded for review to the Assessment Services Quality team mailbox.

Assessment Services will:

• review the matter
• escalate recommendations to the Assistant Director and Director
• communicate to the Assistant Director of the relevant appeals team about changes that are required, the action taken and any progress made
• if appropriate, refer the matter to the HPAU for opinion and advice

There may be differing opinion between the Assessor and the HPAU's consulting Health or Allied Health Professionals. This is a natural part of professionals working together and the collaboration process. The Assessor often has the benefit of having interviewed the customer, while the Health Professional often has experience and the capacity to research treatments of relevant conditions.

The view of Services Australia is that one agency professional view is required for all opinions relevant to an ESAt outcome.

This process will relate to any situation where:

• an ESAt report has been questioned by way of a referral to the HPAU and the outcome of the referral is a potentially significant change to a report
• an Assessor has sought the opinion of the HPAU and the HPAU representative identifies that their opinion is likely to differ from the Assessor's

If the Assessor is planning on seeking HPAU advice, especially if DSP may be cancelled, they should first consult with their Assistant Director to ensure that the decision-making up to that point appears correct and justified.

Before providing any 'formal' written advice on the matter, discussion between the relevant parties must have occurred.

Priority in this process is placed on an open non-defensive collegial discussion with a focus on the appropriate decision. Discussions will begin at the level of Assessor and health professional before proceeding to any resolution process.

If consensus can be reached, the HPAU report should be completed which will then be reflected in the ESAt. Any written advice from HPAU should not be scanned until a consensus view is obtained.

If a consensus cannot be reached, a brief case conference will be organised. This will be a solution-focussed negotiation leading to an agreed resolution with membership consisting of HPAU representative managing the referral, Assessor, and Assessment Services National Team representing National Manager (NM) and providing secretarial duties for the case conference.

Discuss the sources of evidence relating to the case and the relative 'weight' attributed to each piece:

• review any inconsistencies between pieces of written evidences or the customer's presentation
• explore the known treatments and progress of the combination of the customer's medical conditions
• discuss professional perspectives on the matter
• explore sources of difference of opinion and what could lead to consensus

Parties may then agree on the matter at hand or decide to seek further medical information.

In some instances the matter may need to be escalated to senior or expert staff, including staff from HPAU.

The outcome of the case conference will be a written report indicating the consensus opinion.

The written report should be copied to all parties to the case conference and to the Assessment Services Quality team mailbox to be included in the Issues Management Register.

The written report from the HPAU should then be finalised, provided to the referrer and scanned to the customer's record. The Assessor's report should reflect the agreed view on the matter and the rationale. The written report will not make reference to any disagreement, but record the parties' outcome and the consensus outcome.

If a consensus view is not achieved after escalation to the Director HPAU and/or Assessment Services Director, the case must be referred to the National Team via the Assessment Services Quality team mailbox.

The national team will review the matter, liaise with the Director of the HPAU and Director of Assessment Services and make a final recommendation regarding the outcome to the NM for sign off.

This will result in a report being prepared indicating the Assessment Services' one professional view for scanning to the customer's record. The written report will not make reference to any disagreement, but record the parties' outcome and the consensus outcome.