Exempting a job seeker from mutual obligation requirements for serious illness 001-09120080

Job seekers with mutual obligation requirements who are temporarily incapacitated as the result of an illness, injury or medical condition may be eligible for a temporary incapacity exemption. See Assessing and coding medical evidence for temporary incapacity exemptions.

A Temp-Incap Serious Illness exemption may be granted for customers who are suffering from a serious illness. A serious illness or injury is expected to impact on a customer's ability to undertake work, study or meet their mutual obligation requirements for 8 hours or more per week for an extended period (more than 13 weeks and less than 24 months). This exemption can be applied for periods greater than 13 weeks under a single medical certificate.

Note: as a result of their condition, seriously ill customers may be temporarily incapacitated for extended periods of time. However, it is often the case that they will not qualify for Disability Support Pension (DSP) because their condition is:

• not yet diagnosed, reasonably treated and stabilised, or
• temporary (is likely to persist for less than 2 years)

The Temp-Incap - Serious Illness exemption may initially be granted for up to 12 months, according to the dates advised by a medical practitioner on the medical certificate, or following contact with a Service Officer.

If further evidence is provided and it can be determined that the same serious illness condition persists at the end of the initial 12 month exemption, an extension of up to 6 months may be applied. The allowable exemption period will be determined by the dates advised by the medical practitioner on a new medical certificate.

Job seekers granted a Temp-Incap Serious Illness exemption:

• will not be required to provide additional medical certificates for the duration of the exemption, and
• will have modified reporting requirements during the exemption

If a job seeker is still clearly temporarily incapacitated for all work after being granted a total period of 18 months exemption for the same medical condition, they may be granted a further exemption of up to 13 weeks at a time. A new medical certificate will be required for each new exemption period and will be assessed under the temporary incapacity exemption provisions.

To be eligible for a temporary incapacity - serious illness exemption, the following criteria must be met:

• the job seeker must:
• meet all the criteria required for a temporary incapacity exemption
• be temporarily incapacitated as a result of having a serious illness
• be undergoing/recovering from intensive medical treatment (for example, chemotherapy, radiotherapy, etc.) or undertaking rehabilitation for the serious illness
• it is unlikely that the job seeker will experience significant improvement in their medical condition over the period stated on the medical certificate, and
• requiring the job seeker to repeatedly obtain a new medical certificate every 13 weeks would place unreasonable physical and/or mental burden or stress on the job seeker

Note: this exemption should not be used as a way to reduce the number of contacts with job seekers.

Some examples of medical conditions that may indicate a job seeker or participant is seriously ill include:

• cancer/leukaemia
• severe stroke
• acquired brain injuries
• serious burns
• serious physical injuries requiring long recovery periods
• severe mental health conditions for which the person is receiving treatment in an institutional setting

If a job seeker's medical evidence verifies they have a terminal illness, they may be manifestly eligible for Disability Support Pension (DSP).

Note: if the serious illness is primarily as a result of drug or alcohol misuse or dependency, a Temp-Incap Serious Illness exemption cannot be granted unless the job seeker is a Community Development Program (CDP) participant. The job seeker can volunteer to undertake drug dependency treatments or interventions.

A valid medical certificate is preferred, however, any medical documentation which contains the information required for a valid medical certificate will satisfy this requirement.

Where the information contained in a valid medical certificate requires clarification, or if a serious illness is otherwise indicated, it may be appropriate to contact the medical practitioner to make sure that all relevant information is considered in the decision. Additional information obtained via contact with the medical practitioner must be appropriately documented on the customer's record.

Job seekers with a serious illness who clearly meet the criteria for the Temp-Incap Serious Illness exemption do not need to be referred for an Employment Services Assessment (ESAt) to determine whether an exemption can be granted.

A referral for an ESAt in addition to granting a Temp-Incap Serious Illness exemption may be appropriate to determine:

• if a job seeker has a Partial Capacity to Work (PCW)
• identify if another payment is more appropriate
• determine eligibility for Youth Disability Supplement (YDS) or independence, or
• where a job seeker has been suspended for failing to attend a previous ESAt appointment

If the Job Seeker Snapshot identifies the requirement for an ESAt for a job seeker who meets the criteria for the Temp Incap - Serious Illness exemption, and it is determined that an ESAt is not also required, the ESAt flag may be withdrawn so the pending Job Seeker Snapshot can be completed without referring the job seeker for an ESAt.

Assessment Services staff may grant Temp-Incap Serious Illness exemptions for job seekers in place of conducting an Employment Services Assessment (ESAt), where the evidence indicates that this is appropriate. An Assessor may obtain further evidence by contacting the medical practitioner via phone. Further evidence must be documented appropriately. In some circumstances, it may be in the job seeker's best interest to complete the ESAt where a Temp-Incap Serious Illness exemption could be applied. This is to be determined at the Assessor's discretion and is likely only relevant for a small cohort of job seekers.

Job seekers

Job seekers who have been granted the Temp Incap Serious Illness exemption can be manually placed on variable reporting and are required to report every 12 weeks using self-managed services or via Reporting Statement (SU19).

Modified SU19

Where a customer has been placed on variable reporting due to a Temp-Incap Serious Illness exemption, the SU19 is modified to include questions about their medical condition. The exemption will be reconsidered if the customer states on the SU19 their condition has significantly improved or deteriorated. See Reporting requirements for customers receiving a payment with mutual obligation requirements.

Customers who are seriously ill and have been granted a Temp-Incap Serious Illness exemption may find it difficult to conduct their business with the Agency for extended periods. It may be beneficial for them to have a nominee to act on their behalf during the period of incapacity.

If the Service Officer is not satisfied with the integrity of the information on the medical certificate, a temporary incapacity exemption should not be granted. See Suspected fraud in Centrelink Medical Certificate (SU415 or SU683).