Job Capacity Assessments (JCA) 008-06110000

The assessor should consider the customers medical information, medical condition and personal circumstances when deciding the appropriate format of a JCA.

Available formats include face to face, video conference, phone, and file assessment.

The assessor records their format recommendation within the MAT/SA479 when recommending a referral for JCA.

There is also opportunity for the assessor to vary the original format in select circumstances. See:

• Table 2, Step 4 Change format assessment
• Table 4 Customer did not attend scheduled appointment

The assessor must consider how an assessment with no customer contact and/or treating health professional (THP) contact may impact on the assessment. See Table 3 for more information about contacting a THP.

For details to consider for a:

• face to face assessment, see Item 2
• video conference (VC), see Item 3
• phone assessment, see Item 4

JCA by file can by recommended/considered where:

• other interview formats have been carefully considered (face-to-face, video conference or telephone), and
• it is clear these formats are inappropriate for the individual circumstance of the claim
• the customer has a scheduled appointment and consents to a change in format to file
• the customer/nominee has not attended a scheduled appointment, see Table 4

For details to consider for a file assessment, see Table 2.

An assessment conducted by face to face interview is the most appropriate format in the following circumstances:

• Where the customer and/or nominee has requested a face to face assessment
• Where the customer has a communication, hearing or speech disorder, and the assessment cannot be conducted by phone
• A specialist assessment is required
• Customer reported information is required to complete the JCA because of the nature of the condition, or the functional impact. This may include, but not limited to, intellectual or cognitive impairment, or where significant variation exists in the evidence available
• Where the assessor deems that visual confirmation would be beneficial to the assessment (for example, where a physical specialist assessment is required)

Before recommending a face to face assessment consideration must be given to:

• the customer's remote location
• assessor availability
• significant travel time, such as more than 90 minutes each way, would be required by the customer to access the nearest office. This also needs to take into consideration the customer's medical conditions and impact on their ability to travel

If the customer/nominee have requested an interview format that cannot be supported, see Table 5.

Is a face-to-face assessment appropriate?

• Yes, proceed with recommendation of face-to-face assessment. Procedure ends here
• No, go to Item 3, video conference

Before considering an assessment by VC the customer must meet all of the following criteria:

• Access to a device that enables Microsoft Teams
• Reliable internet connection, and
• Registered for myGov and subscribed to online letters

If the customer and/or nominee does not have access to the required technology to accurately complete the assessment, a VC is inappropriate.

If the customer and/or nominee does have access to the required technology, check if any of the following circumstances apply:

• the customer and/or nominee has requested a VC assessment
• the customer has a communication, hearing or speech disorder, and the assessment cannot be conducted face to face or by phone
• where a visual format supports the assessment of the customer's impairment with consideration to the nature of their condition
• a specialist assessment is required that cannot be conducted face to face
• customer reported information is required to complete the JCA because of the:
• nature of the condition, or functional impact (including, but not limited to intellectual or cognitive impairment or where significant variation exists in the evidence available)

A VC should specifically be considered when:

• medical vulnerabilities impact the customer's ability to access a service centre
• customer has a communication, hearing or speech disorder, and an appropriate interpreter is not available in the customer's local area
• customer is in rural or remote areas and has access to the required technology
• customer and/or nominee has requested it

Remote customers

Where the customer cannot reliably access the required technology for VC, the assessor must consider an alternative assessment format including:

• phone assessment, via remote agent or personal device, or
• face to face engagement during remote servicing community trip (where applicable)

If the customer/nominee has requested an interview format that cannot be supported, see Table 5.

If a VC assessment is appropriate, proceed with recommendation of VC format of assessment. Procedure ends here.

If a VC assessment is inappropriate, see Item 4 phone format.

An assessment by phone is the most appropriate format in the following circumstances:

• The customer and/or nominee has requested a phone assessment
• Customer reported information is required for the assessment
• More information is needed from the customer in addition to the medical evidence, or before contacting their treating health Professional (THP)
• The evidence on hand does not clearly indicate, or there are discrepancies in the type and extent of the functional impairment
• Sufficient doubt exists as to the currency or relevance of the evidence, and:
• contact with the customer will help to determine the nature of the evidence, or
• if other sources of evidence are available
• The customer has vulnerabilities (for example, recent history of self-harm) where the customer would benefit from contact, but face to face or file assessment is not suitable for their circumstances

Note: where the customer and/or nominee have requested a phone assessment, the assessor must make all attempts to meet this request.

Is a phone assessment appropriate?

• Yes, proceed with recommendation as phone assessment. Procedure ends here
• No, consideration of an assessment by file may be appropriate. See Table 2

An assessor must only complete/recommend a JCA by file where:

• They have carefully considered other interview formats (face to face, video conference or telephone), and
• It is clear these formats are inappropriate for the individual circumstance of the claim. Go to Step 2 for claim circumstances that may apply
• The customer resides in a remote and/or very remote location and has not attended a scheduled (phone/face to face or VC) appointment, see Table 4, Step 5
• The customer agrees to a change in the original assessment format to a file assessment, go to Step 4
• The customer has not attended a scheduled assessment and the customer meets the guidelines outlined in Table 4
• The customer meets any of the circumstances outlined in Step 2, or
• The customer meets all of the guidelines outlined in Step 3

An assessor can recommend/conduct an assessment by file format in any of the following circumstances:

• There is a history of customer aggression or a Managed Service Plan (MSP), precluding contact by face to face, video conference, or phone
• The customer is deceased
• The customer’s condition or circumstances prevent contact by phone, face to face, or video conference (for example, customer is in prison or psychiatric confinement)
• Engagement with an assessor to conduct an interview is likely to be detrimental to the customer's health and wellbeing because of the nature of their condition. (For example, it is clearly documented on the record, in medical or other evidence, that contact would be detrimental)
• Where evidence exists the customer's medical condition impacts their ability to discuss their functional impairment or work capacity
• It is a sensitive escalated case, or
• It is the preferred format to implement a Merits Review via Administrative Appeals Tribunal, or court case

Note: where the customer has a correspondence nominee, assessors must consider their involvement in an assessment to support the customer to discuss their impairment.

Circumstances where an assessment by file format may also be appropriate, include where all of the below apply:

• The assessor has considered other formats, and they are inappropriate for the claim circumstances
• The medical evidence clearly demonstrates functional impacts with sufficient detail to confidently assess:
• impairment ratings
• continuing inability to work, and
• barriers and interventions for employment services, where indicated
• More customer reported information is not required to complete the JCA
• The assessor has no concerns with the quality, breadth, and currency of the available medical evidence relevant to the claim period.
  For example, it provides a comprehensive view of the condition and its impacts which includes:
• consistent evidence from multiple health professionals, and
• treatment history over a reasonable time period for the condition
• Contact with the customer, or visual confirmation, is not required to confirm the accuracy or currency of the evidence to their current circumstances
• The nature of the condition means the functional impacts and work capacity of the customer is unlikely to significantly improve in the next 2 years
• Medical evidence clearly indicates at least one severe condition meeting medical eligibility on a single Impairment Table
• The recommendation of the assessor is that medical eligibility is met, and
• No clear indication exists that the customer requires, wants, or would benefit from an employment services referral. For instance, the customer has an active referral to an appropriate employment service provider which will not be impacted by the new JCA (e.g. work capacities affecting eligibility)

The assessor must consider how using a file assessment with no customer contact and/or treating health professional (THP) contact may impact on the assessment. For more information for contacting treating health professionals, see Table 3.

Is an assessment by file format considered appropriate?

• Yes, and the customer
• has a booked appointment, go to Step 4
• does not have a booked appointment or SA479 completed – submit SA479 recommending file format of assessment. End of process
• does not have a booked appointment and an SA479 has been completed – annotate the DSP Progress DOC and JCA Ref Required DOC indicating change in format recommendation. End of process
• No, reconsider assessment format and discuss with Assistant Director. Procedure ends here

Assessors undertaking the JCA may decide that file assessment is the appropriate format even where a face to face, video conference, or phone assessment is already booked.

Does the customer meet the file format guidelines identified in Step 2 or Step 3?

• Yes, the assessor must attempt to contact the customer/or nominee before, or at, the scheduled appointment time to discuss the proposed use of a file format. Go to Step 5
• No, the assessment must proceed in the original planned assessment format. Procedure ends here

Where contact with the customer and/or nominee is successful, the assessor should:

• advise that all required information is available to complete the assessment
• offer the option for the JCA to be completed without their further participation
• where appropriate, advise of a referral to a DMA and to expect contact by Sonic HealthPlus to book the DMA appointment
• confirm if the customer needs, wants, or will benefit from an employment services referral. For instance, the customer has an active referral to an appropriate employment services provider which will not be impacted by the new JCA (e.g. work capacities affecting eligibility)

Does the customer and/or nominee agree to changing the format of the assessment to file format?

• Yes, the assessor can proceed with the assessment using file format, and
• Change the format of JCA report in ESSWeb to file format. Information sharing statement (CISS) must be Yes
• The assessor must document the discussion in the Assessment Summary to ensure a contact record is available
• Note must include: ’Customer was contacted, and mode of assessment was varied following customer consent. Customer advised of information sharing statement.”
• Procedure ends here
• No, the assessment must proceed in the original planned assessment format
• The assessor must document the discussion in the Assessment Summary to ensure a contact record is available
• Procedure ends here

It is incumbent on the assessor to identify if THP contact is required to support an assessment regardless of the format used.

This requirement also includes where customer participation in their assessment was considered appropriate (face to face, video conference or phone), but the customer, or nominee, did not attend their scheduled appointments and was not contactable.

Some examples of when the assessor should attempt THP contact, include:

• To get clarification of medical evidence or functional impairments
• To clarify ambiguities in the medical evidence
• To clarify inconsistencies between the medical evidence and customer reported information
• To confirm treatment status (for example, where surgery was considered, but waitlists or customer decision on having it were unclear/could have changed and the medical evidence is from some time before the date of claim)
• To support the file assessment where customer participation in their assessment was considered appropriate (via face to face, video conference or phone), but the customer did not attend an appointment and was not contactable
• For any other reason the assessor deems appropriate

Would contacting the THP be beneficial for the assessment?

• Yes, go to Step 2
• No, procedure ends here

The assessor should make 2 outbound call attempts to contact the THP. The assessor must document the contact attempts in the JCA report.

An assessor must attempt to call the THP:

• on the current phone number listed for the THP and/or medical practice
• at different times of day and when the THP is likely to be available
• over more than one day

If contact with the THP was:

• successful,
• Record the details of the conversation in the relevant section of the JCA report, and
• Create a reference in the ‘References’ section of the Job Capacity Assessment report within ESSWeb. Procedure ends here
• unsuccessful, the assessor must document the following in the Assessment Summary:
• Date, time and outcome of each contact attempt, and
• Reason THP contact was required (for instance. verification of functional impairments). Procedure ends here

If the customer has not attended the scheduled appointment, the assessor must:

• Make 2 outbound call attempts (at least 15 minutes apart) to the customer and/or nominee at the scheduled appointment time. This includes deployment of pre-call notification (SMS) where the customer is subscribed
• Note all unsuccessful call attempts on the customer's record by annotating the DSP Progress DOC in Process Direct:
• date
• time, and
• outcome of these contact attempts

If the customer is identified as residing in a remote and/or very remote geographic location or, booked into a defined remote site in ESSWeb, go to Step 5.

Is the recommendation of the assessor that medical eligibility is met or does the customer meet the guidelines for file format in Table 2?

• Yes, go to Step 2
• No,
• record the appointment outcome as did not attend – follow up (DNAf) within ESSWeb, and
• reschedule the appointment in ESSWeb at least 5 working days in advance, and issue notification of the appointment. Procedure ends here

Note: where notification by post is required, a minimum of 6 working days is required when rescheduling appointments within ESSWeb.

If the customer does not attend the rescheduled appointment, go to Step 3

Varying the original mode/format of assessment in circumstances where the customer did not attend a scheduled appointment may be appropriate if all of the following are met:

• the customer and/or nominee was given appropriate notice, at least 5 working days, to attend the appointment
• 2 outbound contact attempts (at least 15 minutes apart) were made to the customer and/or nominee at the scheduled appointment time. This includes deployment of pre-call notification (SMS) (where the customer is subscribed to electronic messaging)
• recommendation of the assessor is that medical eligibility is met, and
• the assessor considers if THP contact is required in line with Table 3

Does the customer meet all of the guidelines above?

• Yes, go to Step 4
• No, file assessment is inappropriate:
• Reconsider assessment format and discuss with Assistant Director
• Procedure ends here

If the customer has not attended the second scheduled appointment, the assessor must:

• Confirm the customer and/or nominee was given appropriate notice to attend the appointment
• Check that 2 outbound call attempts (at least 15 minutes apart) were made to the customer and/or nominee at the scheduled appointment time. This includes deployment of pre-call notification (SMS) (where the customer is subscribed to electronic messaging), and
• Ensure that all unsuccessful call attempts are documented on the customer's record by annotating the DSP Progress DOC in Process Direct:
• date
• time, and
• outcome of these contact attempts

Where the customer and/or nominee does not attend at least 2 scheduled appointments, assessors can consider use of file format to complete the assessment, if the following process has been followed:

• The customer and/or nominee were given appropriate notice, of at least 5 working days to attend at least 2 scheduled appointments
• 2 outbound call attempts (at least 15 minutes apart), including:
• the deployment of pre-call notification SMS (where the customer is registered for electronic messaging), were unsuccessful, and have been documented in the progress of claim DOC on the customer's record in Process Direct, and
• The customer and/or nominee's initial appointment was rescheduled for failure to attend

Have all 3 of the above criteria been met?

• Yes, go to Step 4
• No, record the appointment outcome as did not attend – follow up (DNAf) within ESSWeb, and reschedule the appointment in ESSWeb at least 5 working days in advance, and issue notification of the appointment. Procedure ends here

Note: , a minimum of 6 working days is required when rescheduling appointments within ESSWeb where notification by post is required.

Assessment format can be varied to file format. The assessor:

• can vary the interview format in the JCA report to file format and complete the assessment using ESSWeb, and
• Must make sure that the date, time and outcome of each contact attempt is recorded in the assessment summary of the JCA report, and
• must consider if they should contact the treating health professional (THP) to complete the assessment – See Table 3

If the customer has been identified as residing in a remote and/or very remote geographic location or, booked into a defined remote site in ESSWeb, a file assessment may be considered if:

• the customer did not attend the first scheduled appointment, and
• the customer is unlikely to be contactable for a second scheduled appointment

If a file assessment is considered appropriate and customer is likely to meet medical eligibility, the remote assessor should consider if THP contact is required, see Table 3.

• If the customer is unlikely to meet medical eligibility based on available medical evidence, the remote assessor must make 2 genuine attempts to contact the THP, and
• Regardless of success of THP contact - all contact attempts must be documented by creating a discussion reference in the JCA report. Details of the discussion/attempts must be documented as per Table 3

If the customer and/or nominee requested an assessment format that cannot be supported, an assessor or administration officer in Assessment Services must make 2 attempts to contact the customer and/or nominee.

This includes use of pre-call notification (SMS) (where the customer is subscribed to electronic messaging).

The assessor or administration officer must attempt to call:

• on every current phone number the agency has recorded for the customer and correspondence nominee (if they have one)
• at different times of day and when the customer is likely to be available
• over more than one day

The assessor or administration officer in Assessment Services must annotate on the JCA ref required DOC in Process Direct (PD) with the:

• date
• time, and
• outcome of these contact attempts

If contact with the customer and/or nominee is:

• successful:
• offer an appropriate alternative format
• annotate the DSP Progress of Claim DOC with conversation details
• book assessment within PD
• procedure ends here
• unsuccessful, and the customer:
• does not have a medical condition that would impede a phone assessment, future book the appointment at least 5 working days in advance as a phone assessment
• has a medical condition that would impede a phone interview (for example, a hearing impairment), future book the appointment at least 5 working days in advance as a video conference assessment