Example 1: John (46 years of age) lodged a claim for DSP noting a diagnosis of schizophrenia. John's psychiatrist has documented that John finds discussing their condition distressing, experiences delusions and is often florid with irrational decision making. The assessor completing the MAt recommends JCA be conducted using file format. JCA is conducted based on the MAt recommendation. Rationale: John has provided a current psychiatrist report confirming diagnosis of schizophrenia, history of current and previous treatment as well the current functional impacts experienced by John. John's psychiatrist also indicates that despite reasonable treatment John is unlikely to see a significant improvement of his condition. John's JCA should be completed as a file assessment because of the: - severity of John's mental health condition impacting John's ability to discuss their impairment
- psychiatrist's statement that John is distressed when talking about their condition which could be detrimental to their health
Because of the comprehensive nature of the medical evidence provided, removes the need to contact John's psychiatrist to complete the assessment. After submitting the assessment, the assessor should consult with the government-contracted doctor (GCD) Contract Team for consideration of DMA with the treating health professional contact (THP). Example 2: Alice (52 years of age) lodged a claim for DSP noting diagnosis of a Traumatic Brain Injury (TBI). The assessor completing the MAt recommends JCA be conducted by phone format. Following a review of the medical evidence, the JCA assessor contacts Alice's GP to confirm: - Alice's condition remains unchanged
- impairments are severe and consistent with the details in the occupational therapy report
Once confirmed, the assessor decides enough medical evidence exists to confidently recommend medical eligibility and considers file format suitable if Alice agrees. The assessor contacts Alice to discuss changing the format of the assessment. Alice is relieved not to have to try and explain their disability and its impacts and agrees to the change in format of assessment. JCA is completed as a file assessment. Rationale: Alice has provided medical evidence that they sustained a traumatic brain injury following a cerebrovascular infarct (stroke) 12 months ago. Alice has undergone both acute and rehabilitative treatment. Based on medical evidence provided by their neurosurgeon, no improvement beyond their current capacity is expected. Alice has provided an occupational therapy assessment outlining their care needs following discharge from hospital as well as medical evidence from their GP. The assessor contacts Alice's GP to confirm that their condition remains unchanged, and their impairments are still consistent with the occupational therapy report. Alice was contacted and agreed to their assessment being completed without their participation. After completion of the report, Alice is told: - the claim has progressed, and
- Sonic HealthPlus may call to arrange an appointment to complete a medical assessment by a GCD
The assessor may also consider if a DMA by their THP contact would also be appropriate to reduce Alice's distress. |