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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 MAT assessor 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 due to:
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he severity of John’s mental health condition impacting John’s ability to discuss their impairment
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the psychiatrist’s statement that John is distressed when talking about their condition which could be detrimental to their health,
Due to the comprehensive nature of the medical evidence provided, contact with John’s psychiatrist is also not required 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 MAT assessor recommends JCA be conducted by phone format.
Following a review of the medical evidence, the JCA assessor contacts Alice’s GP to confirm:
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Alice’s condition remains unchanged
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impairments are severe and consistent with the information in the occupational therapy report
Once confirmed, the assessor decides there is enough medical evidence 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.
When the report is completed, Alice is told that
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their claim has progressed, and
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they may receive a call from Sonic HealthPlus to arrange an appointment for a medical assessment to be completed by a GCD
The assessor may also consider if a DMA by their THP contact would also be appropriate to reduce Alice’s distress.
Example 3:
Alfred lodges a claim for DSP.
The MAT assessor recommends a JCA by phone format. A phone appointment is booked for a JCA in 10 days' time and Alfred is notified.
On the day of the appointment, Alfred does not answer the phone at the scheduled appointment time.
The assessor makes 2 genuine contact attempts, deploying a pre-call notification SMS and documents the contact attempts in the DSP Progress of Claim DOC in Process Direct.
The following day, the assessor reschedules the appointment to 5 working days in the future and issues notification of the appointment.
On the day of the second appointment, the assessor makes:
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2 genuine contact attempts and deploys a pre-call notification SMS. Alfred does not answer the phone at their scheduled appointment time
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notes of the contact attempts in the DSP Progress of Claim doc in Process Direct
Alfred's medical evidence does not clearly demonstrate the impact of their medical conditions.
The assessor attempts to contact Alfred’s GP to discuss the medical evidence provided. The assessor leaves a return phone number and places the assessment on hold. Three working days pass and the assessor has not heard from the Doctor. The assessor attempts a follow up call with the THP but is unsuccessful.
An alteration in the assessment format to file is considered appropriate and the assessment is completed with the available medical evidence recommending medical ineligibility. All contact attempts are clearly documented in the Assessment Summary of the report and why THP contact was required.
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