Job Capacity Assessment (JCA) referral 008-03180010

A JCA referral may be required to assess medical eligibility for:

• Disability Support Pension (DSP) and Special Benefit (SpB) claims
• DSP review of decision
• review of ongoing DSP qualification
• access to the Supported Wage System (SWS)
• Special Disability Trust (SDT)
• foreign pensions requiring a medical assessment for new claims or reviews
• indefinite portability assessments under the ‘no future work capacity’ provisions

An Assessment Services Assessor completes the MAT report/SA479 by:

• reviewing the medical evidence submitted with a DSP new claim, and
• completing a Disability Support Pension Medical Eligibility Assessment Recommendation (SA479) which advises if a JCA referral is required to determine medical eligibility

Note: the Disability Support Pension Medical Eligibility Assessment Recommendation (SA479) is also referred to as a ‘MAT recommendation/SA479’, ‘MAT report/SA479’, ‘MAT recommendation’ or ‘MAT’.

Where the MAT report/SA479 recommends a JCA referral and the customer does not have 10 years qualifying Australian residence or a Qualifying Residence Exemption (QRE), the JCA also needs to assess where the customer's Continuing Inability to Work (CITW) occurred for residency purposes.

If a customer is claiming under an International Agreement, this may require a referral to a JCA or the Health Professional Advisory Unit (HPAU), depending on the customer's circumstances.

Note: a new JCA may be required for customers who supply new medical evidence to support their request for an explanation or formal review of the decision to reject a DSP claim or cancel DSP. See Reviews and appeals for DSP rejection or cancellation decisions.

Streaming

Streaming a DSP claim involves:

• checking the claim and supporting documents
• reviewing the customer’s circumstances, and
• determining the action required to progress to claim finalisation

Initial Streaming (for all claims)

Initial streaming must be done for all DSP claims where a MAT report/SA479 is completed and a work item allocated.

The Disability Processing Service Officer must check the claim and supporting documents to see if, based on available evidence, the customer does, or clearly does not, meet DSP non-medical eligibility.

To meet initial non-medical eligibility for DSP, a customer must:

• be an Australian resident,
• have turned at least 15 years and 9 months and be under Age Pension age when they claim
• clearly meet relevant income and/or assets limit (including partner, if applicable), and
• not have a Compensation Preclusion period which ends 13 weeks after the claim date

If the available evidence shows the customer:

• does not meet the initial non-medical eligibility, reject the claim for the relevant non-medical reason. No further non-medical or medical referrals/assessments are required
• meets the initial non-medical eligibility and there is a ‘current and valid’ JCA report which indicates medical eligibility is not met, reject the claim for the relevant medical reason. No further non-medical or medical referrals/assessments are required
• meets the initial non-medical eligibility and there is a ‘current and valid’ JCA report which indicates medical eligibility is met, a DMA referral may need to be actioned. No further non-medical or medical referrals/assessments are required at this stage
• meets the initial non-medical eligibility and the MAT recommendation is manifestly ineligible, reject the claim for the relevant medical reason. No further non-medical or medical referrals/assessments are required
• meets the initial non-medical eligibility and the MAT recommendation is manifestly eligible, finalise the claim after all relevant non-medical referrals/assessments are completed. The claim may be granted or rejected, depending on outcome of non-medical assessments
• meets the basic non-medical eligibility and the MAT recommendation is for a JCA, complete the rapid streaming checks before actioning a JCA referral request

Rapid Streaming (prior to JCA referral)

Rapid streaming must be done for DSP claims where:

• the customer meets the initial non-medical eligibility checks done for all DSP claims, and
• a MAT report/SA479 recommends a JCA is required

This process defers full non-medical eligibility checks until after the JCA/Disability Medical Assessment (DMA), if the customer is assessed as medically eligible.

Where a customer and/or partner is in receipt of an Income Support Payment (ISP) and they advise information in the DSP claim which impacts their current payment, relevant updates must be made including actioning any non-medical referrals. This must be done as well as actioning the JCA referral.

Service Officers must check the following before making the JCA referral:

• the customer’s residence status to determine if an assessment of where the customer’s Continuing Inability to Work (CITW) occurred needs to be done as part of the JCA. For non-protected SCV holders, the claim is to be sent to International Services before referring for a JCA. See Residence assessment for customers claiming Disability Support Pension (DSP)
• current contact details are recorded on the system including address, phone number, email address, interpreter and nominee information
• check if the customer has a pending review of decision on their DSP eligibility. See Payment pending review (PPR) of decision to cancel DSP due to loss of medical qualification, This is to prevent a new JCA being requested when the customer is DSP/CUR-PPR, indicating a DSP medical cancellation decision is under review with an ARO or the AAT
• check if information on the record indicates the customer may exhibit violent or abusive behaviour towards the Assessor. Advice to the Assessor regarding potential violent behaviour may be required
• any previous JCA or Employment Services Assessment (ESAt) referrals have a status of 'finalised' or 'unable to complete'
• the customer is registered as an active job seeker, If not current, register the customer to allow the assessment to be completed and any subsequent referrals actioned
• customer’s ability to participate in a JCA. If they have a nominee, consider contacting to discuss options, and
• all medical/sensitive information is scanned to the customer's electronic Medical Information File Envelope (eMIFE)

The JCA referral request must not be actioned until all available current and relevant medical evidence is scanned to the customer's record. This is so the Assessor has access to all the available information needed for their assessment.

Medical evidence must be provided for all JCA referrals, except in limited circumstances for vulnerable people.

For a DSP new claim, relevant medical evidence scanned for the assessment can include:

• clinical records, test results, medical certificates, hospital records and specialist reports
• evidence required to assess conditions under specific Impairment Tables such as reports from a Psychiatrist, Registered Psychologist, Ophthalmologist or Audiologist
• verification of terminal illness (SA495) form
• evidence provided by the customer to show they have actively participated in a Program of Support (POS)

See What is medical evidence for Disability Support Pension (DSP)?

In Process Direct, the JCA DSP new claim referral is actioned from within the DSP new claim activity. This creates a work item which is allocated to Assessment Services and includes the required information.

Staff required to use the JCA referral via Fast Note in Customer First are:

• Authorised Review Officers
• Subject Matter Experts
• Staff processing Payment Accuracy Reviews
• Customer Compliance
• International Services
• Supported Wage

Assessment Services use the Fast Note information in Customer First to:

• book an appropriate appointment, and
• contact the customer to tell them of the appointment details.

Medical/sensitive information lodged at a service centre must be scanned at the service centre. See Scanning Centrelink medical/sensitive documents using an MFD.

Historical medical evidence lodged before the introduction of scanning in July 2010 can only be scanned by the Records Management Unit (RMU). If historical information is required, request the information through the mySupport form Create, Transfer or Retrieve a Corporate File. In most cases, the Assessment Services Assessor doing the MAT report will do this if required.

If the customer provides additional medical information, make sure the information is scanned to the customer's electronic Medical Information File Envelope (eMIFE). This information is then available electronically to the Assessor.

All JCA appointments are booked by Assessment Services using the information contained in the JCA Referral Request DOC.

This includes appointments:

• for remote customers
• booked at the request of Legal Services Branch

Some DSP new claim JCA referrals are automatically booked using JESBA (JCA and ESAt Screening and Booking Automation). JESBA books a JCA from details in the JCA Referral Workflow.

Assessment Services:

• review the information and action requests in priority order
• review the medical information to check for manifest eligibility or ineligibility, and to make sure there is sufficient evidence to conduct a JCA
• determine how the assessment will be conducted (for example, phone assessment, face to face, videoconference, file), and
• book the JCA appointment via the referral option in Process Direct

Assessment Services are responsible for cancelling and rescheduling JCA appointments where a customer contacts to say they cannot attend a booked appointment and wants to arrange a new time.

Front of House (FoH) staff and Smart Centre Service Officer(s) are not to reschedule or cancel booked JCA appointments. In these cases, transfer the customer to Assessment Services.

The Resources page contains a link to Assessment Services contact details.

If the customer has a Managed Service Plan (MSP) at the time of making the JCA referral:

• the type of MSP and end date will be pre-populated into the referral
• if they are restricted to 'phone' contact, only phone appointments appear
• if they are restricted to 'writing' contact, a file assessment is to be organised