Checking and actioning a Job Capacity Assessment (JCA) report 008-06070010

This process only applies to JCA Reports in Process Direct for referral reason DSP New Claim and upgraded Employment Services Assessment (ESAt) reports being used for a DSP claim.

Note: if the JCA Referral was not actioned in Process Direct, the JCA Report must be accepted in Customer First. See the Customer First tab.

When allocated a JCA Report, the ESAt/JCA Referral page displays a JCA Report in SUB – Submitted status.

Copy the customer’s CRN displayed at the top of the ESAt/JCA Referral page > return to the Process Direct home page > select Customer Summary > enter CRN and select Go > select customer name in the Search Results.

Before opening the JCA report, staff must check:

• DSP Claim Progress DOC/Notes for information related to the claim
• Check Display on Access (DOA) DOCs for information relating to Personalised Services, and to ensure the claim is not being managed by Customer Critical Response Team (CCRT)

If the claim is being managed by CCRT:

• do not accept the JCA Report or action the DSP Claim
• reassign the work item to a team leader in Work Optimiser
• annotate the DSP Claim Progress DOC and include: ‘JCA Report has been allocated to Team Leader because CCRT are managing the DSP claim under HTU’
• email CCRT to advise a JCA Report has been submitted for a DSP claim they are managing under HTU. Copy your line manager/team leader into the email
• procedure ends here

If the DSP claim is not being managed by CCRT:

• where a JCA report recommends manifest eligibility a work item is allocated to a Disability Processing Service Officer for manual actioning of the new claim. See the Resources page of Assessing eligibility for DSP after a Disability Medical Assessment (DMA)
• if a JCA report recommends medical eligibility (non-manifest), in most cases a DMA referral is auto-generated
• if the system is unable to auto-generate a DMA referral, or is unable to auto-accept the JCA report, or the JCA outcome does not support medical eligibility, manual action is required, go to Step 2

Check Referral Summary (RRSUM).

If the ESAt/JCA Report status is SBMT (Submitted), go to Step 3.

If the upgraded ESAt Report is already accepted, go to Step 3.

If the JCA Report has any other status, for example, New or Reopened, Returned, Unable to Complete (UTC), refer to Streaming a new claim for Disability Support Pension (DSP) for action required to progress the claim. Procedure ends here.

Note: in limited circumstances a DSP New Claim JCA will auto-return upon submission. The Display on Access (DOA) DOC will display the JCA outcome as: Auto Return, Failed Centrelink Validation

This occurs when the JCA Report includes vulnerabilities for a customer on an Income Support Payment (ISP), who does not have participation requirements. For example, Youth Allowance Student (YAL/STU) or Austudy.

If the JCA has been auto-returned:

• refer to Level 2 Policy Helpdesk via the Online Enquiry form
• include in the referral: DSP New claim JCA Auto-returned due to vulnerabilities, please follow-up
• update claim status to On Hold for reason Awaiting Level 2 Policy advice
• apply 'Hold To user'
• when the JCA has been corrected and resubmitted, go to Step 3

For more information about JCA Referral status, see Understanding Job Capacity Assessment (JCA) reports.

In the customer's record, select the relevant JCA report.

To view the JCA Report go to the Transactions TAB > select the DSP Claim and go to the DSP Claim Summary.

DSP Claim Summary

• select > DSP Claim Summary > JCA > Reference ID next to the submitted JCA report
• select the Job Capacity Assessment Report - Submitted link under the ESAt/JCA report twisty. Opening the report enables:
• the Accept and Return buttons
• the Request Finalisation button for users with JCAFIN access

Go to Step 4.

Check if the JCA was conducted as a:

• face to face interview (including video conference or phone)
• file assessment

Check the customer was advised of Information Sharing arrangements, if applicable.

For File Assessments:

• in Assessment Details, check the response to the information sharing is indicated as No

For Face to Face (including video conference or phone) assessments:

• in the Assessment Details, check if Yes is selected indicating the customer has been read the Information Sharing statement explaining how JCA information can be shared and with whom. Assessors are required to do this at each JCA appointment

In the Assessment Details, has the correct Yes or No response been recorded to Client has been advised of information sharing arrangements?

• Yes, see Step 1 in Table 2
• No, the report should not have been completed by the Assessor and/or contains incorrect information, see Step 1 in Table 6

From 1 April 2023, the Impairment Tables used to assess the impact of a customer’s condition(s) changed. This included a change to terminology.

Job Capacity Assessors use the Impairment Tables to assign impairment ratings, when completing assessments for DSP.

The date of claim and date of effect of the JCA Report, determines which version of the Impairment Tables and terminology is used in the JCA report.

Check the date of effect for the DSP Claim - Pension Assessment (PNA)/Start date.

Date of claim and date of effect of JCA is before 1 April 2023 (2012 Impairment Tables version)

If a customer has a medical condition impacting for more than 2 years, it is assessed as:

• permanent, and
• either Fully Diagnosed Treated and Stabilised (FDTS) or Not Fully Diagnosed Treated and Stabilised
• see Table 3

Date of claim and date of effect of JCA is on or after 1 April 2023 (2023 Impairment Tables version)

If a customer has a medical condition impacting for more than 2 years, it is assessed as:

• persist for more than 2 years, and
• either Diagnosed, Reasonably Treated and Stabilised (DTS) or Not Diagnosed, Reasonably Treated and Stabilised
• see Table 4

See the Medical Conditions section of the report.

For customers with medical condition Trans Vaginal Mesh (TVM) where the JCA Report recommends medical rejection:

• do not accept the JCA Report. Update the DSP claim status to On Hold for reason Referred for JCA for 14 days
• annotate the DSP Claim Progress DOC with TVM claim has been referred to CCRT
• complete a referral to CCRT for DSP Claim finalisation and Service Offer Interview (SOI) for TVM case

For all other medical conditions and TVM cases where the JCA supports medical eligibility, continue processing as normal.

Check for manifest eligibility

When an Assessor recommends a customer is manifestly eligible for Disability Support Pension (DSP), they must record the manifest indicator in the Medical Conditions section of the JCA report. This displays in the report as Customer meets manifest criteria for category followed by a specific manifest indicator code.

The codes and corresponding categories are:

• B - Permanent Blindness (BLI)
• T - Terminal Illness (TRM)
• I - Intellectual Disability (INT)
• N - Nursing home level of care (NHM)
• H - Category 4 HIV/AIDS (HV4)
• P - Disability Pension at special rate (TPI)

If the Assessor correctly records the manifest indicator, it pre-fills the Medical Conditions Summary (MCSS) screen when the JCA report is accepted.

If the manifest indicator is not correctly displayed, and the JCA report is accepted by the Service Officer, the customer will be incorrectly assessed. The claim may be rejected or payment may cancel.

Service Officers must ensure the manifest indicator displays correctly before accepting a JCA report. If the Assessor has recommended manifest eligibility in the body of the report (such as in the Remarks or Assessment Summary sections) but the manifest indicator is not displayed in the JCA report, the report must be returned to Assessment Services for correction. The JCA report must not be accepted until it correctly reflects the Assessor's recommendation of manifest eligibility.

To return the JCA Report:

• select Return
• on the JCA Return Confirmation screen:
• Decision Date, select the date the report is being returned
• Return Reason, select the appropriate return reason
• Return Comments, add comments asking the Assessor to further consider their assessment. Provide enough details in the Notes field explaining the reasons for rejecting the report - no manifest indicator coded in the report

To ensure Assessment Services are notified of the JCA Return and amendment required, refer back to Assessment Services.

Note: the referral must be actioned from the DSP Claim activity. To access the DSP claim from the ESAt.JCA Referral page, select the back arrow to return to the DSP Claim Summary > select back again to return to the TS screen or enter the customer’s CRN in the Inbox.

• select > > Referral
• Referral Type, select Assessment Services
• Referral Reason, select from:
• query JCA Quality
• text will pre-fill the Additional Information field
• add additional information, JCA report indicates manifest eligibility has been met, but manifest indicator is not present, please add manifest indicator and resubmit
• select Finish to view successful referral notification. Select OK to return to the Transaction Summary (TS) screen
• the claim is set to status On hold - Awaiting ASB Recommendation. An annotation is added on Notes
• annotate the DSP Claim Progress DOC on DL/Notes with the information from the referral. Add any additional notes as needed

If Service Officers identify a claim rejection or payment cancellation has occurred because the manifest indicator has not been correctly coded and applied in the JCA report, the case must be urgently escalated to the DIS Service Delivery Support Team for investigation and resolution.

The email must be titled:

• URGENT ACTION REQUIRED: INCORRECT CAN/REJ OF RECIPIENT MANIFESTLY ELIGIBLE FOR DSP. CRN: 999 999 999A'

Check medical conditions

Assessors do not need to assess every medical condition and reference every piece of medical evidence.

Assessors do not assess or reference medical conditions/evidence if it is not considered to be currently impacting the customer's functional capacity. For example, where a condition:

• is resolved
• has nil impact
• is secondary, or a symptom of, a primary medical condition

Check all verified and impacting medical conditions have been recorded as detailed on the medical evidence and that the medical evidence supports the assessment of a condition as Temporary, Permanent but not FDTS, Permanent and FDTS, or manifest.

When an Assessor has medical evidence to support manifest eligibility for DSP, they need to mark the condition as Permanent and Verified by medical evidence. It is not mandatory to mark the condition as FDTS or enter FDTS work capacities unless the customer has secondary medical conditions assessed.

For a JCA (or an Employment Services Assessment (ESAt) upgraded to a JCA), check that all medical conditions are recorded under Conditions, including 'permanent' conditions that are likely to be ongoing for at least 2 years, should be marked as permanent and verified. The Assessor needs to determine whether any permanent condition is fully diagnosed, fully treated and fully stabilised

Check to identify any significant inconsistency (outside the range of possibility) between medical condition details and the work capacity details.

Check the assessment of the customer's ability to use public transport without substantial help is consistent with report comments about the customer's mobility. Note: this is only a prompt to consider inviting a claim for Mobility Allowance (MOB) and is not a recommendation of eligibility for MOB.

Impairment ratings can only be applied to permanent conditions that are fully diagnosed, treated and stabilised. The Service Officer is not required to check whether the Assessor's qualifications are the most appropriate for the customer's medical conditions.

The Continuing Inability to Work (CITW)/Blind residence information is included in this section of JCA reports. When a report is accepted, it pre-fills the Pension Disability Information (PDI) screen.

Make sure the barriers included in the report are consistent with the support requirements, interventions and referrals recommended.

If the Support Requirements section is completed, check there are medical conditions indicated in the medical condition section. The Assessor indicates what assistance the customer is best suited for and the referrals made.

Note: where a JCA (or upgraded ESAt) is completed, and the customer is assessed as:

• Medically qualified for DSP, with:
• 20 pts or more under a single Impairment Table, or
• 20 pts or more across multiple Impairment Tables and Program of Support is met, or
• Manifestly medically eligible, and
• Future work capacity (FDTS) is 0-7 hrs p/w, and
• No Employment Services Referral is indicated (‘The client would not benefit from participation in any programme’)

The Assessor may not complete the following sections in the report if the customer has no medical conditions or disability is recorded in the medical condition section:

• Barriers
• Interventions
• Support Requirements
• Employment History (except where supporting work capacity recommendations)

If the customer is assigned at least 20 impairment points but does not have a severe impairment (20 points under a single table), they must have completed a Program of Support (POS). If the assessment indicates the customer has not actively participated in a POS, the Fully Diagnosed, Treated and Stabilised Work Capacity (FDTS) fields are blank.

• Check the non-medical personal factors have not been used as a basis to determine work capacity
• Check the Temporary Reduced Work Capacity is for an appropriate period and supported by available evidence
• Work capacity with intervention should generally be greater or equal to Baseline capacity. If future capacity is shown to decline, identify whether this is explained by a deteriorating condition. Note: FDTS work capacities are not available if the POS indicator is No
• If Baseline or with intervention work capacity is less than 30 hours, there must be a permanent condition to support this. Make sure the work capacity for permanent medical conditions is recorded correctly
• Work capacity with mainstream intervention is to be completed for grandfathered customers. To check, go to the GFS screen in Process Direct and check the status of the 2006 Welfare to Work activity. If the status is:
• GRF or TRA, the customer is grandfathered
• TRR or New, the customer is not grandfathered
• Work capacities must be consistent with the impairment. A 10 point impairment would not be consistent with FDTS 'with intervention' work capacity of 8-14 hours per week)
• For a JCA, or an ESAt which has been upgraded to a JCA, there should also be FDTS work capacities if the customer's conditions attract a rating of 20 points or more, and they have:
• a severe impairment (20 points or more on a single table), or
• actively participated in a Program of Support (POS)
• Where the customer is currently working 15 hours or more per week, in open employment, check the customer’s employment circumstances have been considered, including the sustainability of the employment, in the assessment of the customer’s work capacity

Do not accept the report if recommendations are not consistent with available evidence, see Step 1 in Table 6.

For more information about work capacity, see Assessing Continuing Inability to Work (CITW).

For DSP new claim JCAs, when an assessment of active participation in a Program of Support (POS) is required, assessment of POS and rationale behind the assessment must be clearly outlined within the JCA report.

If the JCA report indicates POS has or has not been met, evidence must be available to support the assessment. As part of checking JCA reports, the Service Officer must make sure the recommendation is consistent with the evidence on hand, (that is, referral screens, Medical Details Section of the claim, information within the report).

Do not accept the JCA report if unclear, see Step 1 in Table 6.

Make sure interventions are consistent with barriers and referrals.

See the Medical Conditions section of the report.

For customers with medical condition Trans Vaginal Mesh (TVM) where the JCA Report recommends medical rejection:

• do not accept the JCA Report. Update the DSP claim status to On Hold for reason Referred for JCA for 14 days
• annotate the DSP Claim Progress DOC with
• complete a referral to CCRT for DSP Claim finalisation and Service Offer Interview (SOI) for TVM case

For all other medical conditions and TVM cases where the JCA supports medical eligibility, continue processing as normal.

Check for manifest eligibility

When an Assessor recommends a customer is manifestly eligible for Disability Support Pension (DSP), they must record the manifest indicator in the Medical Conditions section of the JCA report. This displays in the report as Customer meets manifest criteria for category followed by a specific manifest indicator code.

The codes and corresponding categories are:

• B - Permanent Blindness (BLI)
• T - Terminal Illness (TRM)
• I - Intellectual Disability (INT)
• N - Nursing home level of care (NHM)
• H - Category 4 HIV/AIDS (HV4)
• P - Disability Pension at special rate (TPI)

If the Assessor correctly records the manifest indicator, it pre-fills the Medical Conditions Summary (MCSS) screen when the JCA report is accepted.

If the manifest indicator is not correctly displayed, and the JCA report is accepted by the Service Officer, the customer will be incorrectly assessed. The claim may be rejected or payment may cancel.

Service Officers must make sure the manifest indicator displays correctly before accepting a JCA report. If the Assessor has recommended manifest eligibility in the body of the report (such as in the Remarks or Assessment Summary sections) but the manifest indicator is not displayed in the JCA report, the report must be returned to Assessment Services for correction. The JCA report must not be accepted until it correctly reflects the Assessor's recommendation of manifest eligibility.

To return the JCA Report:

• select Return
• on the JCA Return Confirmation screen:
• Decision Date, select the date the report is being returned
• Return Reason, select the appropriate return reason
• Return Comments, add comments asking the Assessor to further consider their assessment. Provide enough details in the Notes field explaining the reasons for rejecting the report - no manifest indicator coded in the report

To make sure Assessment Services are notified of the JCA Return and amendment required, refer back to Assessment Services.

Note: the referral must be actioned from the DSP Claim activity. To access the DSP claim from the ESAt.JCA Referral page, select the back arrow to return to the DSP Claim Summary > select back again to return to the TS screen or enter the customer’s CRN in the Inbox.

• select > > Referral
• Referral Type, select Assessment Services
• Referral Reason, select from:
• query JCA Quality
• text will pre-fill the Additional Information field
• add additional information, JCA report indicates manifest eligibility has been met, but manifest indicator is not present, please add manifest indicator and resubmit
• select Finish to view successful referral notification. Select OK to return to the Transaction Summary (TS) screen
• the claim is set to status On hold - Awaiting ASB Recommendation. An annotation is added on Notes
• annotate DSP Claim Progress DOC on DL/Notes with the information from the referral. Add any additional notes as needed

If Service Officers identify a claim rejection or payment cancellation has occurred because the manifest indicator has not been correctly coded and applied in the JCA report, the case must be urgently escalated to the DIS Service Delivery Support Team for investigation and resolution.

The email must be titled:

• URGENT ACTION REQUIRED: INCORRECT CAN/REJ OF RECIPIENT MANIFESTLY ELIGIBLE FOR DSP. CRN: 999 999 999A

Check medical conditions

Assessors do not need to assess every medical condition and reference every piece of medical evidence.

Assessors do not assess or reference medical conditions/evidence if it is not considered to be currently impacting the customer's functional capacity. For example, where a condition:

• is resolved
• has nil impact
• is secondary, or a symptom of, a primary medical condition

Check all verified and impacting medical conditions have been recorded as detailed on the medical evidence and the medical evidence supports the assessment of a condition as:

• persist for less than 2 years
• persist for more than 2 years but not DTS
• persist for more than 2 years and DTS
• manifest

When an Assessor has medical evidence to support manifest eligibility for DSP they need to mark the condition as 'persist for more than 2 years' and Verified by medical evidence. It is not mandatory to mark the condition as DTS or enter DTS work capacities unless the customer has secondary medical conditions assessed.

For a JCA (or an Employment Services Assessment (ESAt) upgraded to a JCA), check all medical conditions are recorded under Conditions, including the Assessor needs to determine whether any condition which is likely to persist for more than 2 years is diagnosed, reasonably treated and stabilised.

Check to identify any significant inconsistency (outside the range of possibility) between medical condition details and the work capacity details.

Check the assessment of the customer's ability to use public transport without substantial help is consistent with report comments about the customer's mobility. Note: this is only a prompt to consider inviting a claim for Mobility Allowance (MOB) and is not a recommendation of eligibility for MOB.

Impairment ratings can only be applied to conditions that persist for more than 2 years, and are diagnosed, reasonably treated and stabilised. The Service Officer is not required to check whether the Assessor's qualifications are the most appropriate for the customer's medical conditions.

The Continuing Inability to Work (CITW)/Blind residence information is included in this section of JCA reports. When a report is accepted, it pre-fills the Pension Disability Information (PDI) screen.

Make sure the barriers included in the report are consistent with the support requirements, interventions and referrals recommended.

If the Support Requirements section is completed, check there are medical conditions indicated in the medical condition section. The Assessor indicates what assistance the customer is best suited for and the referrals made.

Note: where a JCA (or upgraded ESAt) is completed, and the customer is assessed as:

• Medically qualified for DSP with:
• 20 pts or more under a single Impairment Table, or
• 20 pts or more across multiple Impairment Tables and Program of Support is met, or
• Manifestly medically eligible, and
• Future work capacity (FDTS) is 0-7 hrs p/w, and
• No Employment Services Referral is indicated (‘The client would not benefit from participation in any programme’)

The Assessor may not complete the following sections in the report if the customer has no medical conditions or disability is recorded in the medical condition section:

• Barriers,
• Interventions
• Support Requirements
• Employment History (except where supporting work capacity recommendations)

If the customer is assigned at least 20 impairment points but does not have a severe impairment (20 points under a single table), they must have completed a Program of Support (POS). If the assessment indicates the customer has not actively participated in a POS, the Diagnosed, Reasonably Treated and Stabilised Work Capacity (DTS) fields are blank.

• Check the non-medical personal factors have not been used as a basis to determine work capacity
• Check the Temporary Reduced Work Capacity is for an appropriate period and supported by available evidence
• Work capacity with intervention should generally be greater or equal to Baseline capacity. If future capacity is shown to decline, identify whether this is explained by a deteriorating condition. Note: DTS work capacities are not available if the POS indicator is No
• If Baseline or with intervention work capacity is less than 30 hours, there must be a condition that persists for more than 2 years, to support this. Make sure the work capacity for conditions that persist for more than 2 years, is recorded correctly
• Work capacity with mainstream intervention is to be completed for grandfathered customers. To check, go to the GFS screen in Process Direct and check the status of the 2006 Welfare to Work activity. If the status is:
• GRF or TRA, the customer is grandfathered
• TRR or New, the customer is not grandfathered
• Work capacities must be consistent with the impairment. A 10 point impairment would not be consistent with DTS 'with intervention' work capacity of 8-14 hours per week)
• For a JCA, or an ESAt which has been upgraded to a JCA, there should also be DTS work capacities if the customer's conditions attract a rating of 20 points or more, and they have:
• a severe impairment (20 points or more on a single table), or
• actively participated in a Program of Support (POS)
• Where the customer is currently working 15 hours or more per week in open employment, check the customer’s employment circumstances have been considered, including the sustainability of the employment in the assessment of the customer’s work capacity

Do not accept the report if recommendations are not consistent with available evidence, see Step 1 in Table 6.

For more information about work capacity, see Assessing Continuing Inability to Work (CITW).

For DSP new claim JCAs, when an assessment of active participation in a Program of Support (POS) is required, assessment of POS and rationale behind the assessment must be clearly outlined within the JCA report.

If the JCA report indicates POS has or has not been met, evidence must be available to support the assessment. As part of checking JCA reports, the Service Officer must make sure the recommendation is consistent with the evidence on hand, (that is, referral screens, Medical Details Section of the claim, information within the report).

Do not accept the JCA report if unclear, see Step 1 in Table 6.

Make sure interventions are consistent with barriers and referrals.

This section captures information not recorded elsewhere. Check the following is recorded in this section:

• the first paragraph confirms whether the assessment was completed successfully or was not able to be completed. If the assessment was not completed, the Assessor's attempts to engage the customer
• other information could include:
• any unverified, self-reported medical conditions or observed symptoms associated with a medical condition. This may include a statement that effective assessment including referrals to specialist services such as Disability Employment Service (DES) depends on whether the customer can provide further relevant medical evidence to support the self-reported medical condition(s)
• any new customer details such as change of address
• any concerns with the medical information available
• details of any referrals made that are not recorded in the Referrals section of the report
• if recommended referral is to be deferred because of the customer's temporary reduced work capacity, dates and time frames for future referral

If a file assessment was conducted, the Assessor must indicate the need for the Service Officer to action the recommended referral.

Note: return the report to Assessment Services for correction if the Assessor has recommended manifest eligibility in the body of the report but the manifest indicator is not displayed. The JCA report must not be accepted until it correctly reflects the Assessor's recommendation of manifest eligibility. For action required for:

• claims with a start date before 1 April 2023, see Table 3
• claims with a DSP start date on or after 1 April 2023, see Table 4

Check the following is recorded:

• whether the report contains (or does not contain) information which, if released to the customer, might be prejudicial to his/her health, including a free text field for an explanation if the answer is 'Yes'
• whether it is considered the customer's personal factors have an impact (no impact, low, moderate or high) on their ability to work, obtain work, or look for work, and a rationale for this determination

Referral recommendations

The Assessor records recommended referrals to providers and non-providers, (for example, community mental health service) in this section of the report.

There are only limited circumstances in which a referral recommendation may not be stated in the report. This is generally only because the customer has a future work capacity (with intervention) of less than 8 hours per week and is unable to benefit from referral to any program.

Return the report if a referral recommendation is not clearly stated in this section of the report and there is no clear reason. See Step 1 in Table 6.

The customer's participation in a current program or activity, or a voluntary participation decision not to accept the offer of a referral are not valid reasons for the absence of a referral recommendation.

Immediate referrals made by the Assessor

The Assessor's actions to make the referral must be clear in the report. This includes:

• if an immediate referral was appropriate, details of the referral, including the service provider and appointment details
• whether a customer with future work capacity or temporary reduced work capacity of less than 15 hours per week declined the offer of a referral
• if the Assessor intended the referral to be deferred because of the customer's temporary reduced work capacity - supported by other information in the report

Check an appointment was made by the Assessor for referrals completed in the Department of Employment and Workplace Relations (DEWR) system:

• enter customer record through Customer Summary
• select > Participation Summary > Online Diary
• to return to claim assessment:
• return to Inbox
• search using CRN
• select DSP claim activity. If needed, re-enter the JCA Report to resume consideration of JCA

Referral recommendations from a file assessment are not actioned by the Assessor. It must be indicated in the Assessment Summary the Service Officer needs to action the recommended referral.

Return the report if an immediate referral is required but the Assessor's referral actions are not evident in the submitted report, see Step 1 in Table 6.

Are there referrals recommended but the customer could not be referred immediately by the Assessor?

• Yes, go to Step 4
• No, go to Step 5

If referrals are recommended to an Employment Services Provider for a job seeker with mutual obligation requirements, but the referral could not be actioned immediately by the Assessor:

• this is still to be recorded as a recommended referral, and
• details such as reasons, date and timeframe for the future referral included

See Deferred referral to Employment Services Providers.

Before accepting a report where future action may be required to make a deferred referral, check the report for any factors that may affect the ability to action a DES referral in the future. See Eligibility and participation requirements for Disability Employment Services (DES).

Read through the report to check it has been completed with enough information to determine income support eligibility and/or appropriate assistance. Check it is internally consistent.

See Table 6.

Reasons for escalating or not accepting the report include the following:

• incorrect version of the Impairment Tables has been used based on date of claim
• incorrect terminologies have been used in the JCA report based on the relevant impairment table version. For examples, see The Impairment Tables Resources page, Frequently asked questions (FAQs)
• the report is not internally consistent
• customer’s current open employment has not been considered in assessed work capacity
• insufficient information for income support decision
• medical evidence not referenced adequately in the report
• POS has not been assessed
• an incorrect, or no, determination has been made of where the customer's CITW arose, for customers who have less than 10 years residence
• the Assessor has not documented why written medical evidence has not been used to verify condition as:
• fully diagnosed, treated and stabilised (2012 Impairment Tables), or
• diagnosed, reasonably treated and stabilised (2023 Impairment Tables)
• the Assessor has documented why written medical evidence has not been used to verify condition as:
• fully diagnosed, treated and stabilised (2012 Impairment Tables), or
• diagnosed, reasonably treated and stabilised (2023 Impairment Tables), and
• the reasons do not meet the specifically defined circumstances
• insufficient information to determine appropriate assistance
• insufficient rationale given for decisions or ratings
• Impairment Tables or ratings used incorrectly
• a referral recommendation has not been made, and no valid reason is stated
• referral action has not been made, or the Assessor's referral actions are not clear
• other errors or reasons as discussed with the Assessor
• Assessor requests return of the report
• inappropriate or prejudicial information is included in the report
• information sharing indicator is incorrect or not recorded. If the Assessor has not advised the customer of information sharing arrangement, it may be a breach of privacy to accept the report
• the report does not address all the customer's medical conditions
• a contributing Assessor has not been consulted, where required
• new medical evidence has been supplied since the JCA report was submitted
• incorrect information recorded. For example, a typographical error. Note: reports with minor spelling or grammatical errors should be accepted unless it impacts the JCA outcome or causes a risk to the agency, if the report was released to the customer. For example, where the report references the incorrect customer name
• missing fields or sections in the report
• DSP is already current and a DSP New Claim or DSP Appeal JCA Report is submitted

If a JCA report indicates potential medical eligibility (excluding manifest), the report cannot be accepted. The claim must be placed on hold while a Disability Medical Assessment (DMA) is undertaken.

If DSP is CUR and a DSP New Claim or DSP Appeal JCA Report is submitted, do not accept the report. Hold the JCA activity on AL for 14 days and refer to Level 2 Policy Helpdesk. See the Resources page for a link to the online form.

Can the report be accepted?

• Yes, go to Step 13
• No, do not return the report, go to Step 2

Identified issues in a JCA report relating to residency and CITW can include:

• an assessment of where the customer’s CITW occurred is not recorded, and this is required based on the customer’s residence status
• an assessment of where the customer’s CITW occurred is recorded, and this is not required because the customer:
• has 10 years qualifying residence, or
• has a Qualifying Residence Exemption (QRE) or
• does not have a CITW (i.e. work capacity is greater than 15 hrs pw)
• an incorrect statement regarding the customer’s period of residence in Australia
• a statement ‘client does not have a continuing inability to work’ when the customer has been assessed as having a CITW (i.e. work capacity is less than 15 hrs per week)
  Note: where the JCA contains a manifest indictor, the fields in regard to the customer’s period of residence and where their CITW occurred, will not present in the report. The Assessor must include this information (if applicable), in the ‘Assessment Summary’ of the report

This process does not apply to upgraded ESAts. Where there is an incorrect statement regarding the customer’s residency in an upgraded ESAt, the report should be accepted. Customer’s residency/CITW will be considered in the MAT report/SA479 (if applicable).

Does the identified issue in the JCA Report relate to the customer’s residency and assessment of where the customer’s CITW occurred?

• Yes,
• apply Hold to User (HTU)
• update status of DSP claim to On Hold for reason Awaiting Level 2 policy advice
• refer error about residency/CITW to Level 2 Policy Helpdesk via the Online Enquiry form (record team leader as the additional contact name)
• annotate DSP Claim progress DOC to include: ‘An error has been found in the JCA referral and CITW assessment in JCA. Requires review. Referred to Level 2 Policy Helpdesk’
• if an error has been found in the JCA Referral, send feedback to the referring Service Officer via the Staff Feedback Tool
• No, go to Step 3

• Where there are no issues in the JCA Report relating to the Impairment Tables version and/or related terminology
• Go to Step 4
• Where the correct version of the Impairment Tables has been applied, but the Assessor has used incorrect terminology, e.g. the 2023 tables apply and the Assessor has used the term “permanent” to describe a disability or medical condition. For more information about the use of the term permanent, see the Frequently Asked Questions tables, in The Impairment Tables
• Go to Step 5
• Where the incorrect version of the Impairment Tables has been applied, review the DSP claim start date and ensure PNA is correct, based on customer circumstances
• If the Impairment Tables in an upgraded ESAt do not align with the PNA date, do not refer to Assessment Services to be amended. The ESAt cannot be considered current and valid for the DSP Claim, refer to MAT to review the MAT report/SA479, see Streaming a new claim for Disability Support Pension (DSP)
• If it is clear the incorrect Impairment Tables version has been applied in a DSP New Claim JCA, and there is a DMA Referral or DMA Report Submitted for the related claim/appeal:
• do not action the JCA or DMA Report
• refer to Level 2 Disability Helpdesk
• annotate the DSP Claim Progress DOC
• hold the DSP claim under HTU for 14 days with reason ‘Awaiting Level 2 Policy Advice‘
• Level 2 will liaise with Assessment Services and GCD Contract Management Team to correct the relevant report
• procedure ends here until corrected reports are resubmitted
• If there is no DMA Referral/Report related to the claim/appeal, refer to Service Support Officer (SSO)
• Go to Step 7

Is the only error due to the Information Sharing Indicator being incorrect or not recorded?

Note: this includes upgraded ESAts, regardless of the report status (i.e. submitted/finalised)

• Yes, information sharing issues can be escalated to Assessment Services for review. Go to Step 6
• No, go to Step 5

Service Officers can refer some JCA issues directly to Assessment Services, without referring to an SSO.

These include:

• new medical evidence lodged since JCA was completed
• internal inconsistency
• medical evidence not referenced
• missing fields and sections in the report

Typographical errors such as minor typing, spelling, grammatical errors which do not impact the JCA outcome or cause a risk to the agency do not need to be referred to Assessment Services. JCA report is to be accepted.

Referral to an SSO is required when:

• there is a complex or sensitive issue and is not appropriate to record on a DOC
• the Service Officer is unsure if the JCA can be accepted or not
• a DMA Referral has occurred, or a DMA Report has been submitted related to the JCA Report

Is a referral to an SSO required?

• No, go to Step 6
• Yes, go to Step 7

Service Officers can refer errors to Assessment Services for review.

Note: typographical errors such as minor typing, spelling, grammatical errors which do not impact the JCA outcome or cause a risk to the agency do not need to be referred to Assessment Services. The JCA report is to be accepted.

If the JCA Report requires review, refer to Assessment Services.

Note: the referral must be actioned from the DSP Claim activity. To access the DSP claim from the ESAt/JCA Referral page, select the back arrow to return to the DSP Claim Summary > select back again to return to the TS screen, or enter the customer’s CRN in the Inbox.

• select Referral
• Referral Summary screen, select Referral Type
• Referral Type, select Assessment Services
• Referral Reason, select one of the following:
• POS Post DMA
• New Medical Evidence
• Query JCA Quality
• Query JCA Status
• text will pre-fill the Additional Information field
• add additional information if required
• select Finish to view the referral notification
• select OK to return to the Transaction Summary (TS) screen
• the claim will be set to status On hold - Awaiting ASB Recommendation. A note is added on DL/Notes under Notes. 'A referral has been created for Assessment Services', with the reason selected
  Note: the additional text added does not display in the Notes and cannot be viewed by Assessment Services in Process Direct
• the JCA activity in Process Direct is automatically put on hold to prevent JCA report being reallocated to another user
• manually hold the NSS/ JCA activity from AL in Customer First for 14 days and add text: referred to Assessment Services due to quality issue with JCA, see DSP Claim Progress DOC
• annotate DSP Claim Progress DOC on DL/Notes with the information from the referral, i.e. the reason the JCA report is being referred to Assessment Services
• claim does not need to be held to user while JCA is being reviewed unless the claim meets Hold To User criteria, as in Work Optimiser for staff

Procedure ends here until referral is actioned by Assessment Services. When completed, go to Step 12.

To refer to SSO:

• use the Direct SSO Referral webform > Benefit Type: DSP > Escalation type: Check JCA/ESAt/DMA report
• place the DSP claim in Process Direct on hold:
• select Status > Edit > change Claim Status to On Hold > use reason Referral to SSO > hold for 14 days
• place JCA report in Process Direct on hold:
• select > DSP Claim Summary > JCA report > Place on Hold > reason Referred to SSO > hold for 14 days to prevent JCA report being reallocated to another user
• manually hold the NSS/ JCA activity from AL in Customer First for 14 days and add text: referred to SSO due to quality issue with JCA, see DSP Claim Progress DOC
• annotate DSP Claim Progress DOC to advise referral to SSO has been actioned due to an issue with the JCA Report and include the specific reason e.g. incorrect version of Impairment Tables used or missing information in report
• claim does not need Hold To User while JCA is being reviewed, unless the claim meets Hold to User criteria, as in Work Optimiser for staff

Procedure ends here, until the SSO has reviewed the JCA.

Action required by SSO depends on if a DMA referral has occurred or not:

• If DMA referral has occurred/DMA report submitted, go to Step 8
• If no DMA referral/report, go to Step 9

SSO must review the query and JCA Report.

Where the SSO determines review of the JCA is not required, they:

• annotate the DSP claim Progress DOC on DL/Notes with outcome
• select Status > Edit> set Claim activity to ‘In Process’ so it presents to Service Officer
• finalise Direct SSO referral in TSC database with the outcome
• advise Service Officer to accept JCA, go to Step 13

Where the SSO determines further review of JCA is required and the DMA status is ‘Referred' or ‘Scheduled’:

• SSO must escalate the matter via email to GCD Contract Management team detailing the:
• issue/error with the JCA Report, and
• expected outcome (for example, no change in decision or update leads to a change in outcome)
• SSO must not take any action on the JCA Report, until they receive a response from GCD

DMA status is not ’Referred’ or ‘Scheduled’, for example, Attended or Submitted, or after GCD team has responded to email (above):

• SSO can escalate the matter to Assessment Services:
• For sensitive complex issues which cannot be recorded on a DOC, go to Step 10
• If the issue is not sensitive or complex. go to Step 11

If there is no DMA Referral, the SSO must review both the query and JCA report.

Where SSO determines a JCA review is not required, they will:

• annotate the DSP claim Progress DOC on DL/Notes with outcome
• select Status > Edit> set Claim activity to ‘In Process’ so it presents to Service Officer
• finalise Direct SSO referral in TSC database with the outcome
• advise Service Officer to accept JCA, go to Step 13

Where SSO determines further review by Assessment Services is required and the JCA query:

• relates to a sensitive or complex issue, go to Step 10
• does not relate to a sensitive or complex issue, go to Step 11

Do not make a referral to Assessment Services through Referrals.

SSO is to:

• email the query to the Assessment Services DAS
• hold the Direct SSO Referral in TSC database until a response from Assessment Services is received

Where a DMA Referral has occurred/DMA Report submitted, and GCD CMT have not already been contacted, send an email to GCD Contract Management team to outline the JCA error / omission being reviewed.

Once response is received and if JCA is:

• re-opened and re-submitted, it will present as a work item to Service Officer
• not re-submitted, SSO must update DSP claim status to In Process:
• annotate the DSP claim Progress DOC on DL/Notes with outcome to advise the JCA report can be accepted
• finalise Direct SSO Referral in TSC database

Go to Step 12.

If there is no sensitive or complex issue and review by Assessment Services is required the SSO is to refer to Assessment Services.

Note: the referral must be actioned from the DSP Claim activity. To access the DSP claim from the ESAt/JCA Referral page, select the back arrow to return to the DSP Claim Summary > select back again to return to the TS screen, or enter the customer’s CRN in the Inbox.

• select > Referral
• from the Referral Summary screen, select Referral Type
• from Referral Type dropdown, select Assessment Services
• Referral Reason, select appropriate reason from one of the following:
• POS Post DMA
• New Medical Evidence
• Query JCA Quality
• Query JCA Status
• text pre-populates in the Additional Information field
• add additional information if required
• select Finish to view a successful referral notification
• select OK to return to the Transaction Summary (TS) screen
• the claim is set to status 'On hold – Awaiting ASB Recommendation'. A note is added on DL/Notes under Notes. ‘A referral has been created for Assessment Services, with the reason selected
  Note: the additional text added is not displayed in the Notes and cannot be viewed by Assessment Services in Process Direct
• annotate DSP claim Progress DOC with the information from the referral, i.e. the reason the JCA Report is being referred to Assessment Services

SSO must finalise the Direct SSO Referral in TSC database and advise the query has been escalated to Assessment Services for review of JCA.

Where a DMA referral has occurred/DMA report submitted, and GCD CMT have not been contacted, send an email to GCD Contract Management team to outline the simple error or omission being reviewed.

Procedure ends here, until the referral is completed by Assessment Services. Once completed, go to Step 12.

Assessment Services reviews the query and the relevant JCA report. If the JCA is:

• reopened and resubmitted, it presents as a work item to a Service Officer
• not resubmitted, Assessment Services:
• updates the DSP claim status to In Process, so it presents to a Service Officer for action, and
• annotates the DSP Claim Progress DOC with the outcome of the quality check

If Service Officers have any concerns with an outcome or response, make a Direct Referral to SSO for review.

For queries raised by SSO via email, Assessment Services respond to the SSO with the outcome:

• SSO to update the DSP claim status to In Process and annotate the DSP claim Progress DOC on DL/Notes with outcome
• SSO to finalise SSO Referral in TSC database

If required, SSO can email the Assessment Services DAS for further advice.

If agreement cannot be reached, the SSO can consider referral to the Health Professional Advisory Unit (HPAU). See Inconsistencies in a Job Capacity Assessment (JCA) report.

Prior to accepting the JCA:

• If the related DSP claim is not already assigned to the Service Officer, locate the claim and apply Hold to User (HTU)
• If the DSP is assigned to the user, apply HTU to prevent allocation to another Service Officer

After reviewing the JCA and the report is ready to finalise:

• select Accept > key date the report is being accepted > Confirm

JCA Report is selected for quality checking

When a JCA Report is accepted in Process Direct, if quality checking is required:

• it does not go through the Quality Management Application (QMA) process
• the JCA activity in Customer First is selected for Quality Online Checking (QOL)
• annotate DSP Progress DOC as follows: JCA Report selected for quality checking. Claim will be completed after quality check has been completed
• locate the related DSP Claim, if not on hold, update status to ‘On Hold’ for reason ‘Referred to JCA’ for 1 day and apply Hold to User

The JCA outcome does not appear on the customer’s Medical Conditions Details (MC) screen, until QOL is complete.

Note: if the JCA Report QOL activity has a status of ‘offline’, complete the report acceptance in Customer First, see the Customer First tab.

Once QOL is complete, continue with action below.

Medical Condition (MC) screen

Check the MC screen to confirm if the correct JCA event date is showing. Check the Pension Assessment (PNA) screen, to make sure the correct start date is coded. If required, manually amend the Date of Event on MC, so the JCA date is the same as the PNA screen date. See also, Youth Disability Supplement (YDS) assessments. This date can affect the customer’s YDS, Pharmaceutical Allowance (PhA), and Pensioner Concession Card (PCC) entitlement.

Once a JCA report has been accepted by the Service Officer, it auto-attaches to the customer's eMIFE. The MC screen and the Work Capacity (WC) screen display with information updated from the report.

Partial Capacity to Work

If the report recommends Partial Capacity to Work (PCW) for Youth Allowance Jobseeker (YAL/CUR-JSKI) customers under 22 years, Process Direct automatically updates the Independence/Homeless/Away for Home Details (NIH) screen to code independence to allow acceptance of the report. Where PD is unable to code the NIH screen, manual action is required to accept the JCA and code NIH.

JCA Report cannot be accepted in Process Direct

If the JCA report does not accept, this is indicative that further assessment of customer circumstances is required.

• Error relates to Independence PCW:
• E516NM - This customer is eligible for the Independent rate of YAL - investigate the customer’s record further to determine eligibility and start date for Independence PCW
• accept the JCA report in Customer First
• See Assessing independence for customers with a partial capacity to work
• Note: independent PCW is only applicable to YAL Jobseekers. Where the error ‘ E517NM - This customer is not eligible for the PCW - Independent Rate’ occurs, this indicates the customer’s YAL status has changed from jobseeker to full-time student or apprentice. See Youth Allowance jobseeker or Australian Apprentice returning to full-time study for coding required to end independent PCW
• If JCA activity is creating a negative adjustment (debt) and an update to Assessment Consequences (ASC) is required:
• accept the JCA Report in Customer First, and
• complete updates to ASC as part of the same activity. See Actioning negative adjustments on the Assessment Results screen.

Note: if the JCA Acceptance has been attempted in PD, the accept button may not be accessible in Customer First. If this occurs:

• select the NSS/JCA activity from Activity List (AL) in Customer First, before selecting Continue, enter MCSS in the Next field, then select Continue
• check the JCA outcome is present on MC, and the correct Event Date is coded (same as the DSP Claim PNA date) and amend (if required)
• go to Assessment Results (AR) screen to finalise the JCA acceptance
• if the JCA outcome is not present on MC, refer to Level 2 Policy Helpdesk via the Online Enquiry form

The JCA report status remains submitted for 28 days. It then becomes finalised from day 29. If required, staff with relevant access can request early finalisation of the JCA report. This stops delays to DSP new claims if a new referral needs to be made immediately after the previous report is submitted. Once the report is selected for finalisation, it finalises overnight.

When the JCA report is accepted, it auto-generates a DOC which includes details when:

• a DES referral was recommended and:
• actioned
• a DES referral was recommended and not actioned/requires action
• a DES referral was recommended and deferred as the customer has a temporary reduced work capacity
• the date a temporary reduced work capacity is expected to end
• information in the report suggests medical eligibility for DSP

Further actions

Service Officer is to continue assessing the DSP claim, see Assessing a new claim for DSP after JCA. Before assessing the DSP claim, staff must locate the claim in Work Optimiser and select ‘Assign to me’.

If the customer meets medical and other eligibility requirements for DSP and currently does not have a claim for DSP, contact them to invite a claim. See Claiming Disability Support Pension (DSP).

When a ESAt/JCA report is accepted the system creates a DOA DOC with the ESAt/JCA Outcome.

The ESAt/JCA assessments is valid for 2 years and the DOA DOC should remain open for this period, except where:

• a customer has a subsequent ESAt/JCA in the 2 year period, or
• duplicate DOA DOC is created for the same ESAt/JCA report

When accepting the ESAt/JCA report or finalising a claim, staff must check DOA DOCs and expire any old ESAt/JCA Outcome DOA DOCs. See Creating, reviewing and deleting documents (including Fast Notes and DOA DOCs) for more information.

DSP New Claim JCA

If a JCA report recommends medical eligibility, in most cases a Disability Medical Assessment (DMA) referral is auto-generated.

If the system is unable to auto-generate a DMA referral or is unable to auto-accept the JCA report, or where the outcome does not support medical eligibility, manual action is required.

When allocated a JCA or upgraded Employment Services Assessment (ESAt) report, before opening the JCA report, staff must check:

• DSP Claim Progress DOC for information related to the claim
• Display on Access (DOA) DOCs for information relating to Personalised Services, and to ensure the claim is not being managed by Customer Centre Critical Response Team (CCRT)

If the claim is being managed by CCRT:

• do not accept the JCA Report or action the DSP Claim
• reassign the work item to a team leader in Work Optimiser
• update the DSP Claim Progress DOC on DL/Notes and include: ‘JCA Report has been allocated to Team Leader because CCRT are managing the DSP claim under HTU'
• email CCRT to advise a JCA Report has been submitted for a DSP claim they are managing under HTU. Copy line manager/team leader into the email
• procedure ends here

If the DSP claim is not being managed by CCRT:

• where a JCA report recommends manifest eligibility, a work item is allocated to a Disability Processing Service Officer for manual actioning of the new claim. See the Resources page of Assessing eligibility for DSP after a Disability Medical Assessment (DMA)
• if a JCA report recommends medical eligibility (non-manifest), in most cases a DMA referral is auto-generated
• if the system is unable to auto-generate a DMA referral, or is unable to auto-accept the JCA report, or the JCA outcome does not support medical eligibility, the manual action is require, go to Step 2

DSP Manual Medical Review JCA

JCA Referral reason for DSP manual medical review must be either DSP Medical Review of Entitlement or DSP Medical Review of Entitlement pre 1/7/06.

Service Officers managing a DSP manual medical review and the JCA is submitted, go to Step 3

Note: if a JCA report for the above referral reason recommends continuing medical eligibility for DSP, a DMA is not required.

See to Initiating and actioning a manual medical review for Disability Support Pension (DSP).

• Check Referral Summary (RRSUM) screen
• If the JCA Report status is Submitted:
• go to Step 3
• If the upgraded ESAt report is already accepted:
• go to Step 3
• If the JCA Report has any other status, for example, New, Reopened, Returned, Unable to Complete, see Streaming a new claim for Disability Support Pension (DSP) for action required to progress claim

Note: in limited circumstances, a DSP New Claim JCA will auto-return upon submission. The Display on Access (DOA) DOC will display the JCA outcome as Auto Return, Failed Centrelink Validation.

This occurs when the JCA Report includes vulnerabilities for a customer on an Income Support Payment (ISP) which does not have participation requirements. For example, Youth Allowance Student (YAL/STU) or Austudy.

For more information about JCA report status, see Understanding Job Capacity Assessment (JCA) reports.

If the JCA has been auto-returned:

• refer to Level 2 Policy Helpdesk via the Online Enquiry form
• include in the referral: DSP New claim JCA Auto-returned due to vulnerabilities, please follow-up
• run the Streaming tool to hold the claim for reason Policy
• apply ‘Hold To user’

When the JCA has been corrected and resubmitted, go to Step 3

In the customer's record, select the relevant JCA report.

The Report Complete screen can also be accessed by selecting the started NSS/JCA activity on the Activity List (AL) screen. If the report is selected via the Assessment Results (AR) screen, it cannot be accepted or returned on the Report Complete screen. This leaves the report with a submitted status preventing any new JCA or Employment Services Assessment (ESAt) referrals.

Check the customer's record and confirm the Reason for Assessment is consistent with the assessment required for their circumstances.

For instance:

• DSP new claim (DSPNC)
• DSP Appeal (DSPA)
• DSP Medical Review of Entitlement (DSPR)
• DSP Medical Review of Entitlement (pre 1 July 2006) (DSPRP)
• Supported Wage System (SWS)

JCA referral reasons 'DSPMR' and 'DSPME' are to be checked by International Services (CIS) staff only.

Is the referral reason DSPMR or DSPME?

• Yes, for:
• CIS staff members, check the report as outlined in Step 1 in Table 2 of Assessment for Disability Support Pension (DSP) recipients going overseas under the no future work capacity provisions. Go to Step 6
• other staff members, re-categorise the work item in Work Optimiser to a CIS new claim work item. Procedure ends here
• No, go to Step 6

How was the JCA conducted?

• face to face interview (including videoconferencing or phone)
• file assessment

Check the customer was advised of Information Sharing arrangements, if applicable.

For File Assessments:

• in the Assessment Details, check the response to the information sharing is indicated as 'No'

For Face to Face Assessments:

• in the Assessment Details, check if 'Yes' is selected indicating the customer has been read the Information Sharing statement explaining how JCA information can be shared and with whom. Assessors are required to do this at each JCA appointment

In the Assessment Details, has the correct 'Yes' or 'No' response been recorded to 'Client has been advised of information sharing arrangements'?

• Yes, see Step 1 in Table 2
• No. The report should not have been completed by the Assessor and/or contains incorrect information. See Step 1 in Table 6

From 1 April 2023, the Impairment Tables used to assess the impact of a customer’s condition(s) changed. This included a change to terminology.

Job Capacity Assessors use the Impairment Tables to assign impairment ratings, when completing assessments for DSP.

The date of claim and date of effect of the JCA Report, determines which version of the Impairment Tables and terminology is used in the JCA report.

Check the date of effect for the DSP Claim (PNA/Start date).

Date of claim and date of effect of JCA is before 1 April 2023 (2012 Impairment Tables version)

If a customer has a medical condition impacting for more than 2 years, it is assessed as:

• permanent, and
• either Fully Diagnosed Treated and Stabilised (FDTS) or Not Fully Diagnosed Treated and Stabilised
• see Table 3

Date of claim and date of effect of JCA is on or after 1 April 2023 (2023 Impairment Tables version)

If a customer has a medical condition which will impact for more than 2 years, it will be assessed as:

• persist for more than 2 years, and
• either Diagnosed, Reasonably Treated and Stabilised (DTS) or Not Diagnosed, Reasonably Treated and Stabilised
• see Table 4

Check the date of effect of JCA for DSP manual medical review for correct version of Impairment Tables

If a DSP medical review is initiated after 1 April 2023 and a JCA is required, the Impairment Tables used by assessors will be the 2023 Impairment Tables version. See Table 4.

See the Medical Conditions section of the report.

For customers with medical condition Trans Vaginal Mesh (TVM) where the JCA Report recommends medical rejection:

• do not accept the JCA Report
• run the Streaming and Progress DOC script to hold the claim for reason JCA for 14 days
• update DSP Claim Progress DOC with 'TVM claim has been referred to CCRT'
• complete a referral to CCRT for DSP Claim finalisation and Service Offer Interview (SOI) for TVM case

For all other medical conditions and TVM cases where the JCA supports medical eligibility, continue processing as normal.

Check for manifest eligibility

When an Assessor recommends a recipient is manifestly eligible for Disability Support Pension (DSP), they must record the manifest indicator in the Medical Conditions section of the Job Capacity Assessment (JCA) report. This displays in the report as Recipient meets manifest criteria for category followed by a specific manifest indicator code.

The codes and corresponding categories are:

• B - Permanent Blindness (BLI)
• T - Terminal Illness (TRM)
• I - Intellectual Disability (INT)
• N - Nursing home level of care (NHM)
• H - Category 4 HIV/AIDS (HV4)
• P - Disability Pension at special rate (TPI)

Where the Assessor correctly records the manifest indicator, it populates the Medical Conditions Summary Screen (MCSS) when the JCA report is accepted.

If the manifest indicator is not correctly displayed, and the JCA report is accepted by the Service Officer, the recipient will be incorrectly assessed. The claim may be rejected or payment may cancel.

Service Officers must make sure the manifest indicator is displaying correctly before accepting a JCA report. Where the Assessor has recommended manifest eligibility in the body of the report (such as in the Remarks or Assessment Summary sections) but the manifest indicator is not displayed in the JCA report, return the report to Assessment Services for correction. The JCA report must not be accepted until it correctly reflects the Assessor's recommendation of manifest eligibility.

Note: when returning the report, Service Officers must include 'No Manifest Indicator coded in JCA Report' in the Return free text field. For further details refer to Table 6.

If Service Officers identify a claim rejection or payment cancellation has occurred because the manifest indicator has not been correctly coded and applied in the JCA report, the case must be urgently escalated to the DIS Service Delivery Support Team for investigation and resolution. The email must be titled:

• 'URGENT ACTION REQUIRED: INCORRECT CAN/REJ OF RECIPIENT MANIFESTLY ELIGIBLE FOR DSP. CRN: 999 999 999A'

Check medical conditions

Assessors do not need to assess every medical condition and reference every piece of medical evidence.

Assessors do not assess or reference medical conditions/evidence if it is not considered to be currently impacting the customer's functional capacity. For example, where a condition:

• is resolved
• has nil impact
• is secondary, or a symptom of, a primary medical condition

Check all verified and impacting medical conditions have been recorded as detailed on the medical evidence and the assessment of a condition as Temporary, Permanent but not FDTS, Permanent and FDTS, or manifest is supported by the medical evidence.

When an Assessor has medical evidence to support manifest eligibility for DSP they need to mark the condition as Permanent and Verified by medical evidence. It is not mandatory to mark the condition as FDTS nor enter FDTS work capacities unless the recipient has secondary medical conditions assessed.

For a JCA (or an ESAt upgraded to a JCA), check all medical conditions are recorded under the Conditions including permanent conditions that are likely to be ongoing for at least 2 years, should be marked as permanent and verified. The Assessor needs to determine whether any permanent condition is fully diagnosed, fully treated and fully stabilised.

Check to identify any significant inconsistency (outside the range of possibility) between medical condition details and the work capacity details.

Check the assessment of the recipient's ability to use public transport without substantial assistance is consistent with report comments about the recipient's mobility.

Note: this is only a prompt to consider inviting a claim for Mobility Allowance (MOB) and is not a recommendation of eligibility for MOB.

Impairment ratings can only be applied to permanent conditions that are fully diagnosed, treated and stabilised.

The Service Officer is not required to check whether the Assessor's qualifications are the most appropriate for the recipient's medical conditions.

The Continuing Inability to Work (CITW)/Blind residence information is included in this section of JCA reports. When a report is accepted, it auto-populates the Pension Disability Information (PDI) screen.

Make sure the barriers included in the report are consistent with the support requirements, interventions and referrals recommended.

If the Support Requirements section is completed, check there are medical conditions indicated in the medical condition section. The Assessor indicates what assistance the recipient is best suited for and this is reflected in the referrals made. For:

• CIS staff checking reports with referral reason DSPMR or DSPME, go to Step 4
• report processing staff, go to Step 5

Note: where a JCA (or upgraded ESAt) is completed, and customer is assessed as:

• Medically qualified for DSP\ with:
• 20 pts or more under a single Impairment Table, or
• 20 pts or more across multiple Impairment Tables and Program of Support is met, or
• Manifestly medically eligible, and
• Future work capacity (FDTS) is 0-7 hrs p/w, and
• No Employment Services Referral is indicated (‘The client would not benefit from participation in any programme’)

The Assessor may not complete the following sections in the report if the customer has no medical conditions or disability is recorded in the medical condition section:

• Barriers
• Interventions
• Support Requirements
• Employment History (except where supporting work capacity recommendations)

For Centrelink International Services (CIS) staff only

The DSP Portability Specific Questions are only available in the DSPMR and DSPME JCA referrals. These questions are opened and mandatory, as is the 'rationale' when the recipient is assessed as 'severely impaired' with a 0-7 hours per week work capacity.

Check the responses to the 2 portability specific questions are sound and meet the guidelines. Where appropriate, and with the Assessor's agreement, return the report to provide additional information regarding the DSP Portability assessment.

If the customer is assigned at least 20 impairment points but does not have a severe impairment, they must have completed a Program of Support (POS). If the assessment indicates the customer has not actively participated in a Program of Support (POS) the Fully Diagnosed, Treated and Stabilised Work Capacity fields are blank.

• Check non-medical personal factors have not been used as a basis to determine work capacity
• Check the Temporary Reduced Work Capacity is for an appropriate period and supported by available evidence
• Work capacity with intervention should generally be greater or equal to Baseline capacity. If future capacity is shown to decline, identify whether this is explained by a deteriorating condition. Note: FDTS work capacities are not available if the Program of Support indicator is 'No'
• If Baseline or with intervention work capacity is less than 30 hours, there must be a permanent condition to support this. Ensure the work capacity for permanent medical conditions is recorded correctly
• Work capacity 'with mainstream intervention' should only be completed for grandfathered recipients. To check if the recipient is receiving DSP under the Grandfather provisions, go to the GFS screen and check the status of the 2006 Welfare to Work activity. If the status is GRF or TRA, the recipient is grandfathered. If the Status is TRR or New, the recipient is not grandfathered
• Work capacities must be consistent with the impairment (that is, a 10 point impairment would not be consistent with FDTS 'with intervention' work capacity of 8-14 hours per week)
• Where the customer is currently working 15 hours or more per week in open employment, check the customer’s employment circumstances have been considered. This includes checking the sustainability of the employment in the assessment of the customer’s work capacity

For a JCA, or an ESAt which has been upgraded to a JCA, there should also be Fully Diagnosed, Treated and Stabilised (FDTS) work capacities if the customer's conditions attract a rating of 20 points or more, and they have:

• a severe impairment (20 points or more on a single table), or
• actively participated in a Program of Support (POS)

Do not accept the report if recommendations are not consistent with available evidence, see Table 6.

See Assessing Continuing Inability to Work (CITW).

For DSP new claim JCAs, when an assessment of active participation in a Program of Support (POS) is required, assessment of POS and rationale behind the assessment must be clearly outlined within the JCA report.

If the JCA report indicates POS has or has not been met, evidence must be available to support the assessment. As part of checking JCA reports, the Service Officer must make sure the recommendation is consistent with the evidence on hand, (that is, referral screens, Medical Details Section of the claim, information within the report).

Do not accept the JCA report if unclear, see Table 6.

Make sure interventions are consistent with barriers and referrals.

See the Medical Conditions section of the report.

For customers with medical condition Trans Vaginal Mesh (TVM) where the JCA Report recommends medical rejection:

• do not accept the JCA Report
• run the Streaming and Progress DOC script to hold the claim for reason JCA for 14 days
• update DSP Claim Progress DOC with 'TVM claim has been referred to CCRT'
• complete a referral to CCRT for DSP Claim finalisation and Service Offer Interview (SOI) for TVM case

For all other medical conditions and TVM cases where the JCA supports medical eligibility, continue processing as normal.

Check for manifest eligibility

When an Assessor recommends a recipient is manifestly eligible for Disability Support Pension (DSP), they must record the manifest indicator in the Medical Conditions section of the Job Capacity Assessment (JCA) report. This displays in the report as Recipient meets manifest criteria for category followed by a specific manifest indicator code.

The codes and corresponding categories are:

• B - Permanent Blindness (BLI)
• T - Terminal Illness (TRM)
• I - Intellectual Disability (INT)
• N - Nursing home level of care (NHM)
• H - Category 4 HIV/AIDS (HV4)
• P - Disability Pension at special rate (TPI)

Where the Assessor correctly records the manifest indicator, it populates the Medical Conditions Summary Screen (MCSS) when the JCA report is accepted.

If the manifest indicator is not correctly displayed, and the JCA report is accepted by the Service Officer, the recipient will be incorrectly assessed. The claim may be rejected or payment may cancel.

Service Officers must make sure the manifest indicator is displaying correctly before accepting a JCA report. Where the Assessor has recommended manifest eligibility in the body of the report (such as in the Remarks or Assessment Summary sections) but the manifest indicator is not displayed in the JCA report, return the report to Assessment Services for correction. The JCA report must not be accepted until it correctly reflects the Assessor's recommendation of manifest eligibility.

Note: when returning the report, Service Officers must include 'No Manifest Indicator coded in JCA Report' in the Return free text field. The Service Officer must also run the ASB Assistance Required Fast Note to alert Assessment Services of the return.

For further details refer to Table 6.

If Service Officers identify a claim rejection has occurred because the manifest indicator has not been correctly coded and applied in the JCA report, the case must be urgently escalated to the DIS Service Delivery Support Team for investigation and resolution. The email must be titled:

'URGENT ACTION REQUIRED: INCORRECT CAN/REJ OF RECIPIENT MANIFESTLY ELIGIBLE FOR DSP. CRN: 999 999 999A'

If the JCA referral is for a DSP manual medical review and the report will result in a cancellation because the manifest indicator has not been correctly coded and applied in the JCA report. The Service Officer managing the medical review must return the report and email Assessment Services to alert them.

Check medical conditions

Assessors do not need to assess every medical condition and reference every piece of medical evidence.

Assessors do not assess or reference medical conditions/evidence if it is not considered to be currently impacting the customer's functional capacity. For example, where a condition:

• is resolved
• has nil impact
• is secondary, or a symptom of, a primary medical condition

Check all verified and impacting medical conditions have been recorded as detailed on the medical evidence and the assessment of a condition as:

• Persist for less than 2 years
• Persist for more than 2 years but not DTS
• Persist for more than 2 years and DTS, or manifest is supported by the medical evidence
• Manifest

When an Assessor has medical evidence to support manifest eligibility for DSP they need to mark the condition as persist for more than 2 years and Verified by medical evidence. It is not mandatory to mark the condition as DTS nor enter DTS work capacities unless the recipient has secondary medical conditions assessed.

For a JCA (or an ESAt upgraded to a JCA), check all medical conditions are recorded under the Conditions including, the Assessor needs to determine whether any conditions that persist for more than 2 years, are diagnosed, reasonably treated and stabilised.

Check to identify any significant inconsistency (outside the range of possibility) between medical condition details and the work capacity details.

Check the assessment of the recipient's ability to use public transport without substantial assistance is consistent with report comments about the recipient's mobility.

Note: this is only a prompt to consider inviting a claim for Mobility Allowance (MOB) and is not a recommendation of eligibility for MOB.

Impairment ratings can only be applied to conditions that persist for more than 2 years, and are diagnosed, reasonably treated and stabilised.

The Service Officer is not required to check whether the Assessor's qualifications are the most appropriate for the recipient's medical conditions.

The Continuing Inability to Work (CITW)/Blind residence information is included in this section of JCA reports. When a report is accepted, it auto-populates the Pension Disability Information (PDI) screen.

Make sure the barriers included in the report are consistent with the support requirements, interventions and referrals recommended.

If the Support Requirements section is completed, check there are medical conditions indicated in the medical condition section. The Assessor indicates what assistance the recipient is best suited for and this is reflected in the referrals made. For:

• CIS staff checking reports with referral reason DSPMR or DSPME, go to Step 4
• report processing staff, go to Step 5
• staff managing DSP manual medical review, go to Step 5

Note: where a JCA (or upgraded ESAt) is completed, and the customer is assessed as:

• Medically qualified for DSP, with:
• 20 pts or more under a single Impairment Table, or
• 20 pts or more across multiple Impairment Tables and Program of Support is met, or
• Manifestly medically eligible, and
• Future work capacity (FDTS) is 0-7 hrs p/w, and
• No Employment Services Referral is indicated (‘The client would not benefit from participation in any programme’)

The Assessor may not complete the following sections in the report if the customer has no medical conditions or disability is recorded in the medical condition section:

• Barriers
• Interventions
• Support Requirements
• Employment History (except where supporting work capacity recommendations)

For Centrelink International Services (CIS) staff only

The DSP Portability Specific Questions are only available in the DSPMR and DSPME JCA referrals. These questions are opened and mandatory, as is the 'rationale' when the recipient is assessed as 'severely impaired' with a 0-7 hours per week work capacity.

Check the responses to the 2 portability specific questions are sound and meet the guidelines. Where appropriate, and with the Assessor's agreement, return the report to provide additional information regarding the DSP Portability assessment.

If the customer is assigned at least 20 impairment points but does not have a severe impairment, they must have completed a Program of Support (POS). If the assessment indicates the customer has not actively participated in a Program of Support (POS) the Diagnosed, Reasonably Treated and Stabilised Work Capacity fields are blank.

• Check the non-medical personal factors have not been used as a basis to determine work capacity
• Check the Temporary Reduced Work Capacity is for an appropriate period and supported by available evidence
• Work capacity with intervention should generally be greater or equal to Baseline capacity. If future capacity is shown to decline, identify whether this is explained by a deteriorating condition. Note: DTS work capacities are not available if the program of support indicator is 'No'
• If Baseline or with intervention work capacity is less than 30 hours, there must be a condition persist for more than 2 years to support this. Ensure the work capacity for medical conditions is recorded correctly
• Work capacity 'with mainstream intervention' should only be completed for grandfathered recipients. To check if the recipient is receiving DSP under the Grandfather provisions, go to the GFS screen and check the status of the 2006 Welfare to Work activity. If the status is GRF or TRA, the recipient is grandfathered. If the Status is TRR or New, the recipient is not grandfathered
• Work capacities must be consistent with the impairment (that is, a 10 point impairment would not be consistent with DTS 'with intervention' work capacity of 8-14 hours per week)
• Where the customer is currently working 15 hours or more per week in open employment, check the customer’s employment circumstances have been considered. This includes checking the sustainability of the employment in the assessment of the customer’s work capacity

For a JCA, or an ESAt which has been upgraded to a JCA, there should also be Diagnosed, Reasonably Treated and Stabilised (DTS) work capacities if the customer's conditions attract a rating of 20 points or more, and they have:

• a severe impairment (20 points or more on a single table), or
• actively participated in a Program of Support (POS)

If JCA is for a DSP manual medical review, POS is not considered in the assessment and the report can be accepted.

Care must also be taken when accepting the report if the JCA indicates a customer meets all other criteria for DSP other than CITW, and the reason they do not meet CITW is because they are currently working unsupported for at least 15 hours and less than 30 hours per week. Additional coding is required to the WC screen to prevent customer’s payment from cancelling. Refer to Initiating and actioning a manual medical review for Disability Support Pension (DSP).

Do not accept the report if recommendations are not consistent with available evidence, see Table 6.

For more information, see Assessing Continuing Inability to Work (CITW) for more information.

For DSP new claim JCAs, when an assessment of active participation in a Program of Support (POS) is required, assessment of POS and rationale behind the assessment must be clearly outlined within the JCA report.

If the JCA report indicates POS has or has not been met, evidence must be available to support the assessment. As part of checking JCA reports, the Service Officer must make sure the recommendation is consistent with the evidence on hand, (that is, referral screens, Medical Details Section of the claim, information within the report).

Do not accept the JCA report if unclear, see Table 6.

Make sure interventions are consistent with barriers and referrals.

See Table 5.

This section captures information not recorded elsewhere. Check the following is recorded in this section:

• the first paragraph confirms whether the assessment was completed successfully or was not able to be completed. If the assessment was not completed, the Assessor's attempts to engage the customer
• other information could include:
• any unverified, self-reported medical conditions or observed symptoms associated with a medical condition. This may include a statement that effective assessment including referrals to specialist services such as Disability Employment Service (DES) depends on whether the recipient can provide further relevant medical evidence to support the self-reported medical condition(s)
• any new recipient details such as change of address
• any concerns with the medical information available
• details of any referrals made that are not recorded in the Referrals section of the report
• if recommended referral is to be deferred because of the recipient's temporary reduced work capacity, dates and time frames for future referral

If a file assessment was conducted, the Assessor must indicate the need for the Service Officer to action the recommended referral.

Note: return the report to Assessment Services for correction if the Assessor has recommended manifest eligibility in the body of the report but the manifest indicator is not displayed. The JCA report must not be accepted until it correctly reflects the Assessor's recommendation of manifest eligibility. For action required for:

• claims with a start date before 1 April 2023, see Table 3
• claims with a DSP start date on or after 1 April 2023, see Table 4

Check the following is recorded:

• whether the report contains (or does not contain) information which, if released to the recipient, might be prejudicial to his/her health, including a free text field for an explanation if the answer is 'Yes'
• whether it is considered the recipient's personal factors have an impact (no impact, low, moderate or high) on their ability to work, obtain work, or look for work, and a rationale for this determination

Referral recommendations

The Assessor records recommended referrals to providers and non-providers (for example, community mental health service) in this section of the report.

There are only limited circumstances in which a referral recommendation may not be stated in the report. This is generally only because the recipient has future work capacity (with intervention) of less than 8 hours per week and is unable to benefit from referral to any program.

Return the report if a referral recommendation is not clearly stated in this section of the report and there is no valid reason, see Table 6.

The recipient's participation in a current program or activity, or a voluntary participation decision not to accept the offer of a referral are not valid reasons for the absence of a referral recommendation.

Immediate referrals made by the Assessor

The Assessor's actions to make the referral must be clearly evident in the report itself. This includes:

• if an immediate referral was appropriate, details of the referral, including the service provider and appointment details
• whether a recipient with future work capacity or temporary reduced work capacity of less than 15 hours per week declined the offer of a referral
• if the Assessor intended the referral to be deferred because of the recipient's temporary reduced work capacity - supported by other information in the report

Check if an appointment was made by the Assessor for a referral completed in the Department of Employment and Workplace Relations system.

Referrals can only be viewed via the Participation Summary in Process Direct – refer to the Process Direct Process Tab for information.

Referral recommendations from a file assessment are not actioned by the Assessor. It must be indicated in the Assessment Summary the Service Officer needs to action the recommended referral.

Return the report if an immediate referral is required but the Assessor's referral actions are not evident in the submitted report, see Table 6.

Are there referrals recommended but the recipient could not be referred immediately by the Assessor?

• Yes, go to Step 4
• No, go to Step 5

Where referrals are recommended to an Employment Services Provider for a job seeker with mutual obligation requirements but the referral could not be actioned immediately by the Assessor, record as a recommended referral and details such as reasons, date and timeframe for future referral included in the Assessment Summary. See Deferred referral to Employment Services Providers.

Before accepting a report where future action may be required to make a deferred referral, check the report for any factors that may affect the agency’s ability to action a DES referral in the future, see Eligibility and participation requirements for Disability Employment Services (DES).

Read through the report to check it has been completed with sufficient information to determine income support eligibility and/or appropriate assistance and it is internally consistent.

See Step 1 in Table 6.

Reasons for escalating or not accepting the report include the following:

• incorrect version of the Impairment Tables has been used on the date of claim
• incorrect terminologies have been used in the JCA based on the relevant impairment table. For examples, see the The Impairment Tables Resources page, Frequently asked questions (FAQs)
• the report is not internally consistent
• customer’s current employment has not been considered in work capacity
• insufficient information for income support decision
• medical evidence not referenced adequately in the report
• POS has not been assessed
• no determination has been made of where the customer's CITW arose, for customers who have less than 10 years residence
• the Assessor has not documented why written medical evidence has not been used to verify condition as:
• fully diagnosed, treated and stabilised (2012 Impairment Tables)
• diagnosed, reasonably treated and stabilised (2023 Impairment Tables), and
• the reasons do not meet the specifically defined circumstances
• insufficient information to determine appropriate assistance
• insufficient rationale given for decisions or ratings
• Impairment Tables or ratings used incorrectly
• a referral recommendation has not been made, and no valid reason is stated
• referral action has not been made, or the Assessor's referral actions are not clear
• other errors or reasons as discussed with the Assessor
• Assessor requests return of the report
• inappropriate or prejudicial information is included in the report
• information sharing indicator is incorrect or not recorded. If the Assessor has not advised the customer of information sharing arrangement, it may be a breach of privacy to accept the report
• the report does not address all the customer's medical conditions
• a contributing Assessor has not been consulted, where required
• new medical evidence has been supplied since the JCA report was submitted
• incorrect information recorded. For example, a typographical error
  Note. reports with minor spelling or grammatical errors should be accepted unless it impacts the JCA outcome or causes a risk to the agency, if the report was released
• missing fields or sections in the report
• DSP is already current, and a DSP New Claim or DSP Appeal JCA Report is submitted

If a JCA report indicates potential medical eligibility (excluding manifest), the report cannot be accepted. The claim must be placed on hold while a Disability Medical Assessment (DMA) is undertaken. If the JCA report is for DSP manual medical review a DMA is not required.

Can the report be accepted?

• Yes, go to Step 13
• No,
• If DSP is current and a JCA is submitted, do not accept the report. Place the JCA activity on AL on hold for 14 days and refer to Level 2 Policy Helpdesk
• For all other issues, go to Step 2

Identified issues relating to residency and CITW can include where the report:

• does not include an assessment of where customer’s CITW occurred, and this was required based on the customer’s residence status
• includes an assessment of where customer’s CITW occurred, and this is not required (because customer has 10 years AU residence or a QRE, or the customer does not have a CITW (i.e. work capacity is greater than 15 hrs pw)
• an incorrect statement regarding the customer’s period of residence in Australia
• a statement ‘client does not have a continuing inability to work’ when the customer has been assessed as having a CITW (i.e. work capacity is less than 15 hrs per week)

This process does not apply to upgraded ESAts. Where there is an incorrect statement regarding the customer’s residency in an upgraded ESAt, the report should be accepted. Customer’s residency/CITW will be considered in the MAT report/SA479 (if applicable).

Does the identified issue in the JCA Report relate to the customer’s residency and assessment of where the customer’s CITW occurred?

• Yes,
• apply Hold to User (HTU)
• stream claim and hold for 14 days for reason Policy
• refer error about residency/CITW to Level 2 Policy Helpdesk via the Online Enquiry form (record team leader as the additional contact name)
• annotate DSP Claim progress DOC to include - ‘An error has been found in the JCA referral and CITW assessment in JCA. Requires review. Referred to Level 2 Policy Helpdesk’
• if an error has been found in the JCA Referral, send feedback to the referring Service Officer via the Staff Feedback Tool
• No, go to Step 3

• Where there are no issues in the JCA Report relating to the Impairment Tables version and/or related terminology
• Go to Step 4
• Where the correct version of the Impairment Tables has been applied, but the Assessor has used incorrect terminology, e.g. the 2023 tables apply and the Assessor has used the term “permanent” to describe a disability or medical condition. For more information about the use of the term permanent, see the Frequently Asked Questions tables, in The Impairment Tables
• Go to Step 5
• Where the incorrect version of the Impairment Tables has been applied, review the DSP claim start date and ensure PNA is correct, based on customer circumstances
• If the Impairment Tables in an upgraded ESAt do not align with the PNA date, do not refer to Assessment Services to be amended. The ESAt cannot be considered current and valid for the DSP Claim, refer to MAT to review the MAT report/SA479, see Streaming a new claim for Disability Support Pension (DSP)
• If the incorrect version of Impairment Tables have been applied for DSP manual medical reviews, Service Officer managing the review can email Assessment Services directly
• Where it is clear the incorrect Impairment Tables version has been applied and there is a DMA Referral or DMA Report Submitted for the related claim/appeal:
• do not action the JCA or DMA Report
• refer to Level 2 Disability Helpdesk
• annotate the DSP Claim Progress DOC
• hold the DSP claim under HTU for 14 days ‘Awaiting Level 2 Policy Advice‘
• level 2 will liaise with Assessment Services and GCD Contract Management Team to correct the relevant report
• procedure ends here until corrected reports are resubmitted
• If there is no DMA Referral/Report related to the claim/appeal refer to Service Support Officer (SSO)
• Go to Step 7

Note: DSP manual medical reviews do not require DMAs.

Is the only error due to the Information Sharing Indicator being incorrect or not recorded?

Note: this includes upgraded ESAts, regardless of the report status (ie. submitted/finalised).

• Yes, information sharing issues can be escalated to Assessment Services for review. Go to Step 6
• No, go to Step 5

Service Officers can refer some JCA issues directly to Assessment Services, without referring to an SSO.

These include:

• new medical evidence lodged since JCA was completed
• internal inconsistency
• medical evidence not referenced
• missing fields and sections in the report

Typographical errors such as minor typing, spelling, grammatical errors which do not impact the JCA outcome or cause a risk to the agency do not need to be referred to Assessment Services. JCA report is to be accepted.

Referral to an SSO is required when:

• there is a complex or sensitive issue that is not appropriate to record on a DOC
• the Service Officer is unsure if the JCA can be accepted or not
• a DMA Referral has occurred, or a DMA Report has been submitted related to the JCA Report

Is a referral to an SSO required?

• No, go to Step 6
• Yes, go to Step 7

Service Officers can refer errors to Assessment Services for review.

Note: typographical errors such as minor typing, spelling, grammatical errors which do not impact the JCA outcome or cause a risk to the agency so not need to be referred to Assessment Services. The JCA report is to be accepted.

If the simple error requires review:

• place the JCA activity on hold for 14 days
• stream the DSP claim and hold for reason ‘Policy’ for 14 days
• update DSP Claim Progress DOC to explain why the JCA was not accepted. Hold DOC for 14 days
• claim does not need to be held to user while JCA is being reviewed unless the claim meets Hold To User criteria, as in Work Optimiser for staff
• run ASB Assistance Required Fast Note and add query details

For DSP manual medical reviews

Service Officers managing the DSP medical review refer errors to Assessment Services:

• email Assessment Services DAS
• Place the JCA activity on hold for 14 days
• Update the DSP Med Eligibility Review doc and
• Apply hold to user

Procedure ends here until referral is actioned by Assessment Services/AS DAS. When completed, go to Step 12.

To refer to an SSO:

• use the Direct SSO Referral webform > Benefit type: DSP > Escalation type: Check JCA/ESAt/DMA Report
• place the JCA activity on hold for 14 days
• stream the DSP claim and hold for reason 'Policy' for 14 days
• update DSP Claim Progress DOC to advise referral to SSO has been actioned due to an issue with JCA Report and include the specific reason e.g. incorrect version of Impairment Tables used or missing information in report
• claim does not need to be held to user while JCA is being reviewed unless the claim meets Hold To User criteria, as in Work Optimiser for staff

Procedure ends here, until the SSO has reviewed the JCA.

Action required by SSO depends on if a DMA referral has occurred:

• If DMA Referral has occurred/DMA Report submitted, go to Step 8
• If no DMA referral/report, go to Step 9

SSO must review both the query and JCA report.

Where the SSO determines review of the JCA is not required, they:

• annotate the DSP claim Progress DOC with outcome
• take the DSP Claim off hold so it allocates to a Service Officer
• finalise Direct SSO referral in TSC database with the outcome
• Service Officer can accept the report, go to Step 13

Where the SSO determines further review of JCA is required and the:

DMA status is ‘Referred’ or ‘Scheduled’:

• SSO must escalate the matter via email to GCD Contract Management team detailing the:
• issue/error with the JCA Report, and
• expected outcome (for example, no change in decision or update leads to a change in outcome)
• SSO must not take any action on the JCA Report, until they receive a response from GCD

DMA status is not ’Referred’ or ‘Scheduled’. For example, Attended or Submitted, or after GCD has responded to email (above):

• SSO can escalate the matter to Assessment Services:
• For sensitive complex issues which cannot be recorded on a DOC, go to Step 10
• If the issue is not sensitive or complex. go to Step 11

If there has been no DMA Referral, the SSO must review both the query and JCA report.

SSO determines:

• no review of JCA is required:
• annotate the DSP claim Progress DOC with outcome
• take DSP claim activity off hold so it presents to Service Officer
• finalise Direct SSO referral in TSC database with the outcome
• advise the Service Officer to accept the JCA, go to Step 13
• further review by Assessment Services is required and the JCA query:
• relates to a sensitive or complex issue, go to Step 10
• does not relate to a sensitive or complex issue, go to Step 11

Do not make a referral to Assessment Services through Referrals

SSO must:

• email the query to the Assessment Services DAS
• hold the Direct SSO Referral in TSC database until a response from Assessment Services is received

Where a DMA Referral has occurred/DMA Report submitted, and GCD CMT have not already been contacted, send an email to GCD Contract Management team to outline the JCA error / omission that is being reviewed

Once response is received and if JCA is:

• re-opened and re-submitted, it will present as a work item to Service Officer
• not re-submitted, SSO must take the DSP claim off hold so it presents to a Service Officer:
• annotate the DSP claim Progress DOC on DL/Notes with outcome to advise the JCA report can be accepted
• finalise Direct SSO Referral in TSC database

Go to Step 12.

Run the ASB Assistance Required Fast Note for checking by the Assessment Services Quality Team:

• annotate the DSP Claim Progress DOC with details
• SSO to finalise the Direct SSO Referral in the TSC database and advise that query has been escalated to Assessment Services for review of JCA

SSO must finalise the Direct SSO Referral in TSC database and advise that query has been escalated to Assessment Services for review of JCA.

Where a DMA Referral has occurred/DMA Report submitted, and GCD CMT have not been contacted, send an email to GCD Contract Management team to outline the JCA error / omission that is being reviewed.

Procedure ends here, until referral completed by Assessment Services. Once completed, go to Step 12.

Assessment Services reviews the query and relevant JCA report.

For queries raised via ASB Assistance Required Fast Note:

• annotate the DSP Claim Progress DOC with outcome
• close the Fast Note DOC

If the JCA is:

• reopened and resubmitted, it will present as a work item to a Service Officer
• not resubmitted, Assessment Services to take the DSP claim activity or DSP request for explanation DOC off hold, so it presents to Service Officer for action

If Service Officers have any concerns with an outcome or response, make a Direct Referral to SSO for review.

For queries raised by SSO via email, Assessment Services respond to the SSO with the outcome:

• SSO to check the DSP claim or DSP request for explanation DOC has been taken off hold and annotate the DSP claim Progress DOC on DL with outcome
• SSO to finalise SSO Referral in TSC database

If required, SSO can email the Development, Assurance, Support Team (DAS) for further advice.

If agreement cannot be reached, the SSO can consider referral to the Health Professional Advisory Unit (HPAU). See Inconsistencies in a Job Capacity Assessment (JCA) report.

For DSP manual medical reviews where the Service Officer managing the review still has concerns with the JCA report, refer to Level 2 DSP Policy Helpdesk.

Before accepting a JCA Report for a DSP New Claim, select the DSP claim from Activity List (AL) and hold for 1 day and apply Hold to User.

Select the Accept report button to accept the report.

When manually accepting a JCA in the Customer First workflow, amend the Medical Conditions Details (MC) screen date of effect to the correct date. The date defaults to the date the JCA is accepted. For DSP, the correct date would generally be the Pensions Assessment (PNA) screen date. See also Youth Disability Supplement (YDS) assessments. This date can affect the customer’s YDS, Pharmaceutical Allowance (PhA), and Pensioner Concession Card (PCC) entitlement.

JCA Report is selected for Quality Online Checking (QOL)

• If the JCA Report relates to a DSP Claim, place the claim on hold for reason ‘JCA’ for 1 days and apply Hold to User
• Add notes to the DSP Claim Progress DOC as follows: JCA Report selected for quality checking. Claim will be completed after quality check has been completed

Once a JCA report has been accepted by the Service Officer, it auto-attaches to the recipient's eMIFE.

The Medical Conditions Details (MC) screen, the Work Capacity (WC) screen and the Pension Disability Information (PDI) screen are displayed with information updated from the report.

The report remains submitted for 28 days. It then becomes finalised from day 29. If required, staff with relevant access can request early finalisation of the JCA report, so DSP new claims are not delayed if a new referral needs to be made immediately after the previous report is submitted. Once the report is selected for finalisation, it finalises overnight.

Partial Capacity to Work (PCW)

• Where an error relating to Independence PCW appears when accepting the report:
• E516NM - This customer is eligible for the Independent rate of YAL - investigate the customer’s record further to determine eligibility and start date for Independence PCW, and
• accept the JCA report in Customer First and
• manually code the NIH screen as part of JCA acceptance
• See Assessing independence for customers with a partial capacity to work
  Note: independent PCW is only applicable to YAL Jobseekers. Where the error ‘E517NM - This customer is not eligible for the PCW - Independent Rate’ occurs, this indicates the customers YAL status has changed from jobseeker to full-time student or apprentice, see Youth Allowance jobseeker or Australian Apprentice returning to full-time study for coding required to end independent PCW

When the JCA report is accepted, it auto-generates a DOC which includes details when:

• a DES referral was recommended and:
• actioned
• a DES referral was recommended and not actioned/requires action
• a DES referral was recommended and deferred as the customer has a temporary reduced work capacity
• the date a temporary reduced work capacity is expected to end
• information in the report suggests medical eligibility for DSP

Further actions

If determining eligibility for income support for a new claim (including reassessing a rejected claim), see Assessing a new claim for DSP after JCA. Before assessing the DSP claim, staff must locate the claim in Work Optimiser and select ‘Assign to me’.

If the customer meets medical and other eligibility requirements for DSP and currently does not have a claim for DSP, contact them to invite a claim. See Claiming Disability Support Pension (DSP).

If the JCA is for a DSP manual medical review, to finalise the review refer to Initiating and actioning a manual medical review for Disability Support Pension (DSP).

When a ESAt/JCA report is accepted the system creates a DOA DOC with the ESAt/JCA Outcome.

The ESAt/JCA assessments is valid for 2 years and the DOA DOC should remain open for this period, except where:

• a customer has a subsequent ESAt/JCA in the 2 year period, or
• duplicate DOA DOC is created for the same ESAt/JCA report

When accepting the ESAt/JCA report or finalising a claim, staff must check DOA DOCs and expire any old ESAt/JCA Outcome DOA DOCs. See Creating, reviewing and deleting documents (including Fast Notes and DOA DOCs) for more information