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

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Example

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When an ESAt is upgraded to a JCA

Joe attends an ESAt interview after having supplied a medical certificate to Services Australia for a bad back. Joe has a history (over 18 months) of supplying medical certificates on and off for a back condition. The medical certificate states it is a temporary exacerbation of a condition where the duration of functional impact is expected to be 24 months or more and the symptoms include generalised lower back pain, referred pain to legs, and an inability to sit or stand for more than 10 minutes.

Joe gets up and down from the chair to stretch and change positions regularly throughout the assessment. Treatment is indicated to be non-steroidal anti-inflammatory drugs (NSAIDs), physiotherapy and exercise. Joe is also a little overweight. The doctor indicates on the certificate that Joe cannot undertake usual work or study, nor do more than 8 hours of work per week.

Joe tells the Assessor the back problems have been an issue since a fall at work 5 years ago, but in the last couple of years it has become worse. Joe says surgery is possible, but there is just as much chance it will do damage as there is it will improve, so Joe's not keen to pursue it. Joe says that even when not suffering a 'relapse' the back problem affects everything.

Joe's history of medical certificates along with verbal history, current medical evidence, presentation at interview, and indication the only treatment option may not be effective, means it is likely the situation will affect Joe's ability to work into the future and will in fact deteriorate.

Therefore, an upgrade to a JCA and the impact of the condition assessed against the Impairment Tables would be appropriate. In this case where medical certificates are the only evidence, contact with Joe's treating doctor would be needed.

Note: before a claim for DSP can be granted, a Disability Medical Assessment (DMA) is required unless the customer is manifestly medically eligible.

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Question

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Question: In what form can medical evidence be provided to assess eligibility for Disability Support Pension (DSP)?

Answer: Medical evidence can be provided in a combination of:

• written medical evidence from medical practitioners and other treating health professionals, including for mental health conditions - a Psychiatrist or Registered Psychologist, for hearing conditions - an Audiologist, for eye conditions affecting vision - an Ophthalmologist, and
• documented conversations between the Assessor, or Health Professional Advisory Unit (HPAU), and the customer's treating doctor or treating health professionals
• See Medical evidence for Disability Support Pension - Disability Support Pension - Services Australia

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Question: When should an ESAt be upgraded to a JCA?

Answer: An Assessor should upgrade an Employment Service Assessment (ESAt) to a Job Capacity Assessment (JCA) where the available evidence indicates the customer meets medical qualification criteria for Disability Support Pension (DSP).

For an assessment to be upgraded to a JCA, the Assessor must determine, based on available evidence, the customer meets the DSP medical eligibility requirements, that is they:

• are manifestly medically eligible, or have verified medical condition(s) which are:
• permanent, fully diagnosed, treated and stabilised (2012 Impairment Tables), or
• persists for more than 2 years and are diagnosed, reasonably treated and stabilised (2023 Impairment Tables)
• attract a rating of at least 20 points under the Impairment Tables
• are unable to work or be retrained for work of at least 15 hours or more per week at or above the relevant minimum wage within the next 2 years because of their impairment, and
• are assessed as either having a severe impairment or as having actively participated in a Program of Support (POS)

If a submitted ESAt report contains sufficient evidence to assess the customer as meeting all medical eligibility criteria for DSP and the assessment was not upgraded, the Service Officer is to:

• review the report to identify the reason the Assessor did not upgrade the assessment
• complete the Direct referral webform. The SSO completes the ASB Assistance Required Fast Note for Assessment Service Quality Team about the reason the assessment was not upgraded
• accept or return the report as necessary

See an example of when an ESAt is upgraded to a JCA.

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Question: What should happen after an upgraded ESAt is submitted?

Answer: After an upgraded Employment Service Assessment (ESAt) has been submitted, (recommending medical eligibility for DSP):

• the Assessor records a Potential DSP eligibility Fast Note so the ESAt is actioned as a priority
• the ESAt report is reviewed and accepted following usual procedures
• once the report is accepted, Service Officers must consider an invite to claim Disability Support Pension (DSP)

The Service Officer should:

• review the customer record to ensure they meet other non-medical DSP eligibility criteria (for example residence)
• attempt to contact the customer twice by phone to invite them to claim DSP and advise them they will need to attend a DMA (unless they are manifestly eligible)
• if the customer can be contacted by phone and accepts the invitation to claim DSP, run the DSP Invite to claim workflow in Process Direct (which will issue a letter and claim form), and take care to explain that the customer does not need to provide further medical evidence when they lodge their claim
• if the customer cannot be contacted by phone, run the DSP Invite to claim workflow, which will issue a letter inviting them to lodge a claim
• see Claiming Disability Support Pension (DSP)

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Question: What is the process to return a report to Assessment Services?

Answer: If a JCA report cannot be accepted due to an error or omission (for example, the Information Sharing indicator is incorrect or not recorded, scrolling/ typo error, missing fields or sections in the report), Service Officers can refer a JCA report for a simple error or omission to Assessment Services for review, without the need to refer to an SSO (Service Support Officer).

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 should be accepted.

For all other report quality concerns or issues, the Service Officer is to complete the SSO Direct Referral webform. The Resources page contains a link to the Social Security and Welfare Quality Team intranet page for access to the webform. The SSO completes a referral to Assessment Services with a possible email if sensitive information needs to be communicated. The Assessment Services Quality team has 2 days to reply to the email, however if no contact is made then the Service Officer may return the report.

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Question: How is medical evidence referenced within the report?

Answer: Original medical evidence must be referenced in a Job Capacity Assessment (JCA) report to support all verified conditions within the report. Previous assessments are not to be used to verify a condition. If medical evidence is not referenced and viewable in document tools/eMife, the report should be returned to Assessment Services.

All verified conditions (persist for less than 2 years and persist for more than 2 years) must be referenced within the JCA report.

The condition must be linked to one or more sources of original medical evidence to confirm the diagnosis.

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Question: What is original evidence?

Answer: Original medical evidence refers to a medical history reports or other medical evidence such as a specialist report. This medical evidence must be a viewable document, which has been scanned to the customer record. It cannot be an earlier Job Capacity Assessment (JCA) report or other document that refers to the original evidence.

Assessors must reference the medical evidence used for the previous report or document, not the report or document itself.

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Question: What type of information does not need to be referenced in a report?

Answer: Test resources and other tools are not required to be referenced within the report.

For example:

• Psychometric and Physical assessment tools used in the preparation of a Specialist Assessment Report
• Depression Anxiety Stress Scales (DASS) used to determine the severity of depression
• Wechsler Adult Intelligence Scale (WAIS) reports