Job Capacity Assessments (JCA) 008-06110000

Assessors undertake a JCA to assess a customer's level of functional impairment and work capacity for a disability or medical condition(s). This helps to determine:

• if the claimant is clearly (manifestly) eligible (if not already identified by MAT)
• if the condition(s) is likely to persist for more than 2 years or not
• if the condition(s) are diagnosed, reasonably treated, and stabilised
• if an impairment rating(s) is applicable and against which Tables
• the customer's Continuing Inability To Work (CITW) and where it arose for residency purposes, or
• where required, if the customer has met the Program of Support (POS) requirement

A JCA may be required when a customer:

• lodges a claim for Disability Support Pension (DSP)
• is getting DSP and requires a medical review of their eligibility
• disagrees with and appeals a decision to reject a DSP claim due to medical ineligibility
• is seeking indefinite portability of DSP under the 'no future work capacity' portability provisions
• claims Special Benefit to be paid under DSP criteria
• is being assessed for Supported Wage System (SWS) but is not in receipt of an income support payment
• needs an impairment and work capacity assessment for a Special Disability Trust

Once a JCA referral is made, Service Officers must contact Assessment Services for all requests to:

• reschedule, cancel, or change an appointment, or
• adjust a planned assessment format

Services Australia notify customers by letter and SMS where the JCA appointment is:

• face to face
• video conference, or
• phone assessment.

The agency provides the appointment date, time, and location if face to face format. Customers do not get any prior notification for file assessments.

A JCA conducted by face to face, video conference, or phone assessment formats gives customers an opportunity to contribute to the assessment and discuss their disability or medical condition(s) with an assessor. Non-attendance means they miss the opportunity and the JCA may be completed by file assessment format instead, using the available evidence.

See Job Capacity Assessment (JCA) and Employment Service Assessment (ESAT) appointments.

If identified on the customer's record, Assessment Services will arrange an interpreter in the customers primary language. Interpreter availability and geographic location may impact the assessment format.

For example:

• A phone interview may be appropriate where an interpreter is not geographically available to conduct a face to face assessment, or
• A face to face assessment may be more appropriate where the customer has a hearing impairment and a phone assessment is not appropriate

Assessment Services may determine that a file assessment is appropriate for a customer who has a future booked phone, face to face or video conference appointment: See Changing a planned assessment format below.

Generally, people with disability should be given the opportunity to participate in any assessments about their disability or medical condition(s).

Assessors can consider which is the most appropriate JCA assessment format within the process guidelines below.

Where the customer has a correspondence nominee, assessors should consider their involvement in an assessment to support the customer to discuss their impairment.

Use of appropriate assessment formats ensures:

• accurate assessments of medical eligibility
• correct outcomes against the policy and legislative framework for Disability Support Pension (DSP), including the use of the Impairment Tables

JCAs are generally done with the customer face to face, by video conference or phone. If it is clear these formats are not appropriate, and only in limited and defined circumstances, the JCA may be done as a file assessment. See the Process page for more details of these circumstances.

Where the customer needs, wants, or will benefit from an employment services referral, or a change in referral recommendation, a discussion with the customer or nominee is required.

For example, a customer under 35 years of age with compulsory participation requirements who does not have a current appropriate referral recommendation in place.

Regardless of the assessment format used, reasonable attempts to contact the customer's treating health professional/s (THP) must occur when there is:

• ambiguity or inconsistency between customer report and THP evidence
• insufficient functional information
• doubt about the currency or relevance of the evidence, or
• where significant time has lapsed between when the evidence was written, and when the assessment is being undertaken, giving rise to reasonable doubt about the currency of the evidence at the time of claim including treatment, functional capacity, CITW etc.

All unsuccessful THP contact attempts should be documented within the assessment summary of the JCA report to ensure a contact record is available.

See below for more details about the requirements and process guidelines for THP contacts.

Where a JCA is required, an Assessor recommends the assessment format within the Disability Medical Eligibility Assessment (SA479/MAT).

Assessors undertaking the JCA may decide, within the process guidelines below, that a file assessment is the appropriate format even where a face to face, video conference, or phone assessment is already booked.

In these circumstances, the assessor must attempt contact with the customer and/or nominee prior to, or at, the scheduled appointment time to discuss the proposed use of a file assessment.

Where contact with the customer and/or nominee is successful, the assessor should:

• advise that all required information is available to complete the assessment
• offer the option for the JCA to be completed without their further participation
• where appropriate, advise of a referral to a Disability Medical Assessment (DMA) and to expect contact by Sonic HealthPlus to book the DMA appointment
• confirm if the customer needs, wants, or will benefit from an employment services referral
• document the discussion in the Assessment Summary to ensure a contact record is available

Note: the appointment must be completed in the original planned assessment format (face to face, video conference, or phone) where:

• contact with the customer prior to the scheduled appointment time is unsuccessful
• the customer and/or nominee declines the file assessment option, or
• it is clear the customer needs, wants, or will benefit from an employment services referral

A JCA referral can only be made if the most recent ESAt/JCA report has a status of 'Finalised'. See Request to finalise an Employment Services Assessment (ESAt) or Job Capacity Assessment (JCA) report to create a new JCA referral.

Claims for income support payments may be lodged up to 3 weeks prior to the customer's release. For JCA queries related to this customer group, contact Assessment Services.

Assessors can arrange a specialist assessment to assist a JCA report and, in some cases where the medical evidence for an ESAt indicates the person may be eligible for DSP, and the:

• necessary information does not exist and is essential for completion of the ESAt or JCA
• available evidence is unclear or insufficient for the assessor to complete the report
• customer cannot obtain or supply additional evidence
• assessor cannot obtain the necessary additional information or clarification from:
• the person's treating doctor(s) or allied health professional
• the Health Professional Advisory Unit (HPAU), or
• contributing assessors

A specialist assessment is generally scheduled after the JCA appointment. In some circumstances an appropriately qualified assessor may conduct a specialist assessment at the time of the JCA appointment. In these cases, notes are added to the future appointment to indicate that the appointment is a specialist assessment. The specialist assessment appointment details can be viewed in the online diary in Process Direct.

In select instances a customer can be referred for a Vulnerable Customer Assessment to obtain a provisional diagnosis of a psychological/mental health condition. See Diagnosis of a medical condition provided by an Assessment Services Psychologist for Disability Support Pension (DSP).

All medical/sensitive information relevant to a JCA must be scanned and attached to the customer's electronic Medical Information File Envelope (eMIFE). If the customer does not supply sufficient medical evidence prior to, or at the time of, their JCA, the assessment will go ahead with the available medical evidence.

Where concerns exist about the authenticity of medical evidence, the assessor must follow the guidelines listed in Managing suspected fraudulent medical evidence.

JCA appointment details can be viewed in Process Direct (PD) using the Online Diary workflow. The Appointment Summary is located on the Provider Summary screen. The assessor completes the JCA report via the Department of Employment and Workplace Relations' Employment Services System (ESSWeb), after conducting the JCA assessment.

The status of any completed JCA or ESAt reports are checked on:

• the Referral Summary (RRSUM) screen in Customer First and Process Direct, or
• More Options menu in Process Direct. Select the DSP Claim Summary function and the JCA/ESAt icon

The JCA may contain:

• the assessors and, if necessary, any contributing assessor's qualifications, see the Resources page for the Matrix of assessor qualifications
• interpreter details and vendor number, if used
• the customer's medical condition(s) including verified status, and/or diagnosed, reasonably treated and stabilised status (DTS)
• details of supportive medical evidence
• recommended impairment rating (if applicable), see The Impairment Tables
• as applicable, details of active participation in a Program of Support (POS) work capacity bandwidth(s), in line with medical evidence, functional impacts and work history, see Work capacity below
• employment history, including qualifications, vocational goals, and previous POS
• vulnerability indicators
• identified current and addressed barriers, and appropriate interventions including recommended referral to Employment Service Provider (ESP)
• for Disability Employment Services referrals (DES), identified employment support requirements, including the type of support recommended and the period for which support is required
• a summary of information not captured in the assessment, such as:
• assessment format if different from the JCA referring assessment format recommended
• medical conditions with no impacts
• recommended referral information including deferred referrals
• unsuccessful contact attempts with the customer or Treating Health Professional (THP)
• risk assessment and verbal consent
• any consultation with the Health Professional Advisory Unit (HPAU)
• if the report contains any information which might be prejudicial to the customer's health if released

Services Australia can release assessment reports, including JCA reports, to the customer. Generally, release of reports help customers understand decisions made based on assessment recommendations. See Release of DSP Medical Assessment Reports.

For Disability Support Pension (DSP) new claims and appeals, (with the exception of manifestly eligible), where the JCA recommends a potential grant, the system automatically refers them to a DMA with a Government-contracted Doctor (GCD) to confirm medical eligibility. For more details about the DMA referral process, see Assessing a new claim for Disability Support Pension (DSP) after a Job Capacity Assessment (JCA).

Customers receiving Disability Support Pension (DSP) have participation requirements if they:

• are younger than 35 years of age
• can work 8 to 14 hours a week, and
• do not have a dependent child younger than 6 years of age

The following information about work capacity applies to customers receiving a payment with mutual obligation requirements, such as Jobseeker Payment. It does not apply to DSP customers.

A customer is assessed as having a Temporary Reduced Work Capacity (TRWC) if they have been assessed by an assessor as being temporarily unable to work for at least 30 hours per week because of a medical condition.

A Partial Capacity to Work (PCW) is decided based on verified medical conditions likely to persist for more than 2 years. The customer is assessed as having a PCW if 'baseline work capacity' and 'with intervention' work capacity are assessed to be less than 30 hours per week. Assessors select a bandwidth(s) for 'baseline' and 'with intervention' work capacity from the following bandwidths:

• 0-7 hour per week
• 8-14 hours per week
• 15-22 hours per week
• 23-29 hours per week
• 30+ hours per week

Customers with a PCW or a TRWC of less than 15 hours per week of 12 weeks or more in duration, must attend quarterly participation interviews with Services Australia to fully meet their requirements, unless they are undertaking paid work or self-employment within their bandwidth.

This quarterly interview requirement for customers with a PCW or TRWC does not apply to DSP customers.

Customers who fail to attend a compulsory quarterly interview appointment may have their payment suspended.

Customers with an assessed TRWC of 0-7 or 8-14 hours per week of less than 12 weeks in duration do not have a quarterly interview requirement. Instead, these customers fully meet their requirements by lodging their Reporting Statement and attending appointments with the agency if requested.

Customers with a PCW or TRWC of either 0-7 or 8-14 hours per week must meet mutual obligation requirements, with the following exceptions:

• while these customers are always encouraged to participate with Employment Services Providers, they cannot be penalised if they choose not to do so
• customers with a TRWC of 0-7 hours per week. Customers cannot be referred to Disability Employment Services (DES) but can be referred to Workforce Australia, and
• to fully meet their requirements through paid work instead of attending quarterly interviews, the hours of work must be within their bandwidth (for example, at least 8 hours per week, if they have a PCW of 8-14 hours per week)

A customer who lodges a medical certificate (seeking exemption from mutual obligation requirements) may be referred for an Employment Services Assessment (ESAt). This is to assess their PCW or TRWC where there is not already a current and valid assessment of the customer's work capacity.

The referral for an ESAt should not delay the decision about the temporary incapacity exemption. In all cases, the decision about whether to grant an exemption is based on available evidence, including the medical certificate completed by the customer's treating doctor.

A customer is assessed as having a Continuing Inability To Work (CITW) if their medical condition(s) stops them from working for more than 15 hours or more per week, and when:

• educational
• pre-vocational
• vocational, or
• work related training is unlikely to enable the customer to do any work for 15 or more hours per week, within 2 years, independently of a program of support.
  A CITW must be met as well as meeting other eligibility criteria for DSP

For the purposes of work capacity, 'work' is considered to be any work. It is not limited by the work the customer usually performs nor, work available in the customer's area.

It is expected that a person will be capable of reliably performing work on a sustainable basis, that is, for a reasonable period of time without requiring excessive sick leave or work absences. In this context, a reasonable period of time generally means 26 weeks and work means work in open, unsupported employment. Sick leave or absences of one month or more (in total) taken in any given 26 week period are considered excessive..

Feedback and complaints may be received at a service centre or smart centre. If they are:

• about legislative decisions made as a result of the JCA, they are to be treated as requests for reviews or appeals of decisions. See Reviews and appeals for Disability Support Pension (DSP) rejection or cancellation decisions for the process to follow
• specific to Assessment Services procedures (for example, booking or interview process), they should be lodged via the Customer Feedback Tool

From 1 April 2023, a new version of Impairment Tables was introduced. The new Tables are used to assess a customer’s medical eligibility for all DSP claims lodged on or after this date. See The Impairment Tables.