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Example 1:
John (46 years of age) lodged a claim for DSP noting diagnosis of schizophrenia. John's psychiatrist has documented that John finds discussing their condition distressing, experiences delusions and is often florid with irrational decision making.
The MAT assessor recommends JCA be conducted using file format, JCA is conducted based on MAT recommendation.
Rationale: John has provided a current psychiatrist report confirming diagnosis of schizophrenia, history of current and previous treatment as well the current functional impacts experienced by John. John's psychiatrist also indicates that despite reasonable treatment John is unlikely to see a significant improvement of his condition.
Given the severity of John’s mental health condition impacting John’s ability to discuss their impairment as well as their psychiatrist’s statement that John is distressed when talking about their condition such that it could be detrimental to their health, it is considered appropriate for John’s JCA to be completed as a file assessment. Due to the comprehensive nature of the medical evidence provided, contact with John’s psychiatrist is also not required to complete the assessment,
Following submission of the assessment the Assessor should also consult with the GCD Contract Team for consideration of DMA with Treating Health Professional contact.
Example 2:
Alice (52 years of age) lodged a claim for DSP noting diagnosis of a Traumatic Brain Injury (TBI).
The MAT Assessor recommends JCA be conducted by phone format.
Following review of the medical evidence the JCA Assessor contacts Alice’s GP to confirm that Alice’s condition remains unchanged, and impairments are of a severe nature and consistent with the reported information in the occupational therapy report.
Following confirmation from the GP the assessor deems there is enough medical evidence to confidently recommend medical eligibility and considers file format suitable if Alice agrees.
The Assessor contacts Alice to discuss changing the format of the assessment. Alice is relieved not to have to try and explain their disability and its impacts and agrees to the change in format of assessment.
JCA is completed as a file assessment.
Rationale: Alice has provided medical evidence indicating that they sustained a traumatic brain injury following a cerebrovascular infarct (stroke) 12 months ago. Alice has undergone both acute and rehabilitative treatment and based on medical evidence provided by their neurosurgeon is not expected to improve beyond their current capacity.
Alice has provided an occupational therapy assessment outlining their care needs following discharge from hospital as well as medical evidence from their GP. The assessor contacts Alice’s GP to confirm that their condition remains unchanged, and their impairments are still consistent with the occupational therapy report.
Alice was contacted and agreed to their assessment being completed without their participation.
Following completion of the report Alice is notified that their claim has progressed, and they may receive a call from Sonic HealthPlus to arrange an appointment for a medical assessment to be completed by a Government-contracted Doctor. The Assessor may also consider if a DMA by THP contact would also be appropriate to reduce Alice’s distress.
Example 3:
Alfred lodges a claim for DSP.
The MAT assessor recommends a JCA by phone format. A phone appointment is booked for a JCA in 10 days' time and notification is issued.
On the day of the appointment Alfred does not answer the phone at their scheduled appointment time.
The assessor makes 2 genuine contact attempts, deploying a pre-call notification SMS and documents the contact attempts in the DSP Progress of Claim DOC in Process Direct.
The following day the assessor reschedules the appointment to 5 working days in the future and issues notification of the appointment.
On the day of the second appointment the assessor makes 2 genuine contact attempts and deploys a pre-call notification SMS. Alfred does not answer the phone at their scheduled appointment time. The assessor also documents the contact attempts in the DSP Progress of Claim doc in Process Direct.
Alfred's medical evidence does not clearly demonstrate the impact of their medical conditions. The assessor attempts to contact Alfred’s GP to discuss the medical evidence provided. The assessor leaves a return phone number and places the assessment on hold. Three working days pass and the assessor has not heard from the Doctor. The assessor attempts a follow up call with the THP but is unsuccessful.
An alteration in the assessment format to file is considered appropriate and the assessment is completed with the available medical evidence recommending medical ineligibility. All contact attempts are clearly documented in the Assessment Summary of the report and why THP contact was required.
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