3.6.5.60 Assessment of SA

Summary

Assessment of SA is based on medical evidence (1.1.M.100) from either the customer's treating doctor (1.1.T.160) or an MASP (1.1.M.80). This topic describes the following assessment issues for SA:

• the need to provide medical evidence,
• which medical certificates are acceptable,
• validation of medical certificates,
• the role of the MASP, and
• referral to the MASP.

Customer to provide medical evidence

A claim for SA must be supported by a certificate from a medical practitioner on the approved form, stating:

• the practitioner's diagnosis (name or description of the condition), AND
• the practitioner's prognosis, AND
• that the customer is incapacitated for work, AND
• the period for which the customer is incapacitated for work.

A certificate which is not on the approved form can be accepted in the circumstances described in the table below.

Acceptable medical certificates

Certificates can only be accepted from a person who is registered and licensed as a medical practitioner under a State or Territory law.

Examples: Certificates from the following practitioners are NOT acceptable: naturopaths, osteopaths, homeopaths, iridologists, reflexologists, chiropractors, acupuncturists, hypnotherapists, podiatrists, optometrists, and physiotherapists.

Role of the MASP

The MASP provides an opinion on medical condition(1.1.M.90), impairment ratings and work capacity, in particular, whether the condition is likely to last for 2 or more years, and therefore whether SA is the most appropriate payment. In providing this opinion, the MASP does not take into account non-medical factors such as age, work history, work skills and literacy, but may make general comments on these factors.

Referral to the MASP

A customer should be referred to an MASP only if the delegate is unable to determine the customer's work capacity and the customer has not been examined in the preceding 6 weeks.

Examples: SA customers can be referred to an MASP in the following circumstances:

• the customer has been off work for a period in excess of that normally associated with their medical condition,
• the medical certificate indicates the customer may be entitled to DSP and an impairment rating and/or other specific information is required on capacity for work,
• information required about the customer's medical condition cannot be obtained from the treating doctor, or
• the customer does not have a regular treating doctor.

Act reference: SSAct section 669 Time limit on qualification for SA, section 94 Qualification for DSP - continuing inability to work

Policy reference: SS Guide 3.6.1 DSP - Qualification & Payability, Part 6 Reviews & Payment Recovery

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Last reviewed: 4 February 2002