The AUWU made contact with Australian Medical Association (AMA) in regards to this issue with the hope of working together to bring Centrelink into line. The AMA made some inquiries to Centrelink about how the system of obtaining medical exemptions works. The AUWU was informed that if your medical certificate is rejected you are entitled to a full explanation both over the phone and in writing as to why an exemption has not been provided. You also have a right to review.
Below is the full response from the Department of Human Services to the questions relating to obtaining a medical certificate.
Are Medical Certificates being rejected? If so, in what circumstances?
The Department of Human Services (DHS) considers all available information when making income support payment decisions relating to medical conditions.
A job seeker who receives a payment which has mutual obligation requirements (e.g. Newstart) may be eligible for a temporary incapacity exemption if they are temporarily incapacitated for all work and unable to undertake another appropriate activity for at least eight hours per week. To be granted an incapacity exemption, the job seeker must provide a medical certificate signed by a medical practitioner which states:
- the medical practitioner’s diagnosis;
- the medical practitioner’s prognosis;
- that the person is temporarily incapacitated for all work (of at least eight hours per week); and
- the period for which the person is incapacitated.
An incapacity exemption may not be granted for a number of reasons including:
- The medical condition is not temporary (i.e. it is likely to persist for more than two years) and it is not a temporary exacerbation of that condition;
- The person has capacity to participate in a suitable program (such as Employment Services);
- The person is able to work at least eight hours per week; or
- Insufficient evidence supplied (e.g. the medical certificate does not contain all the required information).
If a person has capacity to participate in a suitable program, their mutual obligation requirements may be reduced temporarily rather than an exemption being granted. A person may also have their mutual obligation requirements reduced on an ongoing basis if they have a permanent condition and are assessed as having a partial capacity to work.
Is Centrelink experiencing problems with the quality of Medical Certificates provided?
DHS does not have information suggesting that there are problems with the quality of medical certificates provided. While there is a Department of Human Services’ medical certificate available for medical practitioner’s use, the department can still accept non-DHS medical certificates however it must still contain all relevant information in order for a job seeker to qualify for a temporary incapacity exemption.
What is the process when an illness continues for longer than the original certificate may have indicated?
An incapacity exemption can be granted for the period stated on the medical certificate or for a maximum of 13 weeks, whichever is the lesser. Further exemptions can be granted if the job seeker provides medical certificates and continues to meet all the criteria for an exemption.
If a job seeker is considered seriously ill, an exemption can be granted for a period of up to 52 weeks (negating the need to lodge a medical certificate every 13 weeks). A further exemption can be granted for up to 26 weeks, followed by 13 week exemptions if required.
Who decides that a medical certificate should be rejected? Are they a medical practitioner?
Service Officers in DHS assess medical certificates in accordance with the legislation and policy guidelines.
Once a decision to grant (or not grant) an exemption has been made, some job seekers may require an Employment Services Assessment (ESAt) if the medical certificate and other available information indicate that the job seeker:
- may have an ongoing partial capacity to work because of the impact of permanent conditions (i.e. likely to persist for more than two years),
- may have a temporary reduced work capacity of less than 30 hours per week, or
- is potentially eligible for a more appropriate payment such as Disability Support Pension (DSP).
ESAts are conducted by health and allied health professionals employed by the Department.
In addition, the Department’s Health Professional Advisory Unit (HPAU) can be engaged to provide and/or facilitate medical advice and opinion where the diagnosis or impact of medical conditions is unclear or complex, or where the job seeker may potentially be eligible for DSP. The HPAU is a team of health professionals and medical practitioners employed by the Department.
What information is provided to the claimant regarding why their medical certificate was rejected or their claim denied?
If an incapacity exemption is not granted, the job seeker is notified within 48 hours by phone and in writing. A Service Officer provides a full explanation of why the exemption is not granted, their mutual obligation requirements, and may discuss a possible referral for an ESAt. The job seeker is also advised of their right to request a review of the decision.