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Program 1.6: Military Rehabilitation and Compensation Acts Payments—Income Support and Compensation

Description

To provide compensation to current and former members of the Australian Defence Force and their dependants under the Safety, Rehabilitation and Compensation Act 1988 (SRCA) and the Military Rehabilitation and Compensation Act 2004 (MRCA) and related legislation.

Delivery

Deliver income support and compensation to veterans eligible under the SRCA and the MRCA and related legislation, by:

  • processing new claims to determine liability
  • processing incapacity payments for injuries resulting in permanent disability
  • processing non-economic loss lump sums or pensions for injuries resulting in permanent disability
  • processing payments to the dependants of deceased veterans under the MRCA and SRCA.

Safety, Rehabilitation and Compensation Act 1988

Liability

There were 7,139 SRCA liability claims received in 2016–17, compared to 7,343 in 2015–16.

In 2016–17, 6,462 compensation conditions were determined, with an acceptance rate of 55.0 percent, compared to 5,920 in 2015–16, with an acceptance rate of 60.9 percent.

The number of cases on hand at 30 June 2017 was 1,822, compared to 2,133 at 30 June 2016.

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Permanent impairment

There were 5,934 SRCA permanent impairment claims received in 2016–17, compared to 4,385 claims in 2015–16.

In 2016–17, 5,265 permanent impairment conditions were determined, with an acceptance rate of 30.0 percent, compared to 3,159 in 2015–16, with an acceptance rate of 31.6 percent.

A total of 1,630 SRCA one-off lump-sum payments for compensation for permanent impairment were made to clients in 2016–17, compared to 1,055 in 2015–16.

The number of cases on hand at 30 June 3017 was 1,370, compared to 1,938 at 30 June 2016.

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Incapacity

In 2016–17, a total of $75.9 million in SRCA incapacity compensation was paid to 2,126 payees, compared to $72.8 million and 2,160 payees in 2015–16. This represents a 4.1 percent increase in expenditure and a 1.6 percent reduction in the number of payees.

Incapacity payees receive benefits during the year for differing periods according to the length of time they are unfit for service or work and whether or not they are on a current rehabilitation program.

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Compensation for dependants

In 2016–17, 78 dependants of seriously injured or deceased former or serving ADF members received lump-sum compensation payments totalling $17.2 million, compared to 79 dependants and $20.5 million in 2015–16.

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Timeliness

Against a target of 120 days, the mean processing time for SRCA liability cases was 110 days in 2016–17, a 6.8 percent decrease when compared to 118 days in 2015–16. The improvement reflects the success of ongoing DVA initiatives to improve case management practices, business processes and communication with clients.

In addition, the median time taken to process SRCA liability claims in 2016–17 was 88 days, against a target of 100 days.

The median time taken to process SRCA permanent impairment claims in 2016–17 was 137 days, against a target of 100 days.

The median time taken to process SRCA claims for incapacity compensation in 2016–17 was 57 days, against a target of 50 days.

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Quality

DVA continues to work on improving performance by reinforcing policy and procedures and refining and improving staff training. Under the Improving Processing Systems Program, DVA is building a single R&C processing system. This system will include processing of SRCA liability, permanent impairment, and incapacity compensation claims and is expected to improve the quality of transactions.

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Most frequently claimed conditions and acceptance rates

The top 15 conditions most frequently claimed under the SRCA during 2016–17 are shown in Table 12. The top 15 categories represent 89.5 percent of the conditions claimed under the SRCA.

Table 12—Top 15 most frequently claimed conditions under the SRCA in 2016–17
Condition Accepted Acceptance rate (%) Not accepted Total claims
Mental disorders 344 42 472 816
Arthropathies and related disorders—disorders of the joints 566 73 205 771
Sprains and strains of joints and adjacent muscles 518 73 190 708
Deafness 252 42 355 607
Osteopathies, chondropathies and acquired musculoskeletal deformities 294 57 220 514
Disorders of muscle, tendons and other soft tissues 223 45 272 495
Dorsopathies—disorders of the spinal vertebrae and intervertebral discs 299 66 155 454
Other diseases 116 29 286 402
Other diseases of skin and subcutaneous tissue 105 48 115 220
Fractures 129 65 70 199
Other diseases of the ear and mastoid process 55 35 101 156
Other diseases of the digestive system including associated glands (liver, pancreas) 49 33 99 148
Other and unspecified injuries 44 35 83 127
Malignant melanoma of skin 43 52 40 83
Other disorders of the eye 37 46 44 81
Total 3,074 53 2,707 5,781

SRCA = Safety, Rehabilitation and Compensation Act 1988

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Military Rehabilitation and Compensation Act 2004

Liability

There were 9,316 MRCA liability claims received in 2016–17, compared to 8,472 claims in 2015–16.

In 2016–17, 19,683 compensation conditions were determined, with an acceptance rate of 73.3 percent, compared to 14,526 in 2015–16, with an acceptance rate of 71.4 percent.

The number of cases on hand at 30 June 2017 was 2,314, compared to 2,584 at 30 June 2016.

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Permanent impairment

There were 6,155 MRCA permanent impairment claims received in 2016–17, compared to 4,231 claims in 2015–16.

In 2016–17, 4,895 conditions were determined, with an acceptance rate of 59.7 percent, compared to 3,629 in 2015–16, with an acceptance rate of 58.9 percent.

A total of 2,157 MRCA one-off lump-sum payments for compensation for permanent impairment were made to clients in 2016–17, compared to 1,846 payments in 2015–16.

The number of cases on hand at 30 June 2017 was 1,998, compared to 2,008 at 30 June 2016.

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Incapacity

In 2016–17, a total of $132.9 million was paid to 4,180 payees for MRCA incapacity compensation, compared to $112.5 million to 3,629 payees in 2015–16. This represents a 18.1 percent increase in expenditure and a 15.2 percent increase in payees. It continues the forecasted steady growth of the MRCA as potential MRCA payee numbers increase.

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Compensation for dependants

In 2016–17, 68 dependants of seriously injured or deceased former or serving ADF members received lump-sum compensation payments totalling $13.7 million, compared to 54 dependants and $9.3 million in 2015–16.

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Timeliness

Against a target of 120 days, the mean processing time for MRCA liability cases was 107 days in 2016–17, an 8.5 percent decrease when compared to 117 days in 2015–16. The improvement reflects the success of ongoing DVA initiatives to improve case management practices, business processes and communication with clients.

In addition, the median time taken to process MRCA liability claims in 2016–17 was 93 days, against a target of 100 days.

The median time taken to process MRCA permanent impairment claims in 2016–17 was 152 days, against a target of 100 days.

The median time taken to process MRCA claims for incapacity compensation in 2016–17 was 49 days, against a target of 50 days.

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Quality

DVA continues to work on improving performance by reinforcing policy and procedures and refining and improving staff training. Under the Improving Processing Systems Program, DVA is building a single R&C processing system. This system will include processing of MRCA liability, permanent impairment, and incapacity compensation claims and is expected to improve the quality of transactions.

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Most frequently claimed conditions and acceptance rates

In determining the majority of liability cases, the Department refers to the Repatriation Medical Authority SOPs for the relevant condition. Table 13 details the 15 most frequently claimed conditions under the MRCA, based on SOPs usage, in 2016–17. The 15 most frequently used SOPs cover 57.5 percent of the conditions determined under the MRCA.

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Table 13—Top 15 most frequently claimed conditions under the MRCA (based on Statements of Principles) 2016–17
Condition Accepted Acceptance
rate (%)
Not
accepted
Total
Sprain and strain 1,810 88 237 2,047
Osteoarthritis 1,160 89 148 1,308
Tinnitus 1,174 98 19 1,193
Sensorineural hearing loss 851 88 111 962
Lumbar spondylosis 757 90 82 839
Depressive disorder 601 75 204 805
Rotator cuff syndrome 714 95 38 752
Fracture 627 86 106 733
Posttraumatic stress disorder 490 83 98 588
Joint instability 353 85 62 415
Alcohol use disorder 274 78 76 350
Adjustment disorder 232 67 115 347
Chondromalacia patella 325 95 16 341
Shin splints 319 97 11 330
Labral tear 278 88 37 315
Total 9,965 88 1,360 11,325

MRCA = Military Rehabilitation and Compensation Act 2004

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Merit reviews

Two levels of merit review activity are available to clients under the SRCA and the MRCA: reconsiderations and appeals. When an SRCA or MRCA client requests a reconsideration of a decision, a merit review is conducted by a delegate not involved in the original decision-making process.

For primary claim determinations made under the MRCA on or after 1 January 2017, the original determination would be reviewed by the VRB. (further information about merit reviews through the VRB is also contained in the VRB's annual report.)

Clients who are dissatisfied with the outcomes of reviews by the Department (SRCA) or the VRB (MRCA) may appeal to the AAT.

Table 14 summarises SRCA and MRCA merit review activity over the past three years. More information on decisions of the AAT is provided in the 'External scrutiny' section in Part 2 of the annual report.

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Table 14—SRCA and MRCA merit reviews and outcomes 2014–15 to 2016–17
Activity 2014–15 2015–16 2016–17
SRCA
Requests for reconsideration received 913 845 1,378
Requests for reconsideration decided 850 976 1,507
Decisions affirmed at reconsideration 520 682 898
Applications to the AAT 118 155 161
MRCA      
Requests for reconsideration received 485 554 351
Requests for reconsideration decided 518 569 499
Decisions affirmed at reconsideration 178 222 283
Applications to the VRB (s.137) 582 601 965
Applications to the AAT 71 97 106

AAT = Administrative Appeals Tribunal, MRCA = Military Rehabilitation and Compensation Act 2004, SRCA = Safety, Rehabilitation and Compensation Act 1988, VRB = Veterans' Review Board

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