Medico-legal firms – backgrounder

Medico-legal firms are independent providers specialising in examining a client (the veteran) to establish the diagnosis, impairment or incapacity and writing a report associated with medical diagnoses of conditions as part of a compensation claim. 

21 December 2019

Information surrounding a veteran’s medical condition is generally requested by the department to be provided by the veteran’s treating GP and/or specialist doctor.

If a treating GP or specialist is unable to provide this information, then with the agreement from the veteran, a request is sent to an independent medico-legal provider to establish the diagnosis, impairment and /or incapacity. The information provided is used by the department to assess the veteran’s medical condition against their claim.

If the claim is not accepted, the veteran may choose to seek an internal review and/or a review of the decision through the Veteran’s Review Board (VRB). If the claim is upheld at the VRB – that is, the original decision not to accept is agreed – then the veteran may choose to seek an external review through the Administrative Appeals Tribunal.

When providing medical evidence, medico-legal companies are bound by ‘Expert Witness’ protocols which validates their level of independence.

When DVA selects a medico-legal firm for a client, the department takes into account speciality qualifications, quality of the completed reports and/or questionnaires, geographic location, timeliness, and/or cost.

Reviewing the use of medico-legal firms

DVA frequently used medico-legal firms in the past to speed up processing. However, some veterans felt that the use of medico-legal firms did not allow for the detailed knowledge of the individual veteran to be reported, compared to the longstanding relationship that a veteran may have with their treating doctor. Wherever possible, medical reports needed to assess a claim are sourced from the treating doctor.

However, in some cases, the veteran does not have a treating doctor, in which case the option of a medico-legal doctor may be offered to the veteran to allow their claim to be progressed.

More generally, the department is reviewing options to streamline the processes associated with accessing medical advice, and in particular improving the veterans’ and their families’ experience on those occasions when dealing with medico-legal firms.

Outcomes

DVA has addressed the concerns around the use of medico-legal companies by:

  • comprehensively reviewing the use of medico-legal firms and looking to explore future models for engaging and attracting high quality medico-legal providers to deliver fit for purpose services
  • undertaking regular meetings with these companies providing feedback from clients for rectification
  • developing better advice for clients to explain the reason for the visit to the medico-legal company and what they can expect from the appointment
  • reinforcing existing policy that DVA must use the advice of the treating medical practitioner and if detail on the treating medical practitioner is not evident in the claim, the client must be contacted for treating medical practitioner information (ensuring medico-legal companies are not used unnecessarily)
  • improving financial tracking and reporting of the use of medico-legal firms.

2019 Budget initiatives

  • The Department will be extending the Provisional Access to Medical Treatment trial to provide clients with access to treatment for specified conditions before their claim is approved. This trial is getting veterans the treatment they need faster and preventing the risk of further deterioration from their condition. The trial is also providing valuable data to shape the future of service delivery and will enable the DVA to continue to reduce the time taken to approve claims. The program will be subject to evaluation ($4.2 million).
  • From 1 July 2019, all Australian Defence Force (ADF) personnel leaving full-time service can access a fully-funded comprehensive health check from a GP every year for the first five years.

For those in need of immediate mental health support and counselling, Open Arms – Veterans and Family Counselling Service can be contacted on 1800 011 046, 24 hours a day, seven days a week.