Compensation assessments

How you can prepare to see a veteran in your practice

To DVA a veteran is any person who has served more than one day or is serving in the Australian Defence Force. Some serving or ex-serving personnel may not identify with the term ‘veteran’. To identify whether or not someone is a veteran ask, “Have you ever served in the defence forces?” 

• If the answer is “Yes” ask, “Do you have a Veteran Card?”
• If they say they have served and do not have a Veteran Card ask them to contact DVA to check if they’re eligible for funded healthcare and support. 

Further information on veteran status and DVA contact information available from the DVA Basics quick guide.

Veterans may be eligible for DVA funded medical treatment and compensation for health conditions related to their service.

When medical information is needed to assess a claim, DVA will send a Request for Information (including a request letter, the specific form(s) that DVA requires the doctor to complete and a transaction reference number that can be used for invoicing) to the doctor nominated by the veteran.  In general requests for information will either be for liability assessments or permanent impairment assessments.

What are liability assessments?

Liability assessments determine whether a veteran's military service contributed to the development or worsening of a health condition. To assist DVA in determining liability, information related to the diagnosis and key dates are required from a medical practitioner. Acceptance of liability provides the veteran with access to DVA-funded treatment and other benefits.

What are impairment assessments?

An impairment assessment aims to determine the impact of a veteran’s service-related condition(s) on their overall function. DVA asks for information such as the severity of the condition, previous and current treatment, the veteran’s functional status, and a small number of simple examination findings. The assessment should be based on the veteran’s impairment on average – not how their impairment appears on their best or worst day.

What do I need to provide to DVA to get paid for my assessment?

DVA pays for completion of a compensation assessments it has requested with separate consideration of consultation time, number of pages completed, and details of clinical notes or reports provided. DVA should be invoiced directly for this work. Payment is not through Medicare or DVA card arrangements. Further details and billing guidance can be found on the DVA Quick Tips for Health Providers: Billing for Compensation Claims. 

To submit documents:

• Use the Provider Upload Page (PUP).
• You will need a Transaction Reference Number which is attached to the Request from DVA to upload your invoice and documents.
• Upload your assessment first, and then your invoice

What if the assessment is challenging or will take too long?

There is no obligation for the nominated doctor to complete the assessment. If you cannot undertake the assessment in a timely manner, or do not wish to undertake the assessment please inform the delegate who sent you the request – their details will be on the request letter or email. Some assessments are particularly complex and may require an independent examiner or other expert assessors requiring specialist knowledge to assess a veteran’s conditions.

If a provider considers the published fee to be insufficient for a particular assessment, they may request consideration of an above-fee payment before the assessment is undertaken by:

• completing the D9551 form
• sending the form to compensation.trn.prior.approval@dva.gov.au 

DVA compensation fee guidance is available on Fee notes for GPs and specialists. Further information on the DVA compensation report journey is available on the blog From claim to compensation: a GP’s guide to the DVA journey.