LEX 72807 - Page 1 of 40
s22
Assessing and coding medical evidence for temporary incapacity
exemptions 001-22112401
Currently published version valid from 5/04/2023 3:02 PM
Background
s22
This document outlines information to help assess and code medical evidence for determining temporary incapacity
exemptions.
Temporary incapacity exemption
Customers claiming or receiving a participation payment may request a temporary incapacity exemption from mutual
obligation or participation requirements by submitting a valid medical certificate to Services Australia.
A temporary incapacity exemption may be granted if the customer:
•
has an incapacity which makes them unable to work, study or participate in other activities (for 8 hours or
more per week), and
•
the incapacity is likely to be temporary, and
•
lodges a valid medical certificate
A decision to reject an exemption because a customer has some capacity to participate must be supported by current
medical evidence from the medical practitioner.
Information required to assess a temporary incapacity exemption
A valid medical certificate must be provided and is the
primary evidence used to determine whether a temporary
incapacity exemption can be granted.
The following information is not required for a valid medical certificate but may be provided by the medical
practitioner and should be considered before making a decision:
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• the medical practitioner has indicated the person can participate in other ways to meet their requirements
• there is reason to believe the incapacity has been brought about by the person in order to avoid meeting
their requirements
• the incapacity is wholly or mainly caused by drug and/or alcohol dependency/misuse
The medical practitioner's signature is not required if an online SU683 certificate has been lodged via the Health
Professional Online System (HPOS).
A new ESAt is
not required in deciding whether to grant or deny a temporary incapacity exemption. An exemption
decision should be finalised based on available medical evidence. To determine if an ESAt is required following an
exemption decision, see Request an Employment Services Assessment (ESAt).
Decision considerations and other medical evidence
In addition to a medical certificate, Service Officers may need to consider other evidence available on the customer's
record. This includes circumstances where a customer's eligibility for an exemption is less clear, such as where:
• the customer has been, or is expected to be incapacitated for work for more than 2 years
• there is other evidence showing the customer may have some capacity for work
Other sources of evidence may provide useful information for making a decision, however, they
do not replace or
'override' the medical certificate as the primary, and usually most recent, evidence for a temporary incapacity
exemption decision.
Other relevant evidence may include:
• the customer's history of medical certificate submission, including any cumulative, extended period of
incapacity exemptions which may indicate their incapacity is no longer temporary
• any current and valid assessment of the job seeker's work capacity in an Employment Services Assessment
(ESAt) or Job Capacity Assessment (JCA) report
• reported earnings from employment, particularly where the customer is currently working 8 hours per week
or more in open employment for multiple consecutive entitlement periods
• evidence the temporary incapacity may have been:
o primarily caused by, or be attributed to drug and/or alcohol dependency/misuse- this may indicate
an exemption can't be granted
o brought about in order to avoid meeting their requirements
When considering other evidence, care should be taken as previous information can be invalid if the customer's
circumstances have changed.
Although a current and valid ESAt or JCA may provide additional information to support an exemption decision
including assessments of Temporary Reduced Work Capacity (TRWC), customers applying for a temporary incapacity
exemption always need to provide a valid medical certificate. A temporary incapacity exemption cannot be granted
based solely on an ESAt or JCA report, without a valid medical certificate.
Note: Service Officers should take care using ESAt/JCA work capacity recommendations to reject a request for a
temporary incapacity exemption, unless the information is still clearly relevant to the customer's
current medical
circumstances.
An ESAt/JCA assessment of work capacity is a point in time assessment and circumstances may
change. If an ESAt or JCA includes an assessment of Temporary Reduced Work Capacity (TRWC), this does not
replace the assessment of a temporary incapacity exemption based on a valid medical certificate.
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See the Resources page for examples.
Temporary and permanent incapacity
The decision to grant or reject a request for a temporary incapacity exemption must be based on whether the
duration of the current functional impact is temporary or permanent.
Temporary incapacity
A person's incapacity is considered temporary if the duration of the current functional impact is expected to be
resolved, or improve enough to allow a return to work, study or other activities of at least 8 hours per week within 24
months. Further assessments of work capacity are unlikely to be required if only temporary conditions are included on
the medical certificate.
An exacerbation of a permanent medical condition is also considered temporary if it is expected the current functional
impact of the exacerbated symptoms will resolve within 24 months.
For example: a customer's incapacity due to a medical condition may be considered permanent, however, the
symptoms may temporarily worsen/flare up for a short period. In this circumstance, staff may consider the functional
impact is temporary.
Permanent incapacity
A person's incapacity is considered permanent if the duration of the current functional impact is likely to persist for 24
months or longer. Where the medical certificate only includes conditions with a permanent incapacity, an exemption
may not be appropriate. A referral for an Employment Services Assessment (ESAt) should be considered to determine
the customer's ongoing work capacity, or if alternate assistance may be appropriate
Note: ESAts do not apply to
ParentsNext participants.
Serious illness
A serious illness or injury is expected to impact on a customer's ability to undertake work, study or otherwise meet
their requirements for 8 hours or more per week for an extended period (more than 13 weeks and less than 24
months). See Exempting a job seeker from mutual obligation requirements for serious illness.
Inviting a claim for DSP
A customer lodging a medical certificate may be invited to claim DSP only in limited circumstances, including where
they are likely to be manifestly medically eligible.
This includes where:
• available medical evidence clearly shows the customer is terminally ill and their life expectancy is less than 2
years
• the medical evidence shows the customer has a List 1 or List 2 condition
• the recommendation to claim DSP is made by an agency health or allied health professional, including the
Health Professional Advisory Unit, or as part of an ESAt upgraded to a JCA
Evidence of terminal illness includes the treating doctor answering 'Yes' to the question 'Will this result in an average
life expectancy of 24 months or less?' on the Medical Certificate (SU415).
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A customer must not be advised to claim DSP simply because the functional impact duration of their condition is
assessed as 'permanent'. A recommendation to claim DSP should only occur where a customer is likely to meet all
medical eligibility and other criteria for DSP based on available evidence.
Note: diagnosis of a List 2 condition does not mean the customer is automatically medically eligible for DSP -
additional assessment action may be required to ascertain the prognosis or severity/progression of the condition.
Note: if a job seeker's medical evidence indicates they have a terminal illness they may be manifestly eligible for
Disability Support Pension (DSP) and Service Officers should assist with claiming Disability Support Pension (DSP).
See the Resources page for examples.
Maximum exemption period
The maximum exemption period for a single certificate is the lesser of:
• the period of temporary incapacity stated by the medical practitioner on the certificate, or
• 13 weeks (91 days) beginning on the start date of the temporary incapacity period noted on the certificate,
or
• 12 months for the initial exemption period for customers who are undergoing or recovering from intensive
medical treatment for a serious illness. See Exempting a job seeker from mutual obligation requirements for
serious illness for further information
Customers can apply for a further temporary incapacity exemption if they are still temporarily incapacitated and
unable to meet their requirements at the end of their current exemption. Each new medical certificate lodged must be
assessed and a decision reached on whether to grant or reject any further exemption period.
Exemption ending
Expiry of exemption
An exemption review is automatically generated one day after the temporary incapacity exemption ends.
If further medical evidence has not been provided when the exemption period ends, the customer wil be required to
satisfy requirements to continue receiving payments.
Manual y end-dating an exemption
A customer may advise Services Australia they no longer need a temporary incapacity exemption before their current
medical certificate has expired. Before this can be updated, the customer wil need to provide evidence from their
medical practitioner stating they are now able to work, study or participate in other activities of at least 8 hours per
week.
Gap in coverage
A temporary incapacity exemption can be extended if the customer lodges a new medical certificate, and continues to
be eligible for a:
• temporary incapacity exemption, or
• temporary incapacity exemption for serious illness
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If a new valid medical certificate is provided, and there is a gap of less than 14 days between the end of the period of
incapacity on the previous medical certificate and the start of the period of incapacity on the new medical certificate,
the new certificate can be taken as providing continuous coverage. This only applies if the Service Officer is satisfied
the person has remained incapacitated for work during that time and the medical certificate was lodged within 14
days of the expiry date.
If the gap between the periods of incapacity is 14 days or more there is no continuous coverage.
Where there is no continuous coverage the customer is expected to meet their requirements for the non-continuous
period. Eligibility for a temporary incapacity exemption should be assessed from the incapacity start date on the new
medical certificate.
See the Resources page for examples.
Contact with the medical practitioner
It may be appropriate to contact the medical practitioner who issued the medical certificate where:
• information on the medical certificate is incomplete or requires clarification, including where there are
concerns:
o the customer is experiencing vulnerability and may have difficulty contacting their medical
practitioner to request a new/updated medical certificate, or
o a decision not to grant an exemption may have a detrimental impact on customers who may be
experiencing vulnerability and further information is being sought or clarified
• there are valid concerns about the integrity of the information
Any additional information obtained via the contact must be clearly documented on the customer's record, including
the medical professional's contact name and number.
If an Assessor made contact as part of determining an ESAt or JCA, information from the medical practitioner will be
documented in an SA463 Additional Evidence form.
Drug and/or alcohol dependency/misuse
With the exception of Community Development Program (CDP) participants, customers are not eligible for an
incapacity exemption if their temporary incapacity is wholly or mainly attributed to drug and/or alcohol
dependency/misuse. This only applies if it is listed on the medical certificate as the
primary medical condition.
CDP participants undertaking a drug and/or alcohol rehabilitation programme are eligible for a temporary incapacity
exemption.
The exemption can be granted for job seekers who are participating in residential rehabilitation programmes
voluntarily or by Court Order.
For further information related to coding and follow-up action, see:
• Exempting a job seeker from mutual obligation requirements due to special circumstances
• Drug or Alcohol dependency treatment program or intervention as an approved activity
Employment Services and ParentsNext Providers
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Customers are responsible for notifying their provider or Services Australia of their current circumstances. It may be
more appropriate for their requirements to be adjusted rather than exempting them from all requirements. The
customer's provider reviews and/or amends their points target, taking into consideration their current circumstances.
This ensures the customer remains engaged with their provider and will maximise their employment opportunities.
For ParentsNext participants, the provider may also grant the exemption.
If Services Australia grants a temporary incapacity exemption, the following information becomes available to the
provider:
• the type of exemption (temporary incapacity/temporary incapacity - serious illness)
• the date the exemption was granted
• the exemption period (start and end dates)
Providers can also view information recorded in the Job Seeker Snapshot and ESAt/JCA reports.
A decision to reject a temporary incapacity exemption has no direct impact on how a provider delivers their services.
Services Australia does not advise providers when a decision is made to reject an exemption. However, providers may
become aware of the decision where:
• the coding of a medical certificate triggers an update in the Job Seeker Snapshot,
• new information is recorded on the s47E(d)
or
• a new ESAt referral is booked
Review and appeal rights
Decisions related to temporary incapacity exemptions are subject to the usual internal and external review and appeal
processes. See Reviews and Appeals.
Service Officer suspects medical certificate may be fraudulent
If the Service Officer is not satisfied with the integrity of the information on the medical certificate, a temporary
incapacity exemption should not be granted. See suspected fraud in Centrelink Medical Certificate (SU415 or SU683)
for further information.
The Resources page has:
• classification attachments
• examples of how to use evidence to determine whether an incapacity is temporary or permanent and to
inform a decision to grant or reject an exemption request
• how to code temporary incapacity exemptions
• codes for Non-Applied Exemptions
• links to Workforce Australia, forms, helpdesk, Report Suspected Fraud and Corruption and video
demonstrations of Customer First Established Support Links
Related links
Altered processes and mutual obligation requirements for job seekers due to coronavirus (COVID-19) response
Approved activities for customers assessed as having a partial capacity to work (PCW)
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Approved activities for customers assessed as having a temporary reduced work capacity (TRWC)
Assessment Services
Cancel ation of JobSeeker Payment (JSP) or Youth Al owance (YA) (job seeker) at customer's request
Centrelink Medical Certificate (SU415 or SU683)
Circumstances impacting capacity to comply with compulsory requirements
Claiming JobSeeker Payment (JSP)
Classifying Centrelink digital images via the National Queue
Customers claiming JobSeeker Payment (JSP)/Youth Allowance (YA) (Incapacitated)
Drug or Alcohol dependency treatment program or intervention as an approved activity
Eligibility for Disability Support Pension (DSP)
Eligibility for JobSeeker Payment (JSP)
Exempting a job seeker from mutual obligation requirements for serious illness
Health Professional Online Services
How to code and action a manual review
Job Capacity Assessment (JCA) and Employment Services Assessment (ESAt) appointments
Job Plans
Job seekers with a partial capacity to work or a temporary reduced work capacity
Locating digital images via Document Tools in Customer First
Medical conditions, codes and terminology
Mutual obligation requirement exemptions
Negotiating Job Plans for incapacitated persons
ParentsNext appointments and processing
ParentsNext exits and exemptions
Processing JobSeeker Payment (JSP) claims
Providing services to customers with disabilities
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Rejecting a claim for JobSeeker Payment (JSP) or Youth Allowance (YA) (job seeker)
Report Suspected Fraud and Corruption
Request an Employment Services Assessment (ESAt)
Resources on illnesses, injuries and disabilities
Scanning Centrelink medical/sensitive documents using an MFD
Services Australia's responsibilities for managing compliance with compulsory requirements
Using an Employment Services Assessment (ESAt) report to determine payment type
Viewing Centrelink customers' digital images
Youth Allowance (YA) student or Australian Apprentice becomes incapacitated
Process
Medical certificate lodgement and contact about temporary incapacity exemptions
Assessment of a medical certificate for temporary incapacity exemption
Coding the medical certificate
Manually changing the end date of a temporary incapacity exemption or reassessing an incorrectly coded medical
certificate
Advise outcome and determine follow-up actions
Medical certificate lodgement and contact about temporary incapacity
exemptions
Table 1
Item
Description
1
Customer contacts about temporary incapacity exemption but has not submitted a medical
certificate + Read more ..
Tell the customer:
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• they will need to submit a valid medical certificate completed by a medical practitioner
• medical practitioners can access the Centrelink Medical Certificate (SU415) on the Services
Australia website (the Resources page contains a link)
• they can submit the completed medical certificate online or in person
• the medical practitioner can complete an online Medical Certificate (SU683) available in the
Health Professional Online Service (HPOS) and upload it electronically using HPOS
• once submitted, the medical certificate will be assessed and they will be advised of the
outcome
• they must continue meeting their requirements until their application for exemption is
assessed
• to contact their provider
before the scheduled start time of any appointments/activities, if
they are unable to meet their requirements
Procedure ends here.
2
Customer submits a hard copy medical certificate in person at a service centre + Read more ..
A suitably skilled Service Officer is to assess the medical certificate and advise if an exemption can be
granted.
If a walk-in appointment is not possible:
• check the customer's contact details are correct and up to date, and
• scan the medical certificate to the customer's record
An activity will be created and allocated to the next available suitably skilled Service Officer for action.
Tell the customer:
• they will be notified of the outcome when their medical certificate is assessed
• they must continue meeting their mutual obligation requirements until their application for
exemption is assessed
• to contact their provider
before the scheduled start time of any appointments/activities if
they are unable to meet their requirements
The medical certificate must be assessed by no later than close of business the day after lodgement.
To register the medical certificate, see Step 4 in Table 3.
3
Medical certificate has been submitted for a temporary incapacity exemption + Read more ..
If a medical certificate has been submitted online (by the customer or their medical practitioner) or
scanned to the record by a staff member, an electronic copy should be available on the customer's
record.
s47E(d)
If the medical certificate is available and:
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• has been lodged as part of a new claim, go to Item 4
• ready for processing and the Service Officer is:
o suitably trained, see Step 1 in Table 2
o not trained to code/assess, tell the customer:
- they will be notified of the outcome when their medical certificate is assessed
- they must continue meeting their requirements until their application for
exemption is assessed
- to contact their provider
before the scheduled start time of any
appointments/activities, if they are unable to meet their requirements
The medical certificate must be assessed by no later than close of business the day after lodgement.
Procedure ends here.
4
Medical certificate lodged as part of a new claim + Read more . .
Tell the customer their medical certificate will be assessed as part of their claim and they will be
notified of the outcome.
Updates47E(d)
stating a medical certificate has been lodged as part of the new
claim and needs to be actioned.
If processing the claim, see Step 1 in Table 3. Otherwise, procedure ends here.
5
Employment Services Provider contacts about temporary incapacity exemption + Read more ..
If a provider contacts about a temporary incapacity exemption for a customer, tell them:
• customers are responsible for requesting a temporary incapacity exemption, and providing a
valid medical certificate to Services Australia if they believe they are unable to reasonably
meet their requirements due to an illness or injury
• the customer wil be notified of the outcome of their request, and
• until a decision is made whether to grant a temporary incapacity exemption, the provider is to
support the customer in the manner they deem most appropriate
If Services Australia grants a temporary incapacity exemption, providers can view the following
information in their ICT system:
• the type of exemption (Temporary Incapacity/Temporary Incapacity - Serious illness)
• the date the exemption was granted
• the exemption period (start and end dates)
Providers can also view information recorded in the Job Seeker Snapshot and Employment Services
Assessment (ESAt)/Job Capacity Assessment (JCA) reports.
Services Australia does not advise providers when an exemption has not been granted. However,
providers may become aware of a non-grant decision where:
• the coding of a medical certificate triggers an update in the Job Seeker Snapshot, or
• new information is recorded on the s47E(d)
or
• a new ESAt referral is booked
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It may be appropriate for providers to adjust the requirements in a customer's Job Plan/Participation
Plan rather than exempting them from all requirements. This ensures the customer remains engaged
with their provider and will maximise their employment opportunities.
Assessment of a medical certificate for temporary incapacity exemption
For appropriately trained staff only.
Table 2
Step
Action
1
Review the medical certificate + Read more ..
Check the document is a valid medical certificate.
An electronic copy of the medical certificate can be found:
s47E(d)
Note: a signature is not required on the medical certificate if it has been uploaded by the medical
practitioner using the Health Professional Online Service (HPOS).
Does the document contain all the required information for a valid medical certificate?
•
Yes, go to Step 3
•
No, go to Step 2
2
Incomplete medical certificate + Read more ..
If the medical certificate does not contain all the required information, complete the questions
covering an incomplete medical certificate in:
s47E(d)
Contact with the medical practitioner may be required to seek the missing information if there are
concerns the customer is experiencing vulnerability and may have difficulty contacting their medical
practitioner to request a new or updated medical certificate. Go to Step 4.
Where there are no concerns the customers may be experiencing vulnerability and the certificate was:
• lodged in person; return the medical certificate and advise they will need to ask their medical
practitioner to update the form with the outstanding information or complete a new one
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• not lodged in person; a letter is automatically sent to the customer advising the medical
certificate is incomplete. The service officer must make one genuine attempt to contact the
customer to advise the outcome. If subscribed, issue a pre-call notification (SMS only)
between 8:00am to 8:00 pm using the customer's local time. If unable to contact the
customer, cal their correspondence nominee (if they have one). See Disclosing information to
a nominee
Procedure end here.
3
Consider other relevant evidence on the customer's record + Read more ..
Other relevant information may include a current and valid ESAt/JCA report, earnings reported and/or
previously lodged medical certificates. This information can be viewed via:
s47E(d)
Where there is a current and valid ESAt/JCA, consider if the information/recommendations are relevant
to the request for a temporary incapacity exemption. An exemption should not be granted if the
ESAt/JCA indicates the incapacity is not temporary and that the customer has a capacity to work,
unless the medical certificate indicates a new condition or a change to those listed. The customer
should discuss requirements with their provider.
Remember: the medical certificate is the most current evidence of the customer's circumstances and
therefore remains the primary source of evidence for determining whether an exemption should be
granted. An exemption cannot be granted or rejected solely on the recommendations of an ESAt/JCA.
Contact with the medical practitioner may be required to confirm/clarify details provided, including
where:
• it appears an incapacity is not, or may no longer be temporary, or
• there are concerns about the validity of the medical certificate
Is there enough information to make a decision?
•
Yes, go to Step 5
•
No, go to Step 4
4
Contact with the medical practitioner + Read more ..
It may be appropriate to contact the medical practitioner who issued the medical certificate where:
• information on the medical certificate is incomplete or requires clarification, including where
there are concerns:
o the customer is experiencing vulnerability and may have difficulty contacting their
medical practitioner to request a new/updated medical certificate, or
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o a decision not to grant an exemption may have a detrimental impact on a customer
who may be experiencing vulnerability and further information is being sought or
clarified
• there are valid concerns about the integrity of the information
Note: if the medical practitioner has completed an old version of the medical certificate, tell them they
can now access the SU415 on Services Australia's website or explain how to order the latest version. An
old version should still be accepted if it contains all relevant information. See Centrelink Medical
Certificate (SU415 or SU683) for details of how a medical practitioner can order the new form.
If contact with the medical practitioner is:
•
successful, and they advise:
o they never issued the certificate or the information is different, go to Step 7
o the information is accurate, or provides further information. s47E(d)
•
unsuccessful:
o and a valid medical certificate was lodged, document what was going to be
discussed (unless it would be detrimental to the customer) and process the medical
certificate as per normal processes. Go to Step 5
o for all other circumstances, go to Step 7
5
Determine whether the temporary incapacity exemption can be granted + Read more ..
Based on the available medical evidence, an exemption can likely be granted if:
• the customer is suffering from a temporary incapacity, illness or injury,
and
• the customer is currently incapacitated for all work, study other activities of at least 8 hours
per week,
and
• the
incapacity is likely to persist for less than 13 weeks, or 13 weeks to 24 months,
and
• the decision maker is satisfied the incapacity has not been brought about intentionally in
order to gain an exemption,
and
• the
primary condition has not been attributed to drug and/or alcohol dependency/misuse,
and
• other evidence available on the customer's record
supports the determination that an
exemption is appropriate
An exemption may not be appropriate if the customer:
• has previous exemption history or recommendations in a current and valid ESAt indicating
the incapacity is no longer temporary
• is able to work, study or participate in other activities of at least 8 hours per week, or
• has a current assessment of Partial Capacity to Work (PCW) or Temporary Reduced Work
Capacity (TRWC) of more than 8 hours
Where it is not clear if the incapacity is permanent, an ESAt may be required. If referring the customer
for an ESAt, consider granting the exemption to allow time for the ESAt to be completed.
An exemption
cannot be granted where:
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• the medical practitioner has indicated the customer is able to meet their requirements by
undertaking other activities. The customer will need to discuss other ways of meeting their
requirements with their provider
• the primary condition is caused by the customer's substance dependency/misuse, unless the
customer is a CDP Participant. s47E(d)
See Mutual obligation requirements exemptions for more information
• it is clear the incapacity is expected to be permanent (i.e. it is expected to last longer than 24
months)
If it is determined a temporary incapacity exemption:
•
can be granted, go to Step 6
•
cannot be granted, see Step 1 in Table 3
6
Consider whether a Temp-Incap Serious Illness exemption should be applied + Read more . .
A serious illness is expected to impact on a customer's ability to participate for an extended period
(greater than 13 weeks, up to 24 months).
See Exempting a job seeker from mutual obligation requirements for serious illness, before returning
to code the medical certificate. See Step 1 in Table 3.
7
Concerns about the medical certificate + Read more ..
A temporary incapacity exemption can only be granted if the Service Officer is satisfied the medical
certificate is authentic.
Note: do not place the medical certificate on hold.
If the medical practitioner confirmed they did not complete the medical certificate or there are
concerns about the integrity of the document that staff could not verify:
• process the medical certificate as per normal procedures and select the most appropriate
non-exemption reason
• do
not record specific details of the allegations on the customer's record
• complete a Suspected Fraud referral (the Resources page contains a link to the referral form)
If the customer indicates, they are or may be at risk of suicide or self-harm, are experiencing family and
domestic violence, or may require social work support for other complex needs and vulnerable
circumstances, discuss or make a referral to a social worker. See Social work service referral.
Where assistance is required to determine any of the above, discuss with immediate supervisors or
escalate through normal channels.
See Step 1 in Table 3.
Coding the medical certificate
For appropriately trained staff only.
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Table 3
Step
Action
1
Determine the activity type for the medical certificate + Read more ..
If the medical certificate is being coded:
• as part of a new claim, go to Step 2
• for a non-new claim, go to Step 3
2
Medical certificate is being coded as part of a new claim activity + Read more ..
The medical certificate must only be actioned by a suitably skilled Service Officer
within the new claim
activity.
Do not use task selector in Process Direct or the guided procedure in Customer First to
process a medical certificate within a new claim. This must be actioned manually within the new claim
activity in Process Direct:
s47E(d)
Coding a medical certificate within a claim may change the start date of the claim. Service Officers
must assess the impact of the medical certificate and the payment start date.
Prior to finalising the claim, confirm the correct payment start date is displayed/recorded on the
relevant start date calculator screen to ensure payment from the correct qualification start date occurs.
See Calculating the start day for an incapacitated customer.
To begin coding, go to Step 4.
3
Medical certificate is being coded for a non-new claim activity + Read more ..
If the medical certificate is being coded for a
DSP customer with participation requirements, or
solely for the purpose of receiving Pharmaceutical Allowance (PhA) code manually s47E(d)
s47E(d)
For all other scenarios, suitably skilled Service Officers may code the medical certificate using either
the:
s47E(d)
LEX 72807 - Page 16 of 40
Note: the fields to be completed and the order in which they appear will vary depending on whether
s47E(d)
4
Register the medical certificate + Read more ..
Whenever a customer lodges a medical certificate it should be registered, even where it is not valid
and/or will not be coded. This is to ensure Services Australia has a record of the certificate.
Can the medical certificate be processed?
•
Yes, go to Step 5
•
No,s47E(d)
Once registration questions are complete, if the customer has:
• lodged in person, return the medical certificate and advise they will need to ask their medical
practitioner to provide the missing information. Make sure the customer understands what is
required
• not lodged in person, a letter is automatically sent to the customer advising the medical
certificate is incomplete
Procedure ends here.
5
Code the medical certificate + Read more ..
Read
Decision considerations and other medical evidence before coding the medical evidence. See
the Background page.
Where an exemption
is to be granted and the dates on the new medical certificate overlap with a
previously recorded certificate, and a temporary incapacity exemption was
not granted with the first
medical certificate, do not amend the details of the previous certificate. Overlapping the dates is not
an issue where the decision for the previous medical certificate was not exempt, or where the decision
for both the previous and new certificate is not exempt.
Medical Conditions: Record all medical conditions listed on the medical certificate by selecting the
relevant medical condition codes. If a Temp-Incap Serious Illness exemption is to be granted, code the
serious illness condition first so this is recorded as the primary medical condition.
Record the current functional impact for each medical condition as either:
• PRM = Permanent (24 months or more)
• TMP = Temporary (less than 13 weeks, or 13 weeks to 24 months)
Note: REC (Reoccurring) code is no longer required when processing a medical certificate.
Exacerbations of permanent conditions are now considered by the treating doctor within the period of
functional impact recorded on the certificate.
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Prognosis: Record the prognosis of the medical condition from the medical certificate tos47E(d)
follows:
• A - Less than 3 months (
or if the medical certificate states Less than 13 weeks)
• B - 3-12 months (
or if the medical certificate states 13 weeks up to 24 months)
• C - 13-24 months
• D - 24 months or more
If
uncertain is selected, code the length of the medical incapacity stated on the medical certificate.
s47E(d)
To continue coding, go to Step 6.
6
Continue coding the medical certificate + Read more ..
s47E(d)
Assigning Professional: title of the person or authority providing the diagnosis of the medical
condition. The system defaults to 'Treating Doctor' but this can be changed. Use field help ('?') for
relevant values.
Name: the name of the medical practitioner or other health professional.
Note: for remote areas only,
a medical certificate may be completed by a community nurse.
Telephone Contact: the contact phone number for the medical practitioner or other assigning
professional who provided the medical certificate. Record area code and phone number, except for a
mobile phone number - key the whole number in the
Number: field and leave
Area: field blank.
Provider number: (leave blank if not provided).
LEX 72807 - Page 18 of 40
Number Hours per week: the number of hours per week (0-50) the assigning professional considers
the customer is capable of undertaking.
Unfit to work/study from: use the from date on the medical certificate if:
• the start date of the new medical certificate is before the end date of the previously coded
medical certificate, code the
from date as previous medical certificate end date + 1
• the medical certificate was lodged within 14 days with a gap in coverage and the Service
Officer has determined ongoing eligibility for an incapacity exemption, code the
from date as
previous medical certificate end date + 1
Unfit to work/study to: the maximum period a temporary incapacity exemption can be coded for is
13 weeks, unless it is a Serious Illness Exemption and the medical certificate covers a longer period.
The
to date must be the lesser of the end date on the medical certificate or 13 weeks (91 days) from
the unfit to work/study from date, including the
from date.
Determine if a
serious illness exemption can be granted by completing the questions. See Exempting
a job seeker from mutual obligation requirements for serious illness.
s47E(d)
Advise the customer of the outcome. See Step 1 in Table 5.
7
Event Date where customer has a current or recently expired incapacity exemption + Read more
. .
Compare the end date of the existing incapacity exemption, with the
Unfit to work (or study) from
date on the new medical certificate.
Check the
date of receipt of the new medical certificate.
The
Event Date of the new medical certificate can be backdated to the day after the previous
incapacity exemption expired (previous
Unfit to work/study to date + 1) if:
• the new medical certificate was submitted within 14 days of the existing incapacity exemption
expiring, and
• there is a gap of 14 days or less between the incapacity end date on the previous medical
certificate and the incapacity start date on the new medical certificate, and
• the Service Officer is satisfied the person has remained incapacitated for work during that
time
LEX 72807 - Page 19 of 40
If the
Unfit to work (or study) from date of the new medical certificate is
before the end date of the
previously coded medical certificate, the
Event Date is the day after the previous incapacity exemption
expires (previous
Unfit to work/study to date + 1).
Otherwise, the
Event Date is the
Unfit to work/study from date stated on the new medical
certificate. This may mean there is a gap in coverage.
Manually changing the end date of a temporary incapacity exemption or
reassessing an incorrectly coded medical certificate
For appropriately trained staff only.
Table 4
Step
Action
1
Eligibility for change + Read more ..
A change may be required for a previously recorded medical certificate where a customer no longer
needs an exemption or where details were incorrectly coded.
• If the customer notifies they no longer need a temporary incapacity exemption, go to Step 2
• If the previous medical certificate was incorrectly coded, go to Step 3
2
Manual y end exemption + Read more ..
Customers must provide new medical evidence stating the customer now has capacity to meet their
requirements.
Has new medical evidence been provided?
•
Yes, ensure an electronic copy of the evidence is available on the customer's record. go to
Step 4
•
No, no change can be actioned without new medical evidence. Procedure ends here
3
Reassessing an incorrectly coded medical certificate + Read more ..
s47E(d)
only suitably skilled Service
Officers should reassess previously coded medical certificates where an error in the incapacity period
or the customer's capacity to participate has occurred.
Note: the details of a previously assessed medical certificate must not be amended.
As the
Unfit to work/study from and
to dates are the same as those previously coded:
LEX 72807 - Page 20 of 40
The
Date of Event is the date the information is being coded (today's date).
Error message E005CQ -
This DOE has already been recorded will display if the same Date of Event previously recorded is
used.
For coding instructions, go to Step 4.
4
Manual coding instructions + Read more ..
s47E(d)
Record a
DOC confirming the new details coded and any other relevant information disclosed by the
customer.
For follow-up actions, see Step 1 in Table 5.
Advise outcome and determine follow-up actions
For appropriately trained staff only.
Table 5
Step
Action
1
Advise the customer of the outcome + Read more ..
If the assessment is completed
without the customer present, the Service Officer
must make one
genuine attempt to contact the customer to advise the outcome. If subscribed, issue a pre-call
notification (SMS only) between 8:00 am to 8:00 pm using the customer's local time.
If unable to contact the customer, cal their correspondence nominee (if they have one). See Disclosing
information to a nominee.
LEX 72807 - Page 21 of 40
If unable to contact the customer, record details of the contact attempt. Go to Step 2.
If contact with the customer is successful, advise whether the exemption has been granted or not.
• If the exemption was
granted:
o when the exemption wil end
o remind the customer of the requirement to notify Services Australia if there is a
change in their circumstances
o if they are stil unable to meet their requirements when their exemption ends, they
will need to lodge a new medical certificate for assessment of a further temporary
incapacity exemption. The new medical certificate should be lodged within14 days of
the initial exemption end date in order for continuous application of exemption
• If the exemption was
not granted:
o explain why and ensure the customer understands the reason
o remind the customer they must continue to meet their requirements. If they are
unable to attend an appointment/activity (for example, due to their illness or injury)
they must contact their provider as soon as possible to explain why they cannot
attend
Ensure the Job Plan for Centrelink managed job seeker's reflects their current circumstances, and
negotiate a new Job Plan if required.
Note: only ParentsNext providers can update ParentsNext Participation Plans.
2
If a Temp-Incap Serious il ness exemption has been granted + Read more ..
Tel the customer of their future reporting requirements.
Consider whether it is appropriate to discuss nominee arrangements with the customer.
3
Determine appropriate follow-up actions + Read more ..
Consider what follow-up actions/referrals are appropriate for the customer's circumstances. More than
one may be required, depending on the customer's circumstances.
Consider recording a new customer circumstance:
Submission of a medical certificate may indicate there are personal circumstances directly impacting
the customer's ongoing capacity to comply with their requirements. These customers may require
additional support.
See Circumstances impacting capacity to comply with compulsory requirement.
Consider updating the Job Seeker Snapshot:
If the customer is present in the service centre or on the phone, and:
• the medical evidence reveals a change in their circumstances not previously included in the
Job Seeker Snapshot, and
• they have been referred to Workforce Australia
LEX 72807 - Page 22 of 40
Invite the customer to update the Job Seeker Snapshot. See Conducting a Job Seeker Snapshot
interview.
Consider if a referral to a social worker is required:
If the customer indicates they are or may be at risk of suicide or self-harm, are experiencing family and
domestic violence, or may require social work support for other complex needs and vulnerable
circumstances, discuss or make a referral to a social worker. See Social work service referral.
Determine if an ESAt request is required:
Once a decision is made to grant or reject a customer's request for a temporary incapacity exemption,
consider if an ESAt is required to reassess the customer's work capacity is required.
Go to Step 4.
Consider inviting a claim for DSP:
Only invite customer to claim DSP if there is clear evidence they are likely to meet all eligibility criteria
(this includes where the medical certificate indicates the condition will result in a life expectancy of less
than 24 months). It is not appropriate to invite a claim for DSP simply because a customer has a
condition with a functional impact of more than 24 months or more. See Claiming Disability Support
Pension (DSP).
Determine if connection/reconnection with employment services provider or ParentsNext
Provider is required:
Go to Step 5.
If none of the above applies, go to Step 6.
4
Determine if an ESAt request is required + Read more ..
An ESAt request should be considered if the medical certificate and/or other available information
indicates the customer:
• has a medical condition(s) that permanently impacts their ability to work
• has a medical condition(s) that is medium or long term (24 months) in nature, including
episodic or chronic conditions (for example. Schizophrenia, psychosis, depression and anxiety)
• cannot be granted a temporary incapacity exemption and may have a Temporary Reduced
Work Capacity (TRWC) of more than 8 hours but less than 30 hours per week
• has medical condition(s) that appear to be no longer of a temporary incapacity nature based
on multiple medical certificates being lodged for the same condition
Do not make an ESAt referral request where the:
• customer is a
ParentsNext participant
• medical conditions on the certificate have been assessed in a current ESAt that is still valid (no
significant change in medical conditions), or
LEX 72807 - Page 23 of 40
• the incapacity from the customers medical conditions are not expected to impact their work
capacity for longer than 13 weeks
Customers who are temporarily exempt are stil required to attend an ESAt appointment. However, if
the customer would have genuine difficulty attending an appointment due to their medical condition,
consider if the ESAt appointment should be cancelled or deferred. Careful consideration should be
applied where the customer has been granted a temporary incapacity for serious illness.
If an assessment is required, see Request an Employment Services Assessment (ESAt).
See also Job Capacity Assessment (JCA) and Employment Services Assessment (ESAt) appointments.
5
Connect/reconnect with provider + Read more ..
If an incapacity exemption has not been granted and the customer does not have a Temporary
Reduced Work Capacity (TRWC) or a Partial Capacity to Work (PCW) of 0-14 hours per week, ensure
the customer is connected to an appropriate employment services or ParentsNext Provider (if not
already referred).
Determine if the customer is subject to modified mutual obligation requirements. This is normally
assessed from the customer's most recent ESAt.
See:
• Approved activities for customers assessed as having a partial capacity to work (PCW), and
• Approved mutual obligation requirements for customers assessed as having a temporary
reduced work capacity (TRWC)
For ParentsNext participants
If an incapacity exemption has not been granted and the customer has not yet been
referred to a
ParentsNext provider, ensure they have a future ParentsNext appointment booked.
6
Work Item activity + Read more ..
s47E(d)
See Step 6 in Table 1 of Interaction Records.
LEX 72807 - Page 24 of 40
References
Policy
Social Security Guide, 1.1.C.330, Continuing inability to work (CITW) (DSP)
Social Security Guide, 1.1.T.70, Temporary incapacity for work (JSP, YA (job seeker)), or full-time study (YA (student))
Social Security Guide, 3.1.3, Notification & recipient obligations
Social Security Guide, 3.11, Mutual obligation requirements
Social Security Guide, 3.11.5, Exemptions - overview
Social Security Guide, 3.11.5.10, Temporary incapacity
Social Security Guide, 3.11.5.50, Exemption arrangements in ParentsNext (for compulsory participants)
Social Security Guide, 3.2.2, Who is unemployed for JSP?
Social Security Guide, 3.2.1.15, JSP temporary incapacity - work to return to after incapacity ends - definition of work
Social Security Guide, 3.11.5.10, Temporary incapacity
Legislation
Social Security (Administration) Act 1999
• section 63, Requirement to attend Department etc.
• section 64, Requirement to undergo medical examination etc.
• section 40L, Circumstances making it unreasonable etc. to comply with requirements
• section 68, Person receiving social security payment or holding concession card
Social Security Act 1991
• section 542A, Temporary incapacity exemption
• section 542C, Time limit for temporary incapacity exemptions-maximum exemption period
• part 2.12, division 1, Qualification for and payability of JobSeeker Payment
Resources
LEX 72807 - Page 25 of 40
UNSMCER reclassification page
LEX 72807 - Page 26 of 40
UNS008 medical/sensitive (MIFE) documents classification
Using the evidence to determine whether an incapacity is temporary or
permanent
Table 1
Assessment
Description
LEX 72807 - Page 27 of 40
Examples
An assessment of a medical certificate to determine a temporary incapacity exemption
should consider
all relevant information on the certificate, as well as a consideration
of other available evidence and contact with the medical practitioner, if appropriate.
The following examples can be used to help Service Officers to exercise their
discretion when making decisions about temporary incapacity exemptions.
Multiple conditions listed A temporary incapacity exemption may be granted where the customer is temporarily
on medical certificate
unable to participate due to the impacts of a medical condition, injury or illness.
Barry has submitted a medical certificate stating:
• Primary condition - Leg Fracture
o Prognosis (duration of functional impact) 3-12 months
o Dates of incapacity - from 2 February to 4 May
• Secondary condition - Asthma
o Prognosis (duration of functional impact) more than 24 months
• Secondary condition - Spinal Condition
o Prognosis (duration of functional impact) more than 24 months
The medical certificate does not indicate Barry is able to work or meet their
requirements by undertaking other activities.
The Service Officer assessing Barry's medical certificate:
• determines Barry is temporarily incapacitated for all work of at least 8 hours
per week, due mainly to the leg fracture which is expected to be temporary
• records
all conditions, and
• grants Barry a temporary incapacity exemption
Temporary exacerbation Susan suffers from two medical conditions - asthma and anxiety. Normally they do not
of condition
significantly impact their capacity for work. Due to a sudden change in the weather,
Susan is experiencing severe symptoms from asthma and is currently in hospital.
Susan's medical certificate contains the following information:
• Primary condition - Asthma
o Prognosis (duration of functional impact) 3-12 months
o Symptoms - shortness of breath, wheezing, coughing
o Dates of incapacity from 23 March to 18 May
• Secondary condition - Anxiety Disorder
o Prognosis (duration of functional impact) more than 24 months
o symptoms -sleep disturbance
• Susan is unable to work for the next 8 weeks
The medical certificate does not indicate Susan is able to meet their requirements by
undertaking other activities.
The Service Officer:
LEX 72807 - Page 28 of 40
• determines Susan is temporarily incapacitated for all work of at least 8 hours
per week, due mainly to the impacts of asthma
• records
all conditions, and
• grants Susan a temporary incapacity exemption for 8 weeks
All conditions listed on a A temporary incapacity exemption request should not be rejected simply because the
medical certificate are
condition/s listed have been marked as likely to impact for more than 24 months For
'permanent'
example:
The medical certificate contains the following information:
• Primary condition - Epilepsy
o Prognosis - 3-12 months
o Symptoms -
o Treatment - currently trialling a new treatment regime
o Dates of incapacity from 1 June to 31 August
• Secondary condition - Depression
o Prognosis - more than 24 months
o Dates of incapacity - N/A
Both conditions could be considered permanent conditions in that the condition is
likely to continue beyond 24 months,
however, the medical practitioner has noted the
primary condition, has a short term prognosis and the period of expected incapacity is
relatively short. Therefore, the customer's
incapacity for work may be considered as
temporary.
Customer has submitted There is no limit to the number of temporary incapacity exemptions that can be
multiple consecutive
requested or applied. However, repeated submission of medical certificates with the
medical certificates
same or similar temporary incapacity noted may indicate the impact is no longer
detailing the same
temporary. For example:
temporary incapacity
Medical certificate 1 - submitted 6 May
• Primary condition - leg fracture
• Prognosis (duration of functional impact) - less than 13 weeks
• Dates of incapacity - from 4 May to 27 July
Medical certificate 2 - submitted 27 July
• Primary condition - leg fracture
• Prognosis (duration of functional impact) - less than 13 weeks
• Dates of incapacity - from 28 July to 8 August
Medical certificate 3 - submitted 8 August
• Primary condition - ongoing pain from leg fracture
• Prognosis (duration of functional impact) - less than 13 weeks
• Dates of incapacity - from 9 August to 27 September
LEX 72807 - Page 29 of 40
Medical certificate 5 - submitted 27 September
• Primary condition - recovering from surgery to repair leg fracture
• Prognosis (duration of functional impact) - 13 - 24 months
• Dates of incapacity - from 28 September 2021 to 31 January 2023
Medical certificate 4 - submitted 31 January
• Primary condition - Chronic pain from leg fracture
• Prognosis (duration of functional impact) - 13 - 24 months
• Dates of incapacity - from 31 January to 2 May
Each of the medical certificates on their own satisfy the requirements to determine
that a
temporary incapacity for work exists. However, when the history of medical
certificate submission is considered as a whole it becomes clear the customer's
incapacity for work may not be temporary and their ongoing capacity to participate
may be reduced.
Following the most recent medical certificate it would be appropriate to:
• grant the temporary incapacity exemption
• refer the customer for an ESAt
Using other evidence (ESAts and JCAs) to inform a decision to grant or
reject an exemption request
Table 2
Evidence
Description
ESAt is current and valid Rachel has submitted a medical certificate stating:
• Primary condition - Fibromyalgia
o Prognosis (duration of functional impact) - more than 24 months
o Symptoms - constant muscle pain, fatigue
o Treatment - medication
o Dates of incapacity - ongoing
• Secondary condition - Asthma
o Prognosis (duration of functional impact) - more than 24 months
o Dates of incapacity - ongoing
The Service Officer assessing Rachel's medical certificate notes an ESAt was completed
4 weeks ago and considered the impacts of Rachel's medical conditions on their work
capacity. The ESAt report includes the following observations/recommendations:
• Rachel suffers from Fibromyalgia which causes pain and fatigue. It is being
managed with medication
LEX 72807 - Page 30 of 40
• Rachel suffers from asthma but it is usually well managed. Occasional flare
ups occur
• Rachel has a partial capacity to work, 15-22 hours per week
Rachel's ESAt is current, as it is less than 2 years old and it remains valid, as there is no
new evidence to suggest a change in Rachel's medical circumstances or work capacity.
Therefore, it would be appropriate to tell Rachel an exemption cannot be granted and
to discuss their requirements with their provider.
ESAt is current but no
Arash has submitted a medical certificate stating:
longer valid
• Primary condition - Crohn's Disease
o Prognosis (duration of functional impact) - 3-12 months
o Symptoms - abdominal pain, severe diarrhoea, fatigue
o Treatment - currently undertaking a new treatment regime due to
pregnancy
o Dates of incapacity from 3 May to 2 August
The Service Officer assessing Arash's medical certificate notes an ESAt was completed
12 months ago and considered the impacts of Arash's medical condition on their work
capacity. The ESAt report includes the following observations/recommendations:
• Arash suffers from Crohn's Disease, a condition that causes chronic
inflammation of the digestive tract
• At the time of the assessment, Arash's had only recently been diagnosed and
their symptoms were not well control ed
• A Temporary Reduced Work Capacity (TRWC) of 0-7 hours was applied for a
period of 4 weeks (which has now expired)
Arash's ESAt is still current, as it is less than 2 years old. However, it is not valid for
assessing the current medical certificate as the medical certificate contains new
information about Arash's circumstances and likely work capacity. The previous TRWC
recommendation likely supports a decision to exempt Arash from their requirements
during a flare-up of their symptoms.
It would be appropriate to tel Arash they are exempt from mutual
obligation/participation requirements.
Note: the medical practitioner has indicated symptoms may persist for up to 12
months. It would be reasonable to expect that Arash may continue to submit medical
certificates showing a functional impact of less than 13 weeks or 13 weeks to 24
months during this time. If the evidence from the medical practitioner indicates Arash
remains unfit for work, the temporary incapacity exemption should not be rejected.
ESAt is no longer current Stanley has submitted a medical certificate stating:
or valid
• Primary condition - clavicle fracture
o Prognosis (duration of functional impact) - 3-12 months
o Symptoms - pain, reduced mobility
o Treatment - rest, immobilisation, pain management
o Dates of incapacity from 15 April to 15 July
• Secondary condition - low vision in one eye
LEX 72807 - Page 31 of 40
o Prognosis - more than 24 months
o Dates of incapacity - ongoing
The Service Officer assessing Stanley's medical certificate notes an ESAt was
completed more than 2 years ago and considered the impacts of Stanley's medical
condition on their work capacity. The ESAt report includes the following
observations/recommendations:
• Stanley suffers from low vision in their left eye
Stanley's ESAt is no longer current, as it is more than 2 years old. It is not valid for
assessing the current medical certificate as the medical certificate contains new
information about Stanley's circumstances and likely work capacity.
It would be appropriate to tell Stanley they are exempt from mutual
obligation/participation requirements.
Coding temporary incapacity exemptions
Table 3: This table contains examples of keying valid medical certificates and exemptions.
Medical certificate
Examples of how to key temporary incapacity exemption
Calculating 13 weeks
Jenny has submitted a medical certificate stating:
• Primary condition - migraines due to stress
o Prognosis (duration of functional impact) - 3-12 months
o Symptoms - chronic pain
o Treatment - rest, pain management
o Dates of incapacity - from 10 January to 26 April
The medical certificate period covers 15 weeks and exceeds the maximum 13 week
exemption period for a non-serious illness.
A Service Officer assessing Jenny's medical certificate codes the dates for the
allowable 13 week period (91 days) only.
Therefore:
•
Unfit to work/study from date is 10 January
•
Unfit to work/study to date is 10 April
If Jenny is still incapacitated for all work at the end of this period, a new medical
certificate will need to be provided and assessed.
Incapacity exemption not Andrew has submitted a medical certificate on 18 March stating:
granted and new medical
certificate lodged with
• Primary condition - Arthritis
different dates and
o Prognosis (duration of functional impact) - more than 24 months
exemption granted
LEX 72807 - Page 32 of 40
o Dates of incapacity - from 18 March to 26 April
The Service Officer assessing Andrew's medical certificate notes:
• Andrew has a current and valid Employment Services Assessment (ESAt)
which considered the impact of the arthritis on Andrew's capacity to work
• The Assessor determined Andrew has a Partial Capacity to Work (PCW) of 15-
22 hours per week
• The medical certificate indicates only a short period of incapacity, (less than 6
weeks)
The Service Officer decides it is appropriate to contact the medical practitioner and
confirm whether Andrew is suffering from a temporary worsening of symptoms
(exacerbation) that would prevent them from working 15-22 hours per week.
The medical practitioner confirms Andrew is
not suffering from an exacerbation of
their condition, and should be able to undertake 15-22 hours of work per week as
previously assessed.
The incapacity exemption is
not granted because the medical evidence (medical
certificate, ESAt and conversation with the medical practitioner) indicates that:
• All of the conditions listed on the medical certificate have been assessed in a
current and valid ESAt - Andrew has a partial capacity to work
• Andrew is not suffering from an exacerbation of their condition
The medical certificate is coded as follows:
•
Date of Event: 18 March (same date as
Unfit to work/study from)
•
Unfit to work/study from: 18 March
•
Unfit to work/study to: 26 April
•
Date of Receipt (if required): 18 March
•
Non-Exemption Reasons: the Service Officer selects Job seeker is not
incapacitated for all work
•
Exemption granted? No
Andrew is required to continue meeting their mutual obligation/participation
requirements.
On 2 April, Andrew lodges a new medical certificate, stating:
• Primary condition - Back Injury
o Prognosis (duration of functional impact) - less than 13 weeks
o Dates of incapacity - from 2 April to 3 May
• Secondary condition - Arthritis
o Prognosis (duration of functional impact) - more than 24 months
LEX 72807 - Page 33 of 40
The Service Officer assessing the new medical certificate determines an incapacity
exemption can be granted - Andrew is temporarily incapacitated for all work as a
result of a back injury.
•
The details of a previously coded medical certificate must not be
amended. The new medical certificate is coded as follows:
•
Date of Event: 2 April (same date as
Unfit to work/study from)
•
Unfit to work/study from: 2 April.
Note: overlapping dates do not impact
where an incapacity exemption has not been granted for a previous medical
certificate
•
Unfit to work/study to: 3 May
•
Date of Receipt (if required): 2 April
•
Exemption granted? Yes
Incapacity exemption not Sam submitted a medical certificate on 8 May stating:
granted and new medical
certificate lodged with
• Primary condition - Anxiety
the same dates and
o Prognosis (duration of functional impact) - more than 24 months
exemption granted
o Dates of incapacity - from 8 May to 9 July
Based on the available evidence, the Service Officer assessing Sam's medical certificate
determines a temporary incapacity exemption is not appropriate, and rejects the
request.
The Service Officer codes the fol owing:
•
Date of Event 8 May (same date as Unfit to work/study from)
•
Unfit to work/study from 8 May
•
Unfit to work/study to 9 July
•
Date of Receipt (if required) 8 May
•
Non-Exemption Reasons the Service Officer selects Customer's incapacity
for work/study is not temporary
•
Exemption granted? No
They then undertake appropriate follow-up actions.
On 14 May, Sam submits a new medical certificate stating
• Primary condition - Anxiety
o Prognosis (duration of functional impact) - less than 13 weeks
o Dates of incapacity - from 8 May to 9 July
The dates on the new medical certificate are the same as the previous medical
certificate - 8 May to 9 July.
The details of a previously coded medical certificate must not be amended.
However as the
Unfit to work/study from and
to dates are the same as those coded
for the previous medical certificate:
LEX 72807 - Page 34 of 40
The
Date of Event is the date the information is being coded (today's date).
Error
message E005CQ - This DOE has already been recorded will display if the same
Date of Event is used.
The Service Officer actions the new medical certificate on 15 May and codes the
following details:
•
Date of Event 15 May (same date as the date the details are being coded)
•
Unfit to work/study from 8 May.
Note: overlapping dates do not impact
where an incapacity exemption has not been granted for a previous medical
certificate
•
Unfit to work/study to 9 July
•
Date of Receipt (if required) 14 May
•
Exemption granted? Yes
Incapacity exemption
Sarah has submitted a medical certificate on 6 September stating:
granted and new medical
certificate lodged with
• Primary condition - Influenza
overlapping dates but
o Prognosis (duration of functional impact) - less than 13 weeks
incapacity exemption not
o Dates of incapacity - from 6 September to 30 September
being granted
The Service Officer assessing the medical certificate determines the exemption can be
granted and codes the following:
•
Date of Event 6 September
•
Unfit to work/study from 6 September
•
Unfit to work/study to 30 September
•
Date of Receipt (if required) 6 September
•
Exemption granted? Yes
On 23 September, Sarah uploads a new medical certificate stating:
• Primary condition - substance misuse
o Prognosis - less than 13 weeks
o Dates of incapacity - from 23 September to 30 November
The Service Officer assessing the medical certificate determines an exemption cannot
be applied, as the medical condition is wholly or mainly caused by drug and/or
alcohol dependency/misuse.
The details coded for the previous medical certificate must not be amended.
The new medical certificate is coded on 24 September as fol ows:
•
Date of Event 23 September (same date as Unfit to work/study from)
•
Unfit to work/study from 23 September.
Note: overlapping dates do not
impact where an incapacity exemption has been granted for a previous
medical certificate and a further incapacity exemption is not being applied
for the current medical certificate
•
Unfit to work/study to 30 November
LEX 72807 - Page 35 of 40
•
Date of Receipt (if required) 23 September
•
Non-exemption reason drug and/or alcohol misuse
•
Exemption granted? No
Customer currently
David is currently exempt from meeting their mutual obligation requirements as they
exempt and new medical are temporarily incapacitated due to a leg fracture. Their exemption period is 13
certificate submitted with February - 14 May. The injury has not improved and on 12 May, David uploads
overlapping dates
another medical certificate for 10 May to 8 August.
The medical certificate is assessed and it is determined that David remains temporarily
incapacitated for all work. Another exemption period is to be applied. The Service
Officer codes the medical certificate on 16 May as follows:
•
Date of Event 15 May 2019 (same date as Unfit to work/study from)
•
Unfit to work/study from 15 May (previous medical certificate end date of
14 May + 1)
•
Unfit to work/study to 8 August.
Note: this date cannot exceed the end
date on the current medical certificate therefore the coded period is less than
13 weeks
•
Date of Receipt (if required) 12 May (date medical certificate was
uploaded)
Customer recently
Martha is currently exempt from meeting their participation requirements as they are
exempt and new medical temporarily incapacitated due to recent shoulder surgery. Their exemption period is
certificate submitted,
18 April - 9 May. Martha is still recovering and on 13 May they submit another
continuous coverage
medical certificate for the period 13 May to 13 June.
There is a gap in coverage between the dates on the medical certificates, from 10 to
12 May.
The medical certificate is assessed and it is determined that:
• the new medical certificate was submitted within 14 days of the existing
incapacity exemption expiring, and
• the gap between the end of the period of incapacity on the first medical
certificate and the start of the period of incapacity on the new medical
certificate is less than 14 days, and
• the Service Officer is satisfied that Martha has remained temporarily
incapacitated for work during that time
Another exemption period is to be applied. The medical certificate is coded as follows:
•
Date of Event 10 May (same date as Unfit to work/study from date)
•
Unfit to work/study from 10 May (previous medical certificate end date of
9 May +1)
•
Unfit to work/study to 13 June
•
Date of Receipt (if required) 13 May
LEX 72807 - Page 36 of 40
Customer recently
Van is currently exempt from meeting their mutual obligation requirements as they
exempt and new medical are temporarily incapacitated due to a knee injury. Their exemption period is 15 March
certificate submitted, no - 9 May. As a result of intensive physiotherapy, the injury healed within the exemption
continuous coverage
period.
On 21 May, Van submitted a new medical certificate seeking a temporary incapacity
exemption due to a neck injury sustained in a car accident on 19 May. The medical
certificate covers the period from 19 May to 12 July.
There is a gap in coverage between the dates on the medical certificates from 10 to 18
May.
The medical certificate is assessed and it is determined that:
• the new medical certificate was submitted within 14 days of the existing
incapacity exemption expiring, and
• the gap between the end of the period of incapacity on the first medical
certificate and the start of the period of incapacity on the new medical
certificate is less than 14 days
However, Van's incapacity did not continue throughout the gap period, as the neck
injury did not occur until 19 May.
A temporary incapacity exemption will be granted, but there will be a gap in coverage
of 8 days. The medical certificate is coded on 21 May as follows:
•
Date of Event 19 May (same date as Unfit to work/study from date)
•
Unfit to work/study from 19 May (Unfit to work/study from date)
•
Unfit to work/study to 12 July
•
Date of Receipt (if required) 21 May
Non-Applied Exemptions codes
Table 4: This table describes the codes for Non-Applied Exemption that will automatically display in the Non-Applied
Exemptions table on the s47E(d)
Code
Non-Applied Exemption literal Auto/manual
Customer group
s47E(d)
DSP Other special circumstances
Manual
Only valid for DSP customers with
Participation requirements
DSP major personal crisis
Manual
Only valid for DSP customers with
Participation requirements
DSP major personal disruption
Manual
Only valid for DSP customers with
Participation requirements
Illness/Incapacity
Auto/Disability Cluster
Major personal crisis
Manual
LEX 72807 - Page 37 of 40
s47E(d)
Major personal disruption at
Manual
home
Other special circumstances
Manual
Non-Exemption reasons
Table 5: Explanation of reasons in the
Choose Non-Exemption Reasons field.
Item
Explanation
1
Drug and/or alcohol dependency/misuse
When to use:
• medical evidence indicates the customer's incapacity (from the primary medical condition) is
wholly or mainly caused by their drug and/or alcohol dependency/misuse, and
• the customer is not a CDP participant
See Mutual obligation requirements exemptions for more information.
2
Customer's incapacity for work/study/participation is not temporary
When to use:
• the available medical evidence clearly shows the functional impact of the customer's
incapacity is expected to continue for longer than 24 months
Note: carefully consider the customer's circumstances and ensure appropriate follow-up actions are
taken when applying this non-exemption reason.
• request an ESAt if the customer does not have a current and valid assessment of their work
capacity
• consider possible entitlement to Disability Support Pension (DSP), and if appropriate invite to
claim
• consider if a referral to social work is required: If the customer indicates they are or may be at
risk of suicide or self-harm, are experiencing family and domestic violence, or may require
social work support for other complex needs and vulnerable circumstances, discuss or make a
referral to a social worker. See Social work service referral
3
Customer is able to do their usual work or study
When to use:
• based on the available evidence, the customer is able to work, study or participate for 8 hours
or more per week
LEX 72807 - Page 38 of 40
4
Insufficient evidence supplied
When to use:
• the medical certificate does not provide enough information to assess an exemption request
• the Service Officer is not satisfied with the integrity of the information on the medical
certificate, including suspected fraud
• the medical evidence provided by the customer was issued too long ago and can no longer
be considered a current and valid assessment of their medical condition,
and
o it is reasonable to expect the customer could have provided their medical certificate
at an earlier date. For example, if the customer was comatose and did not have
someone to act on their behalf, it would not be reasonable for the medical
certificate to be provided earlier
If the customer is still seeking an exemption, tell them they need to provide a valid medical certificate
from their medical practitioner.
External links
Workforce Australia - Providers
Forms
Centrelink Medical Certificate (SU415)
Claim for Disability Support Pension (SA466)
Claim for Disability Support Pension for a Terminal Illness (SA494)
Information you need to know about your claim for Disability Support Pension
Helpdesk
Level 2 Helpdesk Escalation
Intranet links
Report Suspected Fraud and Corruption
Video demonstrations of Customer First Established Support Links
LEX 72807 - Page 39 of 40
Customer First established support links video demonstration
Training & Support
Add the course number to the
Search field in the Learning Portal (LMS) in ESSentials:
LEX 72807 - Page 40 of 40
•
CLK01431 - Job Seeker Snapshot and RapidConnect
•
CLK01432 - Job Plans, requirements and exemptions
•
CLK01250 - Processing JobSeeker Payment claims
•
CLK01369 - Temporary incapacity exemptions
