Centrelink will usually accept a doctor’s medical certificate without further enquiry. Sometimes, where the certificate is incomplete or altered or there is some doubt about its authenticity, an officer will call the doctor’s surgery.
Centrelink will interview the claimant (and usually their partner, if any) soon after the claim is made. This interview will usually be by appointment in the claimant’s home or in hospital. This is generally a simple process, intended mainly to establish the claimant’s identity and their qualification for the payment. In many cases, however, payments of Sickness Allowance will begin before the interview takes place. Centrelink policy guidelines state that payments should not be delayed by waiting for an interview to be conducted. When the claimant cannot be interviewed due to the illness or injury, a relative, friend or health worker may be interviewed.
Where the certificate indicates that the inability to work may be permanent, or that rehabilitation may be helpful, or where Centrelink considers that the information about incapacity to work from the treating doctor is inadequate or unclear, Centrelink may refer the person for assessment by a Job Capacity Assessor (see Chapter 23, section 1.5).
If such referrals would delay the granting the person Sickness Allowance, Centrelink should be urged to pay Newstart Allowance provisionally, pending the assessment.
Where a dispute arises, it may be necessary to gather further medical and/or non-medical information to show that the claimant is unable to work.
Centrelink carries out regular reviews to check whether people receiving Sickness Allowance are still eligible to do so. The frequency of reviews may change from time to time. Reviews now take place after the first 12 and 26 weeks on Sickness Allowance and then after 40 weeks. The 40 week review requires a report from the treating doctor. Reviews may take place whenever Centrelink chooses, especially if it believes there is a change in the recipient’s circumstances.
Reviews may involve a pre-arranged visit from a Centrelink officer or a requirement to return a form which must be filled out by the claimant and the treating doctor. The completed forms must be returned within 21 days or Sickness Allowance will be suspended. A further 28 days are allowed before Sickness Allowance is cancelled.
Centrelink considers the information received from the claimant and doctor and then decides whether to continue paying Sickness Allowance and, if not, whether Newstart Allowance or Youth Allowance, Disability Support Pension or Special Benefit would be more appropriate. If it decides to make one of these other payments and a claim has been made, payments should commence from the same date as the Sickness Allowance finishes.
The 40 week review involves referral for a Job Capacity Assessment. Payment is continued while the assessment is made.
Particular attention will be paid to whether the person's incapacity for work should still be regarded as temporary.
Where the person no longer has a job or full-time study to return to, they will need to claim an alternative payment - generally Newstart Allowance or Youth Allowance (unemployed), or possibly Disability Support Pension. Where the person is transferring to Newstart Allowance or Youth Allowance (unemployed), consideration may also be given to whether or not they should be given an exemption from the activity test due to incapacity (see section 3), or have reduced activity test requirements as a person with a "partial capacity to work".
Where a person is attending a Commonwealth rehabilitation program, they are automatically placed on Sickness Allowance for the duration of their program as long as the program is for more than six weeks. No medical certificate has to be lodged in these cases, although participants will be reviewed on a three monthly basis.
