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Appendix D: Claims, service and liability provision statistics

Tables D1 to D8 provide an overview of the claims processed and transport arranged by DVA under the Veterans’ Entitlements Act 1986 (VEA), the Safety, Rehabilitation and Compensation (Defence-related Claims) Act 1988 (DRCA) and the Military Rehabilitation and Compensation Act 2004 (MRCA) in 2018–19.

Tables D9 and D10 provide an updated actuarial assessment of movement in the liability for income support, compensation, health and other care services under the DRCA and MRCA.

Veterans’ Entitlement Act

Claims processed

Table D1: VEA claims processed, 2017–18 and 2018–19

2017–18

2018–19

Income support new claims

10,945

10,863

Pensioner-initiated reviews

63,210

58,268

Funeral benefit claims

4,443

3,837

VEA = Veterans’ Entitlements Act 1986

Note: Where results for 2017–18 are provided for comparison, they have been updated based on information available after the end of the financial year and therefore may differ from the results published in the 2017–18 annual report.

Compensation claims

Table D2: VEA compensation claims, 2017–18 and 2018–19

2017–18

2018–19

Disability support

Primary disability claims received1

12,267

19,859

Net claims received

n/a

10,7482

Conditions determined3

14,272

15,858

Proportion of conditions accepted

61.2%

55.8%

Applications for increases in disability pension determined

1,517

1,489

Proportion of increases in disability pension accepted

66.2%

75.2%

Cases on hand at 30 June

2,819

4,640

War widow/ers and dependants

Claims received

1,316

1,111

Net claims received

n/a

1,0034

Claims determined

1,130

982

Proportion of claims accepted

68.1%

64.1%

Cases on hand at 30 June

129

104

VEA = Veterans’ Entitlements Act 1986

1 Includes applications for disability pensions, applications for increases in disability pension and assessments/reviews.

2 DVA’s digital platform allows each condition to be registered as an individual claim. When multiple claims are lodged by a client on the same day, these are bundled into the one claim to streamline the investigation and finalisation of the claim.

3 While a claim can be lodged with one or more conditions, each condition is determined separately.

4 This is different from claims received, as withdrawn cases are excluded (for example, automatic entitlement case).

Top 15 claimed conditions

Table D3: Top 15 claimed conditions under the VEA (based on Statements of Principles), 2018–19

Condition

Number accepted

Acceptance rate (%)

Number not accepted

Total

Osteoarthritis

1,068

59.0

742

1,810

Tinnitus

1,123

74.3

389

1,512

Sensorineural hearing loss

1,106

78.1

311

1,417

Lumbar spondylosis

561

62.1

342

903

Posttraumatic stress disorder

391

72.5

148

539

Solar keratosis

453

86.5

71

524

Non-melanotic malignant neoplasm of the skin

397

83.1

81

478

Depressive disorder

276

61.9

170

446

Sprain and strain

207

50.7

201

408

Alcohol use disorder

211

64.1

118

329

Rotator cuff syndrome

76

25.3

224

300

Cervical spondylosis

56

21.5

205

261

Fracture

130

59.1

90

220

Ischaemic heart disease

108

69.7

47

155

Anxiety disorder

84

56.8

64

148

Total

6,247

66.1

3,203

9,450

VEA = Veterans’ Entitlements Act 1986

Note: in determining the majority of liability cases, DVA refers to the Repatriation Medical Authority Statements of Principles (SOPs). The 15 most frequently used SOPs covered 59.6 per cent of the conditions determined under the VEA in 2018–19.

Safety, Rehabilitation and Compensation (Defence-related Claims) Act

DRCA claims

Table D4: DRCA claims, 2017–18 and 2018–19

2017–18

2018–19

Liability

Claims received

10,122

15,842

Net claims received

n/a

7,4831

Conditions determined2

6,917

9,587

Proportion of conditions accepted

56.0%

75.9%

Cases on hand at 30 June

2,478

3,897

Permanent impairment

Claims received

6,423

11,494

Net claims received

n/a

9,7553

Claims determined

5,453

7,238

Proportion of claims accepted

33.9%

38.8%

One-off lump-sum payments

2,017

2,927

Cases on hand at 30 June

1,344

3,875

Incapacity compensation

Compensation paid

$80.3 million

$93.1 million

Payees

2,185

2,331

Compensation for dependants

Compensation paid

$14.6 million

$31.4 million

Payees

72

117

DRCA = Safety, Rehabilitation and Compensation (Defence-related Claims) Act 1988

1 DVA’s digital platform allows each condition to be registered as an individual claim. When multiple are claims lodged by a client on the same day, these are bundled into the one claim to streamline the investigation and finalisation of the claim.

2 While a claim can be lodged with one or more conditions, each condition is determined separately.

3 This is different from claims received, as it represents a correction of a system issue which incorrectly registered permanent impairment claims prior to the liability determination.

Top 15 most frequently claimed conditions

Table D5: Top 15 most frequently claimed conditions under the DRCA, 2018–19

Condition

Number accepted

Acceptance rate (%)

Number not accepted

Total

Osteoarthritis

920

63.1

539

1,459

Tinnitus

670

71.1

272

942

Sensorineural hearing loss

696

77.0

208

904

Sprain and strain

722

84.1

136

858

Lumbar spondylosis

393

59.5

268

661

Cervical spondylosis

304

80.9

72

376

Depressive disorder

226

66.3

115

341

Non-melanotic malignant neoplasm of the skin

225

67.8

107

332

Posttraumatic stress disorder

225

68.2

105

330

Fracture

256

79.3

67

323

Solar keratosis

217

71.9

85

302

Rotator cuff syndrome

134

47.2

150

284

Alcohol use disorder

88

50.0

88

176

Shin splints

123

88.5

16

139

Joint Instability

108

84.4

20

128

Total

5,307

70.2

2,248

7,555

DRCA = Safety, Rehabilitation and Compensation (Defence-related Claims) Act 1988

Note: The 15 conditions most frequently claimed covered 78.8 per cent of the conditions determined under the DRCA in 2018–19.

Military Rehabilitation and Compensation Act

MRCA claims

Table D6: MRCA claims, 2017–18 and 2018–19

2017–18

2018–19

Liability

Claims received

13,185

29,777

Net claims received

n/a

21,9771

Conditions determined2

23,222

37,977

Proportion of conditions accepted

79.3%

84.1%

Cases on hand at 30 June

3,308

7,307

Permanent impairment

Claims received

7,295

14,354

Net claims received

n/a

12,7643

Claims determined

6,088

8,833

Proportion of claims accepted

74.7%

64.9%

One-off lump-sum payments

3,398

5,993

Cases on hand at 30 June

1,695

5,673

Incapacity compensation

Compensation paid

$153.8 million

$201.6 million

Payees

4,910

6,185

Compensation for dependants

Compensation paid

$35.2 million

$67.7 million

Payees

165

327

MRCA = Military Rehabilitation and Compensation Act 2004

1 DVA’s digital platform allows each condition to be registered as an individual claim. When multiple claims are lodged by a client on the same day, these are bundled into the one claim to streamline the investigation and finalisation of the claim.

2 While a claim can be lodged with one or more conditions, each condition is determined separately.

3 This is different from claims received, as it represents a correction of a system issue which incorrectly registered permanent impairment claims prior to the liability determination.

Top 15 most frequently claimed conditions

Table D7: Top 15 most frequently claimed conditions under the MRCA (based on Statements of Principles), 2018–19

Condition

Number accepted

Acceptance rate (%)

Number not accepted

Total

Tinnitus

5,428

99.5

25

5,453

Sprain and strain

3,277

94.3

199

3,476

Osteoarthritis

2,544

96.3

97

2,641

Sensorineural hearing loss

2,373

97.9

50

2,423

Lumbar spondylosis

1,808

98.1

35

1,843

Rotator cuff syndrome

1,398

97.4

37

1,435

Fracture

1,136

90.4

121

1,257

Depressive disorder

1,006

90.9

101

1,107

Posttraumatic stress disorder

754

90.2

82

836

Chondromalacia patella

613

94.6

35

648

Shin splints

620

95.7

28

648

Joint Instability

509

92.4

42

551

Labral tear

516

97.5

13

529

Cervical spondylosis

300

59.5

204

504

Adjustment disorder

443

91.2

43

486

TOTAL

22,725

95.3

1,112

23,837

MRCA = Military Rehabilitation and Compensation Act 2004

Note: In determining the majority of liability cases, DVA refers to the Repatriation Medical Authority Statements of Principles (SOPs). The 15 most frequently used SOPs covered 62.8 per cent of the conditions determined under the MRCA in 2018–19.

Repatriation Transport Scheme

Table D8: Claims for reimbursement and arranged transport, 2014–15 to 2018–19

2014–15

2015–16

2016–17

2017–18

2018–19

Claims for reimbursement

150,871

146,357

143,256

168,970

174,943

Arranged transport trips

1,273,128

1,211,805

1,323,956

1,301,691

1,210,032

Adjustments to the Military Rehabilitation and Compensation Act liability provisions

Tables D9 and D10 show the movement in the long-term liability for income support and compensation and health and other care services under the DRCA and MRCA over the past two years, based on the advice of the Australian Government Actuary. The movement is recognised as an expense in DVA’s financial statements. Due to the nature of the liability provision, significant adjustments can occur between years.

Table D9 Movement in DRCA and MRCA liability under Outcome 1, 2017–18 and 2018–19

2017–18

2018–19

DRCA

($m)

MRCA

($m)

Total

($m)

DRCA

($m)

MRCA

($m)

Total

($m)

Changes in valuation assumptions

316.1

759.3

1,075.4

552.4

3,186.9

3,739.3

Movements in income support and compensation payments

–142.7

227.3

84.6

–158.6

551.0

392.4

Interest rate

46.0

253.7

299.7

345.7

1,615.4

1,961.1

Total expenses

219.4

1,240.3

1,459.7

739.5

5,353.3

6,092.8

DRCA = Safety, Rehabilitation and Compensation (Defence-related Claims) Act 1988 (previously the Safety, Rehabilitation and Compensation Act 1988); MRCA = Military Rehabilitation and Compensation Act 2004

Table D10: Movement in DRCA and MRCA liability under Outcome 2, 2017–18 and 2018–19

2017–18

2018–19

DRCA

($m)

MRCA

($m)

Total

($m)

DRCA

($m)

MRCA

($m)

Total

($m)

Changes in valuation assumptions

76.8

128.8

205.6

58.9

1,412.6

1,471.5

Movements in income support and compensation payments

–26.2

250.6

224.4

–26.1

534.8

508.7

Interest rate

56.5

351.5

408.0

226.9

1,748.6

1,975.5

Total expenses

107.1

730.9

838.0

259.7

3,696.0

3,955.7

DRCA = Safety, Rehabilitation and Compensation (Defence-related Claims) Act 1988 (previously the Safety, Rehabilitation and Compensation Act 1988); MRCA = Military Rehabilitation and Compensation Act 2004

Visit

https://www.transparency.gov.au/annual-reports/department-veterans-affairs/reporting-year/2018-2019-56