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Second opinions

This second opinion service is used by case managers where the information on the medical certificate is inadequate, unclear or does not appear to align with other information the case manager may have available.

It may also be used where the supporting information provided by the person when applying for an Invalid’s Benefit is inadequate to determine entitlement.

When completing the medical certificate, the health practitioner is able to tick the “second opinion” box at the beginning of the certificate, to initiate a referral by the case manager to a designated doctor.

Role of designated doctor

The designated doctor is expected to provide an independent opinion to the case manager.

Process

Case managers will refer a client to a designated doctor where the medical certificate completed by the health practitioner:

• indicates that the health practitioner is not the best person to provide the information
• has inadequate information to establish medical eligibility
• indicates that the diagnosis is unclear
• provides ambiguous or conflicting information
• substantially differs in its diagnosis or recommendations from the previous medical certificate.

Referrals to a designated doctor may also be made where the client has provided other sources of information (such as a Needs Assessment and Service Co-ordination evaluation or specialist’s report) that are inadequate to determine entitlement or the person is unable to provide relevant information.

A client may also opt for an assessment by a designated doctor.

The case manager may refer to a designated doctor if they have concerns about a client’s:

• engagement in activities that appear to be at odds with their recorded incapacities
• duration on benefit where duration exceeds the expectation for that particular condition.

The referral will be accompanied by a copy of the original medical certificate and/or available supporting information and, where appropriate, the client’s consent to the release of information.

The designated doctor is expected to meet with and assess the patient within 10 days of referral, and provide a completed medical certificate to the case manager within five days of the assessment.

The designated doctor is encouraged to discuss any issues with the patient’s usual GP if this is necessary. If a written report is provided by the client’s usual GP, Work and Income pays the GP a usual practitioner (host doctor) report fee (of $40 plus GST) .

Report

The report completed by the designated doctor seeks to identify the key factors which impact on the person’s ability to work and to address any specific concerns raised by the designated doctor.

Payment

Work and Income, through the National Accounting Centre, provides a payment of $106 (plus GST) for the completion of a designated doctor assessment.

The National Accounting Centre checks in the person’s Work and Income records to ensure that a report has been requested by the case manager before payments are made.

Applying to be a designated doctor

If a registered medical practitioner is interested in becoming a Work and Income designated doctor, they should contact the local health and disability co-ordinator for an application form.

Once completed the form should be returned to the health and disability co-ordinator.

For more information

If you are a designated doctor, please refer to the Designated Doctor Guide or contact your local health and disability co-ordinator for more information.

Resources for designated doctors