RSLWA ADVOCACY CLAIM PACK

About This Claims Package

This claims package is intended to:

Demystify some of the primary claims process
Put you in control of your claim
Guide you through some of the initial process and connect you with an Advocate
Assist our Advocates to process your requests in a timely and efficient manner

About the Returned and Services League of WA (RSLWA)

The RSLWA is:

An organisation that provides Claims Advocacy

Therefore its claims advocates assist veterans with claims to DVA and act as a conduit for the veteran with DVA

A registered charitable organisation

Therefore it does not charge for its services
Therefore any donation over $2 is tax deductable

The RSLWA is not:

DVA or a branch of DVA

Therefore RSLWA Advocates are not Delegates of DVA assigned to determine your eligibility
Therefore RSLWA does not accept or reject a veteran’s claim

Medical practitioners

Therefore RSLWA cannot sign off on any medical condition

Financial advisors

Therefore RSLWA cannot provide advice on whether a lump sum or pension is better in your circumstance

Legal personnel

Therefore RSLWA cannot represent you in court

Elected members of parliament

Therefore RSLWA cannot change laws/acts that are perceived to be inequitable or unjust

Preliminary Information

Do you have a DVA file number? *

YESNO

DVA File Number *

Do you have MyService (DVA online services) connected to your MyGov account? *

YesNo

If other than listed, please specify: *

Given Name(s) *

Last Name *

Did you serve under any other names? *

YESNO

What was the name? *

Email Address *

Do you currently have a fixed abode? *

YESNO

Residential Address *Please include postcode

Do you have a different postal address? *

YESNO

Postal AddressPlease include postcode

Contact Number *

Date of Birth *

Are you an RSLWA member? *

YesNo

Next of Kin Information

Next-of-kin’s name *

Relationship to veteran *

Next-of-kin’s address *

Next-of-kin’s telephone number *

ADF Service History

Branch of Service *

ArmyNavy Air ForceCadets

Enlistment Date *Please estimate if actual dates are unknown

Full Time, Reserves, or Both *

Full TimeReservesBoth

Are you still serving? *

YESNO

Have you contacted the onbase Veterans Services Officer (VSO) *

YESNO

Discharge Date

Discharge Reason *

Service Number *

Rank *

Current Unit

Last Unit

Nature of duties *

Have you deployed on warlike and/or non-warlike operations? *

YESNO

Please note that Op Resolute is not deemed warlike or non-warlike service

What operation or operations did you serve as part of? *Please include dates if available, but if you are unsure of exact dates please note that and instead include an estimate.

Have you deployed on an operation or operations but are unsure of their warlike or non-warlike classification? *

YesNo

What operation or operations did you serve as part of? *Please include dates if available, but if you are unsure of exact dates please note that and instead include an estimate.

Have you ever smoked? *

YESNO

Have you ever consumed alcohol? *

YESNO

DVA Claims History

Have you previously claimed with DVA? *

YESNO

Are you seeking assistance with a new liability claim? *

YESNO

Are you seeking assistance with a claim you have already submitted? *

YesNo

What are the details of the previously submitted claim? *Please include: conditions claimed, date of claim lodgement, prior advocate information if you had representation, and any other information you have available.

Are you seeking assistance with re-submitting a previously rejected claim? *

YESNO

Are you seeking assistance with appealing a recent determination? *

YESNO

Are you lodging any mental health claims? *

YESNO

Are you lodging any claims for a terminal illness? *

YESNO

Are any of the claims you are lodging impacting your ability to work? *

YESNO

How many conditions are you seeking to claim? *

1 - 34 - 67+

Please indicate which conditions you are seeking assistance with *

Are you claiming tinnitus?

YESNO

Please click on the link below to download and complete the Tinnitus Functional Index (TFI)

TFI

Have these conditions been formally diagnosed my a medical practitioner? *

YESNO

Please note, this does not include psychologists, physiotherapists, occupational therapists, or chiropractors

Medical Information

Local medical practitioner's name *

Address

Contact Number

Do you currently have a treating psychiatrist? *

YESNO

Treating psychiatrist name *

Medical History

Current Height (cm's)

Current Weight (kg's) *

What are your current medical conditions? *

Do you experience difficulties with your hearing? *

YESNO

Do you experience ringing in your ears? *

YESNO

Do you have any difficulty with your eyes or vision? *

YESNO

Do you take any prescribed or over the counter medications? *

YESNO

Please list all prescribed medication alongside what these are currently being used to treat *

Do you smoke cigarettes? *

YESNO

How many cigarettes do you smoke per day? *

What type of tobacco products to you use? *

Do you drink alcohol? *

YESNO

How often do you have a drink containing alcohol? *

Monthly or less2-4 times a month2-3 times per week> = 4 times a week

Do you have difficulty getting to sleep or staying asleep? *

NoYes - difficulty getting to sleepYes - difficulty staying asleep

Employment History

Are you currently employed? *

YESNO

Date ceased work *

Are you currently receiving incapacity payments? *

YESNO

Would you like RSLWA to assist you with claiming for incapacity payments? *

YESNO

Name of current employer *

How many hours do you work per week? *

Other Payments

Do you receive, or have you applied for, any payment (e.g. the age pension from Centrelink), other than superannuation? *

YESNO

Type of benefit or pension

Name of source

Date of Claim

Reference No. (If known)

Compensation

Have damages/compensation been claimed or received from any other source for any of the disabilities you are now claiming (e.g. Comcare, Department of Defence, third party accident insurance)? *

YESNO

Nature of injury or disease

Name of source

Date of claim

Reference No. (if known)

Payment Details

Provide details of the Australian account you want your pension to be paid into

Name of bank, credit union or building society *

Branch *

Was this account opened online? *

YESNO

Address

Account in the name of *

Account number *

BSB number *

Account type (e.g. savings) *

General Consent

This section gives RSLWA the authority to act on your behalf with the agencies or individuals such as carers/partners that you nominate here. Please use the checkbox to indicate which agencies you authorise RSLWA to contact:

Proving your identity to DVA

Automatic proof of identity for members who joined the ADF from 1 January 2016 and/or separated from 27 July 2016.

If you are a current or former serving member who has joined the permanent forces or commenced a period of Continuous Full-Time Service from 1 January 2016 and/or separated from 27 July 2016, your proof of identity is automatically established. DVA will rely on the identification and security clearance procedures used by the ADF to satisfy DVA identity requirements. Under this arrangement, you will not need to provide any documentation, such as ADF Identification card or documents from Category A, B or C. There may be limited circumstances where a full POI check will be required.

Streamlined process for current serving members and reservists who hold a valid purple Australian Defence Force (ADF) identification (ID) card.

If you are a current serving member or a reservist who holds a current, valid purple ADF ID card, you can access a streamlined proof of identity process. This streamlined process allows you to prove your identity to DVA where you lodge a claim in person with the Department by simply presenting your ADF ID card to a DVA staff member for authentication. They will then take a certified copy of your card to include with your claim.

When you lodge a claim with DVA, you must show documents from the Category A and B lists below which prove your identity. You must show original documents or true and certified copies of these documents. (See ‘Who can certify copies of documents’ on page 4.) If you mail your claim and originals of your proof of identity documents, your documents will be returned by registered post. From the lists of Category A and B documents on this page, you must provide 3 different documents with 1 document from Category A and two documents from Category B. If none of the documents you produce to satisfy Category A or B provide evidence of your current residential address, then you must also produce a document from Category C:

A B B or A B B C

If any of the documents are in a previous name, you must provide an additional document which shows how your name was changed (e.g. a marriage certificate).

Category A documents

Documents from Category A provide proof of birth or arrival in Australia

Australian passport (current) - not to be used concurrently as a Category B document
Full Australian birth certificate
Record of Immigration Status
Foreign passport and current Australian Visa
Travel document and current Australian Visa
Certificate of Evidence of residential status
Citizenship Certificate

Category B documents

Documents from Category B provide evidence of your identity existing in the community

Australian driver’s licence (current and original)
Australian passport (current) - not to be used concurrently as a Category A document
Australian passport (current)
Australian Defence Force (ADF) identification card (current)
Firearms licence (current and original)
Current overseas passport with valid entry stamp or visa
Medicare card Change of name certificate (for marriage or legal name change - showing link with previous name(s))
Credit or bank account card
DVA card
Security Guard/Crowd Control licence
Australian marriage certificate issued by a government department
Tertiary identification card

Category C documents

Documents from Category C provide evidence of residential address or residence in a Nursing Home or Residential Care Facilit

Utilities notice
Rent details
Document from Nursing Home or Residential Care Facility that provides evidence of residence

If you don’t have the right documents: Other documents may be acceptable. Contact your nearest DVA or VAN office.

Do you currently have certified copies of your ID? *

YESNO

Upload your certified documents

Browse

Who can cerify documents?

Supporting Evidence

Please upload any supporting evidence that you may have, this may include

Witness Statements
Medical Imaging
Medical Reports
Statutory Declaration

Supporting Evidence

Browse

Do you currently have a copy of your ADF medical and service records? *

YESNO

Are these electronic records? *

YESNO

Would you like to request an electronic copy of your ADF records?

YESNO

Request my ADF Records

Please monitor your emails, as we will send you a link to our google drive so you can upload your ADF records

Employment Services

Rewarding work for every Veteran and their immediate family.

Looking for work? Changing careers? Or maybe you want help to find your passion and purpose?

We help Veterans, their partners, and immediate family members find a rewarding job. It doesn’t matter how long ago you served, what stage you are at in your work journey, or how old you are.

Take advantage of our free career support services, specialist coaches and gain access to our extensive employer network.

The RSL Veterans’ Employment Program has received grant funding from the Australian Government and is free to access. You do not need to be a member of the RSL for us to help you.

Would you like assistance with RSL's Veteran's Employment Program? *

YESNO

Welfare Services

The RSLWA was founded to help those who defended our nation and to provide assistance to those who took the oath, as well as their families. Our motto is “serving those who served”.

The Welfare Team at ANZAC House understand that your situation is urgent and are available to respond promptly. We can assist you with emergency financial relief for essentials such as food, rent, utility bills, security bonds, funeral costs, education, clothing, urgent car repairs, transport and referrals to other appropriate services.

The team are respectful, highly skilled and dedicated to assisting those in need. It is advised to book a face-to-face appointment to discuss your unique situation. All applicants are required to provide proof of service, bank statements for last six weeks and copies of accounts for goods or services requiring payment. All payments are made directly to the service providers.

RSLWA Financial Counselling

Financial Counsellors work with people who are in debt or are not able to meet their ongoing expenses and may be able to assist with:

working out payments with creditors and other assistance which may be available,
what you can do if you can’t pay bills, fines or debts
information, options and support for individuals, families and consumer groups to explore, develop and implement strategies to overcome their financial situation
assessing the financial situation to identify immediate remedies and longer term solutions to improve financial wellbeing
Support and enable sound financial decision making

The WA Aged Sailor's, Soldier's and Airmen's Relief Trust Fund (WAASSARTF)

Each year 50% of the money collected on Poppy Day is allocated to WAASSARTF. This fund provides assistance to our Veterans, widows, dependents or ex- ADF members in times of hardship.

Applications can be made for the following:

Rent arrears and security bonds
Outstanding utility accounts
Replacement of white goods
Removal costs
School fees
Mobility Products
Motor vehicle repairs
Funeral assistance

Evidence of financial hardship needs to be established before assistance can be provided.

Monthly Grants can be paid to veterans experiencing ongoing hardship.
Veterans applying for a monthly grant will be interviewed at home by one of the Trustees, this ensures a true account of the veteran’s circumstances and needs are established.
Assistance is restricted to Western Australian residents.

Would you like assistance from RSLWA's Welfare Services team? *

YESNO

RSLWA agrees to:

Act conscientiously and in good faith, and follow all reasonable instructions to best provide Services for the clients and not allow its own interests to conflict with its duties to the Client;
Refer to itself as "advocates or representatives" of the Client in all dealings for the provision of services;
Except as may be authorised by the Client, RSLWA shall not in any way incur any liabilities on behalf of the Client or pledge the credit of the Client.

The Client must:

Act dutifully and in good faith in its relations with RSLWA;
Disclose of all relevant medical information pertaining to the Client’s “Claim”;
Where appropriate, inform RSLWA within a reasonable time of any problems about being able to meets its obligations under any contract concluded by RSLWA.

By signing this agreement I hereby declare that

All of the information I have provided is true and accurate to the best of my knowledge

I have not provided any misleading or false information

Case Allocation

RSLWA is currently experiencing a high volume of inquiries, therefore, there may be extensive wait times before your case is assigned to an advocate. If your case is simple, it can be referred to a DVA Veterans’ Services Officer Team Leader (VSO) who can assist you with submitting your claims in a timelier manner.

Please check this box if you would NOT like this to happen.

Do you have a preference with who manages your case? *

YESNO

Example: male/female advocate or specific advocate

Please specify *

Client Signature *

Draw signature|Type signatureClear

Date *

Thank You

For

Completing the RSLWA Advocacy Claims Package

Once you have submitted this form, you will automatically directed to the RSLWA website.

Please accept this as confirmation that we have received your responses

Client Complexity Factor and Case Allocation

Client Complexity Factor

This is a Complex Case

This is a Simple Case

This case includes an APPEAL

This case requires a Senior Advocate

Advocate

Internal Referrals

This case does not require any internal referrals

This case has been referred to RSLWA's Welfare Services

This case has been referred to RSL's Employment Services

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