Information for health professionals about Disability Support Pension eligibility and claim process.
About Disability Support Pension
Disability Support Pension (DSP) gives financial help to people with a permanent medical condition who are unable to support themselves through paid work.
The person’s condition may be:
- intellectual, or
There are about 3.96 million people with a disability in Australia. Of these, around 750,000 get DSP. As there are strict medical and other eligibility criteria for DSP, not everyone who identifies as having a disability will be eligible.
We decide eligibility for DSP based on:
- Commonwealth social security law, and
- government policy
People who aren’t eligible for DSP may get other income support payments.
Your patients can read more about eligibility for DSP.
To be eligible for Disability Support Pension (DSP), your patient must meet both non‑medical and medical criteria set in law.
To meet the non-medical criteria your patient must:
- be between 16 and age pension age
- meet residency requirements, and
- meet income or assets tests, unless they’re permanently blind and not claiming Rent Assistance
Your patient may make a claim before they’re 16. If eligible, they’ll get DSP from when they turn 16.
To be eligible for DSP, your patient must claim before they reach age pension age.
To meet the medical criteria, your patient must be manifestly medically eligible or have a disability or medical condition that:
- is fully diagnosed, treated and stabilised
- has a minimum impairment rating of 20 points under the Impairment Tables of the Social Security Determination on the Federal Register of Legislation website, and
- means they can’t work or be retrained for any work of at least 15 hours a week in the next 2 years
Manifestly medically eligible
Examples of manifest medical eligibility are when medical information provides clear evidence your patient:
- is permanently blind
- has a terminal illness with a life expectancy of less than 2 years
- has an IQ under 70, or
- needs a nursing home level of care
We process claims from manifestly medically eligible patients as a priority.
If your patient isn’t manifestly medically eligible, but meets the other medical criteria, they must also have actively participated in a Program of Support. This doesn’t apply if they’ve got a severe impairment.
A severe impairment is one we assess as having a minimum rating of 20 points under a single Impairment Table.
How we assess medical eligibility
We determine your patient’s medical eligibility for DSP by how the diagnosed condition affects their capacity to work at the time they claim. We don’t use non-medical factors such as their:
- literacy, or
- fluency in English
Health professionals who assess the medical evidence your patient provides may include:
- health and allied health professionals, such as physiotherapists, nurses and psychologists
- Government-contracted Doctors
They do a comprehensive and impartial assessment of the medical evidence the patient gives us. We then make an informed decision about eligibility.
To determine eligibility, assessors may talk to any or all of the following:
- the patient
- you, or the patient’s other treating health professionals
- our Health Professional Advisory Unit
Fully diagnosed, treated and stabilised
If your patient isn’t clearly manifestly medically eligible, we’ll look at whether their condition meets other requirements.
Their permanent condition must be fully diagnosed, treated and stabilised.
The health professional who diagnoses the condition must be appropriately qualified as set out in the Impairment Tables.
To determine if a patient has been fully treated and stabilised, we consider if:
- the patient has had all reasonable treatment or rehabilitation
- any treatment is continuing or planned in the next 2 years
- there is a reason for them not to have reasonable treatment, and
- there is expected improvement within the next 2 years
For example, if a patient has had a limb amputated we may not assess them as fully treated and stabilised until they’ve finished rehabilitation. This may include getting a prosthesis.
Continuing inability to work
If your patient’s condition is fully diagnosed, treated and stabilised, we assess if they can work or be retrained for any work within the next 2 years.
We consider if their future ability to work would be:
- 15 hours or more per week, and
- at or above the relevant minimum wage
Under law we can’t consider work availability in your patient’s location when we assess their ability to work.
You need to know
If your patient’s claiming Disability Support Pension
If your patient claims Disability Support Pension (DSP), they or we may need to speak with you about their condition. There may be remuneration options for these consultations.
If your patient claims DSP, we’ll ask for evidence showing how their condition affects them.
Treating doctors no longer need to do a medical report. We’ll give your patient a Claim for DSP Medical Evidence Checklist form. This will help them gather the type of evidence we need.
One of our health or allied health professionals may contact you to talk about the medical evidence.
If we contact you, it’s important you make time to speak with the assessor. This can be the best way to get the information we may need to finalise a claim.
Your remuneration options
You can apply the usual Medicare fee if you gather medical evidence as part of a clinical consultation where you examine the patient.
We may pay you a nominal amount if 1 of our health or allied health professionals contacts you to discuss medical evidence.
If your patient’s having a medical review for Disability Support Pension
From 1 July 2016, we’ll undertake over 3 years additional medical reviews of DSP customers.
For these reviews we’ll apply the revised 1 January 2012 Impairment Tables and reassess each customer’s work capacity.
Read more about the Medical risk based review Budget measure.
Treating Doctor Report
We no longer need the Treating Doctor Report as a part of the DSP assessment process. Instead, to support their medical review we’ll ask customers to provide current medical evidence to assist in determining their diagnosis, prognosis and past, current or planned treatment.
Your patient may still contact you to seek assistance in gathering current medical evidence to support their medical review.
Medical evidence required for a DSP review
We’ll send customers a Disability Support Pension Review - Medical Evidence Requirements form to assist them in obtaining medical evidence for their DSP medical review.
Customers are required to provide contemporary medical evidence to support their review. This includes any clinical notes, medical records or other information about your patient’s current, past and planned treatment, which will assist in determining their diagnosis, prognosis and treatment. Other examples include:
- compensation reports
- hospital or outpatient records
- medical history report
- medical imaging reports
- reports from operations
- physical examination report
- rehabilitation reports
- specialist medical reports
Once we get the medical evidence from the customer, we’ll review it to help us determine their medical eligibility for Disability Support Pension.
We may require the customer to attend a Job Capacity Assessment as part of the review.
Read more about Job Capacity Assessments.
We may also require the customer to attend a Disability Medical Assessment (DMA) with a Government-contracted doctor.
Read more about the Disability Medical Assessment.
One of our assessors, health professionals, Authorised Review Officers or Government-contracted doctors may contact you as part of the assessment process. We may ask you to disclose any medical information relevant to assessing the customer’s eligibility for DSP. This may include medical and specialist reports, clinical notes, medical records or other information.
We’ll ask customers to complete a Consent to disclose medical information form to confirm they consent for you to disclose relevant information about their disability or medical conditions to us, or assessors we have engaged.
After the assessment
After we’ve assessed their situation, we’ll contact customers to advise them of the outcome of their medical review. If they’re not eligible for DSP at that time, we’ll discuss other income support options that may be more suitable for their current circumstances.