To be eligible for 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 residence requirements
- meet income or assets tests, unless they’re permanently blind and aren’t claiming Rent Assistance.
Your patient may make a claim before they’re 16. If eligible, they’ll get DSP from when they turn 16. A person can’t claim DSP once they’ve reached Age Pension age.
If your patient meets the non-medical criteria, we consider if they meet the manifest medical eligibility criteria.
Manifest medical eligibility
Examples of manifest medical eligibility are when medical evidence shows your patient:
- is permanently blind
- has a terminal illness where average life expectancy is less than 2 years
- has an intellectual disability with an IQ under 70
- needs nursing home level care.
We process claims from patients who meet these criteria as a priority.
If your patient isn’t manifestly eligible, they need to meet both the:
- non-medical criteria described above
- medical criteria set out below.
To meet the medical criteria, your patient must have a disability or medical condition that:
- is fully diagnosed, treated and stabilised
- has a total rating of at least 20 points on the Impairment Tables, and
- means they can’t work at least 15 hours a week in the next 2 years, even with training.
They must also have actively participated in a Program of Support. This doesn’t apply if their conditions have at least 20 points under a single Impairment Table.
Revised Impairment Tables took effect from January 2012. There are 15 Tables which cover a range of functions. Read more about the Impairment Tables in the Guide to Social Security Law.
How we assess medical eligibility
We determine your patient’s medical eligibility for DSP by assessing how the diagnosed condition affects their capacity to work. We base this assessment on the medical evidence from you and other health professionals who treat your patient.
We don’t consider other factors such as their:
- local labour market
- 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 your patient gives us. We then make an informed decision about eligibility.
To help determine eligibility, our assessors may talk to:
- your patient
- your patient’s other treating health professionals
- our Health Professional Advisory Unit.
Fully diagnosed, treated and stabilised
We may accept a condition as fully diagnosed if an appropriately qualified medical practitioner has made the diagnosis. For most conditions this can be a general practitioner.
To determine if a patient’s condition is fully treated and stabilised, we consider if:
- the patient has had reasonable treatment or rehabilitation for the condition
- any treatment is continuing or planned in the next 2 years
- there is a reason for them not to have reasonable treatment
- further treatment is likely to improve their work capacity within the next 2 years.
For example, you may have a patient who has an amputated arm or leg. We may assess them as not fully treated and stabilised until they’ve finished rehabilitation. This may include getting a prosthesis.
We assess any fully diagnosed, treated and stabilised conditions under the Impairment Tables to assign an impairment rating. The ratings reflect the impact of a patient’s conditions.
Your patient won’t be eligible for DSP if their conditions don’t have a total rating of at least 20 points.
Ability to work
If your patient meets the impairment and Program of Support requirements, we assess their work capacity. We’ll assess if they can work or be retrained for any work within the next 2 years.
This includes any work:
- of 15 hours or more per week
- 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.