Disability Support Pension information for health professionals
Information for health professionals about Disability Support Pension eligibility and the assessment process.
1. About - Disability Support Pension information for health professionals
How Disability Support Pension information for health professionals works.
Information about Disability Support Pension for health professionals
The DSP is financial help for people with a permanent disability or medical condition that stops them from working.
The person’s condition may be any of the following:
There are about 3.96 million people with a disability in Australia. Of these, around 750,000 get Disability Support Pension (DSP). There are strict medical and other eligibility criteria for DSP. Not everyone who has a disability will be eligible.
People who aren’t eligible for DSP may get other income support payments.
Your patients can read more about eligibility for DSP.
Information about Disability Support Pension eligibility criteria for health professionals
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.
2. You need to know - Disability Support Pension information for health professionals
How the Disability Support Pension information for health professionals works.
If your patient’s claiming the Disability Support Pension
If your patient claims DSP, they or we may need to speak with you about their condition. We may be able to pay you for these consultations.
If your patient claims DSP, they’ll need to provide current medical evidence for each condition that affects their work capacity.
The evidence needs to show details of diagnosis and how the condition affects them. In most cases, we also need information about treatment and prognosis.
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.
You can also use the Medical Evidence Checklist for treating health professionals form. This may help you support your patient to provide medical evidence. You can use this to check if your patient’s medical evidence includes relevant information about their condition.
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 will help us get the information we need to assess a claim. If we can’t get this information, we may reject your patient’s claim.
Your remuneration options
The usual Medicare fee can apply if you gather medical evidence as part of a clinical consultation where you examine the patient.
Medical practitioners can also request a payment from us. You can do this if one of our health or allied health professionals contacts you to discuss medical evidence.
If your patient’s having a medical review for the Disability Support Pension
If your patient has a medical review we apply the revised Impairment Tables. We also reassess their work capacity.
You can read about Impairment Tables on the Department of Social Services website.
Medical evidence for the review
Your patient can use a Disability Support Pension Review - Medical Evidence Requirements form. This will help them to get medical evidence for their DSP medical review. Your patient may ask you to help them gather current medical evidence for their medical review.
You can also use the Medical Evidence Checklist for treating health professionals form to check your patient’s medical evidence. This can help you ensure it includes relevant information about their condition.
Once we get the medical evidence, we’ll review it. This will help us determine your patient’s medical eligibility for DSP.
We may require your patient to attend a Job Capacity Assessment as part of the review.
Read more about Job Capacity Assessments.
We may also require your patient to attend a Disability Medical Assessment with a Government-contracted Doctor.
Read more about the Disability Medical Assessment.
We may contact you as part of the assessment process. One of our assessors, health professionals, Authorised Review Officers or Government-contracted Doctors may contact you.
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.
This confirms they consent for you to disclose relevant information about their disability or medical conditions to our assessors.
After the assessment
After we’ve assessed their situation, we 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. This ensures they get the right payment for their situation.