1. Eligibility Criteria
2. Medical evidence for DSP
You need to submit medical evidence if you claim Disability Support Pension (DSP), or have a medical review.
To help Centrelink work out if you can get DSP, they need to know how your condition affects you.
They need medical evidence from your treating health professionals about your conditions. In most cases, they need evidence for each condition that affects your ability to work.
If you don’t give them medical evidence when they ask for it, they may reject your DSP claim or stop your DSP payment.
If you’re having problems with medical evidence contact Centrelink. They can look at your situation and discuss your options.
NOTE: Social Security Rights Victoria now has a DSP toolkit. This is a resource for medical practitioners, social and community workers who want to help their clients obtain evidence for a DSP application. The whole kit, which includes sample letters is available on ssrv.org.au/disability-support-pension-toolkit/.
Note that in Victoria, organisations can arrange a training session in the use of the toolkit by emailing firstname.lastname@example.org or calling 03 9481 0299. Other state-based organisations can arrange training by contacting Social Security Rights in their states.
Types of medical evidence
- medical history records or reports
- specialist medical reports
- psychologist reports, including IQ testing
- special school reports
- other reports such as physiotherapy or audiology reports
- medical imaging reports
- physical examination reports
- compensation and rehabilitation reports
- hospital or outpatient records including details of operations
Most conditions need evidence from a health professional, such as your usual treating doctor.
Conditions that may need specialist evidence
Mental health conditions
Evidence that a psychiatrist or clinical psychologist supports the diagnosis.
An assessment of intellectual function and adaptive behavior supported by a psychologist. This should include information about your IQ score, or ability to undergo testing. A report from your special school may have this information.
Ear conditions affecting hearing or balance
Evidence that an audiologist or an ear, nose and throat specialist supports the diagnosis.
Eye conditions affecting vision
Evidence that an ophthalmologist or ophthalmic surgeon supports the diagnosis.
When claiming DSP, your medical evidence should support what you’ve put in the medical details section of your claim.
In all cases, your medical evidence should:
- show your diagnosed conditions
- include the name and contact details of your doctors and specialists
- be current, usually less than 2 years old
In most cases, Centrelink needs to confirm all of the information below.
- the diagnosis of your condition
- the date of your diagnosis
- the name and contact details of the doctor or specialist that diagnosed your condition
If you already have DSP and Centrelink has asked for current evidence for a medical review, you may not need to get new evidence confirming diagnosis if you’ve given this to us before.
Contact Centrelink to check if you’re not sure.
Centrelink also needs to confirm:
- details of any past, current or planned treatments including if you’re on a waiting list
- if you need special care, including nursing home level or palliative care
- when the symptoms started (date of onset) – including:
- the severity, frequency and duration of the symptoms
- if the symptoms will persist despite treatment and use of aids, equipment or assistive technology
- whether your prognosis will improve, stay the same, or get worse or affects how long you’ll live
Contact Centrelink if you’re not sure what evidence you need to provide.
Centrelink may need to talk to your treating health professional about your medical evidence. You should provide consent Consent to disclose medical information form. Centrelink staff must show this consent form to the treating health professional.
You can also withdraw your consent at any time by contacting Centrelink.
3. Impairment rating measures
An impairment rating measures how much a particular disability affects you and your ability to work. Disability Support Pension. An assessor now uses a set of impairment tables (which can be located at http://www.comlaw.gov.au/Details/F2011L02716 ) to assign you an impairment rating.
To be eligible for a Disability Support Pension, you must be assessed as having an impairment rating of at least 20 points from any of the tables. If you are assessed as having an impairment rating of less than 20 points, your claim will be rejected.
As of January 2016: There are some conditions considered as “manifest”. Manifest grants of the DSP are made without further assessment in the following limited circumstances: a terminal illness (life expectancy of less than two years with significantly reduced work capacity during this period); permanent blindness (meets the test for permanent blindness for social security purposes); an intellectual disability where medical evidence clearly indicates an IQ of less than 70; an assessment indicating that they require nursing home level care; category 4 HIV/AIDS; or in receipt of a Department of Veterans’ Affairs disability pension at special rate (totally and permanently incapacitated). Two lists of conditions have been available since 1 July 2010, to help decision makers determine manifest eligibility for DSP on the grounds of terminal illness, nursing home level care requirements, and/or intellectual disability.
How is an impairment rating obtained?
When you apply for a Disability Support Pension, you will usually be required to attend a Job Capacity Assessment (JCA).
The JCA will be used to determine eligibility for DSP and whether you can work, how much you can work and what help may be needed to assist you to find and keep a job.
Your JCA will consider all the available medical evidence, including any reports from your treating doctors and specialists.
Your assessment will take into account as many different conditions as is relevant. However, you will receive a rating only for your ‘permanent’ conditions. Permanent conditions are conditions that have been ‘fully diagnosed, documented, treated and stabilised’, and are expected to last for more than 2 years. This issue is discussed in more detail below in the ‘Newly diagnosed, controversial, difficult to diagnose and episodic conditions’ section.
Each of your permanent conditions will be given an impairment rating, and all the ratings will be added together to give a total impairment rating.
To maximise your impairment rating, it is most important that you provide information about all your health problems, not just your main medical or psychiatric conditions.
4. What is a ‘continuing inability to work’?
Centrelink will also consider whether you have a ‘continuing inability to work’. A continuing inability to work means that, for the next 2 years, your illness or disability will prevent you from working for 15 hours per week ‘independently of a program of support’.
Independently of a program of support means that you are unlikely to need frequent or ongoing support from a government-funded agency to enable you to prepare for, find or maintain work.
Centrelink will also consider whether you are able to undertake a ‘training activity’, and, if so, whether such training would probably enable you to work within 2 years. The training activity may involve education, pre-vocational training, vocational training, vocational rehabilitation or work-related training (including on-the-job training).
‘Work’ means any type of work that you are capable of undertaking for more than 15 hours per week without special assistance from a government-funded agency . It is not confined to the type of work you have undertaken previously.
In addition, Centrelink will determine for how many hours a week they think you are capable of working. They will not just consider for how many hours you are currently working. For example, if you are currently working for 10 hours per week and receiving a part pension, they will consider whether you are capable of working 15 hours or more per week.
The state of the labour market is not regarded as being relevant to your continuing inability to work. For example, you cannot argue that it is difficult for people of your age to obtain work. However, your age may be relevant when considering suitable training courses.
Sometimes, the 15 hour per week ‘work test’ is not assessed fully, and you may need to raise the matter with Centrelink. For example, if the work capacity assessor decides that your impairment rating is 20 points or more, but you can work for only 12 hours per week (and no more), you are eligible for a Disability Support Pension. The payment you receive will be reduced because of your earned income, but you are eligible for a Disability Support Pension, so you should receive it.
If your claim for a Disability Support Pension is refused, it may be because Centrelink has made unrealistic conclusions about your ability to do certain types of work or training. For example, they may decide that your condition does not prevent you from working or training, but would severely interfere with your ability to attend or concentrate. If an unrealistic conclusion is drawn about your situation, ask your doctor to write a report that specifies and clarifies your condition and its impact.
Training or education
Your work capacity assessment will also consider your ability to undertake and benefit from training or education. If they decide that you are capable of undertaking training that would enable you to work for more than 15 hours per week in 2 years time, you will not be eligible for a Disability Support Pension.
5. What payment can I receive while Centrelink makes a decision?
Centrelink may take a long time to decide whether you are eligible for a Disability Support Pension. In the meantime, you may be able to claim another payment such as Newstart (Incapacitated) or Youth Allowance (Incapacitated). If so, you will be exempt from the activity test until your claim for a pension has been decided.
If you are not eligible for another payment when you lodge a claim for a Disability Support Pension , you should lodge a claim for a Special Benefit at the same time. Details of the Special Benefit are not covered in this guide.
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