Disability Support Pension (DSP) Qualification Requirements
For help in understanding all the acronyms, there are a list of definitions at the bottom of this post. Items that are underlined (not headings) are also explained in the definitions (E.G. Functional Impairment).
In order to qualify for the Disability Support Pension (DSP) and individual must:
Be at least 16 years of age, AND
Satisfy the residence criteria, AND
Be permanently blind, OR
Have a permanent physical, intellectual or psychiatric condition resulting in functional impairment of at least 20 points as measured by the Impairment Tables AND
Have a CITW, OR
Be participating in the Supported Wage System (SWS)
Now, to break it down so that you understand what all these terms and acronyms mean (are you over acronyms yet??? This list might help). Clearly we understand the first 3 points, however, the rest is as follows:
Have a permanent physical, intellectual or psychiatric condition resulting in functional impairment of at least 20 points as measured by the Impairment Tables.
When assessing and individual’s qualification for DSP, the following factors should be considered and assessed:
Medical & Other Evidence for DSP
Primary medical evidence
DSP determinations are based on a range of considerations relating to the qualification criteria for the payment. These considerations include whether a person's condition is permanent, that the acceptable evidence demonstrates that the condition is fully diagnosed, fully treated and fully stabilised and likely to persist for more than 2 years. Diagnosis of medical conditions for DSP purposes can only be provided by an appropriately qualified medical practitioner (exceptions are outlined below). Medical evidence should therefore contain sufficient information to enable DSP determinations to be made, including details of:
the diagnosis of the person's medical condition/s, including date of onset and whether the diagnosis is confirmed, and the details of the medical professional who made the diagnosis,
clinical features including history, current symptoms and prognosis,
past, present and future/planned treatment,
impact of condition/s on ability to function, including whether this impact is long term or temporary and whether the effect of the condition on the person's ability to function is expected to remain unchanged, improve, or deteriorate,
any impact on life expectancy as a result of the medical condition/s, and
any supporting information used by the doctor, such as x-rays, hospital records or pathology results.
Examples of medical evidence could include, but not be limited to:
medical history reports,
specialist medical reports,
medical imaging reports,
compensation reports,
physical examination reports,
hospital/outpatient records,
operative reports,
rehabilitation reports, or
details of any current or planned treatment from a treating doctor or specialist.
Types of evidence acceptable in certain circumstances
The above primary medical evidence requirements may not apply in certain circumstances where sufficient information to make a DSP determination is available from other sources, including for:
People with an intellectual disability who have attended a school which provided tailored education for children with disability, or classes within a mainstream school which were tailored to meet their needs, and are able to provide a report from their school which indicates their IQ.
People who are blind and are able to provide a report from an ophthalmologist, or a report from an optometrist, which is supported by a report from the treating or formerly treating ophthalmologist.
A child assessed before 1 July 2009 as being a profoundly disabled child carer was being paid Carer Payment (CP) up to the time the child turns 16.
A person in receipt of a DVA disability pension at special rate (totally and permanently incapacitated (TPI)). The person must provide their special rate decision letter from DVA or give authority for DHS to obtain the relevant payment information from DVA.
In limited circumstances a claimant's eligibility for DSP may be based on the provisional diagnosis of a mental health condition provided solely by a DHS registered psychologist.
Other medical evidence
The person may choose to provide other relevant medical evidence. This type of evidence may also be available from other sources such as DHS records. However, this type of evidence can only be used as supporting or complementary evidence and cannot be used in isolation from, or instead of, the primary evidence containing the required details (including diagnosis, treatment and prognosis) outlined above. This type of evidence may include but is not limited to:
medical certificates from the person's treating doctor or specialist,
hospital/outpatient reports,
x-ray and other medical investigation reports,
psychometric test results,
prescriptions/sample medication,
medical information used by DHS to assess entitlement to other payments,
Example: If a person has recently attracted payment of CP or CA, the delegate can refer to previous medical reports held on the CP/CA file for the person.
reports from para-professionals, or
reports from non-medical practitioners or community services.
Example: Psychologists, mental health workers, social workers, drug and alcohol counsellors, community medical health workers, physiotherapists and occupational therapists.
Explanation: This type of information may supplement but cannot be used in isolation from or instead of the primary medical evidence from appropriately qualified medical practitioners.
Non-medical evidence
The person may also choose to provide non-medical evidence in support of their DSP claim or continuation. This evidence may include but is not limited to:
reports from alternative health practitioners (e.g. naturopaths, massage therapists), or
letters or references from various sources (e.g. carers, friends, community members),
reports from teachers (other than reports from teachers on behalf of special schools that contain IQ test results).
Explanation: Reports from special schools/teachers on behalf of special schools that contain IQ test results are treated as medical evidence. Non-medical evidence alone cannot be used for determining DSP eligibility.
Evidence of active participation in a Program of Support (POS)
Any material which is related to a person's participation in a POS can be used to determine whether that person has actively participated. This may include information from one or more designated providers. The information in relation to the POS must provide the following:
details of the designated provider,
periods of participation in the program,
periods of non-participation in the program and associated reasons,
reasons for ceasing the program (if any),
the terms of the program that were specifically tailored to address the person's level of impairment, individual needs, barriers to employment, and capacity to work,
the terms with which the person had to comply in order to satisfy the program requirements and the level of compliance with those terms,
details of vocational, rehabilitation or employment activities undertaken during the program, and
the frequency of contact the person had with the designated provider.
Documents or other material that may assist in determining whether a person has actively participated in a POS include but is not limited to:
EPPs,
DES, jobactive (former JSA), CDP (former Remote Jobs and Communities Programme (RJCP)) or Australian Disability Enterprise program progress, exit or closure reports.
A person cannot meet the requirements for active participation in a POS unless they have commenced a POS. A person is generally required to have participated in a POS for at least 18 months during the relevant period applying to the person (generally 36 months). However, a person who has commenced their POS will not be required to have participated for the full 18 months, where:
the POS was terminated before the end of the relevant period applying to the person because the person was unable, solely due to their impairment, to improve their work capacity, or
at the end of the relevant period (e.g. at the date of claim), the person is participating in a POS but is prevented, solely because their impairment, from improving their work capacity through continued participation in the program.
Explanation: The above provisions are not exemptions from the POS requirements. They provide alternative avenues through which persons can meet the POS requirements in certain circumstances. In order for a person to meet the POS requirements under the above provisions, robust evidence must be provided which demonstrates the person commenced a POS but was or is unable to improve their work capacity by participating in a program solely due to their impairment. A report must be provided by the designated provider, which details the person's participation in a POS, why the program was terminated (if relevant) and why the person was or is unable to benefit from continuing in the program as a result of their impairment. This applies to new claimants and certain DSP recipients aged under 35 years who are subject to POS requirements on review, from 1 July 2014.
Specialist Assessments for DSP
Job capacity assessors (assessors) can arrange a specialist assessment to complete a JCA report or an ESAt report, where the evidence supplied to the assessor indicates the person may be eligible for DSP, and:
the available evidence is unclear or insufficient for the assessor to complete the report, and
the person is unable to obtain or supply additional evidence, and
the assessor is unable to obtain the necessary additional information or clarification from the person's treating doctor(s), the Centrelink HPAU or contributing assessors.
A specialist assessment may be conducted internally by an appropriately qualified assessor (including the assessor preparing the JCA/ESAt report), or by an appropriately qualified external medical or allied health professional.
A specialist assessment is generally scheduled after the JCA appointment, once the assessor establishes that a specialist assessment is required. In exceptional circumstances, a specialist assessment may be conducted at the time of the JCA appointment where the assessor establishes that a specialist assessment is required prior to or at the time of the assessment and the person provides informed consent. Clinical assessments which are able to be completed during the JCA and where no specialist report is produced are not considered specialist assessments.
A specialist assessment should only be arranged where:
comprehensive evidence has been provided to the assessor (i.e. a medical report - DSP or a combination of other documentation containing equivalent information) but clarification or additional information is required and cannot be obtained by any other means, or
the assessor observes or suspects that a person has an intellectual disability, acquired brain injury or psychological/psychiatric disorder and there is no evidence of diagnosis or treatment as the person lacks insight into (or does not acknowledge) the condition or is otherwise incapable of independently engaging in medical services to obtain the required information, or
Centrelink Legal Services considers a specialist assessment is required with respect to an appeal to the AAT (or the Federal or High Court).
Explanation: Assessors should refer to the preamble of the appropriate Impairment Table in deciding whether a Specialist Assessment is required.
DSP Assessment of Impairment Ratings
As part of the qualification for DSP a person must have one or more physical, intellectual or psychiatric impairment/s that attract a total impairment rating of 20 points or more under the Impairment Tables.
Note: A claimant who has a total impairment rating of at least 20 points, must also have a CITW to qualify for DSP.
Explanation: Some claimants may have an impairment rating of at least 20 points but do not have a CITW because they can work full-time where wages are at or above the relevant minimum wage or be re-skilled for such work within 2 years.
When can a rating be assigned?
An impairment rating can only be assigned for permanent conditions which cause an impairment that is more likely than not to persist for more than 2 years. A condition is permanent if:
the condition has been fully diagnosed by an appropriately qualified medical practitioner, and
the condition has been fully treated, and
the condition has been fully stabilised.
In limited circumstances diagnosis of a psychological/mental health condition may be provided by a registered DHS psychologist.
Health Professional Advisory Unit (HPAU)
If, following an assessment of all the available medical and other information, there is still a need for an expert medical opinion, the HPAU can provide advice, clarification and interpretation of medical information to assessors and DHS staff for DSP claim, review and appeal purposes.
The HPAU's advice must be recorded and forms part of the medical evidence used to support the decision about qualification.
As you can see, it is quite complex. This information relates to, what I will call, Full –DSP – meaning you have no employment related participation requirements in order to continue receiving your payment. You will have seen mention of the CITW stated throughout this post, and also in the definitions and notice that it has not been addressed in this post. This mostly relates to the DSP – 15-hour Rule. I will address this in another post because, this has become quite lengthy.
Again, as this is so complex – as it always is when referring to legislation and deeds 😳 – if anyone needs further clarification then please message me, I am always happy to help.
As always, using any information that I provide should be done so of your own volition. All information provided was relevant at the time of posting and is my interpretation of the Social Security Act 1991 based on my industry experience within the community/employment services industry.
Definitions
AAT: Administrative Appeals Tribunal
ARO: Authorised Review Officer
CITW: Continuing Inability To Work
CP: Carers Payment
DES: Disability Employment Service
DHS: Department of Human Services
DSP: Disability Support Pension
DSP - 15-Hour Rule: to qualify for DSP a person must have an impairment rating of at least 20 points and have a CITW. Both aspects are of equal importance.
Explanation: People who have an impairment rating of 20 points or more, including those with severe impairments, are not necessarily incapable of working. Their medical impairment/s may cause difficulties in many work situations, but depending on their individual circumstances, coping mechanisms, training, and reasonable adjustments, they may be able to undertake work of 15 hours or more per week, within the next 2 years.
EPP: Employment Pathway Plan
ESAt: Employment Services Assessment
Functional Impairment: For the purposes of DSP, a functional impairment is a loss of functional capacity affecting a person's ability to work that results from the person's medical condition.
HPAU: Health Professional Advisory Unit
Impairment Tables: For the purposes of DSP, the Impairment Tables are tables designed to assess impairment in relation to work. They consist of a set of tables that assign ratings in proportion to the severity or impact of the impairment on function as it relates to work performance.
The Impairment Tables have been reviewed to bring them into line with contemporary medical and rehabilitation practice. The revised Impairment Tables are contained in Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011.
The Tables:
are function based rather than diagnosis based,
describe functional activities, abilities, symptoms and limitations, and
are designed to assign ratings to determine the level of functional impact of impairment and not to assess conditions.
JCA: Job Capacity Assessment
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