Streaming a new claim for Disability Support Pension (DSP) 008-03010100
Expand allFor Disability Support Pension New Claim Smart Centre Processing staff.
This page contains information about streaming and finalising a new claim for Disability Support Pension (DSP) or referring for a Job Capacity Assessment (JCA).
> Referral
> Referral
> Referral
> Referral
> Referral
> Referral
> Referral to view the Referral landing page or
> Referral. Select:
and 
to view the Claim Summary in a new window. If it is blank, press [F5] to refresh the page.
to Update DOR
to Update DOR
to Update DOR
and regenerate the claim.
> DMA Assessment or DSP Claim Summary
> Referral. Select:
> Referral. Select:
and 
to view the Claim Summary in a new window. If it is blank, press [F5] to refresh the page
.
> Selective Application Data. This will create the SAD Task Selection:
> DSP Claim Summary > JCA/ESAt
> Referral to create a 
> Consent to Contact THPCustomer First
On this page:
Claim for DSP for a Terminal Illness (SA494) and/or Verification of terminal illness (SA495)
Review DSP claim details and circumstance updates
Review the Disability Support Pension Medical Eligibility Assessment Recommendation (SA479)
JCA Referral required - commence Rapid Stream
Work item received
Table 1
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Work itemsSelect Ready to receive work item. Review work item and if it relates to:
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Upgraded ESAt Fast Note/DSP InviteAssessment Services determine if an ESAt can be upgraded to a JCA if there is sufficient medical evidence to support medical eligibility for DSP, including manifest. If staff receive a submitted ESAt (upgraded to JCA) and/or Potential DSP eligibility Fast Note:
If there is a DSP claim in progress:
If there is no DSP claim in progress:
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Reassess Rejected Claim - for reason FSD/FRC/POI/IME/FME or GCDIf a Service Officer receives a Reassess Rejected Claim Fast Note, review previous claim to make sure the claim meets the requirements to reopen. If the Reassess Rejected Claim Fast Note clearly states that the customer has requested an explanation of decision or a formal review, complete the Fast Note and record their request. See Request for a Subject Matter Expert (SME) explanation or application for a formal review. Do not reopen and reassess a DSP claim where:
Where the claim can be reopened and reassessed, action required depends on previous rejection reason. If the claim was previously rejected for reason:
Close the Reassess Rejected claim Fast Note, when required action has been taken. Claiming DSP exemption for reindexed claims If the customer is in receipt of Jobseeker Payment (JSP) or Youth Allowance (jobseeker):
See JobSeeker Payment (JSP) and Youth Allowance (YA) (Provisional) for more details. | |
Priority-PossTRM NCL in Prog Fast NoteWhen a Service Officer receives a Priority-PossTRM NCL in Prog Fast Note, they must: Check the DSP Claim Progress DOC. Review the medical evidence and medical assessments including MAt, to determine if manifest medical eligibility has been assessed. If the MAt report/SA479 has been submitted and:
When the work item presents, review the MAt report/SA479. See Table 3 on the Customer First tab. | |
No DSP claim has been lodgedIf only the MEDSA466 has been submitted or a document is lodged but incorrectly classified/uploaded as a SA466, a NCL activity is created and referred to MAt. An Assessment Services Assessor checks the customer's record to make sure a DSP Claim is present before completing a MAt report/SA479. Where no claim is present, the Assessor cancels the MAt referral and annotate the DSP Progress DOC. Service Officers must make genuine attempts to contact the customer/nominee to discuss lodgement of medical evidence without a claim for DSP. Note: if MAt has completed a recommendation/SA479 and no DSP Claim is present, the claim must not be progressed. Send feedback to MAt Assessor via the Staff Feedback Tool. If a DSP claim (SA466) has not been lodged, make genuine attempts to contact the customer/nominee. Was the contact successful?
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Unsuccessful contact attemptIf the contact attempt is not successful:
Attempt to contact the customer again. Was the second contact attempt successful?
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Successful contact attemptIf the contact attempt is successful, tell the customer or nominee:
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Unsuccessful second contact attemptIf the second contact is not successful:
If the MAt/SA479 recommends customer is manifestly medically eligible due to Terminal Illness and supporting documents indicate the average life expectancy of the customer is:
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MAT requests action Fast NoteAssessment Services will create this Fast Note when they are unable to complete a MAt, and further action is required: Review the notes in the Fast Note. Where the Fast Note indicates MAt will recommend manifest medical eligibility, but customer's residence details are unknown:
Where the Fast Note indicates the DSP claim is on the wrong record Paper claims:
Online claims:
Duplicate/intertwined record: See Table 4 > Step 6. |
Claim for DSP for a Terminal Illness (SA494) and/or Verification of terminal illness (SA495)
Table 2
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Work item receivedIs the work item a SA494 and/or SA495?
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SA494 and SA495 work item or SA494 (only) work item receivedSA494 DSP New Claim will be indexed and appear on Activity List (AL) screen. Open the scanned SA494 and check for SA494 Documents tools. If a MAt report/SA479 does not exist:
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SA495 (only) work item receivedCheck the customer's record to see if a DSP Online Claim or Paper Claim (SA466) has been lodged. If there is:
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Check SA495Check the life expectancy details recorded on the SA495. Note: the SA495 does not show if life expectancy is less than 3 months. The details from the health professional or other supporting documentation may indicate this. If there is an indication the average life expectancy of a person with the condition is:
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Life expectancy is less than 3 monthsIf the information given indicates the customer's life expectancy is less than 3 months:
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Life expectancy is between 3 months and up to 2 years (or it is not clear)If the customer is subscribed to electronic messaging, send a pre-call SMS. Note: this functionality is not available to nominees. If a nominee arrangement is in place, attempt to contact the nominee first. Although there is no restriction on contacting customers who have a nominee, the nominee arrangement exists for a reason. Wherever possible, make the initial contact with the customer's nominee and if unsuccessful, attempt to contact the customer. Tell the customer or nominee:
Consider recording an Intent to claim for vulnerable customers. If the contact attempt was:
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No DSP new claim - average life expectancy is above 2 yearsIf the customer is subscribed to electronic messaging, send a pre-call SMS. Note: this functionality is not available to nominees. If a nominee arrangement is in place, attempt to contact the nominee first. Although there is no restriction on contacting customers who have a nominee, the nominee arrangement exists for a reason. Wherever possible, make the initial contact with the customer's nominee and if unsuccessful, attempt to contact the customer. If the contact attempt was successful, tell the customer or nominee:
In the customer's record:
If the contact attempt was not successful:
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Check for DSP new claimIf the work item becomes due:
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Second contact attemptIf the customer is subscribed to electronic messaging, send a pre-call SMS. Note: this functionality is not available to nominees. If a nominee arrangement is in place, attempt to contact the nominee first. Although there is no restriction on contacting customers who have a nominee, the nominee arrangement exists for a reason. Wherever possible, make the initial contact with the customer's nominee and if unsuccessful, attempt to contact the customer. If contact is successful, tell the customer or nominee:
Consider recording an Intent to claim for vulnerable customers. If contact is not successful, annotate original DOC. Close the work item. If the life expectancy for the customer is:
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Unassessed DSP new claim or the customer has lodged an online claimDSP claim is 'On Hold' for reason 'referred to the Medical Assessment Team (MAT)' via the general MAT Referral Fast Note: DSP MAT Recommendation Query > DSP new claim lodged. If the MAT report/SA479 is incomplete:
If the MAt report/SA479 is:
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Commence streaming of claim
Table 3: Service Officers use this process when allocated a DSP Claim / Reindexed claim.
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Check the DSP Claim statusReview the DSP Claim Progress DOC to determine the status of the DSP Claim, including previous referrals. Where the DSP claim has not previously been streamed, go to Step 3. Where the DSP claim has previously been streamed and the claim and it:
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DSP Claim allocated - JCA not submittedWhere staff are allocated a claim and a JCA report has not yet been submitted, action required depends on the status of the JCA. For more information about a JCA status, see Understanding Job Capacity Assessment (JCA) reports. Check Referral Summary (RRSUM) screen. JCA status is 'New' and appointment is booked for a future date (see Latest Effect Date)
JCA status is 'New' and appointment was in the past (see Latest Effect Date)
JCA not yet booked. Check if the JCA Referral Fast Note is still Open/Held on AL
JCA has status of Returned/Reopened
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JCA status is Unable to Complete (UTC)JCA UTC if the assessment could not be completed because, for example, the customer did not attend JCA, claim was withdrawn, incorrect referral reason, customer did not consent to Information Sharing. See Job Capacity Assessments (JCA) referrals - finalising as Unable to Complete (UTC). View the JCA report to see the reason it was UTC. Customer withdrew DSP claim Check Activity List (AL) to see status of DSP Claim. If the customer has:
Customer declines to participate or does not consent to Information Sharing
Customer fails to attend 2 JCA appointments Check the Referral Summary (RRSUM) to see if the customer has contacted and rebooked a JCA appointment. Where JCA appointment has been rebooked:
Where JCA has not been rebooked:
Current and valid ESAt/JCA, or manifest eligibility met Where there is a current & valid ESAt/JCA or manifest eligibility is met, Assessor will complete a new SA479 Review the new MAt report (SA479)
Inappropriate JCA referral/Incorrect referral type
Procedure ends here. If a new JCA Referral is needed, see Table 5. | |
Initial Stream of DSP claimWhen a DSP claim is submitted/scanned, a New Claim activity is created and an automatic referral to MAt is created. Check for a completed MAt report/SA479:
If a MAt report/SA479 has been completed, see Table 4 on the Customer First tab If a MAt report/SA479 has not been completed:
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Check for current MAT referralIs there a current MAT referral?
If the customer is in receipt of JobSeeker Payment (JSP) or Youth Allowance (YA), the system will automatically apply the 'Claiming DSP' exemption for 104 weeks pending assessment of the DSP claim, in most cases. An exception to this is if the customer is in receipt of JSP/YA and they are a New Zealand Non-protected Special Category Visa Holder - the system will not automatically apply the exemption to these customers. For more details, see Jobseeker Payment (JSP) and Youth Allowance (YA) (Provisional). Procedure ends here until MAt report/SA479 is submitted. |
Review DSP claim details and circumstance updates
Table 4: Service Officers must use this process to review the DSP claim and customer circumstances.
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Check how the DSP claim was submittedOnline claim/Assisted Customer Claim (ACC) Information given by the customer in an online claim or ACC can only be viewed in Process Direct. See the Process Direct tab for more details. Paper claim submission Paper claims and scanned supporting documents can be viewed by through Workspace > select Documents Tools under Quick Links. Check customer signature on claim: If the paper claim is lodged without a signature and there is an opportunity to correct this (more information to be requested), ask the customer to sign the form as part of any later request for further information. Claims without a signature can be processed, provided:
If the delegate has any concerns about the customer's identity, or the completeness or accuracy of the information given, the delegate may request a signature. Note: the DSP claim may be signed by the customer or their Correspondence Nominee. No DSP Claim present Where a Service Officer identifies no DSP claim has been lodged/submitted. e.g.
do not proceed with DSP claim, see Table 1 > Step 5 to contact the customer. | |
DSP claim start dateWhen assessing a DSP claim start date, review the claim and customer circumstances to:
Impairment Tables and impact on DSP claim start date The Impairment Tables used to assess medical eligibility for DSP changed on 1 April 2023. It is important the correct claim start date is established and coded on PNA to make sure the correct version of the Impairment Tables is applied, if a JCA/DMA assessment is required. See Impairment Tables - start date scenarios. The following must be checked. Claim submitted via Assisted Customer Claim (ACC) or combined DSP/JSP claim There is a known issue where the incorrect date of receipt may be used in the claim if staff have used the Assisted Customer Claim (ACC) to start and submit the DSP claim, or it is a combined DSP/JSP claim. The following must be checked for all ACC and/or combined DSP claims:
Review Pre-Claim Vulnerable Circumstance
Where the customer has pre-claim vulnerable circumstances recorded within the eight weeks before their intent to claim contact date, the system will automatically calculate the start date. Where a pre-claim circumstance displays with a start date that is more than 8 weeks ago and has no end date, consider if a pre-claim vulnerable circumstance still exists using the available information. In these cases, assess if the:
Claim lodged within 13 weeks of 2 July when Carer Supplement (CS) paid Where the customer lodges a claim for DSP within 13 weeks of 2 July when CS has or is due to be paid, the claim start date is 2 July. This includes when a Carer in a 14-week bereavement period or in a 14-week continuation period after the care receiver has been admitted to an institution. Additional checks to confirm the correct date the claim was submitted If coding a claim, the date of receipt used must be the:
Make sure the claim is indexed from the earliest date the customer may be eligible by checking:
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Duplicate/ Re-provided claimsDuplicate claims (where a second claim is submitted within 13 weeks of a previous claim) Claims for DSP can be submitted at any time. If a customer lodges a DSP claim within the qualification period (for example, 13 weeks) of a previously submitted DSP claim, Service Officers must determine how each claim is to be progressed. Check Pensions Status History Summary (PNSH) and DOCs for a previous DSP claim finalised in the last 13 weeks. Attempt to contact the customer/nominee to establish their reason or intent in lodging a second claim. Customers can also choose to withdraw the subsequent claim. See Cancel or Withdraw an online claim and Withdrawal of claims. Tell the customer that when a claim is withdrawn, they cannot:
Do not withdraw a claim if the customer has not been contacted. If contact is not successful, or the customer wishes to pursue assessment of the subsequent claim, progress claim per normal process. Go to Step 4. For help with multiple claims, or where the customer has attended a JCA/DMA supporting grant for the second claim, Service Officers can contact the Level 2 Policy Helpdesk by submitting an Online Enquiry form. If the customer is seeking reassessment of a previously rejected claim, see Table 1 > Step 4 on the Customer First tab. Re-provided claims (where customer has lodged the same DSP paper claim form) A re-provided claim can be considered a legal claim if the claim is complete and meets the claim lodgement requirements. See Claim lodgement of Centrelink claims. Action required depends on the status of the original DSP claim and contact with the customer/nominee to confirm the reason for lodging the second claim. A claim cannot be cancelled or withdrawn without the customer/nominee agreeing to it. Review the DSP Claim Progress DOC to determine the status of the original claim. Where the original DSP Claim is still in progress, and the customer has either:
Where the original DSP claim was rejected in the last 13 weeks: Try to contact the customer/nominee to establish their reason for re-lodging the claim.
Where the re-provided claim is lodged more than 13 weeks after previous rejection: If the claim is complete and meets the definition of a legal claim, progress the claim as normal, go to Step 4. For help with re-provided claims, submit an Online Enquiry form with Level 2 Policy Helpdesk. | |
Deceased customerWhere a customer has passed away, and there is a potential period of DSP entitlement between the date of claim submission and date of death, the claim must be assessed. Note: if the customer's record has been 'deceased', it must be resurrected. See Undoing a death action. Consider a referral to Customer Critical Response Team (CCRT) where there may be complexity involved in the claim process, go to Step 5. | |
Consider Customer Critical Response Team (CCRT) referralCustomers who are identified at initial review of a DSP claim (or subsequent progression of the claim) as having significant circumstances (for example, at imminent risk of self-harm) may require specialised assistance during the life of their claim - consider referral to the CCRT for ongoing management. To determine if the customer needs a referral to the CCRT for assessment, review claim details carefully to determine if the any of the following are applicable:
For assistance in determining if a referral to CCRT is appropriate, access the Customer Critical Response Team SharePoint page for 'work managed' details. See the Resources page for a link. Based on the presenting claim details and referral criteria for CCRT, does the customer require a referral to the CCRT?
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Check the claim is on the correct recordCheck the claim is indexed on the correct record. Check the customer details in the claim against the new indexed activity to prevent multiple records and intertwined record creation. Is a referral to DQU required for investigation of an intertwined record?
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ImprisonmentIs this customer in prison, charged with an offence and not undertaking a course of rehabilitation, or found guilty and convicted of an offence?
Note: if the release date is unknown, contact F2F Incarcerated Customer Contacts to confirm release date. See Confirming prison admission and release dates. | |
Nominee DetailsService Officers must process the Authorising a person or organisation to enquire or act on your behalf form (SS313) if lodged with a new claim and confirm nominee identification requirements are met. This is to make sure the nominee also receives the claim outcome letter. Check the customer's record to determine if a Nominee update has been requested. Go to Workspace > select Documents Tools under Quick Links Is there a SS313 present requiring an update to Nominee details?
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Relationship detailsCustomers must advise of their current relationship status when lodging a Disability Support Pension claim. Any action that needs to be taken by staff may depend on what is already recorded on the customers record and if there have been any changes. Refer to Relationship details for new claims for details on the following:
To determine if an update is required to the Pensions Assessment (PNA) screen as a result of investigations relating to date of receipt, go to Step 10. | |
Pensions Assessment (PNA) screen updateThe Pensions Assessment (PNA) screen displays the Pension Assessment Date (the assessment/start date of the DSP claim). Make sure the correct Assessment Date (start date) appears on the Pensions Assessment (PNA) screen as this is the date all medical and non-medical eligibility needs to be coded and referenced as the Date of DSP Claim for any JCA/DMA referral request. Start date may need to be later than date of submission
If an update is required on the Pensions Assessment (PNA) screen, change the Assessment Date by correcting the date to the new assessment date. Where there has been a change to the Assessment Date on the PNA screen, Service Officers must clearly document this in the DSP Claim Progress DOC. |
Review the Disability Support Pension Medical Eligibility Assessment Recommendation (SA479)
Table 5: Service Officers must use this process to assess the Medical Assessment (MAt) recommendation contained in the Disability Support Pension Medical Eligibility Assessment Recommendation (SA479).
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Review DSP Claim date in SA479Go to Workspace > select Documents Tools under Quick Links to commence reviewing the MAt report/SA479 Check the DSP Claim date on the SA479 to determine if the DSP Claim date matches the Assessment Date (PNA date) on the Pensions Assessment (PNA) screen - established at Step 10 in Table 4. Is the DSP Claim date on the SA479 the same as the PNA date?
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Review medical recommendation in SA479Review the medical recommendation within the MAt report/SA479 with the medical evidence supplied. Make sure all medical evidence has been considered and supports the Assessor's outcome. If there is a JCA/upgraded ESAt that has not been addressed in the MAt report/SA479, this may need returning to the Assessor for reassessment. Where MAt recommend 'JCA Referral required' the MAt report does not need to include all medical conditions/evidence as this will be assessed in the JCA. Where new medical evidence has been lodged since the MAt was completed, this will be also be considered as part of the JCA, therefore do not query the MAt outcome. Does the Service Officer have any concerns with the medical recommendation or content in the MAt report/SA479?
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Progress claim based on MAt recommendationIn all instances, the medical recommendation in the MAt report/SA479 determines the actions to be taken to progress the DSP claim. Medical recommendation:
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Manifest medical eligibilityDSP claims must be held to user for individual case management until finalisation where an Assessor/Government Contracted Doctor indicates manifest medical eligibility. The following checks must be completed to determine details within the MAt report/SA479. Residence See Residence assessment for customers claiming Disability Support Pension (DSP) to determine if the customer satisfies residence requirements for DSP. Where Manifest medical eligibility is recommended by an Assessor, Continuing Inability to Work (CITW) is assessed in the MAt report/SA479. See the Resources page for the Disability Support Pension Residence Screens Checklist. In the customer's record, check all relevant residence screens as detailed in the Checklist while referencing Assessing if a customer is an Australian resident. In the MAt report/SA479, check the answers to the question: Has the customer resided in Australia for 10 years or do they have a Qualifying Residence Exemption (QRE)?
Customer working or studying 15 hours or more per week Is the customer currently working or studying?
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Trans Vaginal Mesh (TVM) casesAssessor must recommend a JCA referral for all TVM cases. Does the MAt report/SA479 recommend a medical rejection for a TVM case?
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Current & Valid JCA/ESAt recommendedSupported Wage System (SWS) Referral Reason in JCA report Check the submitted report to determine if the Referral Reason is Supported Wage System (SWS). JCA reports conducted for SWS resulting in an Invite to Claim DSP cannot be used as a 'current and valid' assessment for the purpose of a DSP claim.
Impairment Tables check Note: staff must see the DSP Assessment Date (PNA date) established at Step 10 in Table 4 for an accurate assessment within this step. If there is a JCA/upgraded ESAt confirmed as 'current & valid' within the MAt report/SA479 for the current DSP claim:
Is the correct version of the Impairment Tables used for the current DSP claim (based on PNA date), the same as the version used for the JCA/ESAt upgraded to a JCA report?
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Check DSP medical eligibility in JCA/upgraded ESAtReview the JCA/upgraded ESAt to determine if the customer satisfies the medical eligibility requirement for DSP. Customer does not satisfy medical eligibility Check if new medical evidence has been lodged since the MAt assessment:
Customer satisfies medical eligibility: Residence check Check Residence assessment for customers claiming Disability Support Pension (DSP) to determine if the customer satisfies residence requirements for DSP. An assessment of where the customer's Continuing Inability to Work (CITW) occurred must be included in the MAt report when the recommendation is 'current and valid JCA/ESAt'. If the CITW assessment:
Work/Study hours check Check the claim and the DSP claimant's record. Is there evidence the customer is
DMA Check
To determine if a previous DMA assessment is Current & Valid' for the DSP claim being assessed, see Level 2 Policy Helpdesk for appropriate policy clarification:
Use the Level 2 Policy Helpdesk response to answer the following question. Is there a current and valid DMA?
If the Assessor identifies the customer is vulnerable or has special circumstances, they may recommend the DMA is completed as a THP Assessment. If the MAt report/SA479 states the DMA is to be completed as a THP assessment:
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Insufficient medical evidenceIf new medical evidence has been lodged since the MAt report/SA479 was completed, go to Step 11. If the Assessor has determined there is insufficient medical evidence to assess eligibility for DSP, they will attempt to contact the customer and deliver Service Officer Interview (SOI). In certain circumstances, the Assessor can allow the customer an extra 5 days to supply information for their claim. For more information about the MAt SOI process, see Disability Support Pension (DSP) Service Officer Interview (SOI). If the MAt report/SA479 indicates the customer has supplied insufficient or no medical evidence, the claim can generally be rejected. Assessor assesses if a customer is experiencing vulnerability or is at risk and where applicable, attempts are made to gather medical evidence to allow assessment to be completed. Note: for vulnerable circumstances, see Intent to claim and vulnerable customers. It is not appropriate to reject the claim for insufficient medical evidence if there is evidence the customer is experiencing vulnerability or is at risk, and this information has not been considered by the Assessor (this includes where no attempts have been made to contact the customers, the treating health professional or the HPAU). This also covers where there is evidence the customer:
Is it appropriate to reject the claim for insufficient medical evidence?
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Manifestly medically ineligibleIf new medical evidence has been lodged since the MAt report/SA479 was completed, go to Step 11. If MAt report/SA479 recommends manifestly medically ineligible, reject the claim without further requests for information. However, if a customer and/or their partner is currently receiving another income support payment such as Jobseeker Payment:
See Rejecting a new claim for Disability Support Pension (DSP) including manifest rejections. Procedure ends here. | |
Customer working or studying 15 hours or more per weekStaff must consider the customer's current employment and educational circumstances before progressing a claim where MAt report/SA479 recommends:
Review Recommendation Rationale section in the MAt report/SA479 to see if the Assessor has considered customer's employment and/or education in their recommendation. Where the customer is not working/studying, or the Assessor has adequately addressed the customer's employment/ education in the MAt report, progress the claim per the MAt outcome:
Where the customer is working or studying more than 15 hours per week and Assessor has not addressed the customer's employment or education in the MAt report:
Procedure ends here until Assessor has completed the review. | |
Medical evidence lodged since MAt report completedIf further medical evidence has been lodged since initial MAt report/SA479 submitted, Service Officer must review the new medical evidence to determine if there is new information that needs assessment by an Assessor. If the new medical evidence is a duplicate of medical evidence which was available when the MAt report/SA479 was submitted or it is clear the new evidence will not alter the outcome, do not refer back to the Assessor. If medical evidence does not require further assessment by Assessor
If the medical evidence needs further assessment by Assessor Prior to requesting a review by the Assessor, staff are to check if available evidence clearly shows the customer does not meet initial non-medical eligibility check, for example:
Does the customer appear to meet the initial non-medical eligibility checks?
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Querying a MAt recommendationIf a Service Officer has a query or concern with the MAt report/SA479 about clear errors or omissions only, or staff have been directed to refer back to Assessment Services, for example:
If the MAt issue can be escalated by the Service Officer, a new MAT referral is required:
Escalate any other concerns, including MAt report/SA479 to reject Insufficient Medical evidence (IME) for a customer experiencing vulnerability, to a Service Support Officer (SSO) Service Officer is to:
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Escalation of MAt query to Service Support Officer (SSO)Service Support Officer SSO reviews the MAt report/SA479 and query. When:
Assessment Services Assessor reviews the escalation request. This may include revising the original recommendation. Once review has been completed, the Assessor:
Procedure ends here until Assessor submits a new MAt report/SA479. |
JCA Referral required - commence Rapid Stream
Table 6: Service Officers must use this process when the Disability Support Pension Medical Eligibility Assessment Recommendation (SA479) recommends a JCA referral is required.
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Customer is currently receiving Carer Payment (CP)Transferring a customer to DSP may disadvantage customers receiving Carer Payment (CP) who are eligible to receive Carer Supplement (CS). If the customer is currently receiving CP, Service Officers must make genuine attempts to contact the customer/nominee by phone:
Claim lodged within 13 weeks of 2 July when Carer Supplement (CS) paid If the customer decides they want to continue with their claim for DSP, for a change to the Pension Assessment date to occur, their:
If the above applies, Service Officers can change the PNA date to 2 July if the customer is assessed as medically eligible for DSP. Note: if the customer is currently in a Carer Pension bereavement period or in a 14 week continuation period after the care receiver has been admitted to an institution, this contact is not required. If genuine contact attempts by phone are unsuccessful, send a Q164 letter to the customer to request contact. Record details in the claim progress Note or DOC on the customer's record, including:
Hold the claim for the required response time (until day 22, unless other wait time provisions apply). If the customer has not responded to the Q164 by the due date, go to Step 2. | |
Rapid StreamMedical Assessment (MAt) report/SA479 recommends a Job Capacity Assessment (JCA) referral is required. Staff must follow a Rapid Stream process to progress the DSP claim. Where a customer and/or partner is in receipt of an Income Support Payment (ISP) and they advise information in the DSP claim which impacts on their current payment, relevant updates must be made. This includes actioning any non-medical referrals. This must be done as well as actioning the JCA referral. In all other cases, assessment of non-medical eligibility for DSP claims will be deferred until after the JCA/Disability Medical Assessment (DMA) when the customer's medical eligibility for DSP has been established. The Rapid Stream process defers establishing non-medical eligibility criteria prior to actioning a JCA Referral request, such as:
As part of initial streaming, the following checks need to be done based on the available evidence before actioning a JCA Referral request:
If the evidence clearly shows the customer does not meet the initial non-medical eligibility checks, a JCA referral is not to be progressed and the DSP claim is to be rejected. | |
Non-medical eligibilityReview the DSP claim and supporting documents.
Note: if an online claim was lodged, the customer's responses in the claim will populate provisional data after selecting Process. If a paper claim is lodged, a SOA shell is created, and the customer's responses will need to be manually coded after selecting Process. Age When claiming DSP, a person must have:
Check to make sure the customer meets the age requirement for DSP. Income and/or Assets limit When the customer claims DSP, they must meet the relevant income and asset test. See the Rates and Thresholds index and access the Pensions tile to check:
Check if the customer (and partner) meets the relevant income and asset test requirement for DSP based on the available evidence provided. Compensation Disability Support Pension (including blind) is a compensation affected payment (CAP) that:
For information, see The effect of compensation on Social Security payments. Compensation payments are recorded on the Compensation Management System (CMS) in the customer's record (in Customer First) unless otherwise advised by the Compensation Recovery Team (CRT). For example, Income from personal injury insurance schemes and disability benefits coding on the Other Income (OIN) screen. Check if compensation payments (periodic and/or lump sum payments) will impact the customer from their DSP claim date (PNA/Start Date) and the 13 weeks after this date. Is it clear from the available evidence the customer does not meet any of the non-medical criteria outlined above?
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Additional informationIdentity If Identity is not Confirmed, this is to be followed up, if medical eligibility is met after JCA/DMA. Tax File Number If the customer has not supplied a Tax File Number (or their partner, if applicable), this is to be followed up if medical eligibility is met after JCA/DMA. | |
DSP ResidenceSee Residence assessment for customers claiming Disability Support Pension (DSP) to determine if the customer satisfies residence requirements to progress to a JCA referral. Use the DSP Residency Screens Checklist on the Resources page to check and assess the customer's residency status. To assist with determining legal residence status, see Assessing if a customer is an Australian resident. Update details via the Residency Task Selector (RETS):
For further information on coding the above screens, see Residence and Portability screens. Where the customer:
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Customer and/or Partner in receipt of another ISPWhere a customer and/or partner is in receipt of an income support payment (ISP) and they advise information in the DSP claim which impacts their current payment, this is considered to be a notification of a change in circumstances. Staff must review the change in circumstances to determine if an update to the customer and/or partner's record will result in a loss of entitlement/change of rate to their current Income Support Payment. Examples of an impacting change in a customer's circumstances may include but is not limited to:
Has there been a significant change in circumstances that would impact the ongoing eligibility/ rate of payment for customer and/or partner?
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Significant change in circumstancesA significant change in circumstances impacting a customer's rate of payment, needs an immediate update to the customer's record. The customer will meet non-medical eligibility, but their rate may be impacted
Significant change in circumstances where a customer does not meet non-medical eligibility
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Check medical evidence is scanned in eMIFEMedical evidence must be separated from non-medical information and include the Medical Information File Envelope (eMIFE) indicator. If medical evidence has been scanned incorrectly or attached to other claim/ supporting documents, it must be separated. See Scanning Centrelink medical/sensitive documents using an MFD. Where a scanning error has occurred, for example, the medical evidence for the customer has been scanned to the Nominee's record, staff must make sure all relevant documents are scanned to the correct record. See Requesting a document rescan, retrieval or location to correct the scans. | |
Check contact detailsStaff must check the claim details to make sure the existing customer contact details are correct. If changes are required, these must be updated manually within the DSP new claim activity.
Do not finalise the updates as yet, as all updates are actioned in one update via the Selective Application of Data (SAD) function. | |
Access the SAD screenOnce relevant non-medical information has been coded, the SAD function must be applied prior to actioning the JCA referral request. See the Customer First Process tab of Selective Application of Data (SAD) Note: if the SAD activity has been selected for QOL, the JCA referral can still be actioned. Once the SAD has been completed, go to Step 11. | |
Check Activity and Exemption Summary (AEX) screenThe only time the 'Claiming DSP' exemption should not be applied is at the customer's request or if they are receiving JSP/YAL and they are a New Zealand Non-protected Special Visa Category Holder. If AEX is not coded because the customer requested the exemption not be applied, check the DSP Claim Progress DOC as this must be documented if the customer makes/has made this request. If the customer is currently receiving Jobseeker Payment (JSP) and Youth Allowance (YA) (Provisional), the customer is exempt from meeting their participation requirements while their DSP claim is being determined. Note: if the customer is a New Zealand Non-protected Special Visa Category Holder do not apply the Claiming DSP exemption as this will result in the customer losing qualification of their 6 month one off period of JSP/YAL. Consider another exemption type if appropriate. See Mutual obligation requirements exemptions. The period of the 'Claiming DSP' exemption is automatically applied for 104 weeks. Customers receiving Jobseeker Payment (JSP) or Youth Allowance (YA) (jobseeker) who have a 'Claiming DSP' exemption applied will be automatically placed onto a 4 weekly variable reporting frequency, unless they or their partner have recent earnings. See Reporting requirements for customers receiving a payment with mutual obligation requirements for more information. | |
Check for any outstanding ESAt/JCA referralsA new JCA referral cannot be made while there is an existing ESAt or JCA report with a status of submitted (not yet finalised) - see the following for an explanation of the 'status' of an ESAt/JCA report: Note: when an ESAt/JCA report is accepted, the status will remain as 'Submitted' for 28 days. In some cases it may be necessary to manually action an 'early finalisation' of the existing report to achieve a 'Finalised' status to allow a new JCA referral for the DSP claim to proceed. To view the status of any previous ESAt/JCA referral, access via the following:
After reviewing the status of the ESAt/JCA, are any of the following required: Submitted ESAt to be accepted
Early Finalisation When the ESAt/JCA has been accepted but does not have a Finalised status, an early finalisation will be required prior to actioning the JCA Referral request for a DSP claim. Service Officers can request Early finalisation of the ESAt/JCA report by selecting the Request Finalisation button. For Service Officers having difficulty finalising the report:
ESAt referral in progress - customer has a future booked appointment When a customer has been referred for an ESAt and the appointment has been booked for a future date, Service Officers should make a request for the ESAt to be upgraded by the Assessor to a JCA.
ESAT appointment was conducted less than 14 days ago:
ESAt appointment was in the past and the report has not been submitted within 14 days If the ESAt does not have a status of Submitted:
JCA referral in progress is a DSP Appeal referral reason
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JCA referral in progress is for a DSP AppealWhere there is a DSP Appeal JCA in progress (e.g. referred/scheduled or submitted), check if the DSP Appeal JCA relates to a formal review (ARO), Explanation of decision or formal review triage (SME) DSP Appeal JCA relates to a formal review (ARO)
DSP appeal JCA relates to SME Explanation or triage
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Create a JCA Referral
Table 7: Service Officers must use this process when creating a JCA Referral in Process Direct.
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Information required in the JCA Referral requestService Officer will need the following information to insert/answer within the JCA Referral request: Date of Claim Make sure the correct DSP Claim Assessment Date (PNA date) is entered so the correct version of the Impairment Tables is used. See Impairment Tables - start date scenarios. Residence Question 'Has the customer resided in Australia for 10 years or do they have a QRE?' This question defaults to a 'no' answer. See the:
A person has a Qualifying Residence Exemption (QRE) for DSP if the person:
To make sure the correct assessment is undertaken and to avoid unnecessary rework, if the customer:
Connected Assessment Pathway (CAP) CAP allows Medical Assessment (MAt) Assessors to also complete the JCA, after Disability Processing staff have streamed the DSP claim. When an Assessor wants to conduct a CAP JCA by phone, they will select FILE mode on the SA479 and add notes to the SA479 to indicate that a phone booking is required. In this scenario, Disability Processing Service Officers must create a FILE mode JCA Referral. | |
Job seeker statusCheck the Job Seeker Registration screen. Does the customer have an active jobseeker registration?
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Action JCA Referral requestRun the relevant Fast Note - select Auto Text, use Disabilities > Claims > select one of the following templates(based on the mode of the JCA recommendation by Assessment Services):
Make sure all details in the Fast Note are completed correctly:
Note: the Fast Note will stream the referral directly to the JCA Admin Team, bypassing the Assessment Services Triage Team. This process will not happen immediately and may take several hours to move from the Service Officer's region code to the JCA Admin Team. Make sure only these Fast Notes are used. If incorrect details have been entered in the JCA referral Fast Note, annotate the Fast Note to advise the information is incorrect and set as completed. Create a new JCA referral Fast Note with the correct information. Annotate DSP Claim Progress DOC. | |
Check Activity List (AL)As an additional check to make sure there are no open activities related to the DSP claim.
If there is an open Pension System/Selective Task Transfer (STT) activity on AL, the SAD activity is not completed correctly. See Table 6 > Step 10 to complete the SAD. | |
SA472 Consent to contact Treating Health Professional (THP)Consent to Contact THP (SA472) can only be recorded or updated in Process Direct. See the Process Direct tab. If the customer is aged 16 -19 years, go to Step 6. | |
Customers aged 16 to 19 yearsFTB for the child is cancelled automatically when a:
As the claim is progressing to a JCA, Service Officers must check Effect of DSP claim on FTB, to make sure FTB has correctly actioned. See Table 1 > Step 10 in Family Tax Benefit (FTB) for children aged 16-19 years. |