Eligibility for Disability Support Pension (DSP) 008-03050000

Some customers who are considering claiming DSP may not be eligible. They may need to be encouraged to claim JobSeeker Payment (JSP).

Customers claiming JSP may indicate they have an injury or illness that limits their work capacity. This may be conditions, which are likely to persist for more than 2 years, or likely to persist for less than 2 years. These customers are assessed through the Employment Services Assessment (ESAt) process. The ESAt can be upgraded to a Job Capacity Assessment (JCA) if the medical evidence shows they are likely to be eligible for DSP. They can be invited to claim DSP once the upgraded JCA is submitted.

To be eligible for DSP, a person must:

• have turned at least 15 years and 9 months and be under Age Pension age when they claim
• satisfy the residence criteria
• meet the relevant income and asset test
• be manifestly medically eligible, or
• have a diagnosed, reasonably treated and stabilised physical, intellectual or psychiatric condition which attracts at least 20 points under the Impairment Tables, and
• have a Continuing Inability To Work (CITW). This includes active participation in a Program of Support if applicable, or
• be participating in the Supported Wage System (SWS)

Staff should encourage customers to complete the DSP Pre-Claim Guide on the Services Australia website. This will help customers to better understand the eligibility rules for DSP. This may assist the customer with deciding whether to make a DSP claim or not.

To be eligible for DSP, unless manifestly eligible, a customer must first show through medical evidence they have at least 1 condition that can be assessed as:

• likely to persist for more than 2 years, and
• diagnosed, reasonably treated and stabilised

For a condition to be assessed as diagnosed and reasonably treated, the following are considered:

• if the condition was examined by an appropriately qualified medical practitioner
• if there is supporting evidence of that condition
• what treatment or rehabilitation has occurred in relation to the condition, and
• if treatment is continuing or is planned in the next 2 years

A condition is considered stabilised if the customer has:

• undertaken reasonable treatment for the condition. Any further treatment is unlikely to result in significant functional improvement to a level enabling them to undertake work in the next 2 years, or
• not undertaken reasonable treatment and either:
• significant functional improvement to a level enabling them to work in the next 2 years is not expected, or
• there are medical or other compelling reasons for them not to undertake reasonable treatment

To be eligible for DSP, unless manifestly eligible, a customer’s condition, which is likely to persist for more than 2 years and is diagnosed, reasonably treated and stabilised must be assigned an impairment rating of at least 20 points on the Impairment Tables.

There are 15 function-based Impairment Tables. They focus on assessing the impact of impairment on normal functions as they relate to work performance and with a rating assigned consistent with the identified level of impact.

The diagnosed, reasonably treated and stabilised condition is assessed against the relevant Impairment Table to determine the functional impact, with a rating assigned accordingly. For example, a diagnosed, reasonably treated and stabilised mental health condition would be assessed under Table 5 - Mental Health Function.

In all Tables, each level of functional impact has a corresponding points rating. This generic scale is as follows:

• no or minimal functional impact - 0 points
• mild functional impact - 5 points
• moderate functional impact - 10 points
• severe functional impact - 20 points
• extreme functional impact - 30 points

These conditions cannot be rated using the Impairment Tables:

• conditions likely to persist for less than 2 years
• conditions that are likely to persist for more than 2 years, but are not diagnosed, reasonably treated and stabilised

Where an assessment of impairment is required for a condition likely to persist for more than 2 years, and is diagnosed, reasonably treated and stabilised, the customer will be referred for a Job Capacity Assessment

From 1 April 2023, a new version of Impairment Tables was introduced. The new Tables are used to assess a customer's medical eligibility for all DSP claims lodged on or after this date. See The Impairment Tables.

The determination of impairment ratings and CITW are separate assessments based on different criteria. They are of equal importance when assessing eligibility for DSP.

The assessment of CITW is part of the process to determine if the customer is medically eligible for DSP.

A customer has a CITW if their impairment alone prevents them from undertaking both of the following:

• any work for 15 or more hours per week for at least the relevant minimum wage for at least 2 years
• educational, pre-vocational, vocational, or work related training (including on-the-job training) is unlikely to enable them to do any work for 15 or more hours per week for at least the relevant minimum wage, within 2 years independently of a program of support

A customer claiming DSP after 3 September 2011 who is not manifestly eligible or does not have a severe impairment must also show they have actively participated in a Program of Support (POS).

Customers must supply current medical evidence to support their DSP claim. This can include clinical notes, test results and specialist reports. Depending on the medical condition, more specific medical evidence may also be required.

The Disability Support Pension Medical Evidence Checklist (SA473) provides details of what medical evidence customers must provide. This information is in the Claim for Disability Support Pension (SA466), is included in the DSP online claim and is on the Services Australia website.

While customers no longer need to provide specific forms completed by their treating health professional(s) detailing the impact of their medical condition(s), they must supply current evidence with their claim. If they do not provide evidence their claim may be rejected.

The Disability Support Pension Medical evidence requirements Information for treating health professionals (SA478) form helps treating health professionals provide relevant medical evidence to support the customer's claim for DSP or medical review. The form provides relevant information about medical eligibility and the assessment process.

Customers with a terminal illness can lodge a Verification of terminal illness (SA495) form, which is included at the end of the Claim for Disability Support Pension for a Terminal Illness (SA494) and available on the agency’s website.

Support is available to customers who may have difficulty obtaining medical evidence, such as:

• vulnerable customers. For example, people who are homeless or living in a remote community
• customers at risk. For example, People suffering from an undiagnosed mental health condition and disengaged from health services.

DSP customers getting a Department of Veterans' Affairs (DVA) Disability Compensation Payment at the Special Rate - Totally and Permanently Incapacitated (TPI) paid under the Veterans’ Entitlements Act 1986, can provide their Special Rate decision letter to verify their current DVA status.

DVA issues this letter to eligible customers when granting their Disability Compensation Payment at the Special Rate. It contains details of the impairment rating and work capacity as determined by DVA.

The letter is suitable evidence to support manifest medical eligibility for DSP.

To qualify for DSP, a new customer must be under Age Pension age when they claim.

When a current DSP customer turns Age Pension age, they may choose to remain on DSP or transfer to Age Pension.

For example:

• If they would be subject to the sharers rate of Rent Assistance if they transferred to Age Pension, they may choose to stay on DSP
• If they do not satisfy the residence requirements for Age Pension, they may remain on DSP if eligible

DSP is generally a non-taxable payment until a customer reaches Age Pension age. DSP becomes taxable if the customer chooses to remain on DSP after turning Age Pension age.

DSP customers (excluding those aged under 21 without children) may be eligible for the Pension Supplement.

A current and valid Job Capacity Assessment (JCA) may be used to assess medical eligibility for DSP. This applies to new claims and reviews of medical eligibility.

If a customer has been referred for an Employment Services Assessment (ESAt), the Assessor may upgrade the ESAt to a JCA if there is enough medical evidence to confirm the customer may meet all medical eligibility criteria for DSP.

The report can be used to assess eligibility for DSP if the customer then claims. In these cases, an extra JCA is not needed as part of the DSP claim process if the JCA report is still a current and valid assessment of the customer's work capacity. However, a Disability Medical Assessment may be required to verify the customer's medical eligibility for the claim.

If there is a delay finalising a claim for DSP, the customer can continue on their current income support payment provided they remain eligible for that payment.

If the customer is receiving JobSeeker Payment (JSP) or Youth Allowance (YA), they may be exempted from their mutual obligation requirements while the DSP claim is being assessed.

If the customer is not receiving an income support payment, they can apply for JSP within the DSP online claim and Assisted Customer Claim or if lodging a paper DSP claim form consider inviting a claim for JSP or YA (Provisional).

DSP customers (except customers who are permanently blind and exempt from the income and asset test) are subject to:

• a Seasonal Work Preclusion Period (SWPP), and/or
• an Income Maintenance Period (IMP)

Customers getting another income support payment who are serving a SWPP/IMP and deemed eligible for DSP may still be precluded from payment.