Streaming a new claim for Disability Support Pension (DSP) 008-03010100

When a DSP claim is submitted (online/ACC/paper claim is lodged and scanned), a work item is created and allocated to an Assessment Services Assessor for assessment of medical evidence and completion of a DSP Medical Eligibility Assessment Recommendation (SA479).

Note: the Disability Support Pension Medical Eligibility Assessment Recommendation (SA479) is also referred to as a 'MAT recommendation', 'SA479', 'MAT report' or 'MAT'. Throughout this document, the consistent term will be 'MAT report/SA479'. The DSP new claim activity is placed On Hold automatically while awaiting completion of the MAT report/SA479.

Assessors are responsible for checking and assessing all medical evidence and providing a recommendation to Disability Processing Service Officers.

When a claim is submitted without medical evidence and the Assessor considers the customer is likely manifestly medically eligible or vulnerable, the Assessor makes attempts to obtain medical evidence. A Contributing Assessor may be used to provide discipline specific input to the assessment.

The Assessor assesses the medical evidence, completes a DSP Medical Eligibility Assessment Recommendation (SA479), and recommends either:

• the customer is manifest medically eligible
• the customer is manifestly medically ineligible
• there is insufficient medical evidence to assess the functional impact of the customer's medical condition/s
• there is a 'current and valid' Job Capacity Assessment (JCA) that can be used to determine the claim, or
• a JCA is required to assess medical eligibility

An assessment of Continuing Inability to Work (CITW) is completed in the DSP Medical Eligibility Assessment Recommendation (SA479) if manifest medical eligibility or medical eligibility within a current and valid Job Capacity Assessment (JCA) is recommended.

Streaming a DSP claim involves:

• checking the claim and supporting documents
• reviewing the customer’s circumstances
• determining the action required to progress to claim finalisation

Initial Steaming (all DSP claims)

Initial streaming must be done for all DSP claims where a MAT report/SA479 is completed and a work item allocated.

The Disability Processing Service Officer must check the claim and supporting documents to see if, based on available evidence, the customer does, or does not, meet basic DSP non-medical eligibility.

To meet basic non-medical eligibility criteria for DSP, a customer must:

• be an Australian resident
• have turned at least 15 years and 9 months and be under Age Pension age when they claim
• meet relevant income and/or asset limits (including partner, if applicable)
• not have a Compensation Preclusion period which ends 13 weeks after the claim date

If the available evidence shows the customer:

• does not meet the initial non-medical eligibility, reject the claim for the relevant non-medical reason. No further non-medical or medical referrals/assessments are required
• meets the initial non-medical eligibility and there is a ‘current and valid’ JCA report which indicates medical eligibility is not met, reject the claim for the relevant medical reason. No further non-medical or medical referrals/assessments are required
• meets the initial non-medical eligibility and there is a ‘current and valid’ JCA report which indicates medical eligibility is met, a DMA referral may need to be actioned. No further non-medical or medical referrals/assessments are required at this stage
• meets the initial non-medical eligibility and the MAT recommendation is manifestly ineligible, reject the claim for the relevant medical reason. No further non-medical or medical referrals/assessments are required
• meets the initial non-medical eligibility and the MAT recommendation is manifestly eligible, finalise the claim after all relevant non-medical referrals/assessments are completed. The claim may be granted, or it may be rejected for non-medical reasons
• meets the initial non-medical eligibility and the MAT recommendation is for a JCA, complete the Rapid Streaming checks before actioning a JCA referral request

Rapid Stream (only DSP claims requiring a JCA referral)

Rapid streaming must be done for DSP claims where:

• the customer meets the initial non-medical eligibility checks done for all DSP claims, and
• a MAT report/SA479 recommends a JCA is required

This process defers full non-medical eligibility checks until after the JCA/Disability Medical Assessment (DMA), if the customer is assessed as medically eligible.

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 their current payment, relevant updates must be made including actioning any non-medical referrals. This must be done as well as actioning the JCA referral.

Service Officers must check the following before making the JCA referral:

• customer’s residence status to determine if an assessment of where the customer’s Continuing Inability to Work (CITW) occurred needs to be done as part of the JCA. For non-protected SCV holders, the claim is to be sent to International Services before referring for a JCA. See Residence assessment for customers claiming Disability Support Pension (DSP)
• current contact details are recorded on the system including address, phone number, email address, interpreter and nominee information
• check if the customer has a pending review of decision on their DSP eligibility. See Payment pending review (PPR) of decision to cancel DSP due to loss of medical qualification. This is to prevent a new JCA being requested when the customer is DSP/CUR-PPR, indicating a DSP medical cancellation decision is under review with an Authorised Review Officer (ARO) or the AAT
• if there is information on the record indicating the customer may exhibit violent or abusive behaviour towards the Assessor. Advice to the Assessor regarding potential violent behaviour may be required
• all previous JCA or Employment Services Assessment (ESAt) referrals have a status of 'finalised' or 'unable to complete'
• the customer is registered as an active job seeker, if not current, register the customer to allow the assessment to be completed and any subsequent referrals actioned
• customer’s ability to participate in a JCA. If they have a nominee, consider contacting to discuss options, and
• all medical/sensitive information is scanned to the customer's electronic Medical Information File Envelope (eMIFE)

Full non-medical streaming (post JCA/DMA medical eligibility recommendation)

If the JCA and/or DMA recommends medical eligibility, full non-medical eligibility checks must be done before the claim can be finalised. This includes the following, in addition to checks already done for basic DSP non-medical eligibility and rapid streaming:

• gathering all income and asset details not provided with the claim
• requesting further non-medical information
• completing non-medical referrals, if required. For example:
• Complex Assessment (CAO)
• Compensation Clearance (COMP), or
• Member of a Couple Assessment (MOCA)

Hold to User

See the Hold to User new claim criteria if the DSP customer is vulnerable, identified as manifest medically eligible or has complex circumstances.

Customer Critical Response Team

If significant changes occur or are identified at any time during progression of the DSP claim (for example, admission to psychiatric confinement or prison, death of the customer), follow CCRT referral guidelines for appropriate cases before referring the case to CCRT for management, Referrals must be made in consultation with a Team Leader. See the Resources page for further information on referrals to the CCRT.

Forensic Psychology Team

Where a customer is identified by a MAT Assessor as being vulnerable and having forensic sensitivities (for example, extensive incarceration history and complex mental health and/or challenging behaviour), Assessment Services staff will complete the MAT report/SA479 recommending further assessment (JCA) by the Forensic Psychology Team. The Forensic Psychology Team will add a keyword to the claim to escalate for priority streaming and processing. Email the Disability Workload Management Team for more details.

When the DSP new claim, including SA494 Claim for Terminal Illness, is allocated, the Service Officer must:

• check if the Assessor has completed an assessment of medical evidence
• create a MAT referral if an assessment of medical evidence has not been completed
• check the MAT report/SA479 to see if the claim can be finalised without further assessment

Before claim finalisation, a customer, nominee, or the customer's Treating Health Professional (THP) may advise in writing or over the phone their condition is terminal and life expectancy is less than 2 years.

Staff who receive a Priority-PossTRM NCL in Prog work item or a MAT report/SA479 indicating a terminal illness, must follow the required actions on the Process page.

Establishing a person’s identity increases security and reduces identity fraud and privacy risks for the customer and Services Australia.

Customers can get a Confirmed Identity by:

• providing the required identity documents, and completing a facial comparison (linkage) in person with Services Australia, or
• Services Australia accepting their IP3 Digital ID, and it displays as confirmed in the Identity Confirmation Dashboard in Process Direct

In some cases, customers may require help to confirm their Identity. Customers who cannot confirm their identity must complete an alternative identity assessment:

• in person, or
• by phone if they cannot attend in person, when they have a valid reason

A nominee can provide the customer’s Identity documents on behalf of the customer. They can do this:

• in person
• online, or
• by phone

A nominee can also complete an Alternative Identity assessment for the customer if they cannot do so and have a genuine reason. For example, customer is profoundly disabled or incapacitated.

When a child who is 16 to 19 years lodges a DSP claim, staff must make sure Family Tax Benefit (FTB) and Double Orphan Pension (DOP) is cancelled, if DSP is not granted or rejected immediately.

On lodgement of a DSP claim, the system auto cancels the FTB portion for the child.

If the FTB recipient is only receiving FTB for the child claiming DSP, FTB cancels with reason 'Dependant Receiving Precluding Payment (DPP)'.

If the FTB recipient is receiving FTB for multiple children, the FTB part A portion for the child claiming payment cancels. When auto-cancellation does not occur, a Change of Circumstances (CoC) work item is created.

Services Australia has a responsibility under section 28B of the FA (Admin) Act, to check FTB is cancelled for a child who makes a claim for a social security payment or pension. If FTB is not cancelled, and DSP is granted at a later stage, an overpayment of FTB and/or DOP may occur.

If the DSP customer is receiving Double Orphan Pension (DOP), FTB cancellation also cancels DOP. On cancellation of the DOP, a work item is created and sent to region code DOP to notify of DOP cancellation. If auto cancellation does not occur, a work item is created and sent to DOP for follow up.

Customers who are qualified and payable are generally granted from the date they submit a complete claim with all relevant supporting documentation. See Calculating the start day general rule.

Intent to claim provisions may apply to customers in vulnerable circumstances, see Intent to claim and vulnerable customers. After determining the date a claim was made, staff can assess if backdating provisions apply.

Customers can lodge an early claim for DSP up to 13 weeks before the first day of eligibility. Early claim provisions may apply to customers who are turning 16, see Claiming Disability Support Pension (DSP). If an early claim lodgement is accepted, the start date is the first day the customer becomes qualified for the payment. See Early claims.

From 7 December 2020, employment income paid after the claim start day must be assessed for the same period for which it is paid by the employer. Where the income is too high for DSP to be payable, but DSP will become payable within 13 weeks of the date of claim, move the start day to the earliest Entitlement Period Start Date from which DSP is payable.

A customer can lodge a DSP claim 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 need to determine how each claim is to be progressed. Service Officers must attempt to contact the customer or nominee to establish their reason or intent in lodging a second claim. Customers can choose to pursue all submitted claims, but they can also choose to withdraw the latest claim. See Cancel or Withdraw online claim and Withdrawal of claims. If required, Service Officers can seek policy clarification from the Level 2 Policy Helpdesk.

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

Vulnerable people already getting an income support payment may be transferred to DSP without a claim.

This can happen only in specific circumstances. It is known as a Section 12 Deemed Claim. The authority is in the Social Security (Administration) Act 1999.

For more information, see Supporting customers experiencing vulnerability to claim Disability Support Pension (DSP).

Where a Section 12 transfer is approved, it is sent to Services Officers in a Fast Note to action.