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

Select Ready to receive work item.

Review work item and if it relates to:

• a Claim for DSP for a Terminal Illness (SA494) or Verification of Terminal Illness (SA495), see Table 2
• a DSP claim or Reindexed claim, see Table 3
• a Priority-PossTRM NCL in Prog Fast Note, go to Step 4
• an ESAt Upgraded to JCA, go to Step 2
• a Reassess Rejected Claim Fast Note, go to Step 3
• a Transfer to DSP (S12) Fast Note, see Supporting customers experiencing vulnerability to claim Disability Support Pension (DSP)
• DSP Social Online Application (SOA) is present, however no lodged DSP claim, go to Step 5

Assessment Services determine if an ESAt can be upgraded to a JCA where 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:

• review the ESAt to make sure it is complete and accurate. Do not accept the ESAt report
• check if customer has lodged a DSP claim

If there is a DSP claim in progress:

• check and accept the updated ESAt/JCA Report
• if Assessment Services has recorded a Potential DSP eligibility Fast Note, this can be closed
• MAT assessment must be completed to determine if the ESAt outcome is 'Current and Valid' for the purpose of the DSP claim
• go to Table 3

If there is no DSP claim in progress:

• check customer's non-medical eligibility
• check and accept the updated ESAt/JCA Report
• invite customer to claim DSP, if applicable
• after completing DSP invite to claim process, if Assessment Services has recorded a Potential DSP eligibility Fast Note, this can be closed
• procedure ends here

If s Service Officer receives a Reassess Rejected Claim Fast Note, review previous claim to make sure the claim meets the requirements to reopen.

Do not reopen and reassess a DSP claim where:

• the request is made more than 13 weeks after the rejection notice was given, or
• not all requested information has been provided within 13 weeks of the rejection notice
• Note: if either of the above occurs, see Requested documentation not provided resulting in rejection of new claim, for action required
• the DSP claim was rejected for any other reason, see Reviews and Appeals

Where the claim can be reopened and reassessed, action required depends on previous rejection reason. If the claim was previously rejected for reason:

• FSD/FRC or POI:
• Reindex claim
• Review previous rejection DOC to determine action required to progress claim
• If manifest medical eligibility was established before rejection – see Disability Support Pension (DSP) manifest eligibility, or
• If medical eligibility was established after a DMA – see Assessing eligibility for Disability Support Pension (DSP) after a Disability Medical Assessment (DMA)
• For all other cases, see Table 3
• FRP (Failed to Report):
• Review the customer’s circumstances to confirm they are eligible to DSP from original date of claim
• Check customer has provided all information for the outstanding reporting periods
• Reindex claim, remove reporting requirements, code employment income for outstanding reporting periods and finalise claim
• After finalising claim, place the customer on reporting type EAN, see Reporting screens
• IME:
• Check if new medical evidence has been supplied and that it has not already been assessed by MAT
• Reindex claim and refer to MAT using > Referral
• Referral Type: Medical Assessment Team Referral
• Referral reason 'New evidence'
• the DSP claim is placed On Hold with the reason Awaiting MAT
• Procedure ends here until MAT has been completed
• When MAT is completed, go to Table 3 to review MAT and stream claim
• GCD:
• see Disability Medical Assessment (DMA) appointment outcome to reopen and progress claim
• FME:
• Check the customer has contacted within 13 weeks of the rejection and has agreed to attend JCA
• Reindex the claim and see Table 3

Close the Reassess Rejected claim Fast Note when the required action has been done.

When 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 report/SA479, to determine if manifest medical eligibility has been assessed.

If the MAT report/SA479 has been submitted and:

• recommends manifest eligibility:
• apply hold to user until the claim is finalised, per Work Optimiser for staff and
• see Table 3 to progress the DSP claim
• does not recommend manifest eligibility:
• close the Priority-PossTRM NCL in Prog Fast Note
• assess the DSP claim through the normal processes, see Table 3
• does not recommend manifest eligibility and medical evidence indicates a terminal illness:
• refer back to MAT, select > Referral
• Referral Type: Medical Assessment Team Referral
• Referral Reason: Trm Ill – SA494/SA495/Other

Finish

• a referral is created and the DSP claim placed On Hold with reason Awaiting MAT
• annotate DSP Claim Progress DOC on DL/Notes advising MAT referral has been made
• apply Hold to User
• when MAT report/SA479 is submitted, see Table 3

If only a MEDSA466 has been submitted or a document is lodged but incorrectly classified/uploaded as a SA466, a SOA (DSP claim) is created in Process Direct 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 annotates 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, do not progress the claim. Send feedback to MAT Assessor via Staff Feedback Tool.

If a DSP claim (SA466) has not been lodged, make genuine attempts to contact the customer/nominee.

If the contact attempt is:

• successful, go to Step 7
• not successful, go to Step 6

If the contact attempt is not successful:

• annotate the DSP Claim Progress DOC with, 'Customer has lodged MEDSA466 only/insufficient information. Customer is required to lodge a complete DSP claim. Attempt to contact customer/nominee on XX/XX/XXXX was not successful.'
• update claim status to 'On Hold' for reason 'Pending Customer Contact' until next working day
• apply Hold to User

Attempt to contact the customer again. If the second contact attempt is:

• successful, go to Step 7
• not successful, go to Step 8

If the contact attempt is successful, tell the customer or nominee:

• Service Australia has only received:
• medical details section of the DSP claim form, or
• information which indicates you may wish to make a claim for DSP
• a complete DSP claim has not been received
• no more action can be taken unless a complete DSP claim (pages 3 to 25) is received
• advise the options for claiming DSP are:
• applying for DSP online
• Assisted Customer Claim (ACC) if the customer is unable or unsuitable to complete an online claim
• issuing the SA466 paper claim. See First Contact Service Offer (FCSO) workflow
• annotate the DSP Claim Progress DOC with, 'Customer has lodged MEDSA466 only/ insufficient information. Customer has been contacted and advised to complete and submit/lodge a DSP claim.'
• use the Status icon to manually update the claim status to 'Not Required' as the MEDSA466 by itself, is not considered to be a valid or complete claim
• consider recording an Intent to claim for vulnerable customers, if applicable
• procedure ends here

If the second contact is not successful:

• annotate DSP Claim Progress DOC with, 'Second attempt to contact customer/nominee on DD/MM/YYYY was not successful. If customer contacts, please advise the customer they must submit/lodge a claim for DSP
• use the Status icon to manually update the claim status to 'Not Required'

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:

• less than 2 years, refer the Customer Reference Number (CRN) to the Customer Critical Response Team (CCRT), see the Resources page. Procedure ends here
• more than 2 years, use Mail Forms guided procedure in Customer First to manually issue:
• SA466 Claim for Disability Support Pension
• SA369 Income and Assets Form (will be automatically issued)
• procedure ends here

The work item opens in the Transaction Summary (TS) screen.

Is the work item an SA494 and/or SA495?

• Yes, the work item received is a:
• SA494 and SA495, go to Step 2
• SA494, go to Step 2
• SA495, go to Step 3
• No, for all other claims, go to Table 3

Using the Claim work item, select Process.

Open the scanned SA494 and check for the MAT report/SA479 in the Documents tab.

If a MAT report/SA479:

• does not exist:
• see MAT using > Referral, select:
• Referral Type: Medical Assessment Team Referral
• Referral Reason: Trm Ill - SA494/SA495/Other
• the DSP claim is placed On Hold with the reason Awaiting MAT
• annotate DSP Claim Progress DOC on DL/Notes advising MAT referral has been made
• procedure ends here until MAT report is returned
• has been completed, review the MAT report/SA479. See Table 4

In Process Direct, check the customer's record for a submitted DSP online claim or SA466 paper claim.

If there is:

• no DSP new claim, go to Step 4
• an unassessed DSP new claim (On hold or In process), go to Step 10
• a granted claim, close the work item. Procedure ends here
• a DSP claim that has been rejected in the last 13 weeks:
• follow current processes to determine if an explanation, formal review or reassessment is needed
• see Step 5 in Table 2 of Progress of DSP claim

Check 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:

• less than 3 months, go to Step 5
• between 3 months and 2 years (or it is not clear), go to Step 6
• more than 2 years, go to Step 7

If the information provided indicates the customer's life expectancy is less than 3 months:

• refer to the Customer Critical Response Team (CCRT), see the Resources page
• close the work item
• record a DOC saying the SA495 was received without a DSP claim and has been referred to CCRT for follow up
• procedure ends here

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:

• Services Australia has received some medical information. Be aware the customer may not know what their treating doctor has told the agency
• a DSP claim has not been received
• no more action can be taken until a DSP claim is received
• invite a DSP claim using one of the following options:
• DSP online via the Services Australia website
• Assisted Customer Claim (ACC) if the customer is unable or unsuitable to complete an online claim
• Mail Forms guided procedure in Customer First to manually issue the SA494. The guided procedure will automatically issue the Income and Assets (SA369) form
  Note: do not send an SA494 if there is any doubt the customer knows about the terminal prognosis
• First Contact Service Offer (FCSO) workflow to issue the SA466 paper claim
• discuss having a nominee. The Authorising a person or organisation to enquire or act on your behalf (SS313) form is available on the Services Australia website and can be issued via the Mail Forms guided procedure or the FCSO workflow with a paper SA466 claim
• discuss other services available if needed

Consider recording an Intent to claim for vulnerable customers.

If the contact attempt was:

• successful and ACC run:
• record a DOC detailing the outcomes of the conversation
• the DOC automatically closes
• if DSP claim is submitted via ACC, close the work item
• procedure ends here until claim is allocated after MAT is completed
• successful and customer indicates they intend to lodge an online claim for DSP or a DSP Paper Claim (SA494 or SA466) was issued:
• hold the work - use the Status icon to manually Change Status of the work item to On Hold for reason Customer to Provide Information item for 7 days
• record a DOC detailing the outcomes of the conversation
• the DOC automatically closes
• when this work item is due, go to Step 8
• not successful:
• hold the work item - use the Status icon to manually Change Status of the work item to On Hold for reason Pending Customer Contact until next work day
• apply Hold to User
• record a DOC with the attempt to call details
• the DOC automatically closes
• go to Step 8

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.

If the contact attempt was successful, tell the customer or nominee:

• a DSP claim has not been received
• no more action can be taken unless a DSP claim is received
• the options for claiming DSP (if appropriate) are:
• applying for DSP online
• Assisted Customer Claim (ACC) if the customer is unable or unsuitable to complete an online claim
• issue the SA466 paper claim, see First Contact Service Offer (FCSO) workflow
• about other services available if required

In the customer's record:

• record a DOC of the conversation
• close work item
• procedure ends here

If the contact attempt was not successful:

• hold the work item - use the Status icon to manually Change Status of the work item to On Hold for reason Pending Customer Contact until next working day
• apply Hold to User
• record a DOC with the call attempt details and reasons for call

Go to Step 8

If the work item becomes due:

• 1 day after unsuccessful contact, before making a second contact attempt, check if a DSP new claim has now been lodged. If a claim:
• has been lodged, go to Step 10
• has not been lodged, go to Step 9
• 7 days after successful contact, check that a DSP claim has been lodged. If a claim has:
• been lodged, go to Step 10
• not been lodged, refer to Customer Critical Response Team (CCRT) for follow-up action, see the Resources page

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.

If contact is successful, tell the customer or nominee:

• Services Australia has received some medical information. Be aware the customer may not know what their treating doctor has told the agency
• a DSP claim has not been received
• no further action can be taken until a DSP claim is received
• invite a DSP claim using one of the following options:
• DSP online via the Services Australia website
• Assisted Customer Claim (ACC) if the customer is unable or unsuitable to complete an online claim
• Mail Forms guided procedure in Customer First to manually issue the SA494. The guided procedure will automatically issue the Income and Assets (SA369) form. Do not send an SA494 if there is any doubt the customer knows about the terminal prognosis
• First Contact Service Offer (FCSO) workflow to issue the SA466 paper claim
• discuss having a nominee. The Authorising a person or organisation to enquire or act on your behalf (SS313) form is available on the Services Australia website and can be issued via the Mail Forms guided procedure or the FCSO workflow with a paper SA466 claim discuss other services available if needed

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:

• less than 2 years, refer the Customer Reference Number (CRN) to Customer Critical Response Team (CCRT), see the Resources page. Procedure ends here
• more than 2 years, use Mail Forms guided procedure in Customer First to manually issue:
• SA466 Claim for Disability Support Pension
• SA369 Income and Assets Form (will be automatically issued)
• procedure ends here

If the DSP claim is on hold and referred to an Assessment Services Assessor with referral reason MAT Initial Assessment Required, cancel this referral and create a new MAT referral reason Trm Ill - SA494/SA495/Other.

To cancel the referral: select > Referral > Referral ID - MAT Initial Assessment Required > Cancel Referral

If the MAT report/SA479 is:

• complete and recommends manifest due to terminal illness, see Table 3
• completed and does not recommend manifest eligibility, see Table 3
• not complete or does not recommend manifest eligibility and medical evidence indicates a terminal illness:
• select > Referral
• Referral Type: Medical Assessment Team Referral
• Referral Reason: Trm Ill - SA494/SA495/Other
• the DSP claim is placed On Hold for the reason Awaiting MAT
• annotate the DSP Claim Progress DOC on DL/Notes advising MAT referral has been made
• apply Hold to User
• procedure ends here until MAT report is returned here

If the customer is currently receiving CP, Service Officers are to:

• make genuine attempts to contact the customer/nominee by phone
• discuss their current caring arrangements
• discuss the benefits of each payment (CP and DSP)
• explain that any existing qualification from their current payment will cease if DSP claim is granted (for example, they would no longer be entitled to the annual Carer Supplement for CP each July)

Note: if the customer is currently in a Carer Pension bereavement period, 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:

• contact attempts made
• that Service Officers are to discuss with the customer the transfer from CP to DSP and the benefits of each payment
• the customer must determine if DSP is still wanted, or
• if the customer wishes to remain on CP and withdraw their DSP claim

Hold the claim for the required response time.

Review the DSP Claim Progress DOC and DL/Notes to determine the status of the DSP Claim, including previous referrals.

If the DSP claim has not previously been streamed, go to Step 4

If the DSP claim has previously been streamed and the claim:

• is being managed by Customer Critical Response Team (CCRT):
• Do not action the claim
• Reassign the claim to your team leader in Work Optimser
• Annotate the DSP Claim Progress DOC and advise DSP claim has been allocated to team leader because the claim is being managed by CCRT
• was previously referred to JCA and the JCA Report is not yet submitted, go to Step 3
• needs assessment after a DMA, see Assessing eligibility for DSP after DMA
• needs assessment and Manifest eligibility has been met, see DSP manifest eligibility
• is to be rejected, see Rejecting a new claim for Disability Support Pension (DSP)

Where staff are allocated a claim which has previously been referred to JCA, and the JCA report has not yet been submitted, the 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)

JCA status is 'New' and appointment is booked for a future date (see Referral Effective Date)

• use the Status icon to manually Change Status of the DSP claim to On Hold for reason Referred for JCA for 120 days
• annotate DSP Claim Progress DOC on DL/Notes

JCA status is 'New' and appointment was in the past (see Referral Effective Date)

Check to see if the JCA Appointment was:

• in the last 4 weeks:
• use the Status icon to manually Change Status of the DSP claim to On Hold for reason Referred for JCA for 120 days
• annotate DSP Claim Progress DOC on DL/Notes
• more than 4 weeks ago:
• create a referral to Assessment Services > Referral reason: Query JCA status
• claim status automatically updates to On Hold
• annotate DSP Claim Progress DOC on DL/Notes

JCA not yet booked (Current referral is blank)

Check if the JCA Initial Sub activity is present on the Transactions tab.

If the JCA Initial Sub activity is completed/cancelled – re-refer for a JCA using the JCA Referral Workflow:

• Select > Referral
• Referral Type: select Job Capacity Assessment
• Update the Referral Detail:
• Referral Reason: DSP New Claim
• Insert date of claim (see Step 2 in Table 4)
• Assessment Method: Face to Face, File, Phone assessment
• 10 year residency or Qualifying Residence Exemption (QRE) assessment: Yes/No
• ESAT/JCA Finalised Status: Yes, No, Not Applicable
• Applicable Discipline: Physical/Non Physical
• Specialist Referral Required: Yes/No
• Add any additional information or special needs in the dialogue boxes if required. For example, interpreter required, potential violent behaviour, gender preference of JCA Assessor
• Select Finish
• The claim status is set to On Hold for reason Awaiting JCA recommendation
• Annotate the DSP Claim Progress DOC to advise claim has been referred for JCA
• email the Assessment Services, Branch Correspondence Coordination mailbox to request priority JCA booking

If the JCA Initial SUB activity is present - check the annotations on the JCA Referral DOC:

• If there are annotations in the past 2 weeks, for example, no sessions available – no follow-up is required:
• use the Status icon to manually Change Status of the DSP claim to On Hold for reason Referred for a JCA for 42 days
• annotate the DSP Claim Progress DOC
• If there is no annotation on the DOC for the last 4 weeks, send an email to the Assessment Services, Branch Correspondence Coordination mailbox to follow up JCA booking:
• use the Status icon to manually Change Status of the DSP claim to On Hold for reason Referred or JCA for 42 days
• annotate the DSP Claim Progress DOC

JCA has status of Returned/Reopened

• If the JCA was returned or reopened in the last 2 weeks - no follow up is required:
• use the Status icon to manually Change Status of the DSP claim to On Hold for reason Referred for JCA for 42 days
• annotate the DSP Claim Progress DOC
• If the JCA was returned or reopened more than 2 weeks ago:
• Select > Referral
• Referral Type: select Assessment Services
• Update the Referral Detail: Referral Reason: Query JCA Status. Additional information: need date the JCA appointment was attended
• Select Finish
• The claim status is automatically set to On Hold for reason Referred for JCA
• annotate the DSP Claim Progress DOC

JCA status is Unable to Complete (UTC)

JCA is UTC if the assessment could not be completed. For example, because customer did not attend the JCA, claim was withdrawn, incorrect referral reason, customer did not consent to Information Sharing:

• View the JCA Report to determine reason for UTC
• Cancel the JCA MFU from AL
• If claim is to be rejected for reason Failed to Attend Medical (FME), see Rejecting a new claim for Disability Support Pension (DSP) including manifest rejections
• If a new JCA referral is required, see Step 1 in Table 5

When a DSP claim is submitted/scanned, a Social Application (SOA) is created in Process Direct and an automatic referral to MAT is created.

Check for a completed MAT report/SA479:

• Check Documents icon to view the MAT report/ SA479 and
• a DOC on DL/Notes with a subject line of MAT DSP recommendation

Has a MAT report/SA479 been completed?

• Yes, see Table 4
• No, check if there is an Open or On Hold MAT Referral via:
• > Referral to view the Referral landing page or
• Transactions tab
• go to Step 5

Is there a current MAT referral?

• Yes,
• Do not cancel the referral
• Send an email to the Assessment Services, Branch Correspondence Coordination mailbox (Service Officer must cc in their Team Leader)
• Subject Line: Query MAT recommendation for DSP NCL
• Include customer CRN, DSP Claim lodged XX/XX/XXXX, MAT not yet completed, can you please follow-up?
• Use the Status icon to manually Change Status of the DSP claim to On Hold for reason Awaiting MAT
• Annotate DSP Claim Progress DOC on DL/Notes to advise email sent to MAT to follow-up
• No, see MAT using > Referral. Select:
• Referral Type: Medical Assessment Team Referral
• Referral Reason, select appropriate reason from available dropdown options
• Finish
• a referral is created and the DSP claim automatically placed On Hold with reason Awaiting MAT
• annotate DSP Claim Progress DOC on DL/Notes with referral details

If the customer is in receipt of JobSeeker Allowance (JSP) or Youth Allowance (YA), code the ‘Claiming DSP’ exemption on AEX. See Step 7 in Table 6 to code AEX and finalise via SAD. For more information see, Jobseeker Payment (JSP) and Youth Allowance (YA) (Provisional).

Procedure ends here until MAT report/SA479 is submitted.

Online claim/ACC

Information provided by the customer in the online claim or ACC can be viewed by selecting and to view the Claim Summary in a new window. If it is blank, press [F5] to refresh the page.

Paper claim submission

On scanning an SA466, SA494 or SA439 to a customer's record, a SOA shell work item and referral to MAT is automatically generated. The SOA shell contains no claim information apart from the CRN and personal details.

Paper claims and scanned supporting documents can be viewed by:

• selecting links at the bottom of the expanded Claim Summary
• selecting Quick link from the bottom of the open Process Direct window, or
• selecting Documents from the Icon Menu

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.

Nominees can sign a claim on behalf of the customer.

Claims without a signature can be processed, provided:

• information on the form is sufficient for the delegate to assess the claim, and
• the delegate is satisfied the customer has confirmed their identity

If the delegate has any concerns about the customer's identity, or the completeness or accuracy of the information provided, the delegate may request a signature.

When assessing a DSP claim start date, review the claim and customer circumstances to:

• establish the potential DSP start date, and
• update the PNA screen if required

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:

• compare the Receipt Date on the DSP claim activity with the:
• creation date on the DSP ACC Claim Progress DOC, and
• Receipt Date of the MEDDSPOL in Documents tab
• the actual date of receipt for claim is the DOC creation date/date the MEDDSPOL was uploaded
• if the claim displays the incorrect submission date:
• go to the More Options menu
• choose the correct date
• select to Update DOR

See Viewing and processing online and Assisted Customer Claims (ACC).

Review Pre-Claim Vulnerable Circumstance (PRECLM)

• Check Document List (DL) screen for an 'Intention to Claim for a Vulnerable customer' DOC
• Review PRECLM screen to:
• decide if there are any Pre-Claim Circumstances and Contact dates recorded, and
• consider backdating if provisions apply
• where back dating provisions apply, clearly document this in the DSP Claim Progress DOC

Where the customer has pre-claim vulnerable circumstances recorded within the eight weeks before their intent to claim contact date the system automatically calculates the start date.

Where the PRECLM displays with a start date that is more than 8 weeks before their intent to claim contact date and there is no end date. Consider if a pre-claim vulnerable circumstance still exists using the available information.

In these cases, assess if the:

• vulnerable circumstance is no longer active, consider end dating the vulnerable circumstance from the associated circumstance screen and regenerate the claim
• pre claim circumstances are required to remain current on a customer’s record indefinitely. This includes exemptions from seeking child support due to family and domestic violence. In these cases, assessment for these circumstances is required:
• do not end date the exemption
• manually update the claim start date to the date of submission if required
• select to Update DOR
• for more information, see Step 5 in the Recording the intent to claim for a payment or concession card table

Additional checks to confirm the correct date the claim was submitted

If coding a claim, the date of receipt used must be the:

• date when the claim is lodged, received or submitted, or
• deemed date of claim where vulnerable circumstance criteria are met

Make sure the claim is indexed from the earliest date the customer may be eligible by checking:

• the paper claim for a date stamp using Documents to view scans
• the date of receipt (DOR) displays on TS as Date Claim Submitted
• For Paper claims, check date the claim was lodged, check date stamp, and if incorrect select to Update DOR

Where there has been a change to the DOR, staff must clearly document this in the DSP Claim Progress DOC on DL/Notes.

Duplicate claims (where a second claim is submitted within 13 weeks of a previous claim)

Check Pensions Status History Summary (PNSH) and DOCs for a previous DSP claim finalised in the last 13 weeks.

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.

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:

• ask for the claim to be reinstated
• appeal the decision

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 as 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 DSP Claim, Service Officers can contact the Level 2 Policy Helpdesk by submitting an Online Enquiry. See the Resources page.

If the customer is seeking reassessment of a previously rejected claim, see Step 3 in Table 1.

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 on DL/Notes to determine the status of the original claim.

Where the original DSP Claim is still in progress, and the customer has either:

• mailed, lodged or faxed the claim form after uploading, or uploaded multiple times, or
• returned the completed claim form (to address missing information and/or signature) within the requested time frame, see Claims received that are incomplete or incorrect:
• Contact the customer/nominee and confirm reason for lodging the second claim
• If the customer agrees, cancel the second (later) DSP Claim SOA in Process Direct Not Required
• Annotate the second DSP Claim Progress DOC on DL/Notes to advise claim has been marked as Not Required and include reason why
• progress the initial DSP Claim by annotating the original DSP Claim Progress DOC on DL/Notes
• check the status of the claim being progressed is correct and update if required

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.

• If the customer lodged the claim seeking a review of original claim decision, they can withdraw the second claim and either ask for a:
• reassessment of the original claim (if rejection reason was FRC/FSD/POI/IME or GCD), see Request to reassess a rejected claim, or
• SME Explanation or Formal review (for any other rejection reason), see Reviews & Appeals
• If a customer/nominee cannot be contacted, or they do not agree to withdraw the second claim, the claim must be progressed, as normal, go to Step 4

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.

Where 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.

Customers who are identified at initial review of a DSP claim (or during the claim assessment) as having significant vulnerable 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 customer needs to be referred to the CCRT for assessment, review claim details carefully to determine if the any of the following are applicable:

• psychiatric confinement due to criminal charges. See Payability of Disability Support Pension (DSP) for customers who are in psychiatric confinement
• deceased customer where claim has not been finalised prior to death and significant support is required to assist family members with remaining claim process. Note: claim should be held to user for the duration of the claim process if a CCRT referral is not actioned
• check if any vulnerabilities or barriers exist for the customer

For assistance in determining if a referral to CCRT is appropriate, access the Customer Critical Response Team SharePoint page for ‘work managed’ details.

Based on the presenting claim details and referral criteria for CCRT, does the customer require a referral to the CCRT?

• Yes, referrals must be made by a Service Support Officer (SSO) or Team Leader (APS5 or above). See the Resources page to make referrals to the CCRT. Procedure ends here if a referral has been made to CCRT
• No, go to Step 6

Check the customer details in the claim against the new indexed activity to prevent multiple records and intertwined record creation.

Is a referral to Data Quality Unit (DQU) required for investigation of an intertwined record?

• Yes, follow processes detailed in Intertwined Centrelink records. Procedure ends here
• No, go to Step 7

Is this customer in prison, charged with an offence and not undertaking a course of rehabilitation, or found guilty and convicted of an offence?

• Yes, this customer may not be eligible for DSP
• If the customers release date is within 3 weeks of the date of claim lodgement, the claim can be assessed. Go to Step 8
• If the customer entered prison after lodging the claim, assess potential eligibility for the period before entering prison. Go to Step 8
• Otherwise, reject the claim. See Rejecting a new claim for Disability Support Pension (DSP) including manifest rejections
• No, go to Step 8

Note: if the release date is unknown, contact F2F Incarcerated Customer Contacts to confirm release date. See Confirming prison admission and release dates

Service 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. Depending on the type of nominee arrangement, this makes sure the nominee is able to ask about the progress of the claim, sign forms and make changes if needed and also receives the claim outcome letter.

Check the customer’s record to find out if a SS313 has been lodged.

Select the Documents icon and select the hyperlink under Doc View for Document Type: SS313 ‘Authorising a person to act on your behalf’.

Is there a SS313 present requiring an update to Nominee details?

Yes, see Adding or rejecting a nominee request

No, go to Step 9

Changes to the customer’s relationship status must be checked and updated before selecting Process in the claim.

If Marital Status (MS) updates are required and Process has already been selected, select and regenerate the claim.

On the TS screen:

• Link Summary (LS) shows linked records, such as nominees and the customer’s partner (including any Relationship Qualifier Code)
• Marital Status (MS) table shows the customer's relationship details.
• If the information recorded in MS does not match with the claim information, further assessments may be required, see:
• Change in relationship status from single to partnered
• Change in relationship status from partnered to single
• For help with MS coding, see Process Direct navigation, common screens and functions
• If the customer's partner has used the TAC to confirm the relationship through the 'Partner Confirmation Logon' service on the Services Australia website, this will display as a DMODP tile and can be viewed under scanned documents. See Confirming a partnered relationship
• Before linking to a partner, make sure the partner's record is in the same Environment. For help with coding environment transfers and relationships, see the Environment transfers and relationships table

Where there is an indication the customer is separated under one roof or living in a marriage like relationship, this will be considered under the non-medical eligibility check below.

This includes where the customer has completed the Living Arrangements question set and it recommends an SS293 or SS284 is issued.

Go to Step 10 to determine if an update is required to the Pensions Assessment (PNA) screen as a result of investigations relating to date of receipt.

The 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 it is an early claim, for example, customer is 15 years and 9 months, PNA needs to be changed to customer's 16th birthday
• if DSP is not payable at the claim date due to income, but is expected to become payable within 13 weeks of the claim, PNA needs to be changed to the start date of the first entitlement period that it becomes payable
• an exclusion period applies, for example, customer has a compensation preclusion period. PNA needs to be amended to the day after the preclusion period ends. See Calculating the start day general rule

If an update is required on the Pensions Assessment (PNA) screen:

• from TS, select Process
• enter PNA in the Super Key field
• change the Assessment Date by selecting the Calendar and select the new assessment date

Where there has been a change to the Assessment Date on the PNA screen, staff must clearly document this in the DSP Claim Progress DOC on DL/Notes.

Use the Documents icon to open and view the MAT report/SA479

Check the DSP Claim date on the MAT report/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 MAT report/SA479 the SAME as the PNA date?

• Yes, go to Step 2
• No, see Scenarios table on the Resources page:
• If the PNA mismatch does not require referral to MAT, go to Step 2
• If the PNA mismatch does require referral to MAT, go to Step 12

Review 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 or ESAt upgraded to a JCA that has not been addressed in the MAT report/SA479, a quality issue is identified in the report or new medical evidence has been lodged since the MAT report/SA479 was completed, this may need to be returned to the Assessor for reassessment.

Do you have any concerns with the medical recommendation or content in the MAT report/SA479?

• Yes, go to Step 12
• No, go to Step 3

In all instances, the medical recommendation in the MAT report/SA479 determines the actions to be undertaken to progress the DSP claim.

Medical recommendation:

• Manifest medically eligible, go to Step 4
• Medical condition refers to a Trans Vaginal Mesh (TVM) cases – go to Step 5
• Current & Valid JCA/upgraded ESAt – go to Step 6
• Insufficient medical evidence (possible REJ-IME) to assess medical eligibility, go to Step 8
• Any other MAT medical rejection recommendation where the customer is manifest medically ineligible (NDT/MDI/OTH(Age)/MTM), go to Step 9
• JCA referral required, see Table 6

DSP 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 answer to the question: Has the customer resided in Australia for 10 years or do they have a Qualifying Residence Exemption (QRE)?

• If the answer is answered ‘yes’ and the answer is:
• correct based on the information on the customer's residence screens, go to the question below regarding customer’s working 15 hours per week
• incorrect based on the customers residence screens, and the customer does not have 10 years qualifying Australian residence or a QRE, go to Step 12. Procedure ends here until Assessor has reviewed and resubmitted the report
• If the answer is ‘no’, the following questions appear:
• Does the claimant have a Continuing Inability to Work (CITW)? This should be a ‘yes’ answer for manifest medical eligibility
• Did the CITW arise in Australia?
• Yes: Customer’s CITW occurred in Australia - the customer is residentially qualified for DSP, continue to customer working 15 hours per week
• No: Customer’s CITW did not occur in Australia – customer does not meet residence criteria for DSP. See Rejecting a new claim for DSP

Customer working more than 15 hours per week

Is the customer currently working?

• Yes, go to Step 10
• No, go to Disability Support Pension (DSP) manifest eligibility to assess claim

Assessor must recommend a JCA referral for all Trans Vaginal Mesh (TVM) cases.

Does the MAT report/SA479 recommend a medical rejection for a TVM case?

• Yes,
• Send an email to the Assessment Services, Development, Assurance, Support Team (DAS) mailbox (cc in your Team Leader)
• Use the Subject line: MAT Query re TVM case
• Include the following text in the email: ‘MAT outcome recommends rejection. Medical evidence indicates customer has TVM, please review SA479 and change to JCA referral required.’
• Use the Status icon to manually Change Status of the DSP claim to On Hold for reason Awaiting MAT Recommendation for 14 days
• Annotate DSP Claim Progress DOC on DL/Notes
• No, and a JCA referral is recommended for a TVM case, see Table 6

Supported 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.

• If the MAT report/SA479 detail a ‘current & valid’ JCA and the referral reason of the JCA is SWS:
• return the MAT report/SA479 to Assessment Services to request the outcome be changed to JCA Referral required
• Go to Step 12
• If the referral was not SWS, continue to Impairment Tables check

Impairment Tables check

Note: check the DSP Start Date (PNA date) established at Step 10 in Table 4 before continuing.

If there is a JCA or upgraded ESAt confirmed as ‘current and valid’ within the MAT report/SA479 for the current DSP claim:

• check the previous JCA/upgraded ESAt was assessed under the same version of the Impairment Tables that applies to the current claim
• see Impairment Tables - start date scenarios

Is the correct version of the Impairment Tables used for the current DSP claim (based on the PNA date) the same as the version used for the JCA/ESAt upgraded to a JCA report?

• Yes,
• While still in the report, check for any other quality issues, e.g. Information Sharing indicator incorrect
• Where a quality issue is identified in JCA/ESAt, see Checking and actioning a Job Capacity Assessment (JCA) report
• If no quality issues are identified, go to Step 7
• No, the previous assessment cannot be considered ‘current & valid’ as it does not match the correct version of the Impairment Tables used for the current DSP claim. Return to Assessor, go to Step 12

Review the JCA/upgraded ESAt to determine if the customer satisfies the medical eligibility requirement for DSP.

If the customer does not satisfy the medical eligibility requirement for DSP, check if new medical evidence has been lodged since the MAT assessment. If:

• new evidence has been lodged, go to Step 11
• no new evidence has been lodged, see Rejecting a new claim for DSP including manifest rejections

If the Customer satisfies the medical eligibility requirement for DSP check working hours.

Check the claim and the DSP claimant's record. Is there evidence the customer is working 15 hours a week or more unsupported in the open labour market at the relevant minimum wage?

• Yes, go to Step 10
• No, check if there is a Disability Medical Assessment (DMA) with the same Date of Claim/Review as the JCA/ESAt upgraded to a JCA report

DMA reports and referrals are accessed via > DMA Assessment or DSP Claim Summary.

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:

• submit an Online Enquiry form with the Level 2 Policy Helpdesk
• annotate the DSP Claim Progress DOC on DL/Notes with the following: “Referred to Level 2 Policy Helpdesk for a current and valid DMA assessment”
• use the Status icon to manually Change Status of the DSP claim to On Hold for reason Awaiting Level 2 policy advices for 7 days
• apply Hold to User

Use the Level 2 Policy Helpdesk response to answer the following question.

Is there a current and valid DMA?

• Yes, finalise the claim – see Assessing eligibility for Disability Support Pension (DSP) after a Disability Medical Assessment (DMA)
• No, refer the customer for a DMA – see Step 2 in Table 3 in the DMA referral checks table

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/SA479 states the DMA is to be completed as a THP assessment:

• add notes to the Special Requirements section in the DMA referral
• email the Government-contracted doctors (GCD) contract management team to advise a DMA THP assessment has been requested by Assessment Services due to [include the customer’s special circumstances]

If 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 a 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.

The 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 hospitalised
• is experiencing vulnerability or at risk (including where they are homeless or live in a remote area), or
• may satisfy the manifestly medical eligibility requirements

Is it appropriate to reject the claim for insufficient medical evidence?

• Yes, see Rejecting a new claim for DSP including manifest rejections
• No, see Service Support Officer (SSO), go to Step 13

If 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:

• code any changes to their circumstances (such as income and assets)
• apply current notification rules in regard to the requirement for verification

See Rejecting a new claim for Disability Support Pension (DSP) including manifest rejections.

Procedure ends here.

Staff must determine if the customer has a clear ability to work at least 15 hours per week in open employment.

Consider the circumstances before progressing a claim where MAT report/SA479 recommends:

• the customer has been assessed as manifestly medically eligible, or
• there is a current and valid assessment supporting DSP eligibility, or
• the customer needs a JCA referral, and the customer is working at least 15 hours per week

Review Recommendation Rationale section in the MAT report/SA479 to see if the Assessor has considered customer's employment in their recommendation.

To determine if the claim should be manifestly rejected on this criteria:

• consider the customer's employment circumstances
• review information on the DSP Claim
• check payslips and wages
• check employment details coded on the EANS/EAPP
• if needed, contact the customer/nominee to discuss the nature of the employment, determine if the employment is supported, or is in jeopardy, due to the medical condition(s)

Where the customer is not working 15 hrs per week or more in the open labour market, at the relevant minimum wage, and no further assessment is required:

Record this in the DSP Claim Progress DOC on DL/Notes:

• Where the customer is manifestly medically eligible, see Disability Support Pension (DSP) manifest eligibility
• Where there is a Current & Valid Assessment, return to Step 6 to determine if a DMA Referral is required
• Where a JCA referral is required, see Table 6

Where the customer has a clear ability to work at least 15 hours per week in open employment, and the work is sustainable and not in jeopardy, a review needs to be conducted by the Assessor to consider the customer’s employment circumstances:

• Refer back to Assessment Services Assessor (MAT), go to Step 12

Procedure ends here until Assessor has completed the review.

If 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

• annotate the closed MAT DSP recommendation DOC with the following: 'Medical evidence lodged DD/MM/YYYY has been reviewed and no additional assessment required'
• action as per MAT report/SA479, using normal processes

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 the initial non-medical eligibility, for example:

• not an Australian resident
• over Age Pension age
• income and/or assets clearly exceed the threshold
• a Compensation Preclusion period which does not end within 13 weeks of claim date, or
• any other clear reason for not satisfying DSP non-medical criteria

Assessment Services

When new medical evidence is received by the Assessor, a new assessment is completed. The new medical evidence may change the assessment recommendation or have no impact but a new MAT report/SA479 needs to be completed in all cases.

When the new MAT report/SA479 is created, the status of the claim is updated to In Process and is allocated for action.

When the new MAT report/SA479 has been completed:

• return to Step 1 to review the MAT report/SA479 and progress the claim
• check the Medical Condition (MC) screen, and if there is a duplicate MC entry, change the Date of Event on the original MC line to the day before the Pension Assessment Date (PNA) to make sure the claim is finalised with the correct medical outcome

Does the customer appear to meet the initial non-medical criteria?

• Yes, go to Step 12
• No, a further referral to Assessor is not required and the claim must be finalised on non-medical criteria – see Rejecting a new claim for Disability Support Pension (DSP) including manifest rejections

If 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:

• not all fields in the MAT report/SA479 completed
• MAT report/SA479 not uploaded (when required)
• incorrect referral reason. For instance, MAT report/SA479 indicates recommendation is for a new claim when in fact it is for an appeal
• no MAT Recommendation DOC recorded, or MAT report/SA479 is recommending manifest medical eligibility but have not assessed where CITW occurred (where applicable)
• MAT report/SA479 is recommending 'Current & Valid' but assessment was completed under the incorrect version of the Impairment Tables
• MAT report/SA479 is recommending ‘Current & Valid’ for a JCA with a referral reason of SWS
• Claim date (PNA date) in the MAT report/SA479 is not correct
• New medical evidence has been lodged since MAT report/SA479 was uploaded
• Assessment of where CITW occurred is required and not been completed
• Customer is working in the open labour marker 15 + hrs p/w and this has not been considered in SA479
• ESAt has been submitted after the MAT report/SA479 with the ESAt upgraded to a JCA

If the MAT issue can be escalated by the Service Officer, a new MAT referral is required:

• see Assessor using > Referral. Select:
• Referral Type: Medical Assessment Team Referral
• Referral Reason: see the Resources page for a list of MAT referral reasons
• text will auto populate the Assessment Reasoning text box based on the referral reason selected. Additional free text can be manually added
• Finish
• a referral is created and the DSP claim is automatically placed On Hold with reason 'Awaiting MAT Recommendation'
• annotate DSP Claim Progress DOC on DL/Notes advising a new referral to MAT has been actioned and processing staff should see the most recent UNSSPOC/SA479 for an outcome
• Notes is updated with Note for Medical Referral to MAT
• procedure ends here until Assessor has completed a new MAT report/SA479

Escalation to an SSO is required when an Assessor recommends Insufficient Medical Evidence (IME) for a customer experiencing vulnerability, the MAT report/SA479 issue relates to a complex or sensitive issue, or where the SO is unsure if the MAT report/SA479 needs review.

Service Officer is to:

• create an SSO referral using the Direct SSO Referral > Benefit Type: DSP > Escalation type: Manifest Grant/Rejection
• use the Status icon to manually Change Status of the DSP claim to On Hold for reason ‘Referred to SSO’
• place claim on hold for 14 days
• apply Hold to User
• annotate DSP Claim Progress DOC on DL/Notes to advise of referral to SSO and include details of what is required
• procedure ends here until SA479 has been reviewed and the SSO responds

Service Support Officer

SSO reviews the MAT report/SA479 and query. When:

• no further MAT referral is required, SSO is to:
• annotate the DSP Claim Progress DOC on DL/Notes with receipt and outcome of the query
• use the Status icon to manually Change Status of the DSP claim to In Process
• finalise the SSO enquiry in the Technical Support Centre (TSC) database escalation inbox
• further MAT referral is required and query involves sensitive or complex information is to:
• not record sensitive or complex information on DL/Notes
• send an email to the Assessment Services, Branch Correspondence Coordination mailbox with the subject Line: SSO Query of MAT recommendation
• annotate DSP Claim Progress DOC on DL/Notes advising a new referral to Assessment Services has been actioned via email to review the SA479
• do not finalise the SSO enquiry in the TSC database until response from Assessment Services has been received
• once Assessment Services response is received:
• annotate the DSP Claim Progress DOC on DL/Notes with ‘SSO referral completed – returned to Processing for action’
• use the Status icon to manually Change Status of the DSP claim to In Process
• finalise the SSO enquiry in the Technical Support Centre (TSC) database escalation inbox
• further MAT referral is required and query is not sensitive or complex SSO is to:
• see Assessor using > Referral. Select:
• Referral Type: Medical Assessment Team Referral
• Referral Reason: see the Resources page for a list of MAT referral reasons
• text will auto populate the Assessment Reasoning text box based on the referral reason selected. Additional free text can be manually added. It is important the reason for the escalation is clear for someone who may not have reviewed the report
• Finish
• a referral is created and the DSP claim is automatically placed On Hold with reason 'Awaiting MAT Recommendation'
• annotate DSP Claim Progress DOC on DL/Notes advising a new referral to MAT has been actioned and processing staff should see the most recent UNSSPOC/SA479 for an outcome
• finalise the SSO enquiry in the Technical Support Centre (TSC) database escalation inbox
• procedure ends here until Assessor submits a new MAT report/SA479

Assessment Services

• Assessor is to review the escalation request. This may include revising the original recommendation
• once review has been completed, Assessor is to complete and submit a new MAT report/SA479, even if there is no change to the outcome
• when the assessment is submitted, the claim is automatically updated to status of In Process and is ready to be allocated
• if Assessment Services receives the MAT query by email, Assessment Services is to respond to SSO with the outcome via email
• procedure ends here until Assessor submits a new MAT report/SA479

MAT report/SA479 recommends a Job Capacity Assessment (JCA) referral is required.

Staff must follow the 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 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 is 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:

• gathering all income and/or asset details
• requesting further information
• referrals. For example:
• Complex Assessment (CAO)
• Compensation Clearance (COMP), or
• Member of a Couple Assessment (MOCA)

As part of initial streaming, the following checks need to be undertaken based on the available evidence prior to actioning a JCA Referral request:

• over Age Pension age
• income and/or assets clearly exceed the threshold
• a Compensation Preclusion period which does not end within 13 weeks of claim date

If the evidence clearly shows the customer does not meet the initial non-medical check, a JCA referral is not to be progressed and the DSP claim is to be rejected.

Review the DSP claim and supporting documents.

To review the information provided by the customer in the online claim or ACC:

• Select and to view the Claim Summary in a new window. If it is blank, press [F5] to refresh the page

To view paper claims and scanned supporting documents:

• select links at the bottom of the expanded Claim Summary, or
• select Quick link from the bottom of the open Process Direct window, or
• select Documents from the Icon Menu

Note: if an online claim was lodged, the customer's responses in the online claim populates the record. If the claim is a paper claim with a SOA shell created, the customer's responses need to be manually coded.

Check customer tasks, DOCs and Notes by selecting

Age

When the customer claims DSP, a person must have:

• turned at least 15 years and 9 months, and
• be under Age Pension age

Check to make sure the customer meets the Age requirement for DSP or can be assessed under the Age requirement rules.

Income and/or Assets limit

When the customer claims DSP, they must meet the relevant income and asset test.

See the following link and access the Pensions tile to check:

• Pension income disqualifying limits
• Pension asset disqualifying limit
• Youth Disability Support Pension income and asset limits

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:

• can be affected by the receipt of a compensation lump sum and/or periodic payment
• may be recovered, reduced and/or precluded if a customer or their partner receives compensation

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?

• Yes,
• Do not action a JCA Referral
• Reject the claim for the relevant reason, see Rejecting a new claim for DSP including manifest rejections
• No, go to Step 3

Identity

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 be followed up if medical eligibility is met after JCA/DMA.

See 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):

• Activate the Immigration Datalink on the Immigration Enquiry (RSIMME). If successful, the datalink auto-records a customer's visa and movement information from 1 September 1994 and grants of Australian citizenship where available.
• Once the Immigration Datalink has been activated, check:
• Legal Residence Details (RSLEG)
• Country of Residence (CRES)
• Immigration Advised Movements (RSIM)
• Residence Results Display (RSRD)
• Periods of Australian Residence (RSPAR) / Australian Historical Residence (RSAHR)

For further information on coding the above screens, see Residence and Portability screens.

Where the customer:

• is an Australian resident with 10 years qualifying residence or a Qualifying Residence Exemption (QRE):
• customer meets the residence criteria for a JCA referral to be actioned – this must be correctly recorded in the JCA Referral
• go to Step 5
• is an Australian resident with less than 10 years Australian residence and no QRE:
• an assessment of 'where the customer's Continuing Inability to Work (CITW) occurred' is needed and this must be requested as part of the JCA Referral – this must be correctly recorded in the JCA Referral
• JCA assesses where the customer’s CITW occurred
• no further assessment of residence eligibility can be made until JCA Report has been submitted
• it is very important staff correctly answer the Residence/QRE question within the JCA referral
• go to Step 5
• is not an Australian resident (e.g. temporary visa) or where the customer is a non-protected SCV holder:
• the customer does not satisfy residence requirements but may be eligible under an International Agreement
• do not action the JCA referral
• see the Assessing residence matrix in Rejecting a new claim for Disability Support Pension (DSP) including manifest rejections to assess the claim and it will either reject for the relevant residence reason, or present an error ‘E510RS Assessment under an agreement required before rejecting. See Claims for Australian payments under International Agreements for how to refer the claim to Centrelink International Services (CIS)

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, 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:

• income or assets, including commencing employment
• changes in Private Trust/Private Company
• commence receiving compensation payments
• received a lump sum compensation payment
• change in relationship status requiring a MoC assessment

Has there been a significant change in circumstances that would impact the ongoing eligibility/ rate of payment for customer and/or partner?

• Yes, go to Step 6
• No, go to Step 7

A significant change in circumstances, impacting a customer’s rate of payment, needs an immediate update to the customer’s record.

• Request the required information:
• if the required information can be provided verbally, contact the customer to get the information before issuing the request. See Requesting information (CLK) for considerations when making a request, including a verbal request, if applicable.
• for paper claims, issue a Request for Information (RFI) letter using the Request for Information guided procedure in Customer First
• for online claims, request further documents via > Request Documents
• for Assisted Customer Claims (ACC) staff can request information via > Request Documents ONLY if the customer has a Centrelink Online account, see CCM claims, otherwise use the RFI in Customer First
• Action non-medical referrals, such as:
• Complex Assessment Officer (CAO) assessments
• Member of a Couple (MoC) and Separated under one roof (SUOR) assessments, or Member of couple reviews – Separated under One Roof (SUOR)
• Compensation clearances
• Update the DSP Claim Progress DOC on DL/Notes to include any details regarding updates / referrals/ requests made during non-medical eligibility checks due to being ISP/CUR and change in circumstances advised in claim
• Go to Step 7

• do not action the JCA referral
• code the non-medical information and reject the claim. See Rejecting a new claim for Disability Support Pension (DSP) including manifest rejections

Medical 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.

Staff 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. Refer to:

• Address (AD), Accommodation details (ACS) and/or Other Contact Details (OCD) – see Step 4 in the Updating change of address details table in Updating address details
  Note: where Accommodation (ACS) is updated with Rent Verification, code 'NCL' within the DSP claim and update via a SAD activity. This automatically reverts to Rent Verification code 'COA' and cannot be changed back to NCL. Where this occurs, record details in the DSP Claim Progress DOC on DL
• Telephone (TDS) – see Step 2 in the Updating telephone details and payment of TAL table in Updating telephone details and/or paying Telephone Allowance (TAL)
• Email address (EMA) – see the Customer First tab in Adding, changing or removing an email address
• Other Contact Details (OCD) – see Step 4 in the Updating change of address details table in Updating address details
  Note: the OCD field must have confirmed data otherwise the JCA referral request will need rework. If there is only provisional data or no data at all, updates must be made and then completed with any other required updates in the SAD function

Where an ISP/CUR customer has not advised of a change in address and/or accommodation details, but their ACS screen has not been updated in the last 12 months, ACS update for this scenario is not required during Rapid Stream. This can be updated, as required, when the claim is finalised.

Do not finalise the updates as yet, as all updates are actioned in one update via the Selective Application of Data (SAD) function.

Note: the only time the ‘Claiming DSP’ exemption should not be applied is at the customer's request. If AEX is not coded because the customer requested the exemption not be applied, update the DSP Claim Progress DOC on DL/Notes with details of the customer's request.

If the customer is currently receiving Jobseeker Payment (JSP) and Youth Allowance (YA) (Provisional), they are exempt from meeting their participation requirements while their DSP claim is being determined.

• key 'AEX' in the Super Key field, select Enter
• Activity and Exemption Summary (AEX) will display
• check for the “Claiming DSP” exemption

Is an extension to the “Claiming DSP” exemption required on AEX while waiting for additional information to be provided, assessments to be undertaken or the claim to be finalised?

• Yes, while still on the AEX screen
• select Add New Row
• Activity Type: DSP - Claiming DSP
• Start date
• End date
• Save
• do not select Assess at this stage
• go to Step 10
• No, go to Step 10

Note: where AEX has previously been applied and has expired, and the DSP claim is still in progress, it can be extended for a further 13 weeks, see JobSeeker Payment (JSP) and Youth Allowance (YA) (Provisional).

Once relevant non-medical updates have been completed, go to the TS screen and select > Selective Application Data. This will create the SAD Task Selection:

• all provisional updates will be preselected in the SAD Tasks– deselect any tasks/updates that do not require immediate update e.g. Income & Asset updates
• make sure all screens needing to be updated are included (check AEX is included). Select:
• Submit (this will go in to the SAD activity)
• Process
• Assess
• Finish to finalise the SAD update

Note: if the SAD activity has been selected for QMA, the JCA referral can still be actioned, go to Step 11.

QMO must check to make sure the DSP claim remains on hold for reason Referred to JCA after SAD QMA has been completed. Procedure ends here for QMO.

A 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:

• Status of a JCA report, or
• Status of an ESAt report

Note: when an ESAt/JCA report is accepted, the status remains 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:

• key ‘RRSUM’ in the Super Key field, select Enter; or
• select > DSP Claim Summary > JCA/ESAt

After reviewing the status of the ESAt/JCA, are any of the following required:

Early Finalisation

When the ESAt/JCA has been accepted but does not have a Finalised status, an early finalisation is required prior to actioning the JCA Referral request for a DSP claim.

If the Service Officer has the relevant access, action an ‘early finalisation’, see Early finalisation of the ESAt/JCA report.

If a referral to an SSO is needed to request an ‘early finalisation’:

• annotate DSP Claim Progress DOC on DL/Notes
• apply Hold to User
• create an SSO referral using the Direct SSO Referral > Benefit Type: DSP > Escalation type: Early Finalisation of JCA/ESAt/DMA Reports
• use the Status icon to manually Change Status of the DSP claim to On Hold for reason 'Referred to SSO' for 14 days
• SSO is to reply when the ESAt/JCA has a Finalised status
• Service Officer to check the status of Finalised shows on the Referrals Summary screen
• end Hold to User
• go to Step 12

ESAt referral in progress - appointment has not yet been attended

When a ESAt referral is in progress and the appointment has not yet been attended, Service Officers are to make a request for the ESAt to be upgraded/changed to a JCA.

• send an email to ASNAT Support - see Assessment Services
• Subject line: ESAt to be upgraded to JCA
• include in email: Customer CRN and text 'Customer has an ESAt appointment but needs a JCA referral for a DSP New Claim'
• annotate DSP Claim Progress DOC on DL/Notes
• apply Hold to User
• use the Status icon to manually Change Status of the DSP claim to On Hold for reason 'Specialist Assessment Required' for 14 days
• ASNAT Support to reply when ESAt is submitted:
• if ESAt is not upgraded to JCA – check and accept ESAt, request Early Finalisation (see details above)
• if ESAt has been upgraded, return to Assessor to determine if ESAt is current & valid for the DSP claim – see Step 12 in Table 5. Annotate Progress of Claim DOC with action taken, end Hold to User. Procedure ends here

ESAt appointment has been attended and the report has not been submitted within 14 days

If the ESAt does not have a status of Submitted:

• send an email to ASNAT Support - see Assessment Services
• Subject line: ESAt not yet submitted
• include in email: Customer CRN and text 'Customer has an outstanding ESAt Report. Please arrange for Report to be submitted to allow JCA referral for DSP New Claim to be completed'
• annotate DSP Claim Progress DOC on DL/Notes
• apply Hold to User
• use the Status icon to manually Change Status of the DSP claim to On Hold for reason 'Specialist Assessment Required' for 14 days
• ASNAT Support will reply when ESAt is submitted:
• if ESAt is not upgraded to JCA check and accept ESAt, request Early Finalisation (see details above)
• if ESAt has been upgraded to a JCA return to Assessment Services to determine if ESAt is ‘current & valid’ for the DSP claim – see Step 12 in Table 5
• annotate DSP Claim Progress DOC on DL/Notes with action taken
• end Hold to User. Procedure ends here

JCA referral in progress is for a DSP Appeal referral reason

• use the Status icon to manually Change Status of the DSP claim to On Hold for reason 'Specialist Assessment Required' for 28 days after the JCA appointment date
• annotate DSP Claim Progress DOC on DL/Notes with, 'MAT have recommended a DSP New Claim JCA referral but cannot action as customer has a DSP Appeal JCA referral in progress as part of formal review'
• apply Hold to User
• continue to monitor the progress of the formal review / DSP Appeal JCA until the JCA is accepted and review has been finalised by an ARO
• if the decision is affirmed, go to Step 12 to action a new JCA Referral
• if DSP Appeal JCA has not been accepted or the outcome of the review resulted in a DSP grant
• use the Status icon to manually Change Status of the DSP claim to On Hold for reason ‘Awaiting Level 2 policy advices’
• Submit an Online Enquiry Form with Level 2 Policy Helpdesk for advice
• annotate DSP Claim Progress DOC on DL/Notes with: ‘Seeking Policy advices on DSPA JCA report'
• continue Hold to User
• procedure ends here until advices have been received from Level 2 Policy Helpdesk

If none of the above is applicable, go to Step 12.

Service Officer needs the following information to insert/answer the questions 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?’

See the previous assessment of customers Residence (in Step 4).

See the Disability Support Pension Residency Screens Checklist (on Resources page) and Residence assessment for customers claiming Disability Support Pension (DSP) to answer this question correctly.

A person has a Qualifying Residence Exemption (QRE) for DSP if the person:

• resides in Australia, and
• is either
• a refugee, or
• a former refugee

To make sure the correct assessment is undertaken and to avoid unnecessary rework:

If the customer does not have 10 years residence or, does not have a Qualifying Residence Exemption (QRE), No is to be selected.

If customer has 10 years residence or, has a Qualifying Residence Exemption (QRE), Yes is to be selected.

Service Officer must be in the DSP Claim activity /transaction when accessing the JCA Referral.

From TS within the DSP NCL activity select > Referral to create a JCA referral.

A referral is created and the claim put On Hold.

On TS, the claim status displays as On Hold with On Hold Reason: field displaying Referred for JCA.

When Assessment Services actions a JCA referral, Process Direct activates a Jobseeker registration.

After the JCA referral has been created, some DSP new claim JCA referrals are automatically booked using JESBA (JCA and ESAt Screening and Booking Automation).

If staff identify an error in the referral, see Job Capacity Assessment (JCA) referral.

Annotate DSP Claim Progress DOC on DL/Notes.

As an additional check to make sure there are no open work items, go to menu icon Transactions > All Transactions.

The status of the DSP claim work item should be: On Hold.

The status of the JCA referral work item should be: In Process or On Hold.

Is there an open work item for the Selective Activity Data (SAD) activity?

• Yes, complete the SAD activity and go to Step 15
• No, go to Step 15

If the customer (or nominee):

• consents to disclosing medical information, they must sign the SA472 form to allow their THP to provide the customer's relevant medical information to Services Australia. The Consent to contact THP in Process Direct defaults to Yes
• has lodged the SA472 and consent is given:
• make sure the form is scanned to the eMIFE
• do not update Consent to Contact THP
• has not lodged the SA472, implied consent is given:
• do not update Consent to Contact THP
• has lodged an unsigned SA472, implied consent is given:
• do not update Consent to Contact THP
• has lodged the SA472 and consent is not given for Services Australia to contact their THP. This can occur at any stage of the claim process, even if prior consent was given:
• record the Consent to Contact THP as No

Recording or updating the Consent to Contact THP

• Consent to Contact THP cannot be coded within the claim
• go to the Customer Summary tile and key the customer's CRN
• select > Consent to Contact THP
• slide Consent to Contact THP toggle to Yes or No as per customer's consent
• update Start Date with the date the customer advises they consent or do not consent for Services Australia to contact their THP
• End Date is only required if the customer specified an end date to their consent
• if No is selected, choose appropriate Reason
• select Finish

FTB for the child is cancelled automatically when a:

• DSP online claim is submitted, or
• SOA shell is created in Process Direct for DSP claim processing for a paper claim

As the claim is progressing to a JCA, staff must check Effect of DSP claim on FTB, to make sure FTB has correctly actioned. See Step 10 in the Family Tax Benefit (FTB) processing for children aged 16-19 years table.

Select Ready to receive work item.

Review work item and if it relates to:

• a Claim for DSP for a Terminal Illness (SA494) or Verification of Terminal Illness (SA495), go to Table 2
• a DSP claim or Reindexed claim, go to Table 3
• a Priority-PossTRM NCL in Prog Fast Note, go to Step 4
• an ESAt Upgraded to JCA, go to Step 2
• a Reassess Rejected Claim Fast Note, go to Step 3
• a Transfer to DSP (S12) Fast Note, see Supporting customers experiencing vulnerability to claim Disability Support Pension (DSP)
• MEDSA466 (medical details section of SA466, but no claim lodged), go to Step 5

Assessment 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:

• review the ESAt to make sure it is complete and accurate. Do not accept the ESAt report
• check if customer has lodged a DSP claim

If there is a DSP claim in progress:

• check and accept the upgraded ESAt/JCA report
• if Assessment Services has recorded a Potential DSP eligibility Fast Note, this can be closed
• go to Table 3 to progress claim

If there is no DSP claim in progress:

• check customer's non-medical eligibility
• check and accept ESAt/JCA report
• invite customer to claim DSP, if applicable
• after completing DSP invite to claim process, check and accept ESAt
• if Assessment Services have recorded a Potential DSP eligibility Fast Note, this can be closed
• procedure ends here

If a Service Officer receives a Reassess Rejected Claim Fast Note, review previous claim to make sure the claim meets the requirements to reopen.

Do not reopen and reassess a DSP claim where:

• the request is made more than 13 weeks after the rejection notice was given, or
• not all requested information has been provided within 13 weeks of the rejection notice
• If either of the above occurs, see Request to reassess a rejected claim for action required
• the DSP claim was rejected for any other reason, see Reviews and Appeals

Where the claim can be reopened and reassessed, action required depends on previous rejection reason. If the claim was previously rejected for reason:

• FSD/FRC or POI:
• reindex claim
• review previous rejection DOC to determine action required to progress claim if manifest medical eligibility was established previous to rejection, see Disability Support Pension (DSP) manifest eligibility, or
• if medical eligibility was established after a DMA – see Assessing eligibility for Disability Support Pension (DSP) after a Disability Medical Assessment (DMA)
• for all other cases, go to Table 3
• FRP (Failed to Report):
• Review the customer’s circumstances to confirm they are eligible for DSP from original date of claim
• Check customer has provided all information for the outstanding reporting periods
• Reindex claim, remove reporting requirements, code employment income for outstanding reporting periods and finalise claim
• After finalising claim, place the customer on reporting type EAN, see Reporting screens
• IME:
• reindex claim and refer to MAT via Fast Note - select Auto text, use Disabilities > Claims > Template - DSP MAT Recommendation Query > New medical evidence provided post MAT recommendation - MAT to review UNSSPOC dated (use date of previous SA479)
• Manually hold the claim for 42 days
• Procedure ends here until MAT has been completed
• When MAT is completed, see Step 2 in Table 3 to continuing streaming claim
• FME
• Check the customer has contacted within 13 weeks of the rejection and has agreed to attend JCA
• Reindex claim
• GCD:
• see Disability Medical Assessment (DMA) appointment outcome to reopen and progress claim

Close the Reassess Rejected claim Fast Note, when required action has been taken.

When 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:

• recommends manifest eligibility:
• apply Hold to User until the claim is finalised, per Work Optimiser for staff and
• see Table 3 to progress the DSP claim
• does not recommend manifest eligibility:
• close the Priority-PossTRM NCL in Prog Fast Note
• assess the DSP claim through the normal processes, go to Table 3
• does not recommend manifest eligibility and medical evidence indicates a terminal illness:
• refer back to MAT, use Fast Note - select Auto text, use Disabilities > Claims > Priority-Possible Terminal NCL lodged > Confirm
• annotate DSP Claim Progress DOC on DL/Notes advising MAT referral has been made
• hold the DSP claim for 14 days for reason MAT
• apply Hold to User
• assessor will take the DSP claim off hold when MAT report/SA479 is completed
• when the work item presents, review the MAT report/SA479, and see Table 3

If 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 Staff Feedback Tool.

If a DSP claim (SA466) has not been lodged, make genuine attempts to contact the customer/nominee.

Was the contact successful?

• Yes, go to Step 7
• No, go to Step 6

If the contact attempt is not successful:

• annotate the DSP Claim Progress DOC with, 'Customer has lodged MEDSA466 only, customer is required to lodge a complete DSP claim. Attempt to contact customer/nominee on DD/MM/YYYY was not successful.'
• Hold the NCL activity for the reason ‘Customer to provide information’ until next working day
• apply Hold to User

Attempt to contact the customer again. Was the second contact attempt successful?

• Yes, go to Step 7
• No, go to Step 8

If the contact attempt is successful, tell the customer or nominee:

• Service Australia has only received:
• medical details section of the DSP claim form, or
• information which indicates you may wish to make a claim for DSP
• a complete DSP claim has not been received
• no further action can be taken unless a complete DSP claim (pages 3 to 25) is received
• invite a DSP claim using one of the following options:
• applying for DSP online
• Assisted Customer Claim (ACC) if the customer is unable or unsuitable to complete an online claim
• First Contact Service Offer (FCSO) workflow in Process Direct to issue the SA466 paper claim
• annotate the DSP Claim Progress DOC with, 'Customer has lodged MEDSA466 only/ insufficient information. Customer has been contacted and advised to complete and submit/lodge a DSP claim'
• check Activity List (AL) screen and cancel the DSP New Claim as the MEDSA466 by itself, is not considered to be a valid or complete claim
• consider recording an Intent to claim for vulnerable customers, if applicable
• procedure ends here

If the second contact is not successful:

• annotate DSP Claim Progress DOC with, 'Second attempt to contact customer/nominee on DD/MM/YYYY was not successful. If customer contacts, please advise the customer they must submit/lodge a claim for DSP
• check Activity List (AL) screen and cancel the DSP New Claim as the MEDSA466 by itself, is not considered to be a valid or complete claim

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:

• less than 2 years, refer the Customer Reference Number (CRN) to Customer Critical Response Team (CCRT). Procedure ends here
• more than 2 years, use Mail Forms guided procedure in Customer First to manually issue:
• SA466 Claim for Disability Support Pension
• SA369 Income and Assets Form (will be automatically issued)
• procedure ends here

Is the work item a SA494 and/or SA495?

• Yes, the work item received is a:
• SA494 and SA495, go to Step 2
• SA494, go to Step 2
• SA495, go to Step 3
• No. For all other claims, see Table 4

SA494 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:
• use Fast Note - select Auto text, use Disabilities > Claims > Priority-Possible Terminal NCL lodged > Confirm
• hold the DSP claim for 14 days for the MAT
• annotate the DSP Claim Progress DOC with ‘MAT referral has been made’
• apply Hold to User
• the Assessor takes the DSP claim off hold when MAT report/SA479 has been completed
• when the work item presents, review the MAT report/SA479. See Table 4

Check the customer's record to see if a DSP Online Claim or Paper Claim (SA466) has been lodged.

If there is:

• no DSP new claim, go to Step 4
• an unassessed DSP new claim on the AL screen, go to Step 10
• a granted claim, close the work item. Procedure ends here
• a DSP claim that has been rejected in the last 13 weeks:
• follow current processes to determine if an explanation, formal review or reassessment is needed, see Step 5 in Table 2 of Progress of DSP claim

Check 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:

• less than 3 months, go to Step 5
• between 3 months and 2 years (or it is not clear), go to Step 6
• more than 2 years, go to Step 7

If the information provided indicates the customer's life expectancy is less than 3 months:

• refer to the Customer Critical Response Team (CCRT), see Resources page
• close the work item
• record a DOC saying the SA495 was received without a DSP claim and has been referred to the CCRT for follow up
• procedure ends here

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:

• Services Australia has received some medical information. Be aware the customer may not know what their treating doctor has told the agency
• a DSP claim has not been received
• no further action can be taken until a DSP claim is received
• invite a DSP claim using one of the following options:
• DSP online via the Services Australia website
• Assisted Customer Claim (ACC) if the customer is unable or unsuitable to complete an online claim
• Mail Forms guided procedure in Customer First to manually issue the SA494. The guided procedure will automatically issue the Income and Assets (SA369) form. Note: do not send an SA494 if there is any doubt the customer knows about the terminal prognosis
• First Contact Service Offer (FCSO) workflow in Process Direct to issue the SA466 paper claim
• discuss having a nominee. The Authorising a person or organisation to enquire or act on your behalf (SS313) form is available on the Services Australia website and can be issued via the Mail Forms guided procedure or the FCSO workflow in Process Direct with a paper SA466 claim
• discuss other services available if needed

Consider recording an Intent to claim for vulnerable customers.

If the contact attempt was:

• successful and ACC run:
• record a DOC detailing the outcomes of the conversation
• the DOC automatically closes
• if DSP claim is submitted via ACC, close the work item
• procedure ends here until MAT report is returned
• successful and customer indicates they intend to lodge an online claim for DSP or a DSP Paper Claim (SA494 or SA466) was issued:
• hold the work item for 7 days
• record a DOC detailing the outcomes of the conversation
• the DOC automatically closes
• when this work item is due, go to Step 8
• not successful:
• hold the work item to user until next work day
• record a DOC with the attempt to call
• the DOC automatically closes
• go to Step 8

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.

If the contact attempt was successful, tell the customer or nominee:

• a DSP claim has not been received
• no further action can be taken unless a DSP claim is received
• the options for claiming DSP (if appropriate) are:
• applying for DSP online
• Assisted Customer Claim (ACC) if the customer is unable or unsuitable to complete an online claim
• First Contact Service Offer (FCSO) workflow in Process Direct to issue the SA466 paper claim
• about other services available if required

In the customer's record:

• record a DOC of the conversation
• close work item
• procedure ends here

If the contact attempt was not successful:

• hold the work item to user until next working day
• record a DOC with the call attempt details and reasons for call

Go to Step 8.

If the work item becomes due:

• 1 day after unsuccessful contact, before making a second contact attempt, check if a DSP new claim has now been lodged. If a claim:
• has been lodged, go to Step 10
• has not been lodged, go to Step 9
• 7 days after successful contact, check that a DSP claim has been lodged. If a claim has:
• been lodged, go to Step 10
• not been lodged, refer to Customer Critical Response Team (CCRT) for follow-up action

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.

If contact is successful, tell the customer or nominee:

• Services Australia has received some medical information. Be aware the customer may not know what their treating doctor has told the agency
• a DSP claim has not been received
• no further action can be taken until a DSP claim is received
• invite a DSP claim using one of the following options:
• DSP online via the Services Australia website
• Assisted Customer Claim (ACC) if the customer is unable or unsuitable to complete an online claim
• Mail Forms guided procedure in Customer First to manually issue the SA494. The guided procedure will automatically issue the Income and Assets (SA369) form. Note: do not send an SA494 if there is any doubt the customer knows about the terminal prognosis
• First Contact Service Offer (FCSO) workflow in Process Direct to issue the SA466 paper claim
• discuss having a nominee. The Authorising a person or organisation to enquire or act on your behalf (SS313) form is available on the Services Australia website and can be issued via the Mail Forms guided procedure or the FCSO workflow in Process Direct with a paper SA466 claim discuss other services available if needed

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:

• less than 2 years, refer the Customer Reference Number (CRN) to the Customer Critical Response Team (CCRT). Procedure ends here
• more than 2 years, use Mail Forms guided procedure in Customer First to manually issue:
• SA466 Claim for Disability Support Pension
• SA369 Income and Assets Form (will be automatically issued)
• procedure ends here

DSP 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:

• cancel the MAT Referral Fast Note, and
• use Fast Note - select Auto text, use Disabilities > Claims > Priority-Possible Terminal NCL lodged
• hold the DSP claim for 14 days for reason MAT and annotate the DSP Claim Progress DOC advising MAT referral has been made
• apply Hold to User
• procedure ends here until MAT Recommendation is completed. MAT takes the DSP claim off hold when MAT Recommendation has been completed

If the MAT report/SA479 is:

• complete and indicates manifest due to terminal illness, see Table 4
• not complete or the MAT Recommendation indicates not manifest, refer back to MAT:
• use Fast Note - select Auto text, use Disabilities > Claims > Priority-Possible Terminal NCL lodged
• close SA495 work item
• hold the DSP claim for 14 days for reason MAT and annotate the DSP Claim Progress DOC advising MAT referral has been made
• apply Hold to User
• procedure ends here until MAT report/SA479 has been completed. The Assessor takes the DSP claim off hold when MAT report/SA479 has been completed

If the customer is currently receiving CP, Service Officers are to:

• Make genuine attempts to contact the customer/nominee by phone
• Discuss their current caring arrangements
• Discuss the benefits of each payment (CP and DSP)
• Explain that any existing qualification from their current payment will cease if DSP claim is granted(for example, they would no longer be entitled to the annual Carer Supplement for CP each July)

Note: if the customer is currently in a Carer Pension bereavement period, 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:

• contact attempts made
• that Service Officers are to discuss with the customer the transfer from CP to DSP and the benefits of each payment
• the customer must determine if DSP is still wanted, or
• if the customer wishes to remain on CP and withdraw their DSP claim

Hold the claim for the required response time (until day 22, unless other wait time provisions apply).

Review 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 4

Where the DSP claim has previously been streamed and the claim and it:

• is being managed by Customer Critical Response Team (CCRT):
• do not action the claim
• reassign to claim to your team leader in Work Optimser
• annotate the DSP Claim Progress DOC and advise DSP claim has been allocated to team leader because the claim is being managed by CCRT
• was previously referred to JCA and the JCA Report is not yet submitted, go to Step 3
• needs assessment after a DMA, see Assessing eligibility for DSP after DMA
• needs assessment and Manifest eligibility has been met, see DSP manifest eligibility
• is to be rejected, see Rejecting a new claim for Disability Support Pension (DSP)

Where 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)

• Hold the claim for reason JCA for 120 days
• Annotate DSP Claim Progress DOC

JCA status is ‘New’ and appointment was in the past (see Latest Effect Date)

• JCA appointment was in the last 4 weeks:
• Hold the DSP claim for reason JCA for 120 days
• Annotate DSP Claim Progress DOC
• JCA appointment was more than 4 weeks ago:
• Run the ASB Assistance Required Fast Note to query the status of the JCA
• Hold the claim for reason JCA for 120 days
• Annotate DSP Claim Progress DOC

JCA not yet booked. Check if the JCA Referral Fast Note is still Open/Held on AL

• If the JCA Referral DOC is closed:
• Create a new JCA referral via Fast Note – check the correct date of claim (PNA date). See Steps 7 & 8 of Table 4
• Email the Assessment Services, Branch Correspondence Coordination mailbox to request priority JCA booking
• Hold the claim on hold for reason JCA for 42 days
• Annotate DSP Claim Progress DOC
• If the JCA Referral DOC is Open/Held and there are annotations in the past 2 weeks, for e.g. no sessions available:
• No follow-up is required
• Hold the claim for reason JCA for 42 days
• Annotate DSP Claim Progress DOC
• If the JCA Referral DOC is Open/Held and there has been no annotation on the JCA Referral DOC for the last 4 weeks:
• Send an email to the Assessment Services, Branch Correspondence Coordination to follow up JCA booking
• Hold the claim for reason JCA for 42 days
• Annotate DSP Claim Progress DOC

JCA has status of Returned/Reopened

• If the JCA was returned or reopened in the last 2 weeks:
• No follow up is required
• Hold the claim for reason JCA for 42 days
• Annotate DSP Claim Progress DOC
• If the JCA was returned or reopened more than 2 weeks ago:
• Run the ASB Assistance Required Fast Note to query the status of the JCA
• Hold the claim for reason JCA for 42 days
• Annotate DSP Claim Progress DOC

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.

• View the JCA report to determine reason for UTC
• Cancel the JCA Activity MFU on AL
• If the claim is to be rejected for reason Failed to Attend Medical (FME), see Rejecting a new claim for Disability Support Pension (DSP) including manifest rejections
• If a new JCA Referral is needed, go to Step 1 in Table 5

When 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:

• Check Documents tools for the DSP Medical Assessment Recommendation (SA479), and
• a DOC on DLs with a subject line of 'MAT DSP recommendation'

Has a MAT report/SA479 been completed?

• Yes, see Table 4
• No, go to Step 4

Is there a current MAT referral?

• Yes,
• Do not cancel the referral
• Send an email to the Assessment Services, Development, Assurance, Support Team (DAS) mailbox (cc in your Team Leader)
• Subject Line: Query MAT recommendation for DSP NCL
• Include customer CRN, DSP Claim lodged XX/XX/XXXX, MAT not yet completed, can you please follow-up?
• Hold the DSP claim for 14 days for reason MAT
• Annotate DSP Claim Progress DOC on DL to advise email sent to MAT to follow-up
• No,
• see MAT using Fast Note – select Auto Text option > Disabilities > Claim >Template – DSP MAT Recommendation Query > DSP new claim lodged, no MAT assessment completed
• hold the DSP claim for 14 days for the reason MAT
• annotate DSP Claim Progress DOC on DL with referral details

If the customer is in receipt of JobSeeker Allowance (JSP) or Youth Allowance (YA), code the ‘Claiming DSP’ exemption on AEX. See Step 7 in Table 6 to code AEX and finalise via SAD. For more information see, Jobseeker Payment (JSP) and Youth Allowance (YA) (Provisional).

Procedure ends here until MAT report/SA479 is submitted.

Online claim/ACC

Information provided by the customer in an online claim or ACC can only be viewed in Process Direct, see the Process Direct TAB for more information

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:

• information on the form is sufficient for the delegate to assess the claim, and
• the delegate is satisfied the customer has confirmed their identity

If the delegate has any concerns about the customer's identity, or the completeness or accuracy of the information provided, the delegate may request a signature.

Note: the DSP claim may be signed by the customer or their Correspondence Nominee.

When assessing a DSP claim start date, review the claim and customer circumstances to:

• establish the potential DSP start date, and
• update the PNA screen

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:

• compare the Receipt Date on the DSP claim activity within Process Direct with the:
• creation date on the DSP ACC Claim Progress DOC, and
• Receipt Date of the MEDDSPOL in Documents tab
• the actual date of receipt for claim is the DOC creation date/date the MEDDSPOL was uploaded
• if the incorrect Date of Receipt has been used, cancel the NCL activity on AL and reindex the claim using the correct Date or Receipt. See Indexing, re-indexing and cancelling claim activities

See Viewing and processing online and Assisted Customer Claims (ACC).

Review Pre-Claim Vulnerable Circumstance

• Check Document List (DL) screen for an 'Intention to Claim for a Vulnerable customer' DOC
• Key !CUPC in to the Next: field:
• decide if there are any Pre-Claim Circumstances and Contact dates recorded, and
• consider backdating if provisions apply
• where back dating provisions apply, clearly document this in the DSP Claim Progress DOC

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:

• vulnerable circumstance is no longer active, consider end dating the vulnerable circumstance from the associated circumstance screen and regenerate the claim
• pre claim circumstances are required to remain current on a customer’s record indefinitely. This includes exemptions from seeking child support due to family and domestic violence. In these cases, assessment for these circumstances is required:
• do not end date the exemption
• Cancel the NCL activity on AL and reindex the claim using the correct Date or Receipt. See Indexing, re-indexing and cancelling claim activities

Additional checks to confirm the correct date the claim was submitted

If coding a claim, the date of receipt used must be the:

• date when the claim is lodged, received or submitted, or
• deemed date of claim where vulnerable circumstance criteria are met

Make sure the claim is indexed from the earliest date the customer may be eligible by checking:

• the paper claim for a date stamp: access Workspace > select Documents Tools under Quick Links to view the scans
• the date of receipt (DOR) can be viewed by Viewing the DSP/NCL activity from Activity List (AL)
• for Paper claims, check date the claim was lodged, check date stamp, and if incorrect
• cancel the NCL activity on AL and reindex the claim using the correct Date or Receipt. See Indexing, re-indexing and cancelling claim activities
• where there has been a change to the DOR, staff must clearly document this in the DSP Claim Progress DOC on DL

Duplicate 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:

• ask for the claim to be reinstated
• appeal the decision

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 Step 4 in Table 1

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 on DL to determine the status of the original claim.

Where the original DSP Claim is still in progress, and the customer has either:

• mailed, lodged or faxed the claim form after uploading, or uploaded multiple times, or
• returned the completed claim form (to address missing information and/or signature) within the requested time frame, see Claims received that are incomplete or incorrect:
• contact the customer/nominee and confirm reason for lodging the second claim
• if the customer agrees, cancel the second (later) DSP Claim activity from AL
• annotate the second DSP Claim Progress DOC to advise claim has been cancelled and include why the initial DSP Claim is being progressed
• annotate the original DSP Claim Progress DOC on DL
• check the status of the claim being progressed is correct and update if required

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.

• If the customer lodged the claim seeking a review of original claim decision, they can withdraw the second claim and either ask for a:
• reassessment of the original claim (if rejection reason was FRC/FSD/POI/IME or GCD), see Request to reassess a rejected claim, or
• SME Explanation or Formal review (for any other rejection reason), see Reviews & Appeals
• If a customer/nominee cannot be contacted, or they do not agree to withdraw the second claim, the claim must be progressed as normal, go to Step 4

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

Where 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.

Customers 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:

• psychiatric confinement due to criminal charges. See Payability of Disability Support Pension (DSP) for customers who are in psychiatric confinement
• deceased customer where claim has not been finalised prior to death and significant support is required to assist family members with remaining claim process. Note: claim should be held to user for the duration of the claim process if a CCRT referral is not actioned
• check if any vulnerabilities or barriers exist for the customer

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?

• Yes, referrals must be made by a Service Support Officer (SSO) or Team Leader (APS5 or above). See the Resources page to make referrals to the CCRT. Procedure ends here if a referral has been made to CCRT
• No, go to Step 6

Check 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?

• Yes, follow processes detailed in Intertwined Centrelink records. Procedure ends here
• No, go to Step 7

Is this customer in prison, charged with an offence and not undertaking a course of rehabilitation, or found guilty and convicted of an offence?

• Yes, this customer may not be eligible for DSP:
• If the customers release date is within 3 weeks of the date of claim lodgement, the claim can be assessed, go to Step 8
• If the customer entered prison after lodging the claim, assessed potential eligibility for the period before entering prison, go to Step 8
• Otherwise, reject the claim, see Rejecting a new claim for Disability Support Pension (DSP) including manifest rejections
• No, go to Step 8

Note: if the release date is unknown, contact F2F Incarcerated Customer Contacts to confirm release date. See Confirming prison admission and release dates.

Service 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?

• Yes, see Adding or rejecting a nominee request
• No, go to Step 9

Check the customer’s relationship status and make any updates, before assessing the claim.

• Where customer has become partnered, see Change in relationship status from single to partnered
• Where the customer was partnered and is now single, see Change in relationship status from partnered to single

If linking customers, check the customer and partner’s environments. Review Inter-environment change of address (ICoA) transfer of a customer record as required.

Where there is an indication the customer is separated under one roof or living in a marriage like relationship, this will be considered under non-medical eligibility check below.

This includes where the customer has completed the Living Arrangements question set and it recommends SS293 or SS284 is issued.

Go to Step 10 to determine if an update is required to the Pensions Assessment (PNA) screen as a result of investigations relating to date of receipt.

The 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

• It is an early claim, for example, customer is 15 years and 9 months. PNA needs to be changed to customer's 16th birthday
• If DSP is not payable at the claim date due to income, but is expected to become payable within 13 weeks of the claim, PNA needs to be changed to the start date of the first entitlement period that it become payable
• An exclusion period applies, for example, customer has a compensation preclusion period. PNA needs to be amended to the day after the preclusion period ends. See Calculating the start day general rule

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, staff must clearly document this in the DSP Claim Progress DOC on DL.

Go 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?

• Yes, go to Step 2
• No, see Scenarios table on the Resources page
• If the PNA mismatch does not require referral to MAT, go to Step 2
• If the PNA mismatch does require referral to MAT, go to Step 12

Review 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 it is apparent there is a JCA/upgraded ESAt that has not been addressed in the MAT report/SA479, this may need to be returned to the Assessor for reassessment.

Do you have any concerns with the medical recommendation or content in the SA479?

• Yes, go to Step 12
• No, go to Step 3

In all instances, the medical recommendation in the MAT report/SA479 determines the actions to be taken to progress the DSP claim.

Medical recommendation:

• Manifest medically eligible– go to Step 4
• Medical condition refers to a Trans Vaginal Mesh (TVM) cases – go to Step 5
• Current & Valid JCA/upgraded ESAt – go to Step 6
• Insufficient medical evidence (possible REJ-IME) to assess medical eligibility, go to Step 8
• Any other MAT medical rejection recommendation where the customer is manifest medically ineligible (NDT/MDI/OTH(Age)/MTM), go to Step 9
• JCA referral required, see Table 6

DSP 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)?

• If this is answered ‘yes’ and the answer is:
• correct based on the information on the customer's residence screens, go to the question below regarding customer’s working 15 hours per week
• incorrect based on the customers residence screens, and the customer does not have 10 years qualifying Australian residence or a QRE, go to Step 12. Procedure ends here until Assessor has reviewed and resubmitted the report
• If this is ‘no’, the following questions appear
• Does the claimant have a Continuing Inability to Work (CITW)? This should be a ‘yes’ answer for manifest medical eligibility
• Did the CITW arise in Australia?
• Yes: Customer’s CITW occurred in Australia - the customer is residentially qualified for DSP, continue to customer working 15 hours per week
• No: Customer’s CITW did not occur in Australia – customer does not meet residence criteria for DSP. See Rejecting a new claim for DSP

Customer working more than 15 hours per week

Is the customer currently working?

• Yes, go to Step 10
• No, go to Disability Support Pension (DSP) manifest eligibility to assess claim

Assessor must recommend a JCA referral for all Trans Vaginal Mesh (TVM) cases.

Does the MAT report/SA479 recommend a medical rejection for a TVM case?

• Yes,
• Send an email to the Assessment Services, Development, Assurance, Support Team (DAS) mailbox (cc in your Team Leader)
• Use the Subject line: MAT Query re TVM case
• Include the following text in the email: ‘MAT outcome recommends rejection. Medical evidence indicates customer has TVM, please review SA479 and change to JCA referral required’
• Use the Status icon to manually Change Status of the DSP claim to On Hold for reason Awaiting MAT Recommendation for 14 days
• Annotate DSP Claim Progress DOC on DL/Notes
• No, and a JCA referral is recommended for a TVM case. See Table 6

Supported 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.

• If the MAT report/SA479 detail a ‘current & valid’ JCA and the referral reason of the JCA is SWS
• return the MAT report/SA479 to Assessment Services Assessor to request a change to the outcome to JCA Referral required
• go to Step 12
• If the referral was not SWS, continue to Impairment Tables check

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

• check the previous JCA or upgraded ESAt was assessed under the same version of the Impairment Tables would applies to the current claim
• see for The Impairment Tables for start date scenarios

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?

• Yes,
• While still in the report, check for any other quality issues, e.g. Information Sharing indicator incorrect.
• Where a quality issue is identified in JCA/ESAt, refer to Checking and actioning a Job Capacity Assessment (JCA) report
• If no quality issues are identified, go to Step 7
• No, the previous assessment cannot be considered ‘Current & Valid’ because it does not match the correct Impairment Tables version used for the current DSP claim. Return to Assessor, go to Step 12

Review the JCA/upgraded ESAt to determine if the customer satisfies the medical eligibility requirement for DSP.

If the customer does not satisfy the medical eligibility requirement for DSP check if new medical evidence been lodged since the MAT assessment. If:

• new evidence has been lodged, go to Step 11
• no new evidence has been lodged, see Rejecting a new claim for DSP including manifest rejections

If the Customer satisfies the medical eligibility requirement for DSP check working hours.

Check the claim and the DSP claimant's record. Is there evidence the customer is working 15 hours a week or more unsupported in the open labour market at the relevant minimum wage?

• Yes, go to Step 10
• No, check to see if there is a Disability Medical Assessment (DMA) with the same Date of Claim/Review as the JCA/ESAt upgraded to a JCA report

DMA reports and referrals are accessed in CF via Workspace > Search Workspace > DMA Referral Summary (Disability).

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:

• submit an Online Enquiry form with the Level 2 Policy Helpdesk
• annotate the DSP Claim Progress DOC on DL/Notes with the following: “Referred to Level 2 Policy Helpdesk for a current and valid DMA assessment”
• Hold the claim for reason RPO (Policy) for 7 days
• apply Hold to User

Use the Level 2 Policy Helpdesk response to answer the following question.

Is there a current and valid DMA?

• Yes, finalise the claim – see Assessing eligibility for Disability Support Pension (DSP) after a Disability Medical Assessment (DMA)
• No, refer the customer for a DMA – see Step 2 in the DMA referral actions table

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:

• Add notes to the Special Requirements section in the DMA referral, and
• Email the Government-contracted doctors (GCD) contract management team to advise a DMA THP assessment has been requested by Assessment Services due to (include the customer’s special circumstances)

If 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 hospitalised
• is experiencing vulnerability or at risk (including where they are homeless or live in a remote area), or
• may satisfy the manifestly medical eligibility requirements

Is it appropriate to reject the claim for insufficient medical evidence?

• Yes, see Rejecting a new claim for DSP including manifest rejections
• No, see Service Support Officer (SSO), go to Step 12

If 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:

• code any changes to their circumstances (such as income and assets)
• apply current notification rules in regard to the requirement for verification

See Rejecting a new claim for Disability Support Pension (DSP) including manifest rejections.

Procedure ends here.

Staff must determine if the customer has a clear ability to work at least 15 hours per week in open employment.

Consider the circumstances before progressing a claim where MAT report/SA479 recommends:

• there is a current and valid assessment supporting DSP eligibility, or
• the customer needs a JCA referral, and
• the customer is working at least 15 hours per week

Review Recommendation Rationale section in the MAT report/SA479 to see if the Assessor has considered customer's employment in their recommendation.

To determine if the claim should be manifestly rejected on this criteria:

• consider the customer's employment circumstances
• review information on the DSP Claim
• check payslips and wages
• check employment details coded on the EANS/EAPP
• if needed, contact the customer/nominee to discuss the nature of the employment, determine if the employment is supported, or is in jeopardy, due to the medical condition(s)

Where the customer is not working 15 hrs per week or more in the open labour market, at the relevant minimum wage, and no further assessment is required:

Record this in the DSP Claim Progress DOC on DL/Notes:

• Where the customer is manifestly medically eligible, see Disability Support Pension (DSP) manifest eligibility
• Where there is a Current & Valid Assessment, return to Step 6 to determine if a DMA Referral is required
• Where a JCA referral is required, see Table 6

Where the customer has a clear ability to work at least 15 hours per week in open employment, and the work is sustainable and not in jeopardy, a review needs to be conducted by the Assessor to consider the customer’s employment circumstances:

• See Assessor by creating an open work item. Use Fast Note – select Auto text, use Disabilities > Claims > Template – DSP MAT Recommendation Query
• Edit the Fast Note auto text as appropriate
• Hold the claim for reason MAT for 42 days, add notes DSP claim 'Awaiting MAT Recommendation’
• Annotate DSP Claim Progress DOC on DL advising a new referral to MAT has been actioned and processing staff should see the most recent SA479 for an outcome

Procedure ends here until Assessor has completed the review.

If 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

• annotate the closed MAT DSP recommendation DOC with the following: 'Medical evidence lodged DD/MM/YYYY has been reviewed and no additional assessment required'
• action as per MAT report/SA479, using normal processes

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:

• not an Australian resident
• over Age Pension age
• income and/or assets clearly exceed the threshold
• a Compensation Preclusion period which does not end within 13 weeks of claim date, or
• any other clear reason for not satisfying DSP non-medical criteria

Assessment Services

When new medical evidence is received by the Assessor, a new assessment is completed. The new medical evidence may change the assessment recommendation or have no impact but a new MAT report/SA479 needs to be completed in all cases.

When the new MAT report/SA479 is created, the status of the claim is updated to In Process and will be allocated for action.

When the new MAT report/SA479 has been completed:

• return to Step 1 to review the MAT report/SA479 and progress the claim
• check the Medical Condition (MC) screen, and if there is a duplicate MC entry, change the Date of Event on the original MC line to the day before the Pension Assessment Date (PNA) to make sure the claim is finalised with the correct medical outcome

Does the customer appear to meet the initial non-medical eligibility checks?

• Yes,
• create an open work item. Use Fast Note - select Auto text, use Disabilities > Claims > Template - DSP MAT Recommendation Query > New medical evidence provided post MAT recommendation - MAT to review SA479 dated (use date of previous SA479). Note: the Resources page lists all available referral types and associated auto text
• on the AL screen, add the text 'DSP MAT Assessment required' to the new claim activity
• manually hold the DSP new claim activity for reason MAT for 42 days
• annotate DSP Claim Progress DOC on DL
• procedure ends here until MAT have completed a new MAT report/SA479
• No, a further referral to Assessor is not required and the claim must be finalised on non-medical criteria – see Rejecting a new claim for Disability Support Pension (DSP) including manifest rejections

If 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:

• not all fields in the MAT report/SA479 completed
• MAT report/SA479 not uploaded (when required)
• incorrect referral reason. For instance, MAT report/SA479 indicates recommendation is for a new claim when in fact it is for an appeal
• no MAT Recommendation DOC recorded, or MAT report/SA479 is recommending manifest medical eligibility but have not assessed where CITW occurred (where applicable)
• MAT report/SA479 is recommending 'Current & Valid' but assessment was completed under the incorrect version of the Impairment Tables
• MAT report/SA479 is recommending ‘Current & Valid’ for a JCA with a referral reason of SWS
• Claim date (PNA date) in the MAT report/SA479 is not correct
• New medical evidence has been lodged since MAT report/SA479 was uploaded
• Assessment of where CITW occurred is required and not been completed
• Customer is working in the open labour marker 15 + hrs p/w and this has not been considered in SA479
• ESAt has been submitted after the MAT report/SA479 with the ESAt upgraded to a JCA

If the MAT issue can be escalated by the Service Officer, a new MAT referral is required:

• hold the claim for reason MAT for 14 days
• annotate the DSP Claim Progress DOC to advise the details of issue with the MAT Recommendation
• use Fast Note - select Auto text, use Disabilities > Claims > Template - DSP MAT Recommendation Query > Report Incomplete
• add details of query. For example, 'Assessment to determine if CITW occurred in Australia is required’ Note: the Resources page lists all available referral types and associated auto text
• procedure ends here until Assessor has completed a new SA479

Any other concerns, including MAT report/SA479 to reject Insufficient Medical evidence (IME) for a customer experiencing vulnerability, must be escalated to a Service Support Officer (SSO):

Service Officer is to -

• create an SSO referral using the Direct SSO Referral > Benefit Type: DSP > Escalation type: Manifest Grant/Rejection
• hold the claim for reason RPO (Policy) for 14 days
• annotate DSP Claim Progress DOC on DL to advise of referral to SSO and include details of what is required
• use Fast Note - select Auto text, use Disabilities > Claims > Template - DSP MAT Recommendation Query > Report Incomplete
• apply Hold to User
• procedure ends here until MAT report/SA479 has been reviewed and the SSO responds

Service Support Officer

SSO reviews the MAT report/SA479 and query. When:

• no further MAT referral is required, SSO is to:
• annotate the DSP Claim Progress DOC on DL with receipt and outcome of the query
• take the NCL activity off hold
• finalise the SSO enquiry in the Technical Support Centre (TSC) database escalation inbox
• further MAT referral is required and query involves sensitive or complex information SSO is to:
• not record sensitive or complex information on DL/Notes
• send an email to the Assessment Services, Branch Correspondence Coordination mailbox with the Subject Line: SSO Query of MAT recommendation
• annotate DSP Claim Progress DOC on DL advising a new referral to Assessment Services has been actioned via email to review the SA479
• do not finalise the SSO enquiry in the TSC database until response from Assessment Services has been received
• once Assessment Services response is received:
• annotate the DSP Claim Progress DOC on DL with ‘SSO referral completed – returned to Processing for action’
• take the NCL activity off hold
• finalise the SSO enquiry in the Technical Support Centre (TSC) database escalation inbox
• further MAT referral is required and query is not sensitive or complex SSO is to:
• not send the DSP MAT Recommendation Query Fast Note as this duplicates the query
• continue to manage the case and not finalise the enquiry in the escalation inbox. Annotate DSP Claim Progress DOC on DL advising ‘SSO has received an escalation. Fast Note already run to action a new referral to MAT. Processing should see the most recent MAT report/SA479’
• finalise the SSO enquiry in the Technical Support Centre (TSC) database escalation inbox as processing staff should see the most recent MAT report/SA479 for an outcome
• procedure ends here until Assessor submits a new MAT report/SA479

Assessment Services

Assessor reviews the escalation request. This may include revising the original recommendation.

Once review has been completed, the Assessor:

• completes and submits a new MAT report/SA479 even if there is no change to outcome
• takes the DSP/NCL activity off hold
• responds to the SSO with the outcome via email, if Assessment Services received the MAT query by email

Procedure ends here until Assessor submits a new MAT report/SA479.

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:

• gathering all income and/or asset details
• requesting further information
• referrals. For example:
• Complex Assessment (CAO)
• Compensation Clearance (COMP), or
• Member of a Couple Assessment (MOCA)

As part of initial streaming, the following checks need to be done based on the available evidence before actioning a JCA Referral request:

• over Age Pension age
• income and/or assets clearly exceed the threshold
• a Compensation Preclusion period which does not end within 13 weeks of claim date

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.

Review the DSP claim and supporting documents.

Review the information provided by the customer in the online claim or ACC This can only be done in Process Direct, see the Process Direct Tab.

To view paper claims and scanned supporting documents:

• select links at the bottom of the expanded Claim Summary, or
• select Quick link from the bottom of the open Process Direct window, or
• select Documents from the Icon Menu

Note: if an online claim was lodged, the customer's responses in the online claim populates the record. If the claim is a paper claim with a SOA shell created, the customer's responses need to be manually coded.

Age

When the customer claims DSP, a person must have:

• turned at least 15 years and 9 months, and
• be under Age Pension age

Check to make sure the customer meets the Age requirement for DSP or can be assessed under the Age requirement rules.

Income and/or Assets limit

When the customer claims DSP, they must meet the relevant income and asset test.

See the following link and access the Pensions tile to check:

• Pension income disqualifying limits
• Pension asset disqualifying limit
• Youth Disability Support Pension income and asset limits

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:

• can be affected by the receipt of a compensation lump sum and/or periodic payment
• may be recovered, reduced and/or precluded if a customer or their partner receives compensation

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?

• Yes,
• Do not action a JCA Referral
• Reject the claim for the relevant reason, see Rejecting a new claim for DSP including manifest rejections
• No, go to Step 3

Identity

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.

See 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):

• Activate the Immigration Datalink on the Immigration Enquiry (RSIMME). If successful, the datalink auto-records a customer's visa and movement information from 1 September 1994 and grants of Australian citizenship where available
• Once the Immigration Datalink has been activated, check:
• Legal Residence Details (RSLEG)
• Country of Residence (CRES)
• Immigration Advised Movements (RSIM)
• Residence Results Display (RSRD)
• Periods of Australian Residence (RSPAR) / Australian Historical Residence (RSAHR)

For further information on coding the above screens, see Residence and Portability screens.

Where the customer:

• is an Australian Resident with 10 years qualifying residence or a Qualifying Residence Exemption (QRE):
• customer meets the residence criteria for a JCA referral to be actioned – this must be correctly recorded in the JCA Referral
• go to Step 5
• is an Australian resident with less than 10 years Australian residence and no QRE:
• an assessment of 'where the customer's Continuing Inability to Work (CITW) occurred' is needed and this must be requested as part of the JCA Referral – this must be correctly recorded in the JCA Referral
• JCA will assess where the customer’s CITW occurred
• no further assessment of residence eligibility can be made until JCA Report has been submitted
• it is very important staff correctly answer the Residence/QRE question within the JCA referral
• go to Step 5
• is not an Australian resident (e.g. temporary visa) or where the customer is a non-protected SCV holder:
• The customer does not satisfy residence requirements but may be eligible under an International Agreement
• do not action the JCA referral
• see the Assessing residence matrix in Rejecting a new claim for Disability Support Pension (DSP) including manifest rejections to assess the claim and it either rejects for the relevant residence reason, or presents an error ‘E510RS Assessment under an agreement required before rejecting. See Claims for Australian payments under International Agreements for how to refer the claim to Centrelink International Services (CIS)

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, 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:

• income or assets, including commencing employment
• changes in Private Trust/Private Company
• commence receiving compensation payments
• received a lump sum compensation payment
• change in relationship status requiring a MoC assessment

Has there been a significant change in circumstances that would impact the ongoing eligibility/ rate of payment for customer and/or partner?

• Yes, go to Step 6
• No, go to Step 7

A significant change in circumstances impacting a customer’s rate of payment, needs an immediate update to the customer’s record.

• Request the required information:
• if the required information can be provided verbally, contact the customer to get the information before issuing the request. See Requesting information (CLK) for considerations when making a request, including a verbal request, if applicable
• for paper claims, issue a Request for Information (RFI) letter using the Request for Information guided procedure in Customer First
• for online claims, use the Request and manage Customer Tasks guided procedure
• Action non-medical referrals, such as:
• Complex Assessment Officer (CAO) assessments
• Member of a Couple (MoC) and Separated under one roof (SUOR) assessments, or, Member of couple reviews – Separated under One Roof (SUOR)
• Compensation clearances
• Update the DSP Claim Progress DOC on DL to include any details regarding updates / referrals/ requests made during non-medical eligibility checks due to being ISP/CUR and change in circumstances advised in claim
• go to Step 7

• do not action the JCA referral
• code the non-medical information and reject the claim. See Rejecting a new claim for Disability Support Pension (DSP) including manifest rejections

Medical 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.

Staff 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. Refer to:

• Address (AD), Accommodation details (ACS) and/or Other Contact Details (OCD) – see Step 4 in the Updating change of address details table in Updating address details
  Note: where Accommodation (ACS) is updated with Rent Verification, code 'NCL' within the DSP claim and update via a SAD activity. This automatically reverts to Rent Verification code 'COA' and cannot be changed back to NCL. Where this occurs, record details in the DSP Claim Progress DOC on DL
• Telephone (TDS) – see Step 2 in the Updating telephone details and payment of TAL table in Updating telephone details and/or paying Telephone Allowance (TAL)
• Email address (EMA) – see the Customer First tab in Adding, changing or removing an email address
• Other Contact Details (OCD) – see Step 4 in the Updating change of address details table in Updating address details
  Note: the OCD field must have confirmed data otherwise the JCA referral request will need rework. If there is only provisional data or no data at all, updates must be made and then completed with any other required updates in the SAD function

Do not finalise the updates as yet, as all updates will be actioned in one update via the Selective Application of Data (SAD) function,

The SAD function must be applied if details were updated, 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 10.

Note: the only time the ‘Claiming DSP’ exemption should not be applied is at the customer's request. If AEX is not coded because the customer requested the exemption not be applied, apply check the DSP Claim Progress DOC on DL/Notes 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.

AEX can only be updated in Process Direct, see the Process Direct TAB or JobSeeker Payment (JSP) and Youth Allowance (YA) (Provisional) for coding details.

A 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:

• Status of a JCA report, or
• Status of an ESAt 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:

• Key ‘RRSUM’ in Next: field
• Select Enter

After reviewing the status of the ESAt/JCA, are any of the following required:

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.

If the Service Officer has the relevant access, action an ‘early finalisation’ - see Early finalisation of the ESAt/JCA report.

If a referral to an SSO is needed to request an ‘early finalisation’:

• create an SSO referral using the Direct Referral to SSO > Benefit Type: DSP > Escalation type: Early Finalisation of JCA/ESAt/DMA Reports
• Hold the claim for reason Referred to SSO for 14 days
• annotate DSP Claim Progress DOC on DL to advise of referral to SSO and include details of what is needed
• apply Hold to User
• SSO will reply when ESAt/JCA has a Finalised status
• Service Officer to check the status of Finalised shows on the RRSUM screen
• end Hold to User
• go to Step 12

ESAt referral in progress - appointment has not yet been attended

When a ESAt referral is in progress and the appointment has not yet been attended, Service Officers should make a request for the ESAt to be upgraded/changed to a JCA.

• send an email to ASNAT Support - see Assessment Services
• Subject line: ESAt to be upgraded to JCA
• include in email: Customer CRN and text 'Customer has an ESAt appointment but needs a JCA referral for a DSP New Claim'
• annotate DSP Claim Progress DOC on DL
• apply Hold to User
• manually place the DSP claim to On Hold for 14 days with notes on DSP/NCL activity on AL: awaiting Assessment Services support
• ASNAT Support will reply when ESAt is submitted:
• if ESAt is not upgraded to JCA – check and accept ESAt, request Early Finalisation (see details above)
• if ESAt has been upgraded, return to Assessment Services. Use Fast Note – select Auto text > Disabilities > Claims Template – DSP MAT Recommendation Query > Report Incomplete and add details. MAT to determine if ESAt is ‘current & valid’ for the DSP Claim, see Step 12 in Table 5. Annotate DSP Progress of Claim DOC with action taken. End Hold to User. Procedure ends here until MAT is submitted

ESAt appointment has been attended and the report has not been submitted within 14 days

If the ESAt does not have a status of Submitted:

• send an email to ASNAT Support - see Assessment Services
• Subject line: ESAt not yet submitted
• include in email: Customer CRN and text 'Customer has an outstanding ESAt Report. Please arrange for Report to be submitted to allow JCA referral for DSP New Claim to be completed'
• annotate DSP Claim Progress DOC on DL
• apply Hold to User
• manually place the DSP claim to On Hold for reason RPO (Policy) for 14 days with notes on DSP/NCL activity on AL: awaiting Assessment Services support
• ASNAT Support will reply when ESAt is submitted:
• if ESAt is not upgraded to JCA check and accept ESAt, request Early Finalisation (see details above)
• if ESAt has been upgraded to a JCA return to Assessment Services. Use Fast Note – select Auto text > Disabilities > Claims Template – DSP MAT Recommendation Query > add details. MAT to determine if ESAt is ‘current & valid’ for the DSP claim, see Step 12 in Table 5. Annotate DSP Claim Progress DOC on DL with action take. End Hold to User. Procedure ends here

JCA referral in progress is a DSP Appeal referral reason

• manually hold DSP claim for reason RPO (Policy) for 28 days after the JCA appointment date with notes on the DSP/NCL activity on AL: “waiting for DSPA JCA submission”
• annotate DSP Claim Progress DOC on DL with, 'MAT have recommended a DSP New Claim JCA referral but cannot action as customer has a DSP Appeal JCA referral in progress'
• apply Hold to User
• continue to monitor DSP Appeal - when DSP Appeal JCA has been submitted, accepted and finalised, go to section below titled 'JCA referral'
• if DSP Appeal JCA is related to a Formal Review being conducted by an ARO, and the ARO decision has been finalised and implemented:
• hold the claim for reason RPO (Policy) for 14 days
• annotate DSP Claim Progress DOC on DL to advise of referral to Level 2 Policy Helpdesk and what is required
• Submit an Online Enquiry Form with Level 2 Policy Helpdesk for advice
• annotate DSP Claim Progress DOC on DL with: ‘seeking Policy advices on DSPA JCA report'
• continue Hold to User
• Procedure ends here until advices have been received from Level 2 Policy Helpdesk

Service 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 previous assessment of customers Residence (in Step 4).

See the Disability Support Pension Residency Screens Checklist (on Resources page) and Residence assessment for customers claiming Disability Support Pension (DSP) to answer this question correctly.

A person has a Qualifying Residence Exemption (QRE) for DSP if the person:

• resides in Australia, and
• is either
• a refugee, or
• a former refugee

To make sure the correct assessment is undertaken and to avoid unnecessary rework:

• If the customer does not have 10 years residence or, does not have a Qualifying Residence Exemption (QRE), leave the answer as No
• If customer has 10 years residence or, has a Qualifying Residence Exemption (QRE), the answer must be changed to Yes

Check the Job Seeker Registration screen.

Does the customer have an active jobseeker registration?

• Yes, go to Step 4
• No,
• Make sure customer data (specifically OCD, CRES, RSLEG and RSIMME) is coded or updated
• See Eligibility and registration as a Job Seeker Registration Only (JSRO)/No Remote Referral Required (NRRR) job seeker to complete the registration

Run 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 the MAT):

• JCA referral required post MAT - F2F
• JCA referral required post MAT - File assessment
• JCA referral required post MAT - Phone assessment

Make sure all details in the Fast Note are completed correctly:

• Date of claim: date the DSP claim/Appeal was lodged
• Residency: review and advise if the customer meets 10 years residency or has a Qualifying Residence Exemption (QRE) (this will inform the assessor if to determine where the Continuing Inability to Work (CITW) occurred). Make sure this field contains one word: Yes or No
• Discipline: review and advise if the primary medical condition, as outlined in the Medical Assessment Team (MAT) recommendation is Physical or Non-Physical in nature. Make sure this field contains one word: Physical or Non-Physical
• Specialist Referral/Assessment required: Yes/No (if yes, include the type of specialist assessment required)
• Special Needs: if applicable
• Add any more information or special needs in the dialogue boxes if required. For example, interpreter required, potential violent behaviour, gender preference of JCA Assessor

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 on DL.

As an additional check to make sure there are no open activities related to the DSP claim.

• Manually close open digital work items e.g. UNS008. MEDSA466 or SA472
• The DSP/NCL activity should be on hold for reason JCA
• JCA Referral Fast Note should be Open
• SAD activity should be completed or Submitted for QOL

If there is an open Pension System/Selective Task Transfer (STT) activity on AL, the SAD activity is not completed correctly. Go back to Step 9 to complete the SAD.

Consent to Contact THP (SA472) can only be recorded or updated in Process Direct. See the Process Direct TAB.

FTB for the child is cancelled automatically when a:

• DSP online claim is submitted, or
• SOA shell is created in Process Direct for DSP claim processing for a paper claim

As the claim is progressing to a JCA, staff must check Effect of DSP claim on FTB, to make sure FTB has correctly actioned. See Step 10 in the Family Tax Benefit (FTB) processing for children aged 16-19 years table