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

Start date scenarios

Actions

PNA date is after the DSP claim date on the SA479

MAT Recommendation is valid from the date of DSP claim and the following period of 13 weeks. Where the DSP claim date on SA479 is not more than 13 weeks from the PNA date, the SA479 is valid.

PNA date is before the DSP claim date on the SA479 (but within 13 weeks) with outcome: Medically ineligible

Reject the claim if MAT recommendation rejection is due to:

• Insufficient Medical Evidence (IME), or
• Manifestly medically ineligible, and

PNA date is before the DSP claim date on the SA479 (but within 13 weeks) with outcome: Manifestly medically eligible

Review the customer's record and customer circumstances:

• if satisfied that the customer met manifest medical criteria from the PNA date, assess the claim without referral to MAT to change the DSP claim date on SA479
• edit the Date of Event on the MC screen to the same date as the PNA date
• clearly document decision on the DSP Claim Progress DOC

If there is any doubt about the customer's medical eligibility from the PNA date, action a Medical Assessment Team referral for reason:

• Query MAT - Report Inconsistent (manifest reason is not Terminal)
• Trm Ill- SA494/SA495/Other (manifest reason is Terminal)
• add notes in Additional Information field:
• 'DSP claim start date backdated to XX/XX/XXXX [add reason such as Pre-claim vulnerability - homelessness]. Review SA479 and confirm manifest medical eligibility was met on this date.'
• apply Hold to User

PNA date is before the DSP claim date on the SA479 (but within 13 weeks) with outcome: JCA Referral Required

Use MAT to action a referral to JCA:

• in Process Direct, access the JCA referral
• in the following fields:
• Date of claim, key the PNA date

PNA date is before the DSP claim date on the SA479 (but within 13 weeks) with outcome: Current and valid assessment

Use MAT recommendation to reject or progress the current claim where the following 3 criteria are met:

• MAT have determined a previous assessment is current and valid for the current claim
• no new evidence has been provided, and
• the previous assessment was completed within 2 years of the PNA date

If the previous assessment was completed more than 2 years before the PNA date of the current claim, action a Medical Assessment Team referral for reason:

• Query MAT - Report Inconsistent:
• add notes in Additional Information field. For example, 'DSP claim start date backdated to 1 June 2021 for Pre-claim vulnerability. Please review SA479 and confirm previous assessment is current and valid for the purpose of the current DSP claim'
• annotate DSP Claim Progress DOC

PNA date is more than 13 weeks before the DSP claim date on the SA479 - all MAT outcomes

Action a Medical Assessment Team referral for reason:

• Query MAT - Report Inconsistent
• add notes in Additional Information field:

Assistance with determining PNA date or use of MAT recommendation

If staff need help to determine:

• the correct PNA date, see Disability Level 2 Helpdesk