Assessing Disability Support Pension (DSP) claims 008-03030000

At the point of lodgement, register the DSP claim and scan all documentation. Medical and non-medical eligibility for DSP is then assessed. See Claiming DSP.

Customers identified with a potential terminal illness

At the lodgement of a DSP new claim Service Officers may identify the customer has a potential terminal illness (life expectancy is less than 2 years). If so, the claim must be prioritised to the Medical Assessment Team (MAT). To escalate, see Prioritising Disability Support Pension (DSP) claims for terminally ill customers.

The medical evidence required to support a DSP claim depends on the customer's circumstances. New claimants are required to supply medical records such as clinical notes, test results and specialist reports to support their claim. The Medical Evidence Requirements (SA473) form is available to assist customers to determine suitable medical evidence.

If the customer does not submit any medical evidence their claim may be rejected. See Streaming a new claim for DSP.

When accepting medical evidence from customers or when discussing with them details of their medical condition, check if the medical evidence or the customer's statements suggest they may be terminally ill or require nursing home level care. These customers may be manifestly medically eligible for DSP.

Scanning of medical documentation can occur at a Service Centre, Services Australia's scanning provider or as part of an Assessment Services appointment.

The paper version of a medical/sensitive document is placed into the daily scanning batch and destroyed after 10 weeks (70 calendar days). See Scanning Centrelink medical/sensitive documents using an MFD.

See What is medical evidence for DSP?

Once lodged and indexed, DSP claims are assessed through a streaming process.

The streaming process determines if the claim can be manifestly granted, manifestly rejected, or requires a referral for a Job Capacity Assessment (JCA). It also identifies if there is any outstanding information required to process the claim. See Streaming a new claim for DSP.

Potential terminal illness

Where identification of a potential terminal illness (life expectancy is less than 2 years) occurs, Service Officers must prioritise the claim. This ensures the claim presents to the next available Service Officer for immediate action. For full details of the escalation process, see Prioritising Disability Support Pension (DSP) claims for terminally ill customers.

A JCA is an important step in the medical assessment process. It is generally not required when it is clear from available evidence the customer is manifestly eligible or ineligible for DSP.

A claim may be manifestly:

• rejected on non-medical grounds, such as where the customer does not meet age, residence or income/assets criteria
• rejected on medical grounds, such as where medical evidence shows the customer's condition is clearly temporary
• granted where the customer meets the non-medical eligibility criteria and the medical evidence shows the customer meets specific manifest medical eligibility criteria, such as having a terminal illness, or requiring nursing home level care

In these cases, determine the claim without a JCA or Disability Medical Assessment (DMA).

In all other cases a JCA is required to assess the claimant's medical conditions under the Impairment Tables, and to determine if they have a Continuing Inability to Work (CITW).

If a JCA report recommends likely medical eligibility for DSP, and the customer has met the non-medical eligibility criteria, the customer will be referred to a Government-contracted doctor (GCD) for a DMA before their claim is determined. See DMA referrals.

If it is determined a JCA is required, a referral request is sent to the Assessment Services Branch (ASB). The ASB Triage team will undertake an initial assessment to ensure a JCA is required and sufficient medical evidence has been provided. ASB are then responsible for contacting the customer and advising of the JCA details including appointment time, venue and format.

How the claim is assessed once the Job Capacity Assessment (JCA) report is submitted, depends on whether the JCA report indicates:

• medical ineligibility
• manifest grant or reject recommendation
• potential medical eligibility

If medical ineligibility is determined, the claim is finalised and DSP is rejected.

If manifest grant/rejection recommendation is determined, the claim is finalised as DSP is manifestly granted or rejected.

If potential eligibility is indicated, and the customer has met the non-medical eligibility criteria, they are referred to a GCD for a DMA to confirm medical eligibility.

There are 5 possible outcomes from a Disability Medical Assessment (DMA) report:

• medical eligibility for DSP, but some minor adjustments to the medical condition/s and impairment rating/s are recommended
• medical eligibility for DSP, but there are major changes to the medical condition/s and the impairment rating/s resulting in the requirement to now assess active participation in a Program of Support (POS) and/or reassess work capacity
• the customer is manifestly eligible for DSP
• the customer is not medically eligible for DSP
• the customer failed to attend the assessment

For more information, see Assessing a new claim for DSP after a DMA.

When the DSP claim is finalised the customer is contacted by phone and/or letter and advised of the claim outcome.