What is medical evidence for Disability Support Pension (DSP)? 008-03030010

Customer’s claiming DSP must provide Services Australia with medical evidence for the disability or medical condition(s) affecting their ability to function. Insufficient medical evidence will generally result in a DSP claim being rejected.

The medical evidence required depends on each customer's circumstances. Most customers must provide comprehensive evidence, however some may only need to provide certain information, or may not need to provide any new evidence.

Do not ask customers to provide extra medical evidence if it is clear their claim can be manifestly rejected on non-medical grounds. This includes when their income clearly exceeds the relevant limits.

Medical evidence includes documents written by a medical practitioner (such as the customer's treating doctor) and other registered health or allied health professionals. This evidence should support the information provided in the medical details section of the DSP claim.

Statements from the customer or their nominee are not considered medical evidence. This also applies to letters/information from a non-health professional, such as a teacher. However, this information may be taken into account as part of the assessment.

Customers must provide medical evidence when they lodge their online claim. This presents as a required task at the Next Steps section of the DSP online claim. If no medical evidence is uploaded, the claim cannot be submitted.

There are some exceptions to this rule.

Customers who claim JobSeeker Payment (JSP) (Provisional) within the online claim for DSP can submit both claims without providing medical evidence. This allows processing of the JSP (P) online claim while the customer gathers medical evidence for DSP. Generally, a DSP claim will be rejected if medical evidence is insufficient.

Customers who meet the exceptional circumstance criteria can submit their DSP online claim without uploading all required documents. These claims will be referred to the Medical Assessment Team (MAT), using a separate work item. The MAT assessor may contact the customer or health professional to discuss medical evidence before making a recommendation. See the Process page for exception criteria.

Customers must supply current evidence detailing the impact of their medical condition(s) or the claim may be rejected. They do not need to provide specific forms completed by their treating health professional(s).

The Disability Support Pension Medical Evidence Checklist (SA473) lists the medical evidence that can be provided to support a DSP claim and is included in the:

• online claim, and
• Claim for Disability Support Pension (SA466) paper form

Customers with a terminal illness can submit a Verification of terminal illness (SA495) form as medical evidence as part of their Claim for Disability Support Pension for a Terminal Illness (SA494).

The agency can provide support to vulnerable or at risk customers for whom it is difficult to obtain basic medical evidence. For example, people who disengaged from health services due to being homeless, living in a remote community or having an undiagnosed mental health condition.

For each condition that significantly affects the customer's functional capacity and ability to work, information is generally required about the:

• diagnosis of the condition, including whether the diagnosis is confirmed, when the condition was diagnosed, and the details of the health professional who made the diagnosis
• symptoms and functional impact, including current symptoms of the customer's condition (persisting despite treatment, aids, equipment or assistive technology), when the symptoms started (date of onset), the severity, frequency and duration of symptoms, and how the conditions and treatment impact on the customer's ability to function in day-to-day life including at work
• prognosis, including how long the condition is expected to affect the customer's functional capacity, and whether the condition is likely to improve, remain the same or get worse, and
• treatment and care, including the type of treatment undertaken in the past, current treatment, planned treatment (including if on a waiting list), expected impact of current and future treatment and any requirement for nursing home or palliative care

This does not mean the customer is required to provide documentary evidence covering all of these points. However, the customer should provide as much medical evidence as they can so the agency can complete a thorough assessment of the DSP claim.

In certain cases, verification of the diagnosis may be enough to establish medical eligibility for DSP without the need for a comprehensive Job Capacity Assessment. For example, if a customer provides evidence from their treating doctor confirming diagnosis of a 'List 1' manifest condition, the MAT may determine this is sufficient evidence.

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

When talking to customers about providing medical evidence for a DSP new claim, depending on the customer’s circumstances:

• refer to the Disability Support Pension Medical Evidence Checklist (SA473)
• issue the Disability Support Pension Medical evidence requirements Information for treating health professionals (SA478) form. Explain this form:
• is not a medical report, customers claiming DSP still need to provide existing medical evidence
• is optional. Customers claiming DSP are not required to return this form, however the information provided may assist in better understanding the customer's circumstances for assessment and review purposes
• can be used by treating health professionals to provide information about a customer’s relevant medical evidence requirements and the assessment process
• the form is available on the Services Australia website
• can be given to the customer (to submit with their DSP claim), or posted directly to the agency (the address is printed on the form)
• when the form is scanned, it forms part of the medical evidence record for DSP
• issue the Verification of a terminal illness (SA495) form. Explain this form:
• can be completed by the customer’s treating doctor if the customer has no medical evidence showing the diagnosis and prognosis of their condition
• is included at the end of the Claim for Disability Support Pension for a Terminal Illness (SA494), or
• can be accessed by treating doctors via the Services Australia website
• issue the Consent to disclose medical information (SA472) form. Explain this form:
• can be completed by the customer to confirm they consent to their treating health providers providing relevant information about their medical condition to the agency

Do not:

• issue agency forms to collect medical evidence from the treating doctor (this includes the SA012RM and SU684), or
• direct the customer to go to their doctor, specialist or other treating health professional to obtain medical evidence

Diagnosis of the customer's disability or medical condition is usually provided by a medical practitioner. Specialist evidence or specialist confirmation of the treating doctor's diagnosis is required for some medical conditions including:

• an intellectual impairment. An assessment of intellectual function and assessment of adaptive behaviour from a registered psychologist is required, or a report from a special school which includes details of these assessments. Any evidence provided must include information supported by a psychologist about the person's IQ score, or their ability to undergo IQ testing
• a mental health condition such as depression, anxiety or schizophrenia. The diagnosis must be made by a psychiatrist, or by another medical practitioner with supporting evidence from a registered psychologist
• an ear condition affecting hearing or balance. Diagnosis must be made by a medical practitioner, with supporting evidence from an audiologist or an ear, nose and throat specialist
• an eye condition affecting vision. Diagnosis must be made by a medical practitioner, with supporting report from an ophthalmologist or ophthalmic surgeon (a report completed by an optometrist is not sufficient)

In limited cases, a diagnosis of a medical condition can be provided by an Assessment Services Psychologist Specialist Assessment report.

In some cases, new medical evidence is not required for a DSP new claim. For example:

• a customer has previously lodged medical evidence and this evidence is still current and relevant to the customer's circumstances, such as a previous assessment of intellectual function and adaptive behaviour, or
• there is a current and valid Job Capacity Assessment (JCA) on the customer's record, such as when the customer:
• is invited to claim DSP as a result of a recently completed assessment
• has claimed DSP previously (and was rejected on non-medical grounds where medical eligibility was recommended) and there has been no significant change in their medical conditions since the assessment

If there is a current and valid JCA, the customer will still need to undergo a Disability Medical Assessment (DMA) with a Government-contracted Doctor, excluding if the customer is manifestly eligible for DSP.

If a Service Officer determines there is a current and valid assessment or current medical evidence for a customer claiming via an online or Assisted Customer Claim (ACC), the required task can be marked as Not required or as Provided via the Request and Manage Customer Tasks (RMCT) guided procedure.

If no medical evidence has been provided with a DSP new claim within the required timeframe (usually 14 days), the claim will likely be rejected without further notice unless:

• the medical details section of the claim indicates a likely manifest medical condition or other serious health condition(s) which may impact the customer's ability to provide evidence (for example, in intensive care)
• the customer has recently turned 16 years of age and was previously assessed as a profoundly disabled child or as having a very severe disability or medical condition for the purposes of Carer Payment
• the claim or the customer's record indicates a vulnerability issue (for example, homeless, living in a remote community)
• the customer was invited to make a further claim by the agency or the Administrative Appeals Tribunal (AAT) as part of a review of a decision
• the customer recently lodged medical evidence prior to the claim, and it is clear the evidence was lodged to support the claim

If the customer subsequently provides the required medical evidence (and any other information), within 13 weeks of the rejection decision, the claim may be re-opened and reassessed. This does not need an application for a formal review of the decision order for the customer's claim to be reconsidered.