Assessing permanent blindness 008-03040030

A Request for Ophthalmologist/Optometrist Report (SA013) is the best way for customers to provide proof of permanent blindness. However, any report or evidence, which provides the same information is acceptable.

• Yes, go to Step 4
• No, go to Step 3

If the customer has lodged a claim for DSP or Age:

• For DSP new claims: Where a DSP claim is lodged and is in progress, Assessment Services will assess the SA013/ medical evidence as part of the Medical Assessment (MAT) recommendation, see Streaming a new claim for Disability Support Pension (DSP). Close SA013 work item. Procedure ends here
• For Age new claims, go to Step 4

If the customer has not lodged a claim for DSP or Age:

• Check the SA013/medical evidence is complete and signed by the appropriate specialist
• Try to contact the customer by phone to:
• Tell them their SA013/other evidence is received
• Ask what their intention was in lodging the SA013/evidence
• Tell the customer they will need to lodge a claim if they lodged the SA013 with the intention of claiming either Age Blind or DSP Blind (depending on their age)
• Discuss the importance of providing a complete and signed SA013 or similar from their ophthalmologist if the SA013/medical evidence is incomplete and/or unsigned by the appropriate specialist. See Eligibility for DSP and Qualification for Age Pension (Blind)
• Tell the customer no further action can be undertaken until a claim has been lodged. See Claiming DSP and Claiming and re-claiming Age Pension
• If contact is not successful, issue a Q999 (Customer lodged SA013 or medical evidence - not getting DSP or AGE) advice
• Record contact attempt/outcome on the DOC

Procedure ends here.

For current DSP and Age Pension customers and Age Pension new claims

DSP and Age Smart Centre Processing staff only.

SA013/medical evidence for DSP/AGE claims will be assessed as part of the claim. SA013/medical evidence for current DSP/AGE customers will automatically allocate to processing staff, when scanned. A referral is not required.

• Review the SA013/medical evidence provided
• Check the SA013 has been completed by an Ophthalmologist, or by an Optometrist supported by an Ophthalmologist
• Check the specialist(s) qualification using the AHPRA website (see Resources for support with search)
• Check the form has been fully completed and signed by the specialist

Is the SA013/medical evidence incomplete, unsigned, or is not supported by an Ophthalmologist?

• Yes, go to Step 5
• No, go to Step 6

Note: there is no requirement to follow-up unanswered questions on the SA013 if there is sufficient information to determine permanent blindness. For example, if Q5 & Q6 on the SA013 confirms customer’s corrected visual acuity is less than 6/60 in both eyes, and Q7 or Q8 is not answered, no further contact with the customer is required. There is sufficient information available to assess the customer’s permanent blindness.

Make 2 genuine attempts to contact the customer by phone.

Contact is successful:

• Tell the customer the SA013/medical evidence has been received, but permanent blindness cannot be assessed because the form is:
• incomplete
• unsigned
• not supported by an ophthalmologist (where the report was completed by an optometrist)
• Tell the customer they need to provide a new complete SA013. See the Resources page for a link to the Refer to the Request for Ophthalmologist/Optometrist Report (SA013). Tell the customer the SA013 can be printed and help them to locate the SA013 from the website (if applicable). Otherwise, issue an SA013 using the Request for Information workflow
• Record a DOC:
• Summary: SA013 lodged
• Text: SA013/evidence has been lodged but is incomplete/unsigned/not supported by an Ophthalmologist. Called customer to advise they must lodge a new SA013. SA013 issued or reissued form/customer will print SA013 from website. (delete inappropriate text)

Contact is unsuccessful:

• Where the customer does not have contact details, or contact is unsuccessful, issue a Q999 (SA013 Incomplete - unable to assess permanent blindness) and Request for Ophthalmologist/Optometrist Report (SA013).
• Record a DOC:
• Summary: SA013 lodged
• Text: SA013/evidence has been lodged but is incomplete/unsigned/not supported by an Ophthalmologist. Contact with customer was unsuccessful. Issued or reissued Q999 advice. (delete inappropriate text)
• Procedure ends here

Staff must review the SA013/medical evidence to determine if the customer meets the blind criteria.

To be assessed as permanently blind, the customer must meet at least one of the following:

• Visual acuity as measured on the Snellen Scale after correction by suitable lenses of less than 6/60 in both eyes. See the Resources page for information on whether other ratings on the Snellen Scale qualify a customer as permanently blind
• A field of vision constricted to 10 degrees or less of arc around central fixation in the better eye, irrespective of corrected visual acuity (equivalent to 1/100 white test object), or
• A combination of visual defects resulting in the same degree of visual impairment as described in the two points above

Note: where the customer meets one of the 3 criteria above, staff must also consider if the SA013/evidence indicates further treatment which may result in improvement in visual impairment. Where it is clear further treatment will significantly improve the customer’s visual impairment, the criteria for permanent blindness is not met. Where it is not clear, follow the process below - ‘Unsure’.

Does the customer clearly meet the criteria for permanent blindness, based on the criteria above?

• Unsure:
• Where the SA013/medical evidence is not clear, or requires interpretation, staff must consult a Local Peer Support (LPS)
• Where the LPS is unable to assist in determining if the customer meets permanent blindness or not, and specialist opinion is required. go to Step 7
• Yes, go to Step 8
• No, go to Step 9

Where the information in the SA013/medical evidence:

• does not clearly indicate the customer is permanently blind, or not, and further clarification/specialist opinion is required, or
• customer meets the criteria for permanent blindness, but there is an indication visual impairment will improve with further treatment

Refer to Health Professional Advisory Unit (HPAU).

Note: a HPAU referral must not be made unless a LPS has been contacted and the customer is getting DSP/Age Pension or claiming Age Pension.

HPAU Referral:

• Use the webform to submit a HPAU referral request
• Role: use 'Other' and add in notes DSP or Age Processing
• Referral trigger: select Helpdesk
• Primary Medical Condition: enter the medical condition listed on SA013/medical evidence or use 'visual impairment'
• Advice required: select other, and in the notes, add permanent blindness
• Reason for referral to HPAU: to assess SA013/medical evidence to determine if the customer meets the criteria for permanent blindness for DSP/Age
• Add a DOC to the customer’s record: SA013 has been referred to HPAU:
• Summary: SA013/medical evidence referred to HPAU
• Text: Following discussion with LPS, referral to HPAU has been made to determine if customer meets permanent blindness criteria
• Hold the SA013 and relevant work items, under Hold to User (HTU) for 14 days
• Procedure ends here until HPAU recommendation is completed, or the work item falls due

HPAU Recommendation

HPAU will assess the SA013 / medical evidence and recommend if the customer meets permanent blindness criteria. This will be uploaded as a UNSHPAU document.

When the SA013 falls due and the UNSHPAU document:

• has not been uploaded, hold the SA013 for a further 14 days
• has been uploaded:
• Review the HPAU recommendation
• Where the customer meets the criteria for permanent blindness, go to Step 8
• Where the customer does not meet the criteria for permanent blindness, go to Step 9

Where the customer clearly meets the criteria for permanent blindness per SA013/medical evidence, or permanent blindness has been supported by Assessment Services or HPAU report:

Permanent blindness is coded on the Pensions Disability Information (PDI) screen from the date the SA013 was lodged.

DSP and Age Processing Smart Centre staff assess the SA013:

• For DSP New claims see Granting Disability Support Pension (DSP) manifest eligibility
• For DSP/CUR customers, it is important to code Manifest Blind on the medical condition (MC) screen. See Transferring to Disability Support Pension (DSP) (Blind), or
• For Age new claims, see Assessing Age Pension (Blind) claims
• For Age/CUR, see Age Pension (Blind) transfer provisions

Where the SA013/medical evidence indicates the customer clearly does not meet the criteria for permanent blindness:

• For current DSP customers, go to Step 10
• For Age Pension new claims, see Assessing Age Pension (Blind claims)
• For current Age customers, see Age Pension (Blind) transfer provisions

Procedure ends here.

DSP Smart Centre Processing staff only.

Make 2 genuine attempts to contact the customer by phone.

Contact is successful:

• Tell the customer:
• that Services Australia have assessed the SA013/medical evidence about their visual impairment and they do not meet permanent blindness eligibility criteria for DSP
• they remain eligible for Disability Support Pension under their previous assessment
• of their review and appeal rights. See Initial contact about a decision and the review of decision process
• Issue a Q999 (rejecting DSB for a current DSP customer) advising the customer they do not meet the criteria for blind pension and their payment will continue as is
• Include the Appeal paragraph in the letter
• Create a DOC detailing the outcome and the reason for the decision:
• Summary: Customer not eligible for DSP (Blind)
• Text: Medical evidence/SA013 relating to visual impairment has been assessed, and the customer does not meet the eligibility criteria for permanent blindness (DSB), per OB 008-03040030
  Decision: Reject Disability Support Pension (Blind) (DSB)
  Act Reference: Section 95, Social Security Act
  Date DSB claim rejection finalised: DD. MM. YYYY
  Customer remains eligible for DSP under non-permanent blindness medical criteria
  Q999 has been issued
• Procedure ends here

Contact is unsuccessful:

Where the customer does not have contact details, or contact is unsuccessful:

• Issue a Q999 (rejecting DSB for a current DSP customer) advising the customer they do not meet the criteria for blind pension and their payment will continue as is
• Include the Appeal paragraph in the letter
• Create a DOC detailing the outcome and the reason for the decision:
• Summary: Customer not eligible for DSP (Blind)
• Text: Medical evidence/SA013 relating to visual impairment has been assessed, and the customer does not meet the eligibility criteria for permanent blindness (DSB), per OB 008-03040030.
  Decision: Reject Disability Support Pension (Blind) (DSB)
  Act Reference: Section 95, Social Security Act
  Date DSB claim rejection finalised: DD. MM. YYYY
  Customer remains eligible for DSP under non-permanent blindness medical criteria
  Q999 has been issued