Medical Assessment (MAt) 008-20102224

• Checks and assesses all scanned medical evidence
• Considers the impact of barriers to obtaining medical evidence
• Completes a Disability Support Pension Medical Eligibility Assessment Recommendation (SA479) where appropriate
• Uploads this to the customer's record to support the DIS Processing Service Officer's decision, and
• Records the Medical Assessment Recommendation outcome (where required)

If required, the Assessor will contact the customer/nominee, their Treating Health Professional/s (THP), relevant third parties (for example, schools and/or the Health Professional Advisory Unit (HPAU)) to obtain more information.

The Assessor will assess the medical evidence to determine if a recommendation can be made without the need for further assessment of medical eligibility, that is, a Job Capacity Assessment (JCA). Recommendations can include:

• Manifest medical eligibility criteria are met
• The customer is manifestly medically ineligible
• Insufficient medical evidence prevents assessment of the customer's medical condition/s and functional impacts
• A current and valid assessment can be used for the claim determination, or
• A Job Capacity Assessment (JCA) referral is required to determine medical eligibility

A report titled 'DSP Medical Eligibility Assessment Recommendation' is completed by an Assessor and uploaded to the customer's record. The document type is SA479. The SA479 will clearly document:

• evidence taken into account, and the recommendation
• supporting evidence from the customer, details of Contributing Assessors, THP/s and/or HPAU, if applicable
• an assessment of where the customers continuing inability to work (CITW) occurred, if applicable

When the SA479 is submitted, it will trigger the DSP Claim work item to come off hold which is then allocated to a Disability Processing Service Officer. The DIS Service Officer will take the required action on the DSP claim including reviewing the SA479 via scanned documents and may include assessment of non-medical eligibility.

A Job Capacity Assessment (JCA) referral is not required where it is clear from available medical evidence the customer is manifestly medically eligible for DSP. See Disability Support Pension (DSP) manifest eligibility for further information.

A customer is manifestly ineligible where medical evidence shows at least one of the following:

• the customer's medical condition/s are clearly likely to persist for less than 2 years, and the functional impacts are expected to resolve within the next 2 years
• the medical evidence provided does not support assessment against the Impairment Tables (the condition/s are not diagnosed, reasonably treated and stabilised), or
• there is clear evidence the customer is currently working at least 15 hours a week in open employment that is sustained and not in jeopardy

Where a MAt recommendation is rejection on medical grounds, the DSP claim is finalised without further assessment of non-medical eligibility.

Where there is insufficient medical evidence available for the Assessor to make a determination on medical eligibility the Assessor will contact the customer or their nominee to conduct the Service Offer Interview (SOI). The customer may be given 5 business days to provide medical evidence. See Disability Support Pension (DSP) Service Offer Interview (SOI).

Where the customer has evidenced vulnerabilities or where there is reasonable evidence to suspect medical information exists, but the customer is unable to access it due to their vulnerabilities the Assessor may try to gather additional information by contacting the customer’s THP. See Supporting customers experiencing vulnerability to claim Disability Support Pension (DSP). Where no further medical evidence can be obtained, the Assessor will complete a recommendation report indicating that insufficient evidence was provided to assess medical eligibility.

Note: if manifest eligibility indicators are present IME SOI does not apply.

A referral for a Job Capacity Assessment is made where further assessment is required to assess medical eligibility for DSP. The medical evidence must demonstrate:

• the customer's conditions are diagnosed, reasonably treated and stabilised (DTS)
• the impairment rating for DTS conditions needs to be assigned, and
• if the customer has Continuing Inability to Work (CITW)

If there are doubts about the medical evidence’s authenticity Assessors must investigate further by contacting health professionals listed in the evidence to confirm the diagnosis and prognosis. See Managing suspected fraudulent medical evidence for the action an Assessor must take when they suspect medical evidence is fraudulent.

A new version of Impairment Tables was introduced from 1 April 2023. DSP claims that were made before 1 April 2023 need to be assessed against Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011 - Federal Register of Legislation.