To support a claim for Disability Support Pension (DSP), your patient needs medical evidence for each condition that significantly affects their ability to work.
To get DSP, your patient needs to meet both non-medical and medical rules. Read about non-medical rules.
Your patient may get DSP if they have a condition that meets the manifest medical rules. This is based on the medical evidence provided, without further assessment.
Examples of conditions that meet the manifest medical rules include if they:
- are permanently blind
- require nursing home level care
- have an intellectual disability with an IQ of less than 70.
Read about manifest medical rules.
Your patient may get DSP if they have a terminal illness. This applies if the average life expectancy for a person with this condition is less than 2 years.
Complete the Verification of Terminal Illness form (SA495).
Complete the verification section in the Claim for Disability Support Pension for a Terminal Illness form (SA494). Your patient may bring this form for you to complete.
If your patient’s condition doesn’t meet the manifest rules for DSP, they must meet the general medical rules.
Read about the general medical rules.
Medical evidence must show the patient’s condition is diagnosed, reasonably treated and stabilised.
Patients need to provide medical evidence for each condition that affects their capacity to work. In most cases this needs to be current evidence.
The evidence needs to show details of the diagnosis and how their condition affects them. In most cases, we also need information about their treatment and prognosis. We may also need specific medical evidence for certain conditions.
Treating doctors no longer need to do a medical report. We’ll give your patient a DSP Medical Evidence Checklist form (SA473). This helps them gather the type of evidence we need.
The DSP Medical Evidence Checklist for treating health professionals form (SA478) can guide you through what’s required from you to support your patient’s DSP claim.
Your patient may book a consultation with you to discuss the medical evidence available to them. Your patient can read about the medical evidence they need to provide.
One of our health or allied health professionals may contact you to talk about the medical evidence.
This helps us get the information we need to assess a claim. If we can’t get this information, we may reject their claim.
We may need to speak with you about your patient’s condition. We may be able to pay you for these consultations. We have information about remuneration.
If your patient is getting DSP, we may need to review if they still meet medical rules. This is called a medical review.
We may ask you to complete a medical report for your patient. For you to complete the medical report, your patient may need to book a longer consultation time. You can claim your time to complete the report under a Medicare item when included as part of the consultation.
Your patient may also ask you to help them gather current medical evidence for their medical review.
The DSP Medical Evidence Checklist for treating health professionals form (SA478) can guide you through what’s required from you to support your patient.
Your patient can read about medical reviews and what to do if we contact them to participate in a review.
If your patient claims DSP they may ask for your help, during a clinical consultation, to gather medical evidence. Your patient may need a longer consultation time as a result. This is claimable under a Medicare item when included as part of the consultation.
One of our health and allied health professionals, or Government-contracted Doctors, may contact you to ask you to:
- clarify the medical evidence your patient gave us with their DSP claim
- give us further medical evidence.
If this happens, we may recommend you get paid $87.80 (including GST) for verbal advice and $164.64 (including GST) for written advice.
We only make these payments after you give the extra information to us.
Read how we assess your patient’s claim.
Disability Medical Assessment is an online service for Government-contracted Doctors to complete Disability Medical Assessments.
A Government-contracted Doctor from Sonic HealthPlus conducts the Disability Medical Assessment. This assessment helps determine if a customer meets the medical rules for DSP. A customer also needs to meet the non-medical rules to get DSP.
The Disability Medical Assessment page provides information about these assessments.
You can only access this service if you’re an authorised health professional or administrator contracted by us.
After logging on, the service lets you:
- view relevant information to inform a Disability Medical Assessment
- complete and submit a Disability Medical Assessment.
Users can access this system using PRODA.
If you don’t have a PRODA account you’ll need to register.
To log in to PRODA select the PRODA option.
If you’re having trouble accessing the Disability Medical Assessment Referral System contact us.
Read more about your right to privacy.
For more information about the service and support contact us.
Your patient may need to complete forms to support a claim for DSP.
- DSP Medical Evidence Checklist form (SA473)
- Consent to disclose medical information form (SA472)
- Claim for Disability Support Pension for a Terminal Illness form (SA494)
Your patient can read: