We assess if your patient meets both non-medical and medical rules to get DSP.
Even if your patient meets the medical rules they can’t get DSP if they don’t also meet the non-medical rules.
We base the medical assessment on the medical evidence from you and other health professionals who treat your patient.
First, we’ll look at the medical evidence to assess if your patient’s condition meets the manifest medical rules.
If their condition doesn’t meet the manifest medical rules, we’ll look at the medical evidence to assess if the condition meets the general medical rules.
We’ll look at the medical evidence to assess:
- if your patient’s condition is diagnosed, reasonably treated and stabilised
- the suitability of the treatment
- the outcomes of the treatment
- if further treatment may help
- if there are medical or other reasons why your patient can’t get treatment.
Your patient can read about:
Once we get the medical evidence, we’ll review it to see if your patient’s condition meets the medical rules for DSP.
We may require your patient to attend a Job Capacity Assessment as part of the review.
We may also require your patient to attend a Disability Medical Assessment with a Government-contracted Doctor.
As part of the assessment process, one of our health or allied health professionals may contact you. This may include:
- Services Australia health or allied health professionals
- Government-contracted Doctors such as Medical Practitioners and Clinical Psychologists from Sonic HealthPlus who conduct the Disability Medical Assessments.
We may ask you to disclose any medical information relevant to assessing your patient’s eligibility for DSP. This may include medical and specialist reports, clinical notes, medical records or other information.
We’ll ask your patient to complete a Consent to disclose medical information form (SA472).
This confirms their consent for you to disclose relevant information about their disability or medical conditions.
Your patient can read about the Job Capacity Assessment and Disability Medical Assessments.
They assess medical evidence your patient gives us. We then make an informed decision about whether your patient can get DSP.
To help determine eligibility, our assessors may talk to:
- your patient
- you
- your patient’s other treating health professionals
- our Health Professional Advisory Unit.
In some instances, our health and allied health professionals may contact you to discuss your patient’s medical condition and supporting evidence.
If we contact you, we may need to ask about your patient’s:
- diagnosis
- past, current and future treatment
- prognosis and status of their condition
- ability to work.
To get DSP your patient’s condition must be diagnosed, reasonably treated and stabilised.
For your patient’s condition to be diagnosed, the treating doctor or health professional must have:
- examined and diagnosed the condition
- detailed this in medical evidence.
To assess if your patient’s condition is reasonably treated, we check what type of treatment they’ve had. Treatment is from their treating doctor or health professional. We’ll also check their current treatment and if any further treatment is planned for them.
To check if your patient’s condition is stabilised, we look at their medical evidence. We’ll assess whether their ability to work will get better with more treatment or rehabilitation or stay the same.
When providing advice about your patient’s ability to work, consider if they could work 15 hours or more per week with the help of:
- medical treatment
- rehabilitation
- training
- employment services.
After we’ve assessed their claim, your patient is advised of the outcome. If the claim is rejected, we also attempt to call to discuss the reasons why.
If your patient’s situation changes, and they may now be eligible for DSP, they can submit a new claim.
Your patient can read about:
The Impairment Tables for Disability Support Pension are part of social security law for DSP and available on the Department of Social Services website.
We use the Impairment Tables to:
- assess your patient’s diagnosed, reasonably treated and stabilised conditions
- assess the effect your patient’s conditions have on their ability to work
- assign impairment ratings.
We use the Impairment Tables to assess if your patient meets the general medical rules for DSP. We can only use the tables to give an impairment rating if your patient’s conditions are diagnosed, reasonably treated and stabilised.
Some Impairment Tables have specific diagnosis and medical evidence requirements. Your patient must meet these requirements before we can use these tables to assess certain conditions.
The impairment rating relates to functional impact. If your patient uses aids, equipment and assistive technology, they need to use or wear these during our assessment.
Your patient can’t get DSP if their conditions don’t have a total rating of at least 20 points.
If they can’t get DSP, they may be able to get other payments.
Your patient can read about:
A Program of Support (POS) helps people with disability to prepare for, find and keep a job. It may include help with:
- job preparation and job search
- work experience and training
- injury management.
Your patient may have needed to participate in a POS if both:
- their total impairment rating is 20 points or more
- they have less than 20 points on a single Impairment Table.
Your patient can read about participation requirements for Program of Support.