Claiming the Disability Support Pension 29 Oct 2019

Blog / Special Disability Trusts

 

Eligibility for Disability Support Pension (DSP)


To qualify for DSP, a person must meet the following criteria:

• be 16 years of age or more, and
• satisfy the residence criteria,* and
• be permanently blind, or
• have a physical, intellectual or psychiatric condition resulting in functional impairment of at least 20 points as measured by the       Impairment Tables, and
• meet any participation requirements that apply to the person, such as a compulsory activity.

In addition, a person must:

• have a continuing inability to work (ie. unable to work or be reskilled to work at least 15 hours per week in the next 2 years), or
• be participating in a supported wage system.

It’s important to note that a person needs to meet both the impairment criteria (ie functional impairment of at least 20 points as measured by the Impairment Tables) and continuing inability to work (ie unable to work or be reskilled to work at least 15 hours per week in the next 2 years) criteria to qualify for DSP.
 

Impairment criteria

To qualify for DSP, a person must have one or more physical, intellectual or psychiatric impairment(s) that attracts a total impairment rating of 20 points or more under the Impairment Tables.**  The Impairment Tables assess the impact of the impairment on the person’s ability to perform work related tasks and activities.

A person’s medical history is considered as part of the assessment process. They need to provide medical evidence that includes medical reports, medical imaging reports, hospital records, etc. For psychological  impairments, a report from a clinical psychologist or psychiatrist must be provided.

An impairment rating can only be assigned for permanent conditions which cause an impairment that is more likely than not to persist for more than two years. A condition is permanent if:

• the condition has been fully diagnosed by an appropriately qualified medical practitioner, and
• the condition has been fully treated, and
• the condition has been fully stabilised.

A condition is considered fully treated and stabilised if the person has received all reasonable treatment or rehabilitation for the condition and it is considered that any further treatment is unlikely to result in significant functional improvement in the next two years, ie. the treatment will not enable the person to undertake work in the next two years.

There are 15 impairment tables:
• Table 1 – Functions Requiring Physical Exertion and Stamina
• Table 2 – Upper Limb Function
• Table 3 – Lower Limb Function
• Table 4 – Spinal Function
• Table 5 – Mental Health Function
• Table 6 – Functioning relating to alcohol, drug and other substance use
• Table 7 – Brain function
• Table 8 – Communication Function
• Table 9 – Intellectual Function
• Table 10 – Digestive and Reproductive Function
• Table 11 – Hearing and other Functions of the Ear
• Table 12 – Visual Function
• Table 13 – Continence Function
• Table 14 – Functions of the Skin
• Table 15 – Functions of Consciousness

The impairment tables provide a generic scale as follows:
• no functional impact – 0 points,
• mild functional impact – 5 points,
• moderate functional impact – 10 points,
• severe functional impact – 20 points,
• extreme functional impact – 30 points.

Example***

A 55 year old woman has severe deteriorating rheumatoid arthritis. Medication provides limited relief and the doctor has stated she experiences associated chronic pain and fatigue.  This condition is systemic in nature and the woman experiences persistent fatigue, chronic inflammation of her joints with swelling, heat and pain, as well as muscle weakness and difficulty sleeping. Medical evidence states that due to fatigue and pain the woman is unable to perform any light day to day household activities and would not be able to perform clerical or sedentary work tasks for a shift of 3 hours.

The condition is considered fully diagnosed, treated and stabilised and under Table 1 – Functions requiring Physical Exertion and Stamina, the woman would receive an impairment rating of 20 points as the impact on her ability to function is severe.

Continuing inability to work

To qualify for DSP, generally a person must have a continuing inability to work.

For people claiming DSP on or after 3 September 2011, this is defined as ‘an inability to work at least 15 hours per week or undertake a training program to prepare for work, within the next two years because of their impairment’.

A person needs to meet both the impairment rating criteria (ie. functional impairment of at least 20 points as measured by the Impairment Tables) and the continuing inability to work criteria (ie. unable to work or be reskilled to work at least 15 hours per week in the next 2 years) to qualify for DSP.

It is possible to meet one but not both criteria and therefore fail the DSP eligibility conditions. For example, a person with an impairment rating of 20 points or more is not necessarily incapable of working. Their medical impairment may cause difficulties in many work situations, however they may be able to undertake work of 15 hours or more per week, within the next 2 years. In this case they would not qualify for DSP.

Program of support (POS)

To meet the continuing inability to work criteria, an individual who claims DSP on or after 3 September 2011 needs to have actively participated in a program of support (POS), unless the person has a ‘severe impairment’ or qualifies as a manifest grant (see more information below).

A POS is designed to help people to prepare for, find or maintain work, and is generally funded by the Commonwealth. Examples include jobactive, Disability Employment Services, ParentsNext and the Community Development  Program. A job capacity assessor will assess if the person meets all the requirements of active participation in a POS.

To qualify for DSP, people generally need to participate in a POS for at least 18 months in the three years before they claim DSP.

However they do not need to participate in a POS if they have a severe impairment, which occurs where a person receives a ‘severe’ impairment rating of 20 points or more from one impairment table. For example, if John received a rating of 20 points from Table 4 – Spinal Function, he would qualify as having a severe impairment and would not have to participate in a POS. However if John received 10 points from Table 4 – Spinal Function and 10 points from Table 9 – Intellectual Function, he would not meet the ‘severe’ impairment rating and would be required to undertake a POS.

People also do not need to participate in a POS if they have been granted DSP under the manifest grants provisions.

Manifest grants

A manifest grant of DSP can be granted in limited circumstances where it is recognised that the severe medical condition itself provides a continuing inability to work.

An example of a manifest grant occurs where a person has a terminal medical condition that has a life expectancy of less than two years and has a significantly reduced work capacity during the period.

A person can qualify for DSP under manifest grounds based on providing the required medical evidence without the need for further medical assessment. They are considered to meet both the impairment criteria (ie. functional impairment of at least 20 points as measured by the Impairment Tables) and continuing inability to work (ie. unable to work or be reskilled to work at least 15 hours per week in the next 2 years) criteria to qualify for DSP.

Note however that they still need to meet the income and assets tests to receive DSP.

Manifest grants may only be made where a person:

• has a terminal illness (life expectancy of less than 2 years with significantly reduced work capacity during this period), or
• has permanent blindness (meets the test for permanent blindness for social security purposes), or
• has an intellectual disability where supporting evidence clearly indicates an IQ of less than 70, or
• has an assessment indicating the person requires nursing home level care, or
• has category 4 HIV/AIDS, or
• is in receipt of a DVA disability pension at special rate (totally and permanently incapacitated (TPI)).

Two lists of medical conditions are available to help Centrelink determine whether a person falls within some of the above manifest categories, namely, terminal illness, nursing home level care, and/or intellectual disability.****

Where a person has a medical condition that does not appear on the lists, they may still qualify if they meet the criteria listed above.

• List 1 – details conditions which are accepted as manifest (clearly and obviously meet all the DSP qualification criteria) on diagnosis alone (see Appendix A)
• List 2 – details conditions which may be manifest however information is required on the prognosis or severity/ progression of the condition (see Appendix B)

EXAMPLE
Deidre has been diagnosed with Gallbladder cancer. Diedre applies for DSP and provides medical evidence confirming her diagnosis.
As her illness appears on List 1, it is accepted as a manifest grant on diagnosis alone.
Deidre does not need to meet any other medical criteria for DSP, she is considered to manifestly have a continuing inability to work.
However Deidre’s rate of payment is determined by the income and assets tests.

Newstart Allowance while DSP claim is assessed

If a person makes a claim for DSP, they can be paid Newstart while their claim for DSP is being determined. This payment is referred to as Newstart provisional.

Importantly, a person who qualifies for NSA provisional is exempted from the activity test pending the outcome of their claim for DSP.
 

Appendix  A

List 1

A manifest grant of DSP is able to be made when a person is diagnosed with one or more of the following conditions
 
Letter Condition Manifest Category
A Amyotrophic Lateral Sclerosis (ALS) Nursing home level care
Angelman Syndrome Nursing home level care
C Creutzfeldt-Jacob Disease (CJD) – Adult Nursing home level care
G Gallbladder cancer Terminal illness
Gioblastoma Multiforme (brain tumour) Terminal illness
L Lesch-Nyhan Syndrome (LNS) Nursing home level care
Liver cancer (primary cancer) Terminal illness
M Mantle cell lymphoma (MCL) Terminal illness
MPS III (San Filippo Syndrome) Nursing home level care
MPS VII (Sly Syndrome) Nursing home level care
P Patau Syndrome (Trisomy 13) Nursing home level care
Peritoneal Mesothelioma Terminal illness
Plural Mesothelioma Terminal illness
Prader-Willi Syndrome Intellectual disability
S Sjogren-Larsson Syndrome Intellectual disability
Small cell cancer of the large intestine Terminal illness
Small cell cancer of the ovary Terminal illness
Small cell cancer of the prostate Terminal illness
Small cell cancer of the uterus Terminal illness
Small cell lung cancer Terminal illness


 

Appendix B

List 2

Note: A manifest grant of DSP is able to be made when a claimant:

• is diagnosed with one or more of the following conditions on list 2, AND
• the additional action in the table is undertaken, AND
• it provides evidence that the claimant is clearly qualified for DSP.
 


Letter


Condition

Additional
Action Key (see table below)
A Acute leukaemia 1
Adrenal cancer 2
Anaplastic adrenal cancer 2
Astrocytoma Grade III 3
Astrocytoma Grade IV 3
Ataxia Telangiectasia 1
B Bladder cancer 2
Bone cancer 2
Breast cancer 2
C CHARGE Syndrome 4
Chronic Myelogenous Leukaemia (CML) Blast Phase 5
Chronic Obstructive Pulmonary Disease (COPD) 6
Cockayne Syndrome (Types I, II, III) 1
Coffin Lowry Syndrome 1
Cornelia De Lange Syndrome 4
Cri Du Chat Syndrome 4
Cystic Fibrosis 6
D Dementia 1
Down Syndrome 4
Duchenne Muscular Dystrophy 1
F Fragile X Syndrome  (Adult) 4
Friedreich Ataxia (FRDA) 1
H Head and neck cancers 2
I Idiopathic Pulmonary Fibrosis 6
Inflammatory Breast Cancer (IBC) 1
K Kabuki Syndrome 4
Kidney cancer 2
L Large intestine cancer 2
M Machado-Joseph Disease (aka Spinocerebellar
Ataxia Type 3)
1
MPS I (Hurler Syndrome) 4
MPS II (Hunter Syndrome) 4
MPS IV (Morquio Syndrome, MPS I IVA) 1
MPS VI (Maroteaux-Lamy Syndrome) 1
Multiple System Atrophy 1
N Neck and head cancers 2
Non-small Cell Lung Cancer 2
O Ornithine Transcarbamylase (OTC) Deficiency 1
Ovarian cancer 2
P Pancreatic cancer 1
Pelizaeus-Merzbacher Disease 1
Primary Lateral Sclerosis 1
Primary Pulmonary Hypertension 6
R Rett (RTT) Syndrome 1
S Salivary tumours 1
Seckel Syndrome 4
Small intestine cancer 2
Smith-Magenis Syndrome 4
Steele-Richardson-Olszewski diseases
(aka progressive supranuclear palsy)
7
Stomach cancer 2
T Thyroid cancer 1
U Ureter cancer 2


The table below is the additional action key.

The follow up action is to ascertain information on the prognosis or severity/progression of the condition so that a decision can be made whether a manifest grant is appropriate. For potentially terminal cancer type conditions, if the medical evidence indicates the condition has reached the grade or stage indicated in action 2, 3 or 5 in the table below, manifest grant for terminal illness may be made even if the evidence will not state that the condition is likely to be terminal within 2 years. For other conditions, information must be obtained indicating that nursing home level care is required or an intellectual disability attracting at least 20 points exists.

 
Action Explanation Manifest grants category where follow-up action indicates that manifest grant is appropriate
1 Establish prognosis and/ or level of care required as prognosis can vary and/or the condition is progressive. Could be either:
Requires nursing home level care or terminal illness.
Cancer type conditions would be coded as terminal illnesses where prognosis indicates life expectancy of less than 2 years.
For other conditions listed under this follow-up action reason, generally the follow-up is whether the condition has progressed to
a stage where nursing home level care is required.
2 Confirm the associated grade/stage/phase is with distant metastases or inoperable, unresectable or recurrent. Terminal illness.
3 Confirm the associated grade is Grade III or Grade IV. Terminal illness.
4 Establish prognosis and/
or level of care required
as prognosis can vary and investigate whether there is an existing IQ score.
Could be either:
Requires nursing home level care or intellectual disability.
It will depend on additional information obtained.
If IQ score indicates manifest eligibility, use this.
5 Confirm the associated phase is Blast Phase. Terminal illness.
6 Confirm the claimant
is receiving domiciliary oxygen therapy.
Requires nursing home level care.
7 Confirm the likely prognosis of the progressive
condition including impact of dementia.
Requires nursing home level care.








































*    Residence criteria for DSP generally requires a person to be an Australian resident and in Australia on the day of claim. Residence rules also require the person to have 10 years qualifying residence in Australia, however there are other eligibility criteria such as being an Australian resident at the time the person suffered an incapacity that caused a continuing inability to work or permanent blindness.
**   Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011.
***  Adapted from section  3.6.3.05 Guidelines to the rules for applying the impairment tables, Social Security Guide, Example 3
**** Section 3.6.2.20 Manifest Grants and Rejections of DSP, Social Security Guide.


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Disclaimer and Warning
The information above is of a general nature only.  It should not be used as a source to make financial decisions.  It's also important to note that the legislation and figures related to this topic tend to change regularly and therefore the information above may not reflect the current status.  We recommend that if you are looking for advice on this matter, you should contact us .

 


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