Claims for Disability Support Pension (DSP) can take many weeks to process so should be made without delay. Where the claim is successful, payment will be made from the pension payday following the date of claim. Payment can only be made for a period before the date of claim where the claimant previously claimed another type of payment (eg Sickness Allowance, Newstart Allowance, Youth Allowance or Special Benefit) when they should have claimed DSP. If it seems that the person would have qualified for DSP at the time the other payment was claimed, Centrelink should be urged to pay DSP back to the date of the other claim. It is often reluctant to do so, however, unless specifically and firmly requested.
A written claim for DSP can be backdated up to 14 days provided:
It may take weeks or months to decide a claim for DSP, so it is wise to make claims promptly. A person claiming DSP can be paid Newstart Allowance or Youth Allowance as a “provisional payment” where they have an “incapacity to work” because of their medical condition, while the claim is being decided. In these circumstances, Newstart Allowance or Youth Allowance would be paid as “incapacitated”, that is, the person would not be required to satisfy the “activity test” (see Chapter 24 for more information on sickness payments).
A person can claim Disability Support Pension using a Disability Payment Claim package from Centrelink. The package includes forms relating to the person’s medical condition, a form for the treating doctor, and information pamphlets. Where a person is unable to sign the claim form because of a physical, psychiatric or intellectual disability, some evidence of this inability should be attached to the form. Evidence of the person’s incapacity may be required from a medical provider and cannot come from a person wishing to be the disabled person’s nominee, unless that person has power of attorney or is their legal guardian.
While an advocate or nominee can complete the claim form on behalf of a person who is unable to do so, the form can only be signed by a “responsible person”, for example a person who has Power of Attorney. An “Authority for a nominated person” form can be obtained by a person wishing to legally act on behalf of a person receiving a Social Security payment by contacting Centrelink by telephone on 132 717.
It is not necessary to provide any medical records or reports at the time when the claim is made, but doing so may help to speed up processing the claim. On the other hand, a person should not delay putting in a claim for DSP just because they do not have all the medical reports yet. These can be handed in later. Centrelink also requires the person’s treating doctor to complete a form. See Chapter 4.
A person is always advised to lodge their claim for payment as early as possible to maximise the amount of backpay they can receive if their claim is granted. In addition to the general rules for backdating payments (see Chapter 4) special rules for backdating apply where a person has become “incapacitated for work” due to a medical condition.
Where a person claims a pension or allowance within five weeks of the date on which their incapacity began (usually the date of an injury or the date an illness began), payments may be backdated to that date (ie, up to five weeks).
Where a person’s claim for a pension or allowance was made more than five weeks after their incapacity began, payment can be backdated by up to four weeks if Centrelink is satisfied that:
Claimants should try to obtain from their doctors, other health professionals and hospitals, a copy of all records relating to their disability, illness or injury, especially those which are favourable to their claim. This includes clinical notes, specialists’ reports, x-rays etc. Even old medical information may be useful, as it may help establish that a condition has been fully treated and stabilised.
Useful evidence may already be in the Centrelink file, or in a file kept by the solicitor who handled a compensation claim for the person. The Centrelink file can be obtained by using the Freedom of Information Act (see Chapter 5, particularly 5.4).
Claimants should also consider obtaining further reports from their general practitioner or from specialists (possibly including people who they have not previously consulted). Where the existing evidence is not very strong, it is desirable to get further reports before the Job Capacity Assessor assesses the person, especially since the Assessor will rely heavily on the medical reports available to him or her.
When deciding whether to obtain further reports, consider:
Doctors usually charge a fee that may be substantial for a medical report but cannot charge such fees for completion of Centrelink forms. People should check whether it is possible for Medicare to cover the costs. Hospitals also charge a fee for copies of their records (Centrelink can obtain and pay for these records). Where the claimant has to get the records, the hospital may not charge if told that the claimant cannot afford to pay.
It may be very useful to choose doctors specialising in occupational health, or others who are experienced in dealing with work-related injuries. In some cases it may be appropriate to get reports from experts who are not medical practitioners (eg occupational therapists, psychologists or chiropractors).
The best way to request a report is for the person’s adviser to telephone the doctor and briefly outline the situation. It may be possible in the course of discussion to get a clearer idea of whether the doctor is likely to be of assistance. Where the person cannot afford to pay, the doctor should be asked whether he or she is willing to make an examination and report without charge or to charge it to Medicare. Where it is agreed that the doctor will assist, it may be useful briefly to emphasise to the doctor a number of important factors in the case, especially the significance of the Impairment Tables in assessing the client’s eligibility. Check whether the doctor has a copy of the Impairment Tables.
A telephone call to the doctor should be followed by a letter confirming the arrangements and repeating some of the most important factors which you want taken into consideration. However, care should be taken not to make the doctor feel that he or she is being told what to report rather than being consulted as an independent expert.
Where the doctor does not have a copy of the Impairment Tables, it is often helpful to provide a copy, at least of the relevant part of the Tables. An assessment of impairment according to the Tables is essential under the Act, so providing the doctor with the Tables will help in the preparation of a report which can assist Centrelink (or an appeal tribunal) to make the most appropriate assessment. You can get a copy of the relevant Impairment Tables from a Community Legal Centre or Welfare Rights Centre. The Impairment Tables are also available on the Internet at www.facs.gov.au.
Where a medical report will help the claim, it should be sent immediately to Centrelink. Where it may not help the claim, it is not necessary to provide it unless Centrelink requires it.
It may be useful for an adviser to telephone or write to the Centrelink officer responsible for deciding the claim, in order to emphasise key points and enquire whether they have any particular concerns about the claim. An early discussion with the Centrelink officer can be very helpful in deciding whether to ask him or her to obtain further medical reports, and whether the claimant should try to obtain further reports.
“Continuing inability to work” requires that the person’s impairment of itself prevents them from working and prevents them from retraining. However the Federal Court has said that non-medical factors, such as the person’s English language skills, age and the available labour market, should also be taken into consideration. Some of these factors may also be indirectly relevant (see 2.2 to 2.4 above).
The decision to grant a Disability Support Pension is made in three stages:
Stage 1. The claim is assessed to see whether the person can be paid a pension after the application of the income or assets tests or whether the person satisfies residential qualifications. The claim may be rejected on these grounds without any accompanying medical assessment.
Stage 2. The person is generally then referred to a Job Capacity Assessor for an assessment of their impairment rating under the statutory Impairment Tables (ie, to assess whether they have 20 points or more).
The Job Capacity Assessor is a health professional contracted by Centrelink to make these assessments. Job Capacity Assessors may have training in one of the following professions:
JCA referrals are not streamed according to a particular Job Capacity Assessor’s training and experience. This means that, say, Job Capacity Assessors trained as psychologists will not be restricted to making assessments solely on psychiatric, cognitive or intellectual impairments. Any Job Capacity Assessor, whatever their professional qualifications, may be required to conduct JCAs on all manner of physical, psychiatric, psychological and other illnesses, disabilities and barriers to employment.
The Job Capacity Assessor may want further information to assess the person’s impairment, and so may arrange for reports from people such as a medical specialist, or may talk to the person’s treating doctors.
Where it is apparent that a DSP claimant's disability is such that they have a "continuing inability to work" (eg, where a person has a terminal illness), Centrelink may determine that they have a “manifest” disability, and DSP should be granted without a further referral.
Stage 3. Where the person is assessed as having an impairment rating of 20 points or more, the Job Capacity Assessor will then determine whether or not they have a "continuing inability to work". The assessment involves consideration of whether the person would benefit from referral to programs for people with a disability, including programs offered by the Commonwealth Rehabilitation Service or the Disability Employment Network.
Centrelink may review qualification for Disability Support Pension at any time, however most reviews are conducted in one, two or five year cycles. Reviews are in the form of a Job Capacity Assessment.
Medical reviews are not usually required where Centrelink considers such a review to be unnecessary or inappropriate. An example may be where the person’s condition is such that a medical review is clearly unnecessary, such as where the person:
Centrelink can require any information which is relevant to the review. For information and advice about these powers to require information, and how to respond, see Chapter 6.
Reviews often occur when a Disability Support Pension recipient advises that they will be going overseas, especially where it is to be for an extended period. The review will consider whether or not the pensioner is “severely disabled”. This is important because some severely disabled Disability Support Pensioners can have the pension paid overseas indefinitely (see 2.6). Reviews may also be triggered where the person is receiving a regular income from employment, especially where that income substantially reduces the rate of pension. These reviews are also completed by Job Capacity Assessors.
Where, after conducting the review, Centrelink decides that the person is no longer qualified for the pension, or that they are not “severely disabled”, the person receiving the pension would have to appeal against the decision to try to change it (see Chapter 48).
Where a person is receiving Disability Support Pension overseas, Centrelink can review the pension at any time. Depending on the circumstances, Centrelink may ask for current medical records or may arrange for the client to see a doctor in the country in which they are living.
