Change to DSP Medical Assessment
14th Aug 2015
On 1 July 2015, the Department of Social Services broadened the scope of persons affected by procedural changes to the medical assessment of disability support pension (“DSP”) applications. The changes act to further implement measures announced as part of the Government’s 2014-15 Mid-Year Economic and Fiscal Outlook, which previously applied only to persons aged 35 and under living in an Australian capital city. Applicants’ capacity to evidence their disability by presenting a treating doctor report may significantly impact the accuracy of decision-making and reduce future DPS claim acceptance rates.
Pursuant to s94 of the Social Security Act 1991 (Cth), to be granted access to income support by way of a DSP, applicants must evidence a continuing inability to work or be retrained for work for 15 hours or more per week due to a physical, intellectual or psychiatric impairment. This impairment must be demonstrated by the applicant meeting 20 points or more under the Impairment Tables.*
Previously, DSP applicants were required to have their treating doctor complete a medical report form which would describe, inter alia, the diagnosed disability and any resultant incapacity for work. To receive an impairment rating greater than zero, the treating doctor report must have contained information to confirm the impairment resulting from the diagnosed condition was expected to persist, despite a recommended course of treatment being implemented, for at least two years. Once the treating doctor report was submitted, the applicant would attend upon a Centrelink-employed health professional for a job capacity assessment (“JCA”) to be completed. The treating doctor report would obviously be instrumental to inform the health professional performing the JCA.
From 1 July 2015, no treating doctor report is available for submission and applicants lose their best opportunity to submit DSP-specific documentation from a supportive treating doctor. This process is instead replaced by the applicant being required to attend a JCA, with the expectation they will take any existing documentation they have at hand. Obviously, this documentation will not have been originally prepared by a provider with the aim of supporting a DSP claim.
Where an applicant is found by the JCA to be medically qualified for a DSP, they will then be referred for a “disability medical assessment” with a government contracted doctor (“GCD”). During this process, the job capacity assessor and GCD will have discretion whether or not to contact the applicant’s treating doctor, after reviewing the evidence at hand.
It is yet to be seen what effect this administrative change will have on the accuracy of decision-making and/or whether an increased rate of claim rejections will flow. However, with the government’s fiscal policy increasingly impacting people with disabilities, this change should act as encouragement for practitioners to explore clients’ alternate options for financial support. One such avenue is to investigate clients’ eligibility for an income protection or total and permanent disability benefit under their superannuation insurance policy.
Total and permanent disability (“TPD”) insurance is usually offered to individuals, together with life insurance, on taking out a new superannuation policy. Each fund’s TPD definition differs. However, coverage will generally fall within two categories – 'Any Occupation' or 'Own Occupation'. Any Occupation coverage requires that the insured is unable to perform any gainful occupation for which they are reasonably suited by way of education, training or experience. Alternatively, Own Occupation coverage contemplates the insured being precluded from undertaking the material and substantial duties of their usual occupation.
Importantly, fund trustee will ordinarily require the insured applicant to submit two medical reports from treating doctors (usually a general practitioner and treating specialist) upon lodgement of their claim. The report, being a standardised form supplied by the fund for completion, usually includes: a diagnosis of the disabling condition; treatment history; date, extent and permanency of incapacity; and details of the insured’s preclusion from their usual occupational duties. Further, the insured may supply any other supporting documentation they wish in support of their application, for example, an opinion on whether the insured fits within the TPD policy definition from an occupational therapist.
Should a TPD application be approved, the insured may opt to have the insured amount paid as a lump sum cash benefit. Therefore, these individuals, where affected by the recent implementation of changes to the medical assessment of DSP claims, will have available to them financial support when needed most. Unfortunately, superannuation insurers may undertake a prolonged period of investigation prior to determination of a claim. In these circumstances, clients should be advised regarding alternative statutory benefits available to them and whether income protection insurance benefits are under a policy of superannuation insurance, these benefits usually being payable for a total period no more than 2 years.
* Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011 (Cth).
Shane Lawlor is a Lawyer at Gouldson Legal, a Queensland personal injury plaintiff litigation firm. Shane has practiced exclusively in personal injury matters since his admission in 2013. His broadened approach to each claim ensures all avenues of compensation are comprehensively investigated to achieve better client outcomes.
The views and opinions expressed in these articles are the authors' and do not necessarily represent the views and opinions of the Australian Lawyers Alliance (ALA).