How to Claim Disability Support Pension and Submit Medical Evidence in Australia

Who can qualify for Disability Support Pension?

Disability Support Pension (DSP) is an Australian Government income support payment administered by Services Australia through Centrelink. Having a disability or medical condition does not by itself make someone eligible. Services Australia assesses both non-medical and medical rules.

The non-medical rules cover your age, residence, income and assets. You must generally be at least 15 years and 9 months old and under Age Pension age when you claim. Your income and assets, and in some cases your partner's income and assets, can affect whether you qualify and the amount payable.

For residence, you generally need to be living in Australia, physically in Australia and an Australian resident on the day you claim. DSP usually also requires at least 10 years of Australian residence in total, including at least 5 years with no break, but important exceptions apply. These include certain refugees and former refugees, some people who became unable to work or permanently blind while Australian residents, and circumstances covered by an international social security agreement.

What medical rules must you meet?

Services Australia first considers whether you meet the manifest medical rules. Manifest categories include being permanently blind, needing nursing-home-level care, having a terminal illness with an average life expectancy of less than 2 years, having an intellectual disability with an IQ below 70, having category 4 HIV/AIDS, or receiving the specified Department of Veterans' Affairs Disability Compensation Payment at the Special Rate.

If you meet a manifest medical rule and provide the required evidence, you do not need the further general medical assessment. You must still meet the non-medical DSP rules.

If you do not meet a manifest rule

Services Australia assesses you under the general medical rules. Your condition must be likely to persist for more than 2 years, diagnosed, reasonably treated and stabilised. Your condition or conditions must also result in an impairment rating of at least 20 points under the DSP Impairment Tables and prevent you from working at least 15 hours a week in the next 2 years, even with training and support. Program of Support requirements may also apply.

An impairment rating of 20 points does not by itself guarantee DSP. Services Australia also considers the other medical and non-medical requirements.

What medical evidence should you submit?

Services Australia requires medical evidence for each condition that significantly affects your ability to work. In most cases, the evidence should be current and come from your treating doctors or other health professionals.

Useful evidence can include medical history records or reports, specialist reports, psychologist reports including IQ testing, medical imaging reports, physical examination reports and hospital or outpatient records. Compensation and rehabilitation reports, special-school reports, physiotherapy reports and audiology reports can also be relevant.

The evidence should explain your diagnosis, past and current treatment, planned treatment, symptoms, day-to-day functional impact and prognosis. It should also identify your treating health professionals and provide their contact details.

For symptoms, Services Australia may need information about when they began, how often they occur, how long they last and their impact when you use prescribed treatment, aids, equipment or assistive technology.

Is a medical certificate enough for DSP?

Not necessarily. Services Australia states that a medical certificate may not provide enough evidence to assess a DSP claim. Detailed medical records or reports may be needed to establish the diagnosis, treatment history, prognosis and functional impact of your conditions.

Your treating health professional can use the Disability Support Pension Medical Evidence Checklist for treating health professionals (SA478). Use of SA478 is optional, but it can help ensure the evidence covers the information Services Australia needs.

What does diagnosed, reasonably treated and stabilised mean?

For the general medical rules, Services Australia must be satisfied from your evidence that the relevant condition is diagnosed, reasonably treated and stabilised.

For most conditions, a general practitioner can make the diagnosis, although some conditions require diagnosis or evidence from an appropriately qualified specialist. Services Australia considers the treatment you have received, the results of treatment, current treatment and whether further reasonable treatment is likely to substantially improve your condition or functional capacity.

A condition can still be stabilised while treatment continues. The important question is whether the available evidence shows that significant functional improvement is unlikely with further reasonable treatment.

How do the Impairment Tables and Program of Support affect your claim?

Services Australia uses the DSP Impairment Tables to assess the functional impact of conditions that are diagnosed, reasonably treated and stabilised. To satisfy the impairment requirement you need at least 20 impairment points.

If you have 20 points or more under a single Impairment Table, you do not need to meet the Program of Support requirement. If your combined rating is at least 20 points but you have fewer than 20 points on any single table, you may need to meet the Program of Support rules.

A Program of Support is designed to help people with disability prepare for, find and keep work. It can include job preparation, job search, work experience, training and management of a medical condition.

How do you claim DSP online?

The easiest method identified by Services Australia is an online claim. You need a Centrelink online account linked to myGov.

1. Sign in to myGov.
2. Select Go to Centrelink.
3. Select Make a claim or view claim status, then Make a claim.
4. Under Disabled, ill or injured, select Get started.
5. Complete the questions and provide the required supporting documents and medical evidence.

If you cannot claim online, you can use the Claim for Disability Support Pension form. A separate Claim for Disability Support Pension for a Terminal Illness form is available where the terminal-illness criteria apply.

When do supporting documents need to be provided?

As you complete the claim, Centrelink identifies documents as required or supplementary. Required documents must be provided before you can submit the claim.

Services Australia's DSP supporting-documents guidance says supplementary documents can be submitted within 14 days after you submit the claim. If Services Australia asks for additional information while assessing your claim, it will put the claim on hold while waiting. Its guidance says you need to provide requested documents within 14 days or the claim may be rejected.

Depending on your circumstances, Centrelink may ask for financial records, bank and investment details, income and assets information, employment documents, residence history, relationship details, accommodation information or other evidence in addition to your medical records.

What happens after you submit the claim?

Services Australia first assesses the non-medical rules. It then considers whether your evidence establishes manifest medical eligibility. If not, it assesses the general medical rules.

You may be asked to attend a Job Capacity Assessment and Disability Medical Assessment. If you have new evidence that you have not already submitted, you can bring it to these appointments. Services Australia may also contact your treating doctors or other health professionals about the evidence.

There is no single published standard processing time for every DSP claim. When you submit an online claim, Centrelink gives you a receipt containing your claim ID, an estimated completion date for your claim and a link to track progress.

You can track the claim through myGov and your Centrelink online account or through the Express Plus Centrelink mobile app. Services Australia will contact you if it needs more details or requires you to attend an assessment.

Can you get financial support while waiting for DSP?

You may be eligible for another income support payment while Services Australia assesses your DSP claim, including JobSeeker Payment or Youth Allowance for job seekers. Eligibility for those payments is assessed separately.

If you make your DSP claim online, Services Australia allows you to claim JobSeeker Payment as part of the online claim. Otherwise, you may need to make a separate claim for interim income support.

If you are granted or already receive another income support payment, Services Australia says you do not need to meet mutual obligation requirements while your DSP claim is being assessed. You can choose to continue participating where doing so helps with a Program of Support.

Common problems that can delay or weaken a DSP claim

• Submitting only a brief medical certificate when detailed evidence is needed.
• Leaving out a condition that significantly affects your ability to work.
• Providing evidence that identifies a diagnosis but does not explain treatment, functional impact or prognosis.
• Not providing documents marked as required in the claim.
• Missing a request for additional documents while the claim is on hold.
• Not attending a Job Capacity Assessment or Disability Medical Assessment when Services Australia requires one.

If you have difficulty obtaining medical evidence, Services Australia advises contacting the Disability and carers line to discuss your options rather than submitting an incomplete claim without seeking help.

How will you receive the decision?

Services Australia sends a letter explaining the DSP decision through your preferred communication channel, which may be your myGov Inbox, Centrelink online account, Express Plus Centrelink mobile app or post.

If the claim is granted, the letter tells you when your DSP starts and the amount you will receive. DSP rates depend on factors including your age, relationship circumstances, income and assets.

If the claim is rejected, Services Australia explains the decision and your options. If you disagree, you can ask Services Australia to explain the decision and can request a review.

Depending on your circumstances, other Centrelink support may also be relevant. A person providing constant care may need the separate process for Carer Payment, while people who meet the applicable income requirements can check the Low Income Health Care Card.