Disability Support Pension medical appeals. What are the medical criteria for Disability Support Pension?

Transcription

1 Disability Supprt Pensin factsheet Disability Supprt Pensin medical appeals If yur applicatin fr Disability Supprt Pensin has been rejected n medical grunds, yu have the right t appeal. This factsheet sets ut sme infrmatin which may help yu cllect the evidence yu need t prve that yu satisfy the medical requirements fr Disability Supprt Pensin. There are ther requirements yu have t meet t qualify fr Disability Supprt Pensin which are nt discussed in this factsheet. What are the medical criteria fr Disability Supprt Pensin? T be eligible fr Disability Supprt Pensin yu must: scre at least 20 pints under the impairment tables ; yur medical cnditins d nt receive any pints unless they: - have been fully diagnsed, treated and stabilised; and - are unlikely t significantly imprve with r withut reasnable treatment within the next tw years. have a cntinuing inability t wrk: ie yu must be unable t wrk mre than 15 hurs per week fr the next tw years; and have actively participated in a prgram f supprt, unless exempt frm this requirement. The 20 pints requirement Many claims are rejected because Centrelink award less than the required 20. If this happens, it is a gd idea t lk at the impairment tables and see whether r nt yu (and yur dctr) agree this is the crrect decisin, r whether there are any ther pints, under a different r the same table, which ught prperly t be allcated t yur cnditins. The current tables are available publicly n the internet at: If yu dn t qualify fr 20 pints acrss these tables (eg 10 under ne table, 10 under anther), yu wn t qualify fr Disability Supprt Pensin. If yu can identify a table number under which yu ught t be awarded pints, and/r yu think yu shuld be awarded mre pints fr yur cnditin than Centrelink have assessed fr yu then we suggest yu shw these tables t yur treating dctr and ask them t cnfirm the number f pints, and the table number these shuld be allcated under. This is nt yur dctr s main jb and they may nt be willing t write such a letter. It is up t yu t Page 1

2 Disability Supprt Pensin ask them whether they wuld be willing t help in this way. It may help them if yu can pint them t the tables yu believe yu scre pints under. N pints: nt diagnsed N pints are awarded if Centrelink finds yur cnditin t have nt been diagnsed at the time yu claim Disability Supprt Pensin r sn after. Fr mental health cnditins, yu need t have a diagnsis frm either a psychiatrist r clinical psychlgist. A diagnsis frm a registered psychlgist is nt enugh. If yu have been seeing a registered psychlgist r general practitiner fr mental health prblems, but have nt seen a clinical psychlgist r psychiatrist by the time yu ldge yur Disability Supprt Pensin claim, yu shuld ask fr a referral t ne as sn as pssible. When yu see the clinical psychlgist r psychiatrist, yu shuld take any reprts r ther dcuments relating t yur medical histry t yur appintment and ask them : t cnfirm yur existing diagnsis and whether r nt, in their pinin, it is a lngstanding cnditin; whether any new treatment they suggest is being undertaken with the gal f preventing yur cnditin frm wrsening, r with a view t yur cnditin getting better. whether any new treatment they suggest is likely r unlikely t result in significant functinal imprvement t a level enabling yu t undertake wrk in the next tw years. If yu nly see a clinical psychlgist r psychiatrist fr the first time after yu claim the Disability Supprt Pensin, yu may need t appeal any Centrelink decisin t reject yur claim and ldge a new claim fr Disability Supprt Pensin with Centrelink. Yu can d bth at the same time. N pints: nt fully treated and stabilised N pints are awarded if Centrelink finds yur cnditin t be nt fully treated and stabilised. If any cnditin yu have was nt awarded pints because it was nt fully treated and stabilised yu culd ask yur dctr in particular t cmment n: what treatment has ccurred in relatin t yur cnditin (and when this treatment ccurred); what treatment is cntinuing r planned fr the next tw years; whether any new treatment they suggest is being undertaken with the gal f preventing yur cnditin frm wrsening, r with a view t yur cnditin getting better; and whether any further reasnable treatment is likely r unlikely t result in significant functinal imprvement t a level enabling yu t undertake wrk in the next tw years. Cntinuing inability t wrk Centrelink smetimes reject a claim n the basis that a persn des nt have a cntinuing inability t wrk that they culd wrk fr 15 hurs r mre a week with apprpriate supprt, r d a training activity t prepare fr wrk, within the next tw years. If yur claim was rejected n this basis, it wuld help if yu culd get ne f yur dctrs t cmment n this issue in writing. In particular, they shuld cmment n the impact f yur cnditins n yur ability (within the next tw years) t: Page 2

3 Disability Supprt Pensin regularly reprt t wrk; persist at wrk tasks; understand and fllw wrk instructins; cmmunicate with thers in the wrkplace; travel t/ frm wrk; mve arund at wrk; attend t persnal care needs in the wrkplace; manipulate bjects at wrk; exhibit apprpriate behaviur at wrk; undertake a variety f tasks and t alternate between tasks; and lift, carry and mve bjects at wrk. If pssible, if they culd als cmment n: what level f assistance (lw, mderate, high) yu wuld need t maintain any kind f emplyment; and the impact f yur cnditins n yur ability t undertake any training activities t prepare yu fr wrk. The prgram f supprt requirement T shw that yu have actively participated in a prgram f supprt, yu need t shw that in the three years befre yu claimed the disability supprt pensin: yu have been with a prgram f supprt fr 18 mnths; yu have cmpleted a prgram f supprt; r yu were with a prgram f supprt which was terminated because yur medical cnditins alne meant that cntinuing wuldn t imprve yur capacity t find, get r stay in wrk. Yu can als shw yu meet this requirement if: yu were with a prgram f supprt when yu claimed the disability supprt pensin, but cntinuing wuld nt help imprve yur capacity t find, get r stay in wrk. If yur prvider disagrees with yu n this, yu have the right t get medical evidence frm yur dctr. The requirement des nt apply if yu have a severe disability r illness which gives yu 20 pints under a single impairment table. A prgram f supprt means a prgram designed t assist a persn in preparing fr, finding and keeping emplyment. It includes using a Jb Services Australia prvider, an educatinal r vcatinal prgram, r a prgram specifically fr peple with a disability, eg, Disability Emplyment Netwrk and Vcatinal Rehabilitatin prgrams. A prgram f supprt can include a prvider authrized by a wrkers cmpensatin authrity. If yu attempted t return t wrk fllwing a wrkers cmpensatin claim, fr example, yu shuld ask them fr a letter cnfirming yur participatin and the length f time yu were engaged with them with the gal f addressing barriers t emplyment, r in lking fr wrk. If yu are appealing t the SSAT, bear in mind that it is up t yu t shw that yu have met this prgram f supprt requirement by shwing evidence f the dates yu participated with a prgram f supprt. Centrelink ften d nt give the SSAT evidence t shw that yu have met this requirement. Centrelink have a standard frm which yu culd use t ask any frmer prvider fr infrmatin abut yur past experience with them, which is available here: Page 3

4 Disability Supprt Pensin As well, a sample letter is attached t this factsheet: dear prvider / frmer prvider which yu culd give t any rganisatin yu dealt with in helping yu prepare fr r find wrk, explaining what srt f infrmatin yu need. Appeal rights If yur Disability Supprt Pensin Claim has been rejected, yu have 13 weeks in which t appeal. T appeal simply tell Centrelink that yu are nt happy with their decisin and that yu wuld like t appeal t an Authrised Review Officer (ARO). If yu have already had a decisin by an ARO, yu have the right t appeal further and yu need t d this within 13 weeks f the ARO decisin. Fr mre infrmatin n appealing see the Factsheet Appeals hw t appeal against a Centrelink decisin. T best supprt yur appeal yu need t check which part f the qualificatin criteria yu did nt satisfy t see what yu will need t get supprting evidence abut. If yu are nt sure, yu can use the sample letter attached t address all aspects f qualificatin. Gathering the evidence yu need t prve yur qualificatin fr Disability Supprt Pensin can be exhausting and frustrating fr many peple with disabilities. Hwever if yu d nt prduce any new medical evidence since the last decisin Centrelink made abut yur claim, the decisin n appeal will likely be the same decisin. In sme cases, as well as ldging an appeal (r instead) yu may need t ldge a new claim as well. This is because the decisin maker lking at yur appeal can nly lk at yur medical cnditin frm the time yu claimed and during the 13 weeks after yur claim. Yu may need g ldge anther claim if: there has been any change in yur medical cnditin, if there might be a prblem getting a dctr t say what yur cnditin was during this timeframe, r where Centrelink have raised any issue abut whether yur cnditin is fully treated, diagnsed r stabilised. If yur claim has been rejected fr Disability Supprt Pensin, yu may be receiving an activity tested payment like Newstart Allwance while yur appeal is n ft. See ur factsheet Ill, injured r have a disability: yur scial security rights fr mre infrmatin. Please nte: This factsheet cntains general infrmatin nly. It des nt cnstitute legal advice. If yu need legal advice abut yur scial security entitlement, please cntact yur lcal Welfare Rights Centre/Advcate. Welfare Rights Centres are cmmunity legal centres, which specialise in scial security law, administratin and plicy. They are entirely independent f Centrelink. All assistance is free. This factsheet was updated in May Page 4

5 Disability Supprt Pensin Dear Dctr Sample letter t a dctr I need t get a Disability Supprt Pensin. T be qualified fr Disability Supprt Pensin, I must: have a physical, intellectual r psychiatric cnditin that has a rating f at least 20 pints under the impairment tables; and [Date] be fully diagnsed, treated and stabilised, and my cnditin must be unlikely t significantly imprve, with r withut reasnable treatment, within the next tw years; and be prevented, because f my impairment, frm wrking mre than 15 hurs per week fr the next tw years; and be prevented, because f my impairment, frm undertaking a training activity that wuld equip me t wrk 15 hurs per week within tw years, independently f a prgram f supprt. Unless I scre 20 pints under a single impairment table, I will be required t g nt Newstart Allwance and try t find wrk r d a training activity with the help f a prgram f supprt fr a reasnable perid. It wuld be helpful if yu culd write a brief letter that addressed my situatin in relatin t the abve criteria, namely: Hw many pints, in yur pinin, I shuld receive accrding t the enclsed impairment table(s). Whether my cnditin has been fully diagnsed. Please specify what treatment yu are giving me fr each f my cnditins. Whether the treatment I am currently receiving, r any treatments reasnably available t me are likely r unlikely t make a big difference t my cnditin t the pint that I culd wrk fr 15 hurs a week r mre within the next tw years. Whether yu think my cnditin is likely t get better, stay the same r get wrse in the next tw years (including with the treatments I am currently receiving r likely t receive). Whether yu think I am unable t d any type f wrk fr 15 hurs a week r mre ver the next tw years. Whether yu think my medical cnditin means that my participatin with a prgram f supprt prgram is likely r nt likely t imprve my capacity t find, get r stay in wrk. Please address the letter t whm it may cncern as I will likely be frwarding this letter t Centrelink and / r the Scial Security Appeals Tribunal. I thank yu sincerely fr yur time and assistance in this matter. Yurs faithfully, [signature and name]. Page 5

6 Disability Supprt Pensin Sample letter t a prvider / frmer prvider Dear prvider / frmer prvider, [Date] I wuld like yu t give me a letter that gives Centrelink infrmatin abut my participatin with yur prgram. Please culd yu set ut in writing: 1. Details f yur prgram f supprt; 2. The dates I am / have been registered with yur prgram when I started and when I finished; 3. If I finished r was terminated: the reasn why in particular: a. did I cmplete the prgram? b. was it because my state f health meant that cntinuing with yur prgram wuld nt imprve my capacity t find, get r stay in wrk? 4. If I am currently still registered with yur prgram: whether yu think that cntinuing wuld nt imprve my capacity t find, get r stay in wrk because f my state f health; 5. Any perids I was nt able t participate in yur prgram including exemptins, reliefs f suspensins, and the reasn fr these perids; 6. The terms f the prgram that were tailred t address my level f impairment, individual needs, barriers t emplyment and capacity t wrk; 7. The terms I had t cmply with t satisfy thse prgram requirements and my level f cmpliance with thse terms; 8. The vcatinal, rehabilitatin r emplyment activities I participated in as part f the prgram; and 9. The frequency f cntact that I had with yu as my prvider during the times I was with yur prgram. Thank yu fr yur help. Yurs faithfully, [signature and name]. Page 6