To get DSP, your patient must meet both non-medical and medical rules. They need to provide medical evidence to support their claim.
Non-medical rules govern whether your patient meets the age limit, residency requirements and level of income and assets. Medical rules relate to how your patient’s medical condition affects their ability to work.
If your patient meets the non-medical rules, we consider if they meet the medical rules. They need to meet either the manifest medical rules or general medical rules to get DSP.
Your patient may make a claim before they’re 16. If they meet eligibility rules, they’ll get DSP from when they turn 16. A person can’t claim DSP once they’ve reached Age Pension age.
Manifest medical rules
We’ll first check if they meet manifest medical rules.
A condition will meet the manifest medical rules if any of the following apply:
- they're permanently blind
- they need nursing home level care
- they have a terminal illness with average life expectancy of less than 2 years
- they have an intellectual disability with an IQ of less than 70
- they have category 4 HIV/AIDS
- they get a Department of Veterans’ Affairs Disability Compensation Payment at the Special Rate (totally and permanently incapacitated) paid under the Veterans’ Entitlement Act 1986.
Your patient can also read more about manifest medical rules to see if they're able to get DSP.
General medical rules
If your patient doesn’t meet manifest medical rules, they need to meet both the:
- non-medical rules
- general medical rules.
To meet general medical rules, your patient must have a disability or medical condition that meets all of the following:
- will last more than 2 years
- is fully diagnosed, treated and stabilised
- results in an impairment rating of 20 points or more
- will stop them working at least 15 hours a week in the next 2 years.
For your patient’s condition to be fully diagnosed their treating doctor or health professional must have completed both of these:
- examined and diagnosed the condition
- detailed this in medical evidence.
For your patient’s condition to be fully treated, they'll need to have had appropriate treatment from a treating doctor or health professional. We’ll also check their current treatment and if any further treatment is planned for them.
For your patient’s condition to be fully stabilised, we’ll assess both of these:
- their medical evidence
- whether their ability to work will get better or stay the same with more treatment or rehabilitation.
They may also need to complete a Program of Support before they can get DSP.
A Program of Support helps people with disability to prepare for, find and keep a job. It may help your patient with any of the following:
- job preparation and job search
- work experience and training
- management of their medical condition.
This doesn’t apply if their conditions have at least 20 points under a single Impairment Table. If they do need to meet this requirement, they must have actively participated in the Program.
If your patient doesn’t meet medical rules they can’t get DSP. They may be able to get other payments.
Your patient can read more about any of the following: