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Your condition must be fully diagnosed, treated and stabilised for us to assess you under the general medical rules. You won’t get DSP if we assess that your condition is not fully diagnosed, treated and stabilised. Our team of appropriately qualified health professionals uses your medical evidence to assess this.
We assess your medical evidence according to social security law.
Your medical evidence will need to show the following:
- details of any treatment
- that a qualified health professional has diagnosed your condition.
For example, an ophthalmologist must support a diagnosis of an eye condition affecting vision.
When your condition is fully diagnosed
For your condition to be fully diagnosed, your treating doctor or appropriately qualified health professional must have:
- examined and diagnosed your condition
- detailed this in medical evidence.
Example where a condition isn’t fully diagnosed
Boris’s eyesight has been getting worse over a number of years. He regularly goes to his optometrist for eye tests and a check of his prescription glasses. His optometrist tells him he has glaucoma and prescribes some eye drops.
Boris’s eyesight continues to get worse. His optometrist advises him to see an ophthalmologist. Boris does not make an appointment with the ophthalmologist. Boris applies for DSP.
Boris’s medical condition is not considered fully diagnosed because he hasn’t seen an ophthalmologist. Boris can’t get DSP.
When your condition is fully treated
To assess if your condition is fully treated, we first check what type of treatment you’ve had. This is treatment from your doctor or health professional. We’ll also check your current treatment and if any further treatment is planned for you. We consider the next 2 years from when you claim.
We’ll look at your medical evidence to assess:
- the suitability of the treatment
- the outcomes of the treatment
- if further treatment may help
- if there are medical or other reasons why you can’t get treatment.
Example where a condition isn’t fully treated
Mark has arthritis in both his hips. He finds it hard to walk far and is in a lot of pain. He is on the waiting list for a right hip replacement. His left hip isn’t as bad. He has lost his job because he can't work in his casual job as a delivery driver. Mark applies for DSP.
Mark’s doctor confirms that Mark is taking pain relief for his hip. He is also on the waiting list for surgery for his right hip. Mark’s doctor expects that this treatment will happen within the next 2 years.
Mark’s condition isn’t yet fully treated. Mark can’t get DSP.
When your condition is fully stabilised
To check if your condition is fully stabilised, we’ll look at your medical evidence. We’ll assess whether your ability to work will get better or stay the same with more treatment or rehabilitation. We consider the next 2 years from when you claim.
You won’t get DSP if we assess that your condition is not fully diagnosed, treated and stabilised.
Examples where a condition isn’t fully stabilised
Example 1 – not fully stabilised and a likelihood of improvement
Joe became ill this year with cancer. While getting treatment at his local hospital, Joe stops working. Joe applies for DSP. We assess the medical evidence Joe submits with his DSP claim.
Joe’s doctor says that Joe’s treatment needs to continue for another 12 months. The treatment has a good success rate.
While the doctor expects Joe will have some ongoing cancer symptoms, he will be well enough to work after finishing treatment.
This means that Joe’s condition isn’t fully stabilised as he’s still having treatment and his condition will improve. Joe can’t get DSP.
Example 2 – not fully stabilised and treatment is improving the condition
Yaser got a back injury from an accident while on holiday. His doctor prescribes medication and sends him to a physiotherapist. Yaser is unable to work while he’s getting treatment. He submits a claim for DSP.
We assess the medical evidence Yaser provides with his DSP claim. Yaser’s doctor says that his injury is improving with treatment.
We determine that Yaser’s injury is not stabilised as it’s getting better with treatment. Yaser can’t get DSP.
Read more about who can get DSP.