FOI/LEX 76225 - Page 2 of 35
• identified by Service Officers or Employment Services Providers as continually unable to comply with requirements, and
demonstrating behaviours consistent with a chronic mental health condition
These procedures do not apply to customers who are willing and able to obtain medical evidence, in accordance with normal
procedures.
Health Professional Advisory Unit (HPAU)
The Health Professional Advisory Unit (HPAU) can provide and/or facilitate medical advice and opinion for the purpose of helping
to determine a customer's eligibility for DSP. Psychologists conducting these assessments are required to consult with the HPAU
before the submission of the Specialist Report and Job Capacity Assessment (JCA) report to make sure that all medical factors are
considered. Once medical factors are excluded, the determination of vulnerability sits with the assessor in consultation with their
Assistant Director.
Impairment Table changes from 1 April 2023
From 1 April 2023, a new version of Impairment Tables was introduced. The new Tables are used to assess a customer's medical
eligibility for all DSP claims lodged on or after this date. See The Impairment Tables.
Related links
The Health Professional Advisory Unit (HPAU)
What is medical evidence for Disability Support Pension (DSP)?
Job Capacity Assessment (JCA) Referral
Process
Medical evidence requirements for DSP
This table describes the process in assessing if a customer is medically eligible for the DSP without providing medical evidence.
Item
Description
1
Medical evidence requirements for a DSP new claim + Read more ..
There is no variation to the usual eligibility rules for DSP, including the requirement that a medical condition must be
diagnosed, reasonably treated and stabilised in order to be assigned an impairment rating (IR), which must be at least 20
points, and for the customer to have a continuing inability to work (CITW).
47E(d)
Subject to approval by a Senior Service Officer (SSO) or other senior staff member at SO5 level or above, eligibility for DSP
may be determined based on medical conditions diagnosed solely by an Assessor who is a registered Psychologist.
In all cases, the diagnosis must be provided as part of a Specialist Assessment, and documented in the customer's JCA report.
If a DSP Processing Team staff member (SO5 or above) determines DSP medical eligibility and medical evidence
requirements are met based on the submitted JCA report, the customer will be invited to claim DSP.
FOI/LEX 76225 - Page 3 of 35
2
Requirement for senior staff involvement + Read more ..
A decision to invite a claim for, or grant DSP solely on the basis of a provisional diagnosis provided by an Assessment
Services Psychologist must be approved by an SSO or senior staff member at the level of SO5 or above. Social Workers can
also identify customers who may meet these criteria.
Senior or professional staff should be closely involved in supporting the customer's referral to a JCA making sure all available,
relevant evidence has been gathered before the referral and is available to the Assessor.
If the customer does not have a nominee, the Service Officer should fol ow this up as there may be someone able to act on the
customer’s behalf and be able to access medical information for the customer.
As part of the decision making process the Health Professional Advisory Unit (HPAU) must also be engaged to provide and/or
facilitate medical advice and opinion for the purpose of helping a decision-maker determine a customer's eligibility for DSP.
Note: only specific staff can contact the HPAU and then only for specific reasons, depending on the Service
Officer's/Specialist's role.
3
Work item 47E(d)
- DSP Assessment Services Opinion - Referral + Read more ..
This work item is created when medical evidence is scanned and identified as a Psychologist Report.
• Check 47E(d)
screen to iden�fy why the request was made
• Ac�on the scan and update customer details as per unstructured Medical Documents
• select the Transac�on ID from 47E(d)
screen
• Select 47E(d)
• Change Status 47E(d)
4
Granting DSP + Read more ..
Claims for DSP where the medical evidence has been completed by an Assessment Services Psychologist in a Specialist
Assessment, are to be assessed by a DSP Processing Team staff member (SO5 or above) due to the sensitivity and complexity.
The customer must meet all qualification and payability requirements for DSP.
All cases where a customer is granted DSP solely on the basis of a provisional diagnosis provided by an Assessment Services
Psychologist, must have a keyword of 47E(d) attached to the 47E(d)
DOC on the customer's record.
5
Customer not qualified for DSP + Read more ..
The assessment may indicate the customer does not meet medical qualification therefore they will not be granted DSP. The
customer may also not wish to claim DSP.
If the customer is receiving a payment, such as JobSeeker Payment (JSP) with mutual obligation requirements, their
requirements must be reviewed taking into account the information in the report, particularly where the customer has a partial
capacity to work or a temporary reduced work capacity.
6
Referring the customer for further assistance + Read more ..
The customer must be offered information and assistance to be referred to a Community Health Centre or General Practitioner
for a ful mental health assessment, and connection to other socially inclusive community services. These referrals should only
be made with the customer's consent.
Wherever possible, the Assessor should be involved in making these referrals. Social Workers or Senior Service Officers
(SSO) must support the Assessor in providing information about these services to the customer and making referrals where
required.
References
FOI/LEX 76225 - Page 4 of 35
Policy
Social Security Guide, 1.1.J.10, Job capacity assessment (JCA)
Social Security Guide, 3.6.2.10, Medical & Other Evidence for DSP
Social Security Guide, 1.1.C.330, Continuing inability to work (CITW) (DSP)
Legislation
Links to the Federal Register of Legislation site go to a 'Series' page. Select the ‘Latest’ version.
Social Security (Administration) Act 1999, section 12, Deemed claim in certain cases
Training & Support
Add the course number to the Search field in the Learning Portal (LMS) in ESSentials:
•
CLK00465 - Introduction to Job Capacity Assessments
FOI/LEX 76225 - Page 5 of 35
s22
Cancellation of Disability Support Pension (DSP) 008-03130030
Currently published version valid from 9/03/2023 3:11 AM
Background
s22
This document outlines how to cancel DSP when a customer is no longer qualified or when they request cancellation. The Service
Officer must ensure that cancellation is the correct action to take. Take care if a customer with a mental health condition requests
cancellation of their payment.
When DSP may be cancelled
• The customer requests to cancel their DSP or submits a claim for another payment.
Note:
o This may place vulnerable customers at risk where DSP is cancelled
o Further actions must occur before cancelling DSP in these circumstances
o A customer initiated request to cancel DSP is not a decision under social security law. This means that once DSP is
cancelled:
the decision will not be overturned at review,
and DSP cannot be restored on request of the customer
• The customer no longer meets the qualification and/or payability provisions for DSP. Once the record is updated, DSP will
auto cancel. For example, a medical service update determines the customer no longer meets DSP impairment criteria
o DSP does not cancel immediately as a result of a DSP Service Update or Payment Accuracy Reviews if the
customer no longer meets impairment and/or CITW requirements
o It is cancelled after 42 days from the date the advice is sent to the customer
• DSP was suspended for 2 years because the customer was imprisoned or in psychiatric confinement in connection with a
criminal charge
• DSP was suspended for 2 years because the customer advised within the notification period a return to work or increase in
income which precluded payment, and DSP has not been restored. Note: this is an auto cancellation
• The customer fails to comply with the notification requirement and/or customer obligations
• The customer's partner fails to take action to obtain a comparable foreign payment
• The customer has been advised that another pension or allowance is deemed more appropriate. For example, they reach
Age Pension age. If a DSP customer reaches Age Pension age, DSP auto cancels in most cases. Customers in the DSP
grandfathered group who elect to transfer to another payment such as Carer Payment will lose their 'Grandfathered Status'
if they decide to transfer back to DSP
• The customer dies
• The customer starts work of 30 hours or more per week at award wages and fails to notify within 14 days
When DSP is cancelled with a return to work reason, DSP is deemed suspended. This means payment may be restored if the
customer ceases work or reduces hours of work to below 30 hours per week within 2 years.
FOI/LEX 76225 - Page 6 of 35
However, if DSP is cancelled outside the notification period, before the customer notified they had started work of 30 hours a week
or more, payment cannot be suspended or deemed to be suspended. It must be cancelled from the day work started.
Effect of PPL/DAP on DSP
For children born or entering care:
• from 1 October 2016, Paid Parental Leave (PPL) and Dad and Partner Pay (DAP) granted to the customer (and/or their
partner) are treated as ordinary income for calculating the rate of payment for DSP
• prior to 1 October 2016, PPL and DAP are not treated as assessable income for DSP
PPL and DAP will not reduce DSP to nil rate. The customer would need to have other income for their rate to be reduced to nil and
cancel. If DSP cancels due to other income, it may be reinstated depending on the customer’s current circumstances.
See Restoration of DSP.
Automatic and manual cancellations
Automatic cancellation will occur following reassessments when no continuing eligibility exists. For example, when a change of
income or assets takes a customer over the income or assets threshold. When the income or assets are updated, the system will:
• calculate if the customer has lost eligibility and
• automatically cancel the DSP due to income or assets
Payments may also be automatically cancelled when a customer is no longer eligible. For example, when a customer fails to return
correspondence or provide a tax file number. In these cases, the system will set up a manual follow up (MFU) activity for action.
If a vulnerable and at risk customer remains without income support payment for a minimum of six weeks due to an automatic
suspension or cancellation, the customer may be eligible for manual intervention.
Note: customers overseas permanently are not
eligible for this initiative. Any MFUs generated for customers in this situation should be cancelled.
Manual cancellation is where a Service Officer makes a decision to cancel a customer's payment based on the applicable social
security law and codes this as a direct cancellation.
Automatic cancellation is the preferred method. Manual cancellation of records should only occur when automatic cancellation by
coding a change in circumstances is not available.
Related links
Cancellation, suspension and rejection codes for Disability Support Pension (DSP)
Commencing or returning to work or self-employment Disability Support Pension (DSP)
Customer ceases work or reduces hours of employment within the two year suspension period for Disability Support Pension (DSP)
Disability Support Pension (DSP) customer going overseas
Restoration of Disability Support Pension (DSP)
Eligibility for Mobility Allowance (MOB) and rates
Providing services to customers with disabilities
Work Bonus and balance for pensioners of Age Pension age
Transitional rules for pension customers who were on payment at 19 September 2009
Income Test for single pension customers
FOI/LEX 76225 - Page 7 of 35
Income Test for partnered pension customers
Income Test for Disability Support Pension customer who is under 21 years, with no dependent children and with affecting income
at 19 September 2009
Income Test for Disability Support Pension customer who is under 21 years, with no children
Disability Support Pension (DSP) letters and advices
Manual intervention for Automatic Suspension and Cancellation of vulnerable and at risk customers
Process
Cancelling DSP
DSP cancellation and follow up action
Cancelling DSP
Table 1
Step
Action
1
Check that the cancellation action is correct + Read more ...
Customers in the DSP grandfathered group who elect to claim another payment, e.g. Carer Payment, will lose their Grandfathered
Status if they decide to reclaim DSP.
If a vulnerable and at risk customer remains without income support payment for a minimum of 6 weeks due to an automatic
suspension or cancellation, they may be eligible for manual intervention.
Note: customers who are overseas permanently are not
eligible for this initiative. Cancel any MFUs generated for customers in this situation.
Is a potentially vulnerable customer (for example, but not limited to, a customer with acquired brain injury, mental health issue,
intellectual disability or other conditions that may impact decision making) requesting cancellation of DSP,
or claimed another
payment that will result in cancellation of DSP?
•
Yes, go to Step 2
•
No, go to Step 3
2
Discuss the reason with the customer + Read more ...
Providing services to customers with disabilities.
Further actions
must occur before cancelling DSP in these circumstances, including:
• Consulting with a team leader
before making a decision to cancel DSP
• If cancelling DSP, consider a further case consultation with a social worker or other specialist (e.g. Community
Engagement Officer, Indigenous Service Officer)
Before cancelling DSP, discuss the reason with the customer or their nominee. Advise the customer or nominee:
• If the customer claimed and is granted another income support payment, it will result in the cancellation of DSP.
FOI/LEX 76225 - Page 8 of 35
• DSP cannot be restored once cancelled. A new claim and current medical evidence
must be lodged to re-test eligibility
for DSP
Cancellation at the customer’s request is not a decision under Social Security Law, therefore, once DSP is cancelled:
•
the decision will not be overturned on review •
DSP cannot be restored on request of the customer
Has the customer provided a valid reason for cancelling payment?
•
Yes, see Step 1 in Table 2
•
No, go to Step 3
3
Does the customer want to continue with their cancellation request or claim for another income support payment? + Read
more ...
•
Yes, see Step 1 in Table 2
•
No, record decision on a
DOC. If a claim for another income support payment was lodged, the claim will need to be
withdrawn. See Withdrawal of claims.
DSP cancellation and follow up action
Table 2
Step
Action
1
Cancellation reason + Read more ...
• If the customer has advised they have
started or returned to work, see Commencing or returning to work or self-
employment DSP. Procedure ends here
• If the cancellation is the result of
updating the customer's circumstances (e.g. increased income/assets above the
thresholds, change in relationship status or death of the customer or partner, go to Step 2
• If the result of a Service Update or Payment Accuracy Reviews is that the customer is no longer medically qualified for
DSP, go to Step 3
• If the customer requests to cancel the payment, go to Step 6
• For all
other cancellations, go to Step 4
2
Record the updated information + Read more ...
If the customer is to be cancelled due to a change in circumstances, the new circumstances must be recorded as this may affect
the customer's eligibility for other payments for example Mobility Allowance (MOB).
If the DSP customer is receiving the higher rate of MOB and is cancelled due to
increased hours, they may continue to receive
MOB at the higher rate. For more information, see Eligibility for Mobility Allowance (MOB) and rates.
When a customer with employment income is:
•
under Age Pension age, Working Credit may enable the customer to keep some of their income support payment
while they are working
•
over Age Pension age and getting a pension (excluding Parenting Payment Single), they may be eligible for the Work
Bonus.
Note: the Work Bonus is not used in the customer's transitional rules calculation, but partners may still benefit
by the reduction in total income
When a customer's income
reduces their fortnightly rate to nil and some is employment income, if the customer notified:
FOI/LEX 76225 - Page 9 of 35
•
within 14 days, they may be eligible to have their payment suspended instead of cancelled. See Commencing or
returning to work or self-employment DSP
•
outside 14 days, payment may remain current at nil rate for up to six fortnights if still eligible for DSP
DSP will auto cancel when recording the change of circumstances. The 47E(d)
screen shows this.
• An automatic advice should generate. Check this in the 47E(d) field help on the 47E(d)
screen, or see if a
Manual Follow-up (MFU) creates on the 47E(d)
screen the next day
• Check if the customer's partner is receiving a payment, and if it should be cancelled. If it should cancel but has not
auto cancelled, , cancel their payment using the appropriate 47E(d)
• Record details on a
DOC
Go to Step 7.
3
Record decision not to continue DSP + Read more ...
Record a
DOC that the customer is not qualified to continue receiving DSP as a result of the service update.
The DSP cancellation is not to take effect until
42 days after sending the advice to the customer.
Create a 47E(d)
Activity on the 47E(d) screen to submit the cancellation activity with the correct date.
4
Is the customer partnered and/or a care receiver? + Read more ...
• If the customer is a
care receiver (and carer on Carer Payment), go to Step 5
• If the customer is
partnered (but not a care receiver), check if their partner gets a payment which needs to be
cancelled. If so, refer to the relevant procedure in Cancellation of payments. Go to Step 6
• If
not partnered or a care receiver, go to Step 7
5
DSP customer is a care receiver + Read more ...
When a care receiver's payment is cancelled, an Income & Asset Review 47E(d)
is created
on the 47E(d)
screen on their record.
When the IAR review is due, the system issues a Carer Payment - Income and assets details of the person being cared for (16
years and over) (SA304(A)) form if the carer receiver is getting an income support payment from Services Australia or the
Department of Veterans' Affairs (DVA).
If the care receiver's DSP is suspended and is likely to remain suspended for a long time (e.g. Suspended RTW), issue the
SA304(A) form manually to the care receiver.
If the care receiver has a partner or carer receiving CP, the eligibility to remain on CP depends on the level of continuing care.
The Carers Processing Service Team should investigate this. Use
Fast Note – 47E(d)
47E(d)
Include relevant information in the
Fast
Note text. Advise that the care receiver’s DSP has been suspended or cancelled. CP qualification will only continue if
• the care receiver still requires a qualifying level of personal care and/or supervision, and
• the carer still provides the equivalent of a working day of personal care over the 24 hour period
6
Customer requests to cancel the payment + Read more ...
Before cancelling a payment, take care to check if the customer has lost eligibility for that payment.
If a customer with mental health issues, impaired cognitive capacity, or other impairment or vulnerability requests cancellation,
consult with a team leader.
If cancelling the payment will place the customer at risk, consider a case consultation and referral to
a social worker, or other specialist officer before cancelling.
Cancellation at the customer’s request:
FOI/LEX 76225 - Page 10 of 35
•
cannot be formally reviewed as the decision has not been made under any provision of the Social Security Act 1991.
So if a customer requests cancellation and later wants to change the request, it cannot be legally reviewed
•
cannot be restored because the decision has not been made under the Social Security Act 1991
Record on a
DOC:
• any discussions with the customer about their reasons for cancelling payment
• advice or action taken to ensure the customer is not placed at risk
If there is
no indication that the customer is vulnerable and may be further disadvantaged by cancellation:
• Go the
47E(d) screen
• Code 47E(d)in the 47E(d)
: field
• Code 47E(d) in the 47E(d): field
• Code the relevant cancellation/rejection reason code in the 47E(d)
: field. Use 47E(d)
for the relevant code
• Code date of effect in 47E(d)
: field. For a voluntary surrender/cancel of DSP, encourage the customer to give the
reason and relevant date (e.g. returned to work, increase in income, re-partnered.) so that a proper date of effect of
cancellation can be determined. If they do not give any details of why they want DSP cancelled, code date paid to
(DPT) + 1
• Record details in a
DOC • Finalise activity via 47E(d)
screen
• Advise the customer of the outcome and advise there are no review and appeal rights
• Check the MFU activity on 47E(d)screen the following day to see if the manual letter needs to be sent. If so, use 47E(d) or
47E(d)
7
Check that the customer and/or partner have not been overpaid + Read more ...
47E(d)
Go to the 47E(d) screen and check for a
debt activity.
References
Policy
Guide to Social Security Law, 3.6.1.100, continuation Variation or Termination of DSP - 30 Hour Rule
Legislation
Links to the Federal Register of Legislation site go to a 'Series' page. Select the 'Latest' version.
DSP qualifications
Social Security Act 1991, section 94, continuing inability to work
Manual cancellations
Social Security (Administration) Act 1999
• section 80, Cancellation or suspension determination
• section 81, Cancellation or suspension for non-compliance with certain notices
FOI/LEX 76225 - Page 11 of 35
Automatic cancellations
Social Security (Administration) Act 1999
• section 93, customer complying with subsection 68(2) notice
• section 94, customer not complying with subsection 68(2) notice
• section 95, failure to provide statement under subsection 68(2)
Training & Support
Add the course number to the
Search field in the Learning Portal (LMS) in ESSentials:
•
CLK01111 - Suspensions, cancellations & restoration
FOI/LEX 76225 - Page 12 of 35
s22
Reviews and appeals for Disability Support Pension (DSP) rejection or
cancellation decisions 008-03190000
Currently published version valid from 14/07/2023 8:17 PM
Background
s22
This document explains details on how to manage reviews and appeals of decisions for a DSP customer.
Rejected DSP claim / cancelled DSP
When a customer's claim for DSP is rejected or their DSP is cancelled, they have the right to have the decision reviewed. There are
several levels of review and appeal both internal and external to Services Australia.
Note: if the DSP claim has been rejected for reasons 47E(d)
or 47E(d) and the customer has provided the
required information within 13 weeks of the rejection, the claim can be reopened without the need for a SME quality
check/explanation of decision or formal review.
Internal:
• before 15 May 2021, a quality check by a Subject Matter Expert (SME)
• from 15 May 2021, an explanation of the decision by a SME, or
• formal review of the decision by an Authorised Review Officer (ARO)
External:
• Administrative Appeals Tribunal (AAT) first review
• AAT second review
• Federal Court, on a point of law only
• High Court, with leave of the Court
An internal review of decision must be completed before initiating an external review.
Further assessments via the Medical Assessment Team (MAT), Job Capacity Assessment (JCA) or Disability Medical Assessment
(DMA) may be requested as appropriate during the process.
Quality check of DSP medical decision requested before 15 May 2021
If required, the Medical Assessment Team (MAT) will refer customers for an Appeal JCA after a SME request to reassess medical
evidence.
The 47E(d)
Fast Note was amended to include additional information required for MAT to refer the
customer for an Appeal JCA.
FOI/LEX 76225 - Page 13 of 35
For DSP SMEs, where a DSP claim has been rejected and the customer has requested a review of decision before 15 May 2021:
• SME will refer to ARO if the DSP claim was rejected on the basis of a DMA recommendation
• SME wil refer to MAT where further medical evidence was provided
• MAT will refer to JCA (if required) for DSP Review of Decision
Explanation of DSP medical decisions requested from 15 May 2021
From 15 May 2021, a new internal review process applies to both DSP new claims and medical reviews where a customer requests
an explanation of a decision to reject or cancel DSP due to medical eligibility.
Customers can either:
• request an explanation of a decision which will be provided by a SME, or
• apply for a formal review of a decision which will be undertaken by an ARO
Although DSP claims are processed in 47E(d)
, action all SME explanation processes in 47E(d)
.
Payment pending review (PPR)
From 15 May 2021,
only consider PPR for customers who have applied for a formal review of the decision to cancel their DSP.
See Payment Pending Review (PPR) of decision to cancel DSP due to medical eligibility.
Implementing review of decision outcomes
Service Officers or SMEs must follow the appropriate procedures to finalise and implement review of decision outcomes for:
• ARO decisions
• AAT decisions
Job Capacity Assessment (JCA) requests for AAT, Federal Court or High Court
Al new assessments required for the:
• AAT first review, will be made by an ARO
• AAT second review, Federal Court or High Court, wil be referred directly to Assessment Services from the Litigation and
Information Release Branch. These referrals will be managed by the Assessment Services National Administration Team
(ASNAT) Support Team
Impairment Table changes from 1 April 2023
From 1 April 2023, a new version of Impairment Tables was introduced. The new Tables are used to assess a customer's medical
eligibility for all DSP claims lodged on or after this date. See The Impairment Tables.
The Resources page contains:
• suggested 47E(d) text
• links to the Assessment Services Branch homepage, and
• contact details for Assessment Services
Related links
Request for an explanation or application for a formal review (CLK)
Reviews by an Authorised Review Officer (ARO)
FOI/LEX 76225 - Page 14 of 35
SME explanations, ARO referrals and implementing ARO decisions
Implementing the outcome of a failure review or appeal
Administrative Appeals Tribunal (AAT) (CLK)
The Health Professional Advisory Unit (HPAU)
Appeals (APL) system (CLK)
Job Capacity Assessment (JCA) Referral
Checking and actioning a Job Capacity Assessment (JCA) report
Access to scanned medical information for Assessment Services
The Impairment Tables
Process
This page contains details about when and how a Job Capacity Assessment (JCA) referral is made when required as part of the
review/appeal process.
On this page:
Customer contact about a rejected or cancelled DSP claim
SME quality checks/explanations for DSP claims rejected for non-medical reasons
SME quality checks of DSP medical decisions for reviews requested before 15 May 2021
SME explanations of DSP medical decisions requested on or after 15 May 2021
Making a JCA referral for a formal review of decision
Making an ESAt or JCA referral when a review of a previous decision is pending
Customer contact about a rejected or cancel ed DSP claim
Table 1: For non-disability processing and disability trained staff.
Step
Action
1
Determine DSP rejection/cancellation reason + Read more ..
When a customer's claim for DSP is rejected or their DSP is cancelled, they have the right to have the decision reviewed.
It is important the decision is discussed with the customer, at first point of contact.
If the customer has lodged new information but not requested an explanation or applied for a formal review, the Service
Officer (SO) is to consider the new information and:
FOI/LEX 76225 - Page 15 of 35
• if the original decision can be reassessed and the outcome wil be ful y favourable, undertake a reassessment
• if the new informa�on wil not change the original decision, or if the decision can be reassessed but the outcome
wil not be fully favourable, make genuine atempts to contact the customer to discuss the new informa�on and
provide review and appeal op�ons
If the customer requests an explanation, applies for a review or provides more information regarding a decision, the action
required depends on the reason for the rejection/cancellation. For DSP claims rejected for:
• reason47E(d)
or47E(d) (insufficient medical evidence), go to Step 2
• reason 47E(d), go to Step 3
• reason 47E(d) go to Step 4
• medical reason, such as 47E(d)
(excluding reason 47E(d) - insufficient medical evidence), go to Step
5
• all other DSP rejec�on and cancel a�on reasons, go to Step 6
Disability SME only
To action a:
• SME quality check/explana�on for a non-medical decision, see Table 2
• SME quality check requested before 15 May 2021, see Step 1 in Table 3, or
• SME explana�on of decision requested from 15 May 2021, see Step 1 in Table 4
2
DSP claim rejected for reason 47E(d)
or 47E(d)
(Insufficient medical evidence) + Read more ..
Non-disability processing staff
Claim can be re-opened where:
• DSP claim has been rejected for reason 47E(d)
or 47E(d), and
• customer has provided the required informa�on within 13 weeks of the rejec�on
A SME quality check/explanation of decision or formal review is not required in this instance, see Request to reassess a
rejected claim.
Possible terminal illness
Create a Fast Note for the Disability processing team if the:
• claim was rejected 47E(d) within the last 13 weeks, and
• customer has lodged either:
o a Verifica�on of terminal il ness form (
SA495), or
o other medical evidence indica�ng a possible terminal il ness
Use Fast Note - 47E(d)
Add notes to
indicate the customer has supplied evidence of terminal illness.
The
Fast Note work item presents as the highest work priority for the Disability processing team. See Prioritising Disability
Support Pension (DSP) claims for terminally ill customers.
Disability processing staff
When allocated a 47E(d)
Fast Note or
Priority-47E(d)
Fast Note, see Streaming a new claim for
Disability Support Pension (DSP) to 47E(d)and progress DSP claim.
Procedure ends here.
3
DSP claim rejected for reason 47E(d)
+ Read more ..
FOI/LEX 76225 - Page 16 of 35
If the DSP claim was rejected for reason 47E(d) (failed to attend/participate in a Disability Medical Assessment), reopen and
reassess the DSP claim. A SME quality check/explanation or formal review is not required if the customer:
• contacts within 13 weeks of the rejec�on, and
• indicates their inten�on to atend a Disability Medical Assessment (DMA)
See Disability Medical Assessment (DMA) appointment outcome for action required.
Procedure ends here.
4
DSP claim rejected for reason 47E(d) + Read more ..
DSP claim is rejected for 47E(d) (failed to attend medical examination - JCA).
If the customer fails to attend a Job Capacity Assessment, and it could not be completed as a file or phone assessment, or the
customer would not participate in the assessment, the JCA referral is finalised as 47E(d) (Unable to complete) and claim
rejected.
DSP Claim can be reopened and reassessed if the customer:
• contacts within 13 weeks of the rejec�on, and
• indicates their inten�on to atend/par�cipate in the JCA
47E(d) the claim and progress the claim, see Streaming a new claim for Disability Support Pension (DSP).
Procedure ends here.
5
DSP claim rejected for a medical reason 47E(d)
or any other medical reason), excluding reason
47E(d)
- insufficient medical evidence + Read more ..
If the customer does not understand or agree with the decision as to why their claim was rejected for the medical reasons
above, including where the customer has provided, or will provide, further medical evidence for consideration, explain their
options to request:
• an explana�on
• a formal review
For action required, see Reviews and appeals.
Procedure ends here.
6
All other DSP rejections or cancellations + Read more ..
If the customer does not understand, or agree with a decision, explain their options to request an explanation of the decision or
a formal review. For action required, see Reviews and appeals.
Procedure ends here.
SME quality checks/explanations for DSP claims rejected for non-medical reasons
Table 2: For appropriately trained staff only.
Step
Action
1
SME quality check/explanation registered for rejection reason 47E(d)
or47E(d)+ Read more
...
Reopen the DSP claim, without the need for SME quality check/explanation or formal review, if a SME quality check has
been registered for rejection reason:
• 47E(d)
or47E(d)and the customer has supplied all the required informa�on within 13 weeks of the
rejec�on
• 47E(d) and the customer has contacted within 13 weeks of rejec�on indica�ng their inten�on to atend DMA
FOI/LEX 76225 - Page 17 of 35
• 47E(d) and the customer has contacted within 13 weeks of rejec�on indica�ng their inten�on to atend/par�cipate
in JCA
The SME
must make genuine attempts to contact the customer to tell them a SME quality check/explanation is
not
required and the DSP claim can be reopened.
If the customer requests to
withdraw the quality check/explanation:
• ac�on the withdrawal using the 47E(d)
script
• 47E(d) DSP claim and progress accordingly in 47E(d)
• annotate 47E(d)
Notes to advise claim has been reopened
If the customer
cannot be contacted:
• 47E(d) claim and progress accordingly in 47E(d)
• annotate the
DSP Appeal47E(d)
Notes to advise claim has been reopened
• hold the
DSP Appeal/47E(d)
for 7 days
• DSP claim and DSP Appeal held under Hold to User
• when the
DSP Appeal/47E(d)
becomes due, make genuine atempts to contact the customer to discuss
withdrawing the quality check/explana�on:
o if the customer agrees to withdraw the quality check/explana�on, ac�on the withdrawal using
the 47E(d)
script
o if contact is unsuccessful, hold
DSP Appeal 47E(d)
for a further 7 days
Continue to make contact attempts to discuss the quality check/explanation until the DSP claim is finalised.
Record all attempts to contact the customer about the quality check/explanation in the
DSP Appeal 47E(d)
an
47
d
DSP Progress 47E(d)
/Notes.
If customer contact is unsuccessful, finalise the quality check/explanation when the claim is finalised.
Procedure ends here.
2
SME quality check/explanation registered for rejection reason 47E(d)
(excess income and assets) or 47E(d)
(compensation
income too high) + Read more ..
Where a SME quality check/explanation has been registered for rejection reason:
•
(
47E(d) excess income and/or assets), or
• 47E(d) (compensa�on income too high)
and the SME determines:
• the rejec�on was correct and non-medical eligibility is not met, go to Step 3
• non-medical eligibility is met, and the customer requires a medical assessment (referral to JCA), reopen the DSP
claim and refer to JCA
The SME
must make genuine attempts to contact the customer to tell them a SME quality check/explanation is
not
required and the DSP claim can be reopened.
If the customer requests to
withdraw the quality check/explanation:
• ac�on the withdrawal using the 47E(d)
script
• 47E(d) DSP claim and progress accordingly in 47E(d)
• annotate
DSP 47E(d)
to advise claim has been reopened
If the customer
cannot be contacted:
• 47E(d) claim and progress accordingly in 47E(d)
• annotate the
DSP Appeal/47E(d)
and
DSP 47E(d)
/Notes to advise claim has been reopened
• hold the
DSP Appea 47E(d)
for 7 days
FOI/LEX 76225 - Page 18 of 35
• DSP claim and DSP Appeal held under Hold to User
• when the
DSP Appea 47E(d)
becomes due, make genuine atempts to contact the customer to discuss
withdrawing the quality check/explana�on:
o if the customer agrees to withdraw the quality check/explana�on, ac�on the withdrawal using
the 47E(d)
script
o if contact is unsuccessful, hold
DSP Appeal 47E(d)
for a further 7 days
Continue to make contact attempts to discuss the quality check/explanation until the DSP claim is finalised.
Record all attempts to contact the customer about the quality check/explanation in the
DSP Appeal 47E(d)
47E(d) nd
DSP 47E(d)
Notes.
If customer contact is unsuccessful, finalise the quality check/explanation when the claim is finalised.
Procedure ends here.
3
All other non-medical decisions + Read more ..
For all other non-medical rejection reasons, the SME must follow the process in SME explanations, ARO referrals and
implementing ARO decisions.
Procedure ends here.
SME quality checks of DSP medical decisions for reviews requested before 15 May 2021
Table 3: For appropriately trained staff only.
Step
Action
1
DSP claim rejected on basis of MAT/JCA Recommendation - SME referral to MAT + Read more ..
If a customer has requested a SME quality check
after a DSP Claim has been rejected on the basis of MAT or JCA and:
• no new evidence has been supplied, go to SME explana�ons, ARO referrals and implemen�ng ARO decisions
• new medical evidence has been provided, or a SME iden�fies an error in the original decision recommenda�on, the
case must be returned to MAT, use Fast Note 47E(d)
47E(d)
DSP SME
must:
• complete al the required informa�on in the
Fast Note
• record notes in the
DSP47E(d)
and clearly outline the reason for return to MAT. For example, new medical
evidence lodged or details of the error iden�fied in original decision
• place the
DSP 47E(d) on Hold to User for 7 days
MAT Assessor:
• considers exis�ng medical evidence in the context of the appeal request, and
• completes a new recommenda�on to support the review of decision and uploads this47E(d)
47E(d)
Note: where new medical information is not relevant to the original decision under consideration (that is, DSP claim date and
13 weeks thereafter), however the Assessor indicates the evidence may require further assessment, the Assessor will
recommend the decision is unchanged and add notes to the SA479/MAT Recommendation. The SME is to discuss a possible
reclaim with the customer.
If an appeal JCA referral is required:
• complete the
JCA ref required post MAT 47E(d)
Fast Note
• select referral reason47E(d)
in
Fast Note
• annotate the
DSP 47E(d) with the text 47E(d)
', and
FOI/LEX 76225 - Page 19 of 35
• place the appeal on hold for 28 days
MAT Assessors who are not trained in the JCA referral process must take the
DSP 47E(d)
off hold so it allocates back
to a SME to complete the JCA referral.
Where a JCA referral is not required, return the work item to the DSP SME by taking the
DSP 47E(d)
off hold.
A
new MAT recommendation
must be completed in all scenarios where
new medical evidence is submitted as part of the
request for a review of a decision, even if this evidence does not change the outcome of the recommendation.
In scenarios where the customer has appealed a rejection as a result of an assessment of their DSP claim, and a different
rejection reason applies on the basis of a new assessment,
do not 47E(d)
and reject the claim.
Issue the customer with a Q351 letter advising of the outcome of the quality check, select 47E(d) Incorrect decision at
47E(d)
of the Q351 letter and include the new rejection reason in the free text area.
In any scenario where the customer cannot be contacted to advise of the outcome of the quality check:
• finalise the quality check
• issue the customer with a Q351 leter to no�fy the customer of the outcome and their further review rights.
See SME explana�ons, ARO referrals and implemen�ng ARO decisions
2
SME action post MAT Reassessment + Read more ..
The SME is to review the MAT outcome. If a quality issue is identified, the SME is to refer back to the MAT via the
DSP
47E(d)
Fast Note and select relevant option.
If the MAT decision:
• is
unchanged and the rejec�on supported, contact the customer and finalise appeal as outlined in SME
explana�ons, ARO referrals and implemen�ng ARO decisions. Where the MAT determines the decision is
unchanged because the new medical informa�on is outside the DSP claim period, however may require further
assessment, discuss reclaiming DSP
•
recommends manifest medical eligibility:
o MAT wil assess Con�nuing Inability to Work (CITW) where manifest medical eligibility is met. If CITW
assessment is required but has not been assessed, use 47E(d)
Fast Note 47E(d)
47E(d)
to request CITW assessment
o hold
DSP 47E(d) for 7 days under Hold to User
o once CITW has been assessed, see Residence Assessment for customers claiming Disability Support
Pension
o finalise claim as outlined in Gran�ng Disability Support Pension (DSP) (manifest) or Rejec�ng a new claim
for Disability Support Pension (DSP) including manifest rejec�ons
o contact customer and finalise appeal as outlined in SME explana�ons, ARO referrals and implemen�ng
ARO decisions
•
recommends JCA Referral:
o MAT wil refer to JCA in most instances and place the
DSP 47E(d) on hold for 28 days
o if JCA Referral has not been ac�oned by MAT, create a
JCA Referral 47E(d)
using referral
reason 47E(d)
o annotate the
DSP 47E(d) to advise JCA Referral has been ac�oned, and
o Hold to User for 28 days
3
SME action post JCA Assessment + Read more ...
If the JCA decision:
•
supports rejec�on:
o SME to ac�on (accept) JCA as outlined in Checking and ac�oning a Job Capacity Assessment (JCA) report
o contact customer and finalise appeal as outlined in SME explana�ons, ARO referrals and implemen�ng
ARO decisions
•
supports manifest grant:
o assess DSP claim per normal process
o make sure non-medical eligibility is assessed. See Gran�ng Disability Support Pension (DSP) (manifest)
FOI/LEX 76225 - Page 20 of 35
o contact customer and finalise appeal as outlined in SME explana�ons, ARO referrals and implemen�ng
ARO decisions
•
supports DSP eligibility (not manifest):
o the auto DMA Referral should occur
o if the Auto DMA Referral is not successful, ac�on DMA referral for reason DMA Appeal as outlined
in Disability Medical Assessment referrals
o annotate
DSP 47E(d) to advise DMA referral has been made
o Hold to User for 28 days
o when DMA has been submited, go to Table 4 in Assessing eligibility for Disability Support pension (DSP)
a�er a Disability Medical Assessment (DMA), to finalise claim
o contact customer and finalise appeal as outlined in SME explana�ons, ARO referrals and implemen�ng
ARO decisions
4
DSP claim rejected on the basis of a DMA recommendation - referral to ARO + Read more ..
Where the customer’s DSP claim was originally rejected on the basis of a DMA recommendation, DSP SMEs must refer the
case for a formal review by an ARO. This includes situations where additional medical evidence has been provided.
SME action required:
• run 47E(d)
script
• at Step 447E(d)
• at Step 5 47E(d)
• at Step 647E(d)
• at Step 7 47E(d)
47E(d)
• select '
No' to the ques�on 'Is the customer sa�sfied with the outcome of the quality check?'
• annotate the
DSP 47E(d) to indicate the customer was not actually contacted and why the mater was
referred to an ARO
5
Implementing ARO/AAT decisions for DSP medical decisions + Read more ..
When the ARO or AAT make a decision regarding DSP medical eligibility that requires implementation by a SME, the
instructions are recorded on a
DOC and allocated to a SME.
When implementing ARO/AAT decisions, the SME must:
• review the decision and update the customer’s record as per the instruc�ons provided
• check if updates are required to the Medical Condi�ons Details47E(d)and Work Capacity Details 47E(d) screens
• if the DSP claim was originally rejected on the basis of a MAT Recommenda�on, there wil be no corresponding JCA
line present on the 47E(d)screen and a
Manual JCA ac�vity may be required
• refer to Service Support Officer (SSO) via 47E(d)
overrides or Manual JCA coding is
required. Details of the updates required must include:
o ARO/AAT decision, medical condi�ons, impairment ra�ngs, work capacity, POS (if applicable), and
relevant DSP decision date
• annotate the 47E(d)
DOC to advise referral to SSO has been made
• Hold to User for 28 days
Note:
do not 47E(d)
a DSP 47E(d)
activity while awaiting updates to be made.
SSO will review the ARO/AAT decision and action as follows:
• complete 47E(d)
, see Overriding Medical Condi�ons and Work Capacity recommenda�ons in a Job
Capacity Assessment (JCA) report, or
• refer to Level 2 Policy Helpdesk to request Manual JCA coding 47E(d) coding. 47E(d) coding is required when
there is no exis�ng ESAt/JCA entry on 47E(d)for the Event Date of the DSP claim because the medical outcome was
determined by a MAT Recommenda�on or a Current & Valid ESAt/JCA, from an earlier date
• Level 2 wil update 47E(d)and 47E(d) screen details as required, document the record and finalise the Level 2 Enquiry
FOI/LEX 76225 - Page 21 of 35
• SSO wil finalise 47E(d) database entry to advise SME that 47E(d) overrides or Manual JCA updates have been
finalised
The SME will:
• ac�on claim per normal process, including assessment of non-medical eligibility and run the 47E(d)
47E(d)
script in 47E(d)
to update 47E(d)
system
• if the claim is not ready to be finalised for a non-medical reason,
do not 47E(d)
the claim. Annotate the 47E(d)
47E(d)
DOC and hold for relevant period with outstanding detail. For example, Request for Informa�on
required
• once the non-medical eligibility has been assessed:
o
an
47E(d)
d finalise the claim, and
o run the 47E(d)
script
6
DMA Error 47E(d) + Read more ..
ARO decisions:
ARO decisions to grant DSP must be supported by a DMA assessment (unless customer is manifestly medically eligible).
If decision has been made by ARO and:
• no DMA is present, SME must contact the ARO, refer to process in SME Explana�ons, ARO referrals and
implemen�ng ARO decisions
• DMA is present:
• 47E(d)the claim in 47E(d)
• Make sure non-medical eligibility has been established
• Finalise claim as outlined in 47E(d)
Table 4 of Assessing eligibility for Disability Support Pension
(DSP) a�er Disability Medical Assessment (DMA)
• Run the 47E(d)
script
• DMA report has been accepted and the 47E(d) error is present: 47E(d)
• Check the DMA Report has been accepted and outcome appears on
screen from the correct 47E(d) Date
• If DMA has been accepted and the error is s�l present, refer to process 47E(d)
of Assessing eligibility for Disability Support Pension (DSP) a�er Disability medical Assessment (DMA)
AAT decisions
DMA Error 47E(d)wil be present where AAT make a decision to grant DSP but no DMA exists.
When implementing an AAT decision and an
er
47E(d) ror is present:
• 47E(d)DSP new claim ac�vity in 47E(d)
and make sure claim is ful y coded and
ready to
be finalised
• apply all updates within the claim via 47E(d)
•
47E(d)
go to the47E(d)creen to make sure there are no other errors presen�ng on
• if 47E(d) overrides or Manual JCA coding is required, this must be completed via the 47E(d)
web form
as a separate request
before running the
Fast Note
• use Fast Note - 47E(d)
47E(d)
• annotate the 47E(d)
DOC to advise of the referral to SSO for finalisa�on due to 47E(d)
and place the DSP new claim ac�vity on hold for 5 working days
Service Support Officer (SSO):
• finalise the claim, and
• record the appeal outcome via the 47E(d)
script
• refer to Table 4, Step 12 to determine if a post appeal ESAt is required
If the SSO identifies any errors or outstanding information/assessments required before DSP claim can be finalised, SSO will:
FOI/LEX 76225 - Page 22 of 35
• annotate the 47E(d)
• send feedback to SME via Staff Feedback Tool, and
• refer back to SME via email to their Team Leader for fol ow up ac�on
SME explanations of DSP medical decisions requested on or after 15 May 2021
Table 4: For appropriately trained staff only.
Step
Action
1
DSP claim rejected and no new medical evidence lodged + Read more ..
If the customer has requested an explanation of the decision after the DSP claim has been
rejected and
no new medical
evidence has been supplied, the
SME must:
• check the record to get a clear understanding of why the decision was made
• check for any errors or informa�on that was not considered in the original decision:
o if an error regarding medical eligibility (for example, incorrect version of the Impairment Tables has been
applied) or informa�on that was not considered is iden�fied, go to Step 2
o if no errors in the original decision are iden�fied or no informa�on is provided, make genuine atempts to
contact the customer to provide an explana�on of the decision
If customer contact is successful:
• explain the reason for the decision
• where the rejected DSP claim was lodged before 1 April 2023, tel the customer the Impairment Tables used to
assess medical eligibility for DSP have changed from 1 April 2023. Direct the customer to the Services Australia
website for more details
• explain their review and appeal rights including:
o they can apply for a formal review at any �me
o it is important to apply for a formal review within 13 weeks of being no�fied about the decision. If their
applica�on is made more than 13 weeks a�er being no�fied of the decision and the decision can be
changed, they may only receive their en�tlement from the date they applied for the formal review
o ask the customer if they would like to provide any addi�onal medical evidence to be considered
If the customer does not want to supply additional medical information:
• 47E(d)
script and finalise the request for an explana�on with the outcome 47E(d)
(Decision not changed)
• if the customer wants to apply for a formal review of the decision, in the script, key today’s date as the date the
customer applied for a formal review on the 47E(d)
screen. See 47E(d)
47E(d)
script
• procedure ends here
If the customer indicates they would like to supply additional medical information for the SME explanation:
• tel the customer to supply informa�on within 7 days. Explain that if informa�on is not provided, the explana�on
wil be finalised and no further ac�on wil be taken
• update the 47E(d)
DOC and hold for 7 days
• apply Hold to User
After 7 day hold period, if information has:
• been supplied, go to Step 2
• not been supplied, use the 47E(d)
script to finalise the request for an explana�on
• procedure ends here
If customer contact attempt is unsuccessful:
FOI/LEX 76225 - Page 23 of 35
• use the 47E(d)
script to finalise the request for an explana�on with the outcome 47E(d)
(Decision not changed)
• the script creates a 47E(d) to be sent to the customer invi�ng them to contact
•
DOC the record with the informa�on required to explain the decision to the customer if they contact
• procedure ends here
2
Customer lodges new medical information or medical error identified + Read more ..
Determine the basis for the medical rejection (for example, MAT, JCA, DMA) where:
• the customer has requested a SME explana�on a�er their DSP claim has been rejected and has supplied new
medical evidence, or
• an error regarding medical eligibility/evidence has been iden�fied
If the DSP claim was rejected on the basis of:
• MAT or JCA recommenda�on, go to Step 3
• DMA recommenda�on, go to Step 7
3
DSP claim rejected on the basis of MAT or JCA recommendation + Read more ..
The SME must:
• create an open work item using the Fast Note - 47E(d)
47E(d)
• annotate 47E(d)
clearly advising that addi�onal medical evidence has been provided or an error
regarding medical eligibility/evidence has been iden�fied and referred to MAT for considera�on and hold for 7 days
• apply Hold to User
The MAT Assessor will:
• consider exis�ng or new medical evidence in the context of the appeal request, and
• complete a new recommenda�on to support the review of decision and upload this to47E(d)
(47E(d) or
SA479)
Note: where new medical information is not relevant to the decision under consideration (that is, DSP claim date and 13
weeks thereafter), however the Assessor indicates the evidence may require further assessment. The Assessor will recommend
the decision is unchanged and, add notes to the SA479/MAT Recommendation. The SME is to discuss a possible reclaim with
customer. For decisions, with a date of effect before 1 April 2023, tell customer about the new Impairment Tables from 1
April 2023 and direct them to the Services Australia website.
Once the MAT assessment has been completed, the SME is to review the MAT outcome, if a quality issue is identified, the
SME is to refer back to the MAT via 47E(d)
Fast Note and select relevant option.
Where MAT recommends:
• the decision is unchanged or varied, go to Step 4
• manifest medical eligibility, go to Step 5
• JCA referral, go to Step 6
4
MAT recommends no change or variation to DSP rejection + Read more ..
If the decision is unchanged or varied, the SME must:
•
not 47E(d) and reject a claim decision, even if the rejec�on reason has changed. For example, 47E(d)
47E(d)
• make genuine atempts to contact the customer to provide an explana�on
FOI/LEX 76225 - Page 24 of 35
If customer contact is
successful:
• explain the reason for the decision, including any changes in medical eligibility
• if the MAT determine the decision is unchanged because the new medical informa�on is outside the DSP claim
period, however may require further assessment, discuss reclaiming DSP
• where the rejected DSP claim was lodged before 1 April 2023, tel the customer the Impairment Tables used to
assess medical eligibility for DSP have changed from 1 April 2023. Direct the customer to the Services Australia
website, for more details
• explain their review and appeal rights, including:
o they can apply for a formal review at any �me
o it is important to apply for a formal review within 13 weeks of being no�fied about the decision. If their
applica�on is made more than 13 weeks a�er being no�fied of the decision and the decision can be
changed, they may only receive their en�tlement from the date they applied for the formal review
• clearly
DOC the discussion with the customer, including if they were sa�sfied with the explana�on
• use the 47E(d)
script and finalise the request for an explana�on with the outcome 47E(d)
(Decision not changed)
• if the customer wants to apply for a formal review of the decision, in the script, at
Finalise Explana�on and/or
Refer to ARO (if appropriate) > '
Has the customer applied for a formal review by an ARO?' > select
Yes. See Using
the 47E(d)
script
• procedure ends here
If customer contact attempt is
unsuccessful:
• use the 47E(d)
script and finalise the request for an explana�on with the outcome 47E(d)
(Decision not changed)
• 47E(d)
invi�ng them to contact to discuss the decision
• clearly
DOC the record advising contact unsuccessful and include the informa�on required to explain the decision
to the customer if they contact. Include details about assessment of new medical informa�on and the outcome of
the MAT Assessment
• procedure ends here
5
MAT recommends manifest medical eligibility + Read more ..
The SME must check customer’s residence details and determine if a Continuing Inability To Work (CITW) assessment is
required, and has been assessed.
If a CITW assessment is required and not assessed:
• use the 47E(d)
Fast Note,47E(d)
• annotate the 47E(d)
DOC to advise referral to MAT to assess CITW and hold for 7 days
• apply Hold to User
Once CITW has been assessed, continue assessment on non-medical eligibility. See Streaming a new claim for Disability
Support Pension.
If non-medical eligibility is met:
• finalise claim as outlined in Gran�ng Disability Support Pension (DSP) (manifest)
• make genuine atempts to contact the customer and complete the47E(d)
DOC
If contact is:
•
successful:
o explain the decision
o use the 47E(d)
script with outcome
Decision 47E(d)
47E(d)
•
not successful:
o use the47E(d)
script with outcome
Decision 47E(d)
47E(d)
o 47E(d)
invi�ng customer to contact to discuss the decision
FOI/LEX 76225 - Page 25 of 35
If non-medical eligibility is not met make genuine attempts to contact the customer and explain medical eligibility has been
met, but customer is not eligible for DSP due to non-medical eligibility. If contact is:
•
successful:
o use the 47E(d)
script and select the outcome 47E(d)
o if the customer wishes to apply for a formal review, in the script, 47E(d)
47E(d)
See Using
the 47E(d)
script
•
not successful:
o use the 47E(d)
script and select the outcome47E(d)
• 47E(d)
invi�ng customer to contact to discuss the decision
• procedure ends here
6
MAT recommends JCA Referral + Read more ..
MAT
must take 47E(d)
DOC off hold so work item presents to SME for actioning.
The SME must make genuine attempts to contact the customer.
If customer contact is successful:
• explain further assessment of medical eligibility is needed
• to make sure a thorough assessment, the decision wil be referred to an Authorised Review Officer who wil
undertake a formal review
• use the 47E(d)
script and finalise the request for an explana�on:
o select the
Outcome 47E(d)
o in the
Reason for outcome, 47E(d)
47E(d)
47E(d)
o key 47E(d)
as the date the customer applied for a formal review
o 47E(d)
confirming the referral to ARO
• Refer to JCA, use
Fast Note - 47E(d)
47E(d)
o In the
Fast Note text, select47E(d)
o Make sure the ques�on regarding Residence/Qualifying Residence Exemp�on is answered correctly,
see Disability Support Pension Residence Screens Checklist
• where the rejected DSP claim was lodged before 1 April 2023, tel the customer the Impairment Tables used to
assess medical eligibility for DSP have changed from 1 April 2023. Direct the customer to the Services Australia
website, for more details
• procedure ends here
If customer contact attempt is unsuccessful:
• use the 47E(d)
script and finalise the request for an explana�on:
o select the outcome 47E(d)
o in the
Reason for outcome, 47E(d)
47E(d)
47E(d)
o key 47E(d)
as the date the customer applied for a formal review. See 47E(d)
47E(d)
script
o 47E(d)
confirming the referral to ARO
•
cancel the47E(d)
and issue a
manual leter. In47E(d)
o go to the 47E(d)
screen. The47E(d) of the leter wil be 47E(d)
o 47E(d)
The leter status wil change to47E(d)
o47E(d)
o send a 47E(d)
to no�fy the customer that the decision has been referred to an ARO who wil
undertake a formal review. See suggested text on the Resources page
o use the 47E(d)
Fast Note47E(d)
• procedure ends here
7
DSP claim rejected on the basis of DMA recommendation + Read more ..
FOI/LEX 76225 - Page 26 of 35
The SME must:
• inves�gate the original decision
• check for any errors or informa�on that was not considered in the original decision. For example, informa�on on
medical condi�on which was previously provided but not considered in the DMA report
• review new medical evidence and determine if further assessment of the medical evidence is required. For
example, further assessment would not be required if:
o the medical evidence is the same as the evidence that has already been assessed, or
o it is clear the new evidence wil not impact medical eligibility as it relates to a condi�on which is likely to
persist for less than 2 years
If the SME determines a further medical assessment is:
• not required, go to Step 8
• required, go to Step 9
8
SME determines further medical assessment is not required + Read more ..
The SME must make genuine attempts to contact the customer.
If customer contact is
successful, explain:
• new medical evidence has been considered but outcome has not changed
• where the rejected DSP claim was lodged before 1 April 2023, tel the customer the Impairment Tables used to
assess medical eligibility for DSP have changed from 1 April 2023. Direct the customer to the Services Australia
website, for more details
• explain their review and appeal rights including:
o they can apply for a formal review at any �me
o it is important to apply for a formal review within 13 weeks of being no�fied about the decision. If their
applica�on is made more than 13 weeks a�er being no�fied of the decision and the decision can be
changed, they may only receive their en�tlement from the date they applied for the formal review
• use the 47E(d)
script and finalise the request for an explana�on with outcome 47E(d)
47E(d)
• if the customer wants to apply for a formal review of the decision, in the script, 47E(d)
47E(d)
select 47E(d) See Using
47E(d)
script
• procedure ends here
If the customer contact attempt is
unsuccessful:
• use the 47E(d)
script and finalise the request for an explana�on with outcome47E(d)
47E(d)
• 47E(d)
invi�ng them to contact to discuss the decision
• procedure ends here
9
SME determines further medical assessment is required + Read more ..
The SME must make genuine attempts to contact the customer.
If customer contact is
successful, explain:
• further assessment of medical eligibility is needed
• to make sure a thorough assessment, the decision wil now be referred to an Authorised Review Officer who wil
undertake a formal review
• use the 47E(d)
script and finalise the request for an explana�on:
o select the outcome 47E(d)
o in the
Reason for outcome, key 47E(d)
47E(d)
o key
d
47E(d) ate as the date the customer applied for a formal review
• 47E(d)
confirming the referral to ARO
FOI/LEX 76225 - Page 27 of 35
• procedure ends here
If customer contact is
unsuccessful:
• use the 47E(d)
script and finalise the request for an explana�on
o select the outcome 47E(d)
o in the
Reason for outcome, key the text 47E(d)
47E(d)
o key 47E(d) date as the date the customer applied for a formal review
o 47E(d)
confirming the referral to ARO
•
cancel the47E(d)
and issue a
manual leter. 47E(d)
o go to the 47E(d)
screen. The 47E(d) of the leter wil be 47E(d)
o 47E(d) the leter. The leter status wil change to generated 47E(d)
o 47E(d) the leter
o send a 47E(d) to no�fy the customer that the decision has been referred to an ARO who wil
undertake a formal review. See suggested text on the Resources page
• procedure ends here
10
Implementing ARO/AAT decisions for DSP medical decisions + Read more ..
When ARO or AAT make a decision regarding DSP medical eligibility that requires implementation by a SME, the
instructions are recorded on a
DOC and allocated to a SME.
When implementing ARO/AAT decisions:
• review the decision and update the customer’s record as per the instruc�ons provided
• check if updates are required to the 47E(d)
and 47E(d)
screens
• if the DSP claim was original y rejected on the basis of a MAT Recommenda�on, there wil be no corresponding JCA
line present on the
s
s47E(d) creen and a
Manual JCA ac�vity may be required
• refer to Service Support Officer (SSO) via 47E(d)
where 47E(d) overrides or Manual JCA coding is
required. Details of the updates required must include:
o ARO/AAT decision, medical condi�ons, impairment ra�ngs, work capacity, POS (if applicable), and
relevant DSP decision date
• annotate the 47E(d)
DOC to advise referral to SSO been made
• Hold to User for 28 days
Note:
do not index a DSP 47E(d)
activity while awaiting updates to be made.
SSO will review the ARO/AAT decision and action as follows:
• complete 47E(d) overrides per Overriding Medical Condi�ons and Work Capacity recommenda�ons in a Job
Capacity Assessment (JCA) report, or
• refer to Level 2 Policy Helpdesk to request Manual JCA coding. 47E(d) coding is required when there is no exis�ng
ESAt/JCA entry on 47E(d)for the Event Date of the DSP claim because the medical outcome was determined by a MAT
Recommenda�on or a Current & Valid ESAt/JCA, from an earlier date
• Level 2 wil update47E(d) and 47E(d) screen details as required, document the record and finalise the Level 2 Enquiry
• SSO wil finalise 47E(d)
entry to advise SME that 47E(d)overrides or Manual JCA updates have been
finalised
The SME will:
• ac�on claim per normal process, including assessment of non-medical eligibility and run the 47E(d)
47E(d)
script in 47E(d)
system
• if the claim is not ready to be finalised for a non-medical reason, do not 47E(d)the claim. Annotate the 47E(d)
47E(d)
DOC and hold for relevant period with outstanding detail. For example, Request for Informa�on
required
• once the non-medical eligibility has been assessed:
o 47E(d) and finalise the claim in 47E(d)
o if no error presents and claim is finalised run the 47E(d)
script, and
o refer to Step 12 to determine if a post appeal ESAt is required
FOI/LEX 76225 - Page 28 of 35
o if a DMA Error 47E(d) presents, go to Step 11
11
DMA Error 47E(d) + Read more ..
ARO decisions
ARO decisions to grant DSP must be supported by a DMA Assessment (unless customer is manifestly medically eligible).
• If decision has been made by ARO, and no DMA is present, SME must contact the ARO, refer to process outlined
in SME Explana�ons, ARO referrals and implemen�ng ARO decisions
• If decision has been made by ARO and DMA is present:
o 47E(d) the claim 47E(d)
o Make sure non-medical eligibility has been established
o Finalise claim as outlined in the47E(d)
of Assessing eligibility for Disability Support
Pension (DSP) a�er a Disability medical Assessment (DMA)
o Run the 47E(d)
script
o Refer to Step 12, to determine if a post appeal ESAt is required
• If the DMA Report has been accepted and the 47E(d) error is present:
o Check the DMA Report has been accepted and outcome appears on
sc
47E(d)
reen from the correct Event
Date
o If DMA has been accepted and the error is s�l present, refer to process outlined in the 47E(d)
47E(d) Assessing eligibility for Disability Support Pension (DSP) a�er Disability medical Assessment
(DMA)
AAT decisions
DMA Error 47E(d)wil present where AAT make a decision to grant DSP but no DMA exists.
When implementing an AAT decision and an 47E(d)
error is present
• 47E(d)DSP new claim ac�vity in 47E(d)
and make sure claim ful y coded and ready to be
finalised
• apply al updates within the claim via 47E(d)
• go to the
47E(d)
47E(d)screen to make sure there are no other errors presen�ng on
• if 47E(d) overrides or Manual JCA coding is required, this must be completed via the 47E(d)
web form
as a separate request
before running the
Fast Note
• use Fast Note 47E(d)
47E(d)
• annotate the 47E(d)
DOC to advise of the referral to SSO for finalisa�on due to 47E(d) error
and place the DSP new claim ac�vity on hold for 5 working days
Service Support Officer (SSO):
• finalise the claim
• record appeal outcome via the 47E(d)
script
• refer to Step 12, to determine if a post appeal ESAt is required
If the SSO identifies any errors or outstanding information/assessments required before DSP claim can be finalised, SSO will:
• annotate the 47E(d)
• send feedback to SME via Staff Feedback Tool, and
• refer back to SME via email to their Team Leader for fol ow up ac�on
12
Post appeal ESAt referral + Read more ..
Where47E(d)
and 47E(d)
screens are updated by manual overrides of the JCA, the amended
work capacity may not be recognised by Employment Services Providers such as, Workforce Australia or Disability
Employment Services (DES). Therefore, a post appeal implementation ESAt may be required:
• If a JCA assessment was undertaken as part of the ARO/AAT appeal an ESAt referral is not required. Procedure ends
here
FOI/LEX 76225 - Page 29 of 35
• If a manual JCA ac�vity 47E(d)) was coded by Level 2 an ESAt referral is not required. Procedure ends here
• If 47E(d) overrides were completed to support the appeal implementa�on:
o Check customer’s 47E(d)
in 47E(d)
and view 47E(d)
47E(d)
o If there is no Provider referral, ESAt referral is not required. Procedure ends here
• If customer has a current Provider referral, refer for a DSP Volunteer ESAt:
o Use Fast Note, 47E(d)
47E(d)
o Add text to ESAt referral - 47E(d)
47E(d)
For more information, see Request an Employment Services Assessment (ESAt).
Making a JCA referral for a formal review of decision
Table 5
Step
Action
1
Customer has requested a review of a decision or has appealed a review officer's decision to the Administrative
Appeals Tribunal (AAT) first review + Read more ..
Customer has requested a review of a decision or has requested an AAT first review of a review officer's decision to:
• reject a new claim for DSP, or
• cancel payment of DSP
Tribunals can request Government-contracted Doctors (GCD) to appear before them to give evidence.
Note: DSP cannot be granted without the claimant having attended a Disability Medical Assessment (DMA) (excluding
manifest cases). See Eligibility for Disability Support Pension (DSP).
When a review of decision is received:
• the JCA wil be booked into the 47E(d) as a DSP Appeal by Assessment Services if the request is for a file
assessment, the original assessor (where possible) wil conduct this assessment, this is due to their prior knowledge
of the customer as they have met them in person
• the Assessor wil then review the previous assessment and addi�onal medical informa�on provided and complete a
new report with recommenda�ons
A DMA is required where an Authorised Review Officer (ARO) sets aside or varies a DSP claim rejection and:
• the claim was manifestly rejected
• the JCA report indicated no Diagnosed, Reasonably Treated and Stabilised (DTS) condi�ons or impairment ra�ngs/s
<20 points
• the JCA report indicates impairment ra�ng/s >20 points, but:
o POS not met, or
o work capacity > 15 hours per week, or
o inability to work did not occur in Australia
2
Customer has applied for a second review or has lodged an appeal with the Federal or High Court + Read more ..
Customer is appealing to the:
• AAT (second review)
• Federal Court, on a point of law only, or
• High Court, with leave of the Court
To complete a new JCA referral as part of the review and appeal process, there are different teams and roles involved:
• Li�ga�on and Informa�on Release (LIR) Branch, go to Step 3
FOI/LEX 76225 - Page 30 of 35
• Assessment Services Na�onal Administra�on Team (ASNAT) Support Team (ASNAT Support), go to Step 4
• Assessment Services Director (ASD), go to Step 5
• Assessment Services Assistant Director (ASAD):
o to assign the assessment, go to Step 6
o for quality assurance, go to Step 8
• Assessor, go to Step 7
3
Litigation and Information Release (LIR) Branch, Services Australia Legal Division initiate the JCA request + Read
more ..
For an AAT second review, or an appeal to Federal Court or High Court, an Advocate from the LIR Branch, Services
Australia Legal Services Division will email the ASNAT Support requesting a JCA for the customer. The request should
include:
• Customer name, contact details and Customer Reference Number (CRN)
• Details of original claim
• Appeal deadline
• Original JCA provider
• Prevalent medical condi�ons and medical evidence. Medical evidence can be obtained by contac�ng the LIR
Branch, Services Australia Legal Services Division
• Date the report is required by, and
• Addi�onal requests (for example, what the report should concentrate on, report submission details)
The LIR Branch are responsible for recording a
DOC on the customer's record advising an AAT second review, Federal Court
or High Court Appeal is in progress and details about the JCA referral.
Note: the AAT, Federal Court or High Court can request clarification from the Health Professional Advisory Unit (HPAU), in
reference to advice the HPAU has previously provided regarding a DSP new claim or DSP medical review.
4
ASNAT Support - action the JCA request + Read more ..
On receipt of the emailed request:
• record details of the customer into the 47E(d)
as an appeal
• assign the new assessment to the Assessment Services Director (ASD) responsible for the Zone
• email the JCA request to the ASD including:
o Referral reason (either pre 1/7/06 DSP appeal or DSP appeal)
o Format of assessment (prescribed by the LIR Branch request)
o Assessor discipline (determined by customer's primary medical condi�ons)
o Report date
o Arrangements for medical evidence (either atached as PDFs or electronic Medical File Envelope (eMIFE))
o Request for appointment details and the name of the Assessor to be provided to the ASNAT Support
o Any other specific aspects the Advocate has requested to have addressed or inves�gated for example, if
the customer has indicated there is a specific symptom that requires further inves�ga�on
o Any special interview condi�ons required for example, Interpreter
The ASD will acknowledge receipt of the email and make sure the details of the appointment time/date and assessor is
provided to the ASNAT Support and the Advocate:
• Advocates must be informed of the �me/date of assessment so that:
o medical informa�on can be provided to the assessor
o to allow the AAT or Court to be informed of the date the assessment wil be completed
• the ASNAT Support team wil update the Appeals database with the assessment details once provided by the
Assessment Services Assistant Director (ASAD), including the Assessor and appointment date/�me
• when ASNAT Support is advised who the Assessor is, the ASD wil check their qualifica�ons meet requirements, and
no�fy the LIR Branch of the details of the assessment
• two days before the due date, ASNAT Support wil check on progress, and send a reminder of the due date to the
ASD. When the report has been submited and received by ASNAT Support, they wil send a clearance email to the
Director with a coversheet detailing expert witness guidelines and a request for the assessor to lodge a claim for
reimbursement in the 47E(d)
for reimbursement from the Department of Social Services
FOI/LEX 76225 - Page 31 of 35
Any additional paperwork received from the LIR Branch needs to be forwarded directly to the Assessor.
Note: ASNAT Support must monitor appeal assessment due dates by checking the 47E(d)
each
morning.
5
Assessment Services Director (ASD) - assign the request + Read more ..
Acknowledge the email request from ASNAT Support and assign the assessment to the appropriate ASAD.
Make sure the details of the appointment time/date and Assessor is provided to ASNAT Support and the Advocate.
If the assessment is not submitted by the day before the due date, a reminder will be received from ASNAT Support to ASD to
follow up with the ASAD.
6
Assessment Services Assistance Director (ASAD) - assign the assessment + Read more ..
Assign the JCA assessment request to a team Assessor with the appropriate qualifications to undertake the new
assessment,
or the requested Assessor.
The ASAD makes sure the assessor is aware that:
• they may be required to atend the AAT or Court hearing to give evidence about the content of their report and
assessment of the customer
• they must use a Contribu�ng Assessor if the Impairment Table(s) used are not within their area of exper�se
Provide ASNAT Support with the Assessor details, along with the customer's appointment time/date once arranged.
7
Assessor - complete the DSP Appeal JCA report + Read more ..
Review the medical information, particularly any additional information which was not available for the original assessment
and consider the specific request/requirements detailed in the email.
If unable to contact the customer's doctor and get clarification about a medical condition, contact the Health Professional
Advisory Unit (HPAU) and discuss.
Where required conduct a face to face assessment. This is required where evidence is provided about a new condition that was
not previously assessed.
Engage a Contributing Assessor if the Impairment Table(s) used is not within the assessor's area of expertise.
When completing the report make sure:
• all medical informa�on par�cularly any addi�onal informa�on which was not available for the original assessment
has been reviewed
• specific request/requirements provided by the LIR Branch were addressed/inves�gated
• if required, a face to face assessment was conducted
• the report includes any differences in assessed work capacity or impairment ra�ngs from the original report and
the reasons for these differences, or confirms there is no change with the addi�onal informa�on
Once the draft JCA has been completed, arrange for the ASAD to apply the quality assurance process to the assessment.
The ASNAT Support will send a claim form to the Assessor for them to complete to claim reimbursement from the
Department of Social Services once the appeal assessment has been completed.
8
ASAD - quality assurance + Read more ..
In completing a quality assurance (QA) check of an appeal report, the ASAD is required to make sure:
• the Assessor discipline is appropriately matched to the medical condi�on and the correct version of the
Impairment Tables
• if the report was a file assessment, the report includes advice the Informa�on Sharing Arrangements was
not
read to the client
• the Advocate's requests were met
• the Contribu�ng Assessor was used where required
FOI/LEX 76225 - Page 32 of 35
• the report reviews the customer's present eligibility for DSP and contains comments rela�ng to eligibility for DSP at
the �me of the original claim, plus 13 weeks
• al decisions are supported by medical evidence
• details of any contact with or atempts to contact the trea�ng doctor were made (where required) are recorded
• any specific requests by the Advocate have been addressed
• all recommenda�ons in the report are ful y jus�fied and provide a clear ra�onale as to how they were reached
including an explana�on of why any outcomes may differ from the original report
• high quality presenta�on ensuring the report has no typographical or gramma�cal errors
The National Support Professional Services Team can offer support and guidance to assist in the completion of complex
appeals.
Once the QA check has been completed, the report is to be submit ed.
The ASAD is to ask the Assessor to submit the report and provide a copy of the submitted report to the ASD to forward to the
ASNAT Support. A copy is also to be forwarded to the LIR Branch where appropriate.
Note: if the report is opened and changed by the Assessor they must advise the LIR Branch of the changes made.
The ASNAT Support will send a claim form to the Assessor to complete to claim reimbursement from the Department of
Social Services once they have completed the appeal assessment. The ASAD will make sure that a claim for the time spent on
the appeal is sent to ASNAT Support.
The ASAD will make sure that:
• the LIR Branch receives a copy of the submited report, and
• a claim is sent for work done an Appeal Assessment to ASNAT Support
The National Support Professional Services Team will incorporate into the Quality Framework, random sampling of this work
to make sure that consistency and quality of AAT Appeal reports is maintained.
9
When an 'Appeal Outcome' JCA is required + Read more ..
An 'Appeal Outcome' JCA will be required where it is decided, fol owing a review of decision, that the customer's medical
condition/s, impairment rating/s or work capacity is different from the most recent JCA report.
This must be conducted as a file assessment. The referral is arranged using one of the following reasons:
• a JCA using 47E(d) Appeal Outcome (DSP) reason wil require comple�on of 'with interven�on' work capacity
• a JCA completed using 47E(d) Appeal Outcome (DSP pre 1/7/06) reason wil require comple�on of 'with
mainstream interven�on' work capacity
There should generally be no need to override the original JCA recommendations on the 47E(d)
47E(d)
screens as the review of decision outcome will be applied to the customer's record once the new report is
accepted.
The Assessor completing the 'Appeal Outcome' JCA report must make sure the recommendations in the report (including
medical conditions, impairment, work capacity and referral recommendations) are consistent with the delegate's decision
taking into account relevant medical evidence.
Staff accepting a submitted 'Appeal Outcome' JCA report must make sure that:
• recommenda�ons about medical condi�ons, impairment and work capacity are consistent with the review of
decision
• the correct Event Date is recorded, consistent with the decision being reviewed
• appropriate ac�on is taken to connect customers with mutual obliga�on requirements with the recommended
services (such as Disability Employment Services (DES))
DSP customers with participating requirements are identified.
10
Finalise the review + Read more ..
FOI/LEX 76225 - Page 33 of 35
To finalise appeal
47E(d)
Making an ESAt or JCA referral when a review of a previous decision is pending
Table 6
Step
Action
1
Pending review of a previous decision + Read more ..
In most cases there should be a
DOC on the customer's record showing the progress of their review request and a contact
person.
If required to confirm the identity of the contact person go to the 47E(d)
screen in the 47E(d)
system 47E(d).
Select the relevant appeal record.
Check the 47E(d)
screen and identify the current review level. Go to the following screens:
• for Subject Mater Expert (SME), go to the 47E(d)
screen and check the 47E(d)
field
• for Authorised Review Officer (
ARO), go to the 47E(d)
screen and check the
47E(d) field
• Administra�ve Appeals Tribunal (AAT
first review)
o for maters s�l current at the AAT, go to the 47E(d)
screen
o for maters finalised at the AAT, go to the 47E(d)
screen and check the 47E(d)
47E(d)
• for Administra�ve Appeal Tribunal (AAT
second review), go to the 47E(d)
screen and check the 47E(d)
47E(d)
field
If the deferral
DOC is due, go to Step 4.
Is a review of decision underway?
•
Yes, go to Step 2
•
No, con�nue making an ESAt or JCA referral. Procedure ends here
2
Consultation required to determine if referral should be deferred + Read more ..
Determine if a new assessment may affect the outcome of the review of decision:
• for an internal review, check with the SME or ARO
• for an AAT first �me review (current), check with the ARO
• for an AAT first �me review (finalised and returned to the agency), check with an Advocate in the Legal Services
Division
FOI/LEX 76225 - Page 34 of 35
• for an AAT second review (regardless of progress), check with an Advocate in the Legal Services Division
This is important if the review request is concerned with medical or work capacity issues affecting entitlement and mutual
obligation requirements.
3
Deferring or proceeding with a referral + Read more ..
Does this consultation indicate a new assessment should be deferred until after the current review of decision is finalised?
•
Yes, create a Note/
DOC on the customer's record. Do not finalise the Note/
DOC. Resubmit the Note/
DOC for the
expected decision date of the review (up to a maximum of 28 days)
•
No, con�nue making an ESAt or JCA referral. Procedure ends here
4
Finalise the decision + Read more ..
When the review of decision has been finalised:
• record the outcome of our review
• record any ac�on take on the referral
• finalise the
DOC
If still required make a new ESAt or JCA referral.
Resources
Suggested 47E(d) text
Letter text
47E(d)
Intranet links
Assessment Services Branch
Contact details
Assessment Services
FOI/LEX 76225 - Page 35 of 35
Training & Support
Add the course number to the
Search field in the Learning Portal (LMS) in ESSentials:
•
CLK01303 - The Internal Review Process (CSDG only)
•
CLK01252 - The SME role in Internal Review
