1.1.M.100 Medical evidence (DSP, SA, JSP, partial capacity to work)
For the purposes of DSP, SA, JSP and determining partial capacity to work (1.1.P.65), medical evidence is corroborating evidence that provides information about a person's medical condition/s (1.1.M.90) and resulting impact. This documentation may include, but is not limited to:
- reports, medical records or certificates from medical practitioners including specialists
- reports from health professionals including allied health professionals
- results of diagnostic tests
- compensation or rehabilitation reports
- medical imaging or operative reports, or
- hospital records.
Medical evidence requirements may vary depending on the purpose for which the evidence is collected and used.
For DSP, medical evidence requirements may vary depending on a person's circumstances (126.96.36.199). Generally, medical evidence for DSP must contain sufficient information to determine whether a person's condition is permanent for DSP purposes (1.1.P.220), that is whether the condition is fully diagnosed, treated and stabilised (1.1.F.240) and more likely than not to persist for more than 2 years. As such, the required primary medical evidence for DSP must contain information about diagnosis, treatment (past, current and future) and prognosis for the condition. For DSP, the Impairment Tables (1.1.I.10) also set out when supporting evidence of a diagnosis is required. In addition, the evidence must also contain sufficient information on the condition's impact on the person's ability to function.
For SA or JSP, the primary source of medical evidence is a certificate from a medical practitioner containing information about diagnosis, prognosis and whether the person is incapacitated for their usual work or study, and if so for how long.
For the purpose of determining whether a person has a partial capacity to work because of an impairment, medical evidence is required to contain diagnosis by a medical practitioner of a condition that gives rise to the impairment as well as information about the functional impact of the impairment.
Note: SA closed to all new entrants on 20 March 2020 and ceases on 20 September 2020.
Those receiving SA before 20 March 2020 may continue to receive the payment for the length of their medical certificate, as long as they remain eligible, or may transfer to JSP (1.2.1.05).
From 20 March 2020, SA recipients who require income support after their current medical certificate expires must transfer to JSP or another income support payment.
Act reference: SSAct section 94 Qualification for DSP, section 593 Qualification for JSP, section 666(1) Qualification for SA, section 16B Partial capacity to work
Policy reference: SS Guide 188.8.131.52 Medical & Other Evidence for DSP, 3.6.5 SA - Qualification & Payability, 1.1.P.65 Partial capacity to work (JSP, YA (job seeker), PP & SpB (NVH)), 3.6.3 Guidelines to the Tables for the Assessment of Work-related Impairment for DSP