6.2.5.03 DSP - application of DSP qualification rules at review

Overview

Since 2006, the DSP legislative qualification criteria have undergone a number of changes, mainly to the CITW (1.1.C.330) requirements and associated definitions.

The Impairment Tables (1.1.I.10) were also reviewed in 2011 and again in 2022, and the revised (current) Impairment Tables have been in force since 1 April 2023.

This topic explains which DSP impairment and CITW qualification criteria apply at review, dependent on the DSP recipient's start date and other factors. The topic also explains which version of the Impairment Tables is to be used at review.

Assessment of impairment at review

At review ALL DSP recipients are assessed against the DSP qualification requirement of having a physical, intellectual or psychiatric impairment of at least 20 points under the Impairment Tables. However, depending on the commencement date of an individual review, either the pre 2023 or the current Impairment Tables are used at review to assess the recipient's impairment.

Which version of the Impairment Tables applies at review?

The current Impairment Tables (commenced on 1 April 2023) apply to ALL DSP medical reviews, regardless of a recipient's start date on DSP, where a notice to participate in such a review is issued on or after 1 April 2023.

Assessment of CITW at review - DSP recipients with start date before 11/05/2005

At review, DSP recipients whose start date on DSP is before 11 May 2005 are assessed against the pre-1 July 2006 CITW criteria and definitions, including the 30 hour work capacity rule.

Assessment of CITW at review - DSP recipients with start date from 11/05/2005 to 30/06/2006

These DSP recipients originally qualified for DSP under the 30 hour work capacity rule. Recipients in this group are known as transitional recipients.

At review, these recipients are assessed against the CITW criteria and definitions in force from 1 July 2006, including the 15 hour work capacity rule. The POS requirements do not apply to these recipients.

In practice it is unlikely that decision makers would now encounter any cases in this category that have not already been reviewed.

Assessment of CITW at review - DSP recipients with start date on or after 1/7/2006

At review, ALL DSP recipients whose start date on DSP is on or after 1 July 2006 are assessed against the CITW requirements of being unable to work for 15 hours per week in the next 2 years and being unable to be retrained for such work in the next 2 years (the 15 hour work capacity rule).

However, under the SSAct sections 96(1) and 96(2), from 1 July 2012 DSP recipients may continue to receive DSP if they obtain paid work of at least 15 and less than 30 hours a week notwithstanding that to qualify for DSP they must be assessed as having a work capacity of less than 15 hours a week. This means that if a DSP recipient to whom the 15 hour work capacity rule applied at claim is reviewed and is found working for these hours but is also found not be a reviewed 2008-2011 DSP starter (1.1.R.285), they will be considered to have a CITW.

The POS requirements (1.1.P.440) generally do not apply at review unless a DSP recipient is a reviewed 2008-2011 DSP starter. A recipient can only become a reviewed starter if the recipient is under age 35 at review, their start date is between 1 January 2008 and 2 September 2011 and they meet all the other conditions for reviewed starters. The rules applying at review to DSP recipients under age 35 whose start date on DSP is between 1 January 2008 and 2 September 2011 are provided below.

DSP recipients under age 35 years with start date between 01/01/2008 & 31/12/2011

The following rules apply to reviewing DSP recipients who are under age 35 when they are given a review notice (initial review) and whose start date on DSP is between 1 January 2008 and 2 September 2011.

The DSP recipients in this category who are found on review to have a total impairment rating of less than 20 points and/or are found NOT TO meet the CITW criteria of being unable to work for at least 15 hours per week in the next 2 years and being unable to be retrained for work in the next 2 years, do not qualify for DSP and their payment is to be cancelled.

The DSP recipients in this category who are found at review to have a severe impairment (that is, they are assessed as having an impairment rating of at least 20 points under a single Impairment Table) and meet the CITW criteria of being unable to work for at least 15 hours per week in the next 2 years and being unable to be retrained for such work in the next 2 years, continue to qualify for DSP. The POS requirements do not apply to these recipients.

The DSP recipients in this category who are found at review NOT TO have a severe impairment (that is, they are assessed as having at least 20 points under the Impairment Tables with no rating of at least 20 points under a single table) and meet ALL OTHER conditions for reviewed 2008-2011 DSP starters in the SSAct section 94(5), will become reviewed 2008-2011 DSP starters for DSP qualification purposes.

The DSP recipients who become reviewed 2008-2011 DSP starters continue to qualify for DSP at least until such time when their DSP qualification is reviewed again (subsequent review) but are required to meet the additional CITW requirement in the SSAct section 94(2)(aa) of undertaking and actively participating in a POS for and within a certain period of time (1.1.A.30).

If a DSP recipient under age 35 and start date between 1 January 2008 and 2 September 2011 has their DSP cancelled as a result of the initial DSP qualification review (cancellation decision) and the cancellation decision is subsequently overturned on internal review or on appeal (review decision), and the review decision determines that the person has no severe impairment, the person CAN become a reviewed 2008-2011 DSP starter (upon further assessment by Services Australia of the person's circumstances) if they meet ALL the other conditions for reviewed 2008-2011 DSP starters in the SSAct section 94(5).

Reviewed 2008-2011 DSP starters will generally have their subsequent review after 36 months of becoming a reviewed 2008-2011 DSP starter. At this review, the reviewed 2008-2011 DSP starters who have had an opportunity to participate will have their CITW reassessed against ALL the CITW criteria in the SSAct sections 94(2)(aa), 94(2)(a) and 94(2)(b) , including whether:

• they have actively participated in a POS, and
• whether they meet the other CITW requirements of being unable to work for at least 15 hours per week in the next 2 years and being unable to be retrained for such work in the next 2 years.

The result of the subsequent review will determine whether these recipients remain qualified for DSP or not. If they are found NOT TO meet the required CITW criteria because they have not actively participated in a POS and/or they do not meet one or more of the CITW criteria in the SSAct section 94(2)(a) and 94(2)(b), they will not be eligible for DSP.