3.6.2.100 DSP Assessment of Impairment Ratings

Overview

Qualification for DSP as set out under section 94(1)(b) of the SSAct, requires first establishing that the person's medical condition (1.1.M.90) attracts an impairment rating of 20 points or more under the impairment tables. The impairment tables (1.1.I.10) are part of the DSP legislation.

Explanation: The tables consist of system based tables that assign ratings in proportion to the severity or impact of the condition(s) on normal function as they relate to work performance. The tables are function based rather than diagnosis based. The rating is expressed as a number of points and is indicative of the degree of loss of functionality, NOT a percentage figure.

Note: A claimant who has an impairment rating of at least 20 points, must also have a CITW (1.1.C.330) to qualify for DSP.

Explanation: Many claimants will have an impairment rating of at least 20 points but do not have a CITW because they can work full-time where wages are at or above the relevant minimum wage or be re-skilled for such work within 2 years.

Act reference: SSAct schedule 1B Tables for the Assessment of Work-related Impairment for DSP

When can a rating be assigned?

An impairment rating can ONLY be assigned for permanent conditions where the medical condition has been:

• fully diagnosed, AND
• treated, AND
• stabilised (unlikely to show any significant functional improvement leading to a capacity to work (1.1.W.60) within the next 2 years, with or without reasonable treatment).

Note 1: The concept of permanent versus temporary impairment has a specific meaning for social security purposes. The definition of 'permanent' for the purposes of DSP does not mean indefinite, but rather 'fully diagnosed, treated and stabilised and likely to last for at least 2 years without significant functional improvement that would lead to a capacity to work within the next 2 years'.

Note 2: Impairments that do not meet this definition are considered temporary and must not be rated under the impairment tables.

Policy reference: SS Guide 1.1.F.240 Fully diagnosed, treated & stabilised (FDTS) (DSP)

Diagnosed

For a condition to be considered 'diagnosed', it is not essential for the treating doctor to provide distinctive characterisation in precise medical terms, but rather that the condition has been identified by the doctor by means of the patient's symptoms.

Example: Cervical spondylosis instead of neck pain.

Where the doctor has indicated that the diagnosis is presumptive on the TDR, it is likely that the condition is not fully diagnosed.

Diagnosis of intellectual or learning impairment by a treating doctor with no accessible supporting evidence to confirm an IQ score of less than 70 without using a cognitive assessment tool that is widely accepted by local hospitals and medical services is not sufficient for a diagnosis of 'intellectual disability'. These cases should be referred to a JCA.

Conditions not indicated on the TDR

Where the claimant indicates that they have a medical condition that is not listed on their TDR, the claimant should be referred back to their treating doctor for further diagnosis and treatment.

Explanation: The onus is on the claimant to provide all relevant medical evidence in support of their claim.

Treated

For a condition to be fully treated, consideration is given to:

• current, past and future treatment, and
• whether the treatment is considered reasonable.

In order to establish whether a condition has been fully treated, the TDR and other supporting information should be assessed and the claimant interviewed to establish whether:

• the current and past treatment (including secondary rehabilitation) has comprehensively exhausted all treatment options,
• any further treatment or investigation is planned, and
• further reasonable treatment has been recommended or suggested but rejected by the claimant.

A condition should generally be considered temporary and not rate under the impairment tables where:

• further (non-invasive) medical treatment is available, or
• secondary rehabilitation has not been undertaken, or

Example: Outpatient services, pain management programs.

• invasive surgery is planned or being considered, and
• that treatment could result in a significant functional improvement leading to a capacity to work within the next 2 years.

This information may indicate that the condition has not been fully treated (and stabilised), and therefore should not be considered permanent for DSP purposes.

Also, where the JCA provider identifies reasonable treatment that was not attempted/undertaken, and they feel that this treatment could result in a significant functional improvement leading to a capacity to work within the next 2 years, then the condition should not be considered to be fully treated. In these circumstances, the assessor should discuss the treatment identified with the treating doctor.

Stabilised

For conditions to be fully stabilised:

• all available (reasonable) treatment that may result in significant functional improvement leading to a capacity to work within the next 2 years has been undertaken, or
• it must be considered that with or without treatment, a significant functional improvement leading to a capacity to work within the next 2 years is unlikely to occur.

Indicators on the TDR of whether a condition is stabilised

Information provided by the doctor about each medical condition at sections I and J of Part A of the TDR, are a good indication of whether a condition is stabilised - see tables below:

Fluctuating, episodic or intermittent conditions (1.1.I.190)

In cases where the claimant's medical condition is variable, there are additional factors to be considered in the assessment of their ability to work such as:

• how long does each acute or more severe phase of the condition last on average? and
• on how many days per year is the claimant incapacitated by the condition?

A JCA may be necessary to assist in gaining an overall impression of the claimant's level of functional impairment.

Explanation: It is not appropriate to assign a rating based on either the acute or non-acute phase of the condition, as the rating indicates the overall level of impairment.

Which table should be used?

The following table explains which impairment table should be used to assign a rating:

Note: If the condition(s) impact(s) on the functionality of more than one body system or structure a rating may be assigned on all relevant tables. However, the total impairment rating should reflect the overall level of the claimant's impairment and should not be 'double scored'. A score should NOT be allocated for each condition, and added together as this would effectively be double scoring.

The impairment rating assigned on a single table must be consistent with the values allowed on each impairment table.

Example: If a given table allows for increments of 0, 10, 20, 30 or 40, the decision maker CANNOT assign a rating of 15 NOR can the decision maker assign a rating of 50 on this table.

Act reference: SSAct Guide to the Impairment Tables for Schedule 1B

Policy reference: SS Guide 3.6.1.10 Qualification for DSP - 30 Hour Rule, 3.6.1.12 Qualification for DSP - 15 Hour Rule, 3.6.2.112 DSP Assessment of Continuing Inability to Work - 15 Hour Rule

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Last reviewed: 1 March 2010