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Where sufficient information is provided by the claimant and their treating doctor, a claim can be determined without the need for further assessment in the following situations:
DSP claimants are considered to be manifestly (1.1.M.30) qualified, because they clearly and obviously meet ALL the qualification criteria in section 94 of the SSAct. ONLY in very clear cut CASES OUTLINED BELOW, can claims be GRANTED without FURTHER ASSESSMENT.
This provision also applies in reverse, in that a claim from a person who is clearly and obviously NOT qualified can be rejected without further medical examination.
As with all other claims for DSP, documented evidence of the extent and severity of the condition/s is necessary to assess the impact on the claimant's CITW (1.1.C.330). All decisions must be fully documented on the SA287 disability payments record of decision form.
DSP may only be granted without the need for further assessment in the following LIMITED CIRCUMSTANCES.
Manifest grants may only be made to a person with:
Note: Care recipients may be accepted as requiring nursing home level care if they were assessed as a profoundly disabled child (1.1.C.146), and the person's carer MUST have:
Act reference: SSAct section 94 Qualification for DSP-continuing inability to work
Policy reference: SS Guide 3.6.1.10 Qualification for DSP - 30 Hour Rule, 3.6.1.12 Qualification for DSP - 15 Hour Rule, 3.6.2.10 Medical Evidence for DSP, 3.6.2.30 Manifest Grants & Continuing Inability to Work (DSP)
Manifest inability to work is accepted if medical evidence indicates the claimant's current medical condition (1.1.M.90) is chronic and debilitating with a prognosis (1.1.P.440) that the condition is terminal, AND life expectancy is 24 months or less.
A claimant whose medical evidence clearly indicates that they have NO vision is accepted as being manifestly qualified for DSP.
Example: A person who has been totally blind since birth or has lost both eyes due to cancer or an accident.
A claimant whose supporting report (SA013) completed by their treating ophthalmologist confirms that they meet the criteria for permanent blindness is accepted as being manifestly qualified for DSP.
Note: It is not acceptable to make a manifest grant if an optometrist completes the SA013, even if the details of a treating or formerly treating ophthalmologist are provided.
Act reference: SSAct section 95(1) Qualification for DSP-permanent blindness
Policy reference: SS Guide 3.6.2.40 Assessment of Blindness for DSP
A claimant whose supporting documentation clearly indicates that they have an intellectual disability which would attract an impairment rating of 20 points or more under the impairment tables is accepted as having a manifest inability to work.
Policy reference: SS Guide 3.6.2.50 Assessment of People with Intellectual Impairments for DSP
A claimant who has an assessment indicating they are a long term patient of a hospital or nursing home, or require nursing home level care because of illness or infirmity AND are unlikely to be discharged in the foreseeable future, is accepted as having a manifest inability to work. The supporting medical evidence needs to provide details of:
Note: A person does not have to be in a nursing home to be manifestly granted DSP, it is sufficient that they require the same level of care (usually provided by carer/s).
A claimant who has Category 4 HIV/AIDS is accepted as having a manifest inability to work, subject to medical evidence (1.1.M.100) supporting the claim.
ALL the guidelines about impairment ratings and inability to work apply equally to adults and young people applying for DSP.
A claim for DSP can be rejected without any further assessments where the claimant does not meet the basic qualifications for DSP (other than medical or work capacity), the person cannot make a proper claim for DSP or DSP is not payable.
Example: If any of the following preclude the person from DSP, residence, age, compensation preclusion and income and assets.
A claim for DSP can be rejected without an assessment if there is substantial evidence to indicate that:
Example: A person with a condition that is clearly temporary such as a simple fracture, where it is clearly evident that the impairment and corresponding inability to work would be expected to exist for less than 2 years. In this instance NO impairment rating could be assigned, as the condition is not expected to exist for more than a few weeks. The person could not be seen to have a CITW, and a more appropriate form of income support such as NSA or SA should be considered.
It is expected that the decision to reject a claim for DSP without a JCA would only be exercised where the presented information is unambiguous.
Example: Where the TDR indicates the medical condition is definitely short term or where the person is working 15 hours or more per week at relevant minimum wages (1.1.R.133).
Where a claimant seeks a review of the decision to reject DSP on the grounds of being manifestly ineligible, the delegate must then refer the case for an appropriate assessment.
Act reference: SSAct schedule 1B Tables for the assessment of work-related impairment for DSP
Policy reference: SS Guide 3.6.2.30 Manifest Grants & Continuing Inability to Work (DSP), 3.6.2.100 DSP Assessment of Impairment Ratings, 3.6.2.110 DSP Assessment of Continuing Inability to Work - 30 Hour Rule
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Last reviewed: 1 July 2009
