(This is a re-post. Maybe it can give some Aussies a place to start…)
It seems to me that the government departments that deal with disability payments (from all different countries) have a policy to just reject all claims (like the insurance company in The Rainmaker).
I know that every time I have applied for anything from Centrelink (the Australian version), I have been rejected; and each time, I have either had to appeal or follow-up with many, many phone calls. But each time, I have received (finally!) what I was supposed to receive.
So, today’s post is going to try to make it easier for Aussie FM sufferers to get the Disability Support Pension. (If you are from another country and can write a post that will help others from your country, I am happy to publish it)
DISABILITY SUPPORT INFORMATION
*** Please note – This is NOT legal advice This has been written based on my personal experience: I successfully appealed the rejection of my Disability Support Pension application.
I have put this together, hoping it will help others in the same predicament.
Basically, this is how it works:
You apply for Disability Support Pension
You must have a total impairment rating of 20 points or more under the Impairment Tables.
To get a rating you must have a permanent condition that is more likely than not to persist for more than 2 years.
You receive Disability Support Pension
Seems easy, right?
When can a rating be assigned?
An impairment rating can only be assigned for permanent conditions which cause an impairment that is more likely than not to persist for more than 2 years.
A condition is permanent if:
- the condition has been fully diagnosed by an appropriately qualified medical practitioner, and
- the condition has been fully treated, and
- the condition has been fully stabilised.
What does ‘fully diagnosed, fully treated & fully stabilised’ mean?
According to the Guide to Social Security Law (Version 1.191 – Released 12 November 2012), which is run on an Australian Government site and is therefore reliable (although you should always check for updates):
Fully diagnosed and fully treated
In determining whether a condition has been fully diagnosed by an appropriately qualified medical practitioner and whether it has been fully treated, the following is to be considered:
- whether there is corroborating evidence of the condition, and
- what treatment or rehabilitation has occurred in relation to the condition, and
- whether treatment is continuing or is planned in the next 2 years.
A condition is fully stabilised if:
- either the person has undertaken reasonable treatment for the condition and any further reasonable treatment is unlikely to result in significant functional improvement to a level enabling the person to undertake work in the next 2 years, or
- the person has not undertaken reasonable treatment for the condition and:
- significant functional improvement to a level enabling the person to undertake work in the next 2 years is not expected to result, even if the person undertakes reasonable treatment, or
- there is a medical or other compelling reason for the person not to undertake reasonable treatment.
This is the point where most of our applications are rejected.
I suggest that, when writing a letter of appeal (or even your first statement), you address each point clearly and concisely.
When you get past this point, you can move on to your impairment…
Assessment of Impairment Ratings
As part of the qualification for a Disability Support Pension (DSP), a person must have one or more physical, intellectual or psychiatric impairment(s) that attract a total impairment rating of 20 points or more under the Impairment Tables.
For the purposes of DSP, the Impairment Tables are tables designed to assess impairment in relation to work. The tables were revised earlier this year, so you need to make sure that you are looking at the right information. (The Centrelink representative will always ask you if you looked at the most recent tables!)
- are function based rather than diagnosis based,
- describe functional activities, abilities, symptoms and limitations, and
- are designed to assign ratings to determine the level of functional impact of impairment and not to assess conditions.
A claimant who has a total impairment rating of at least 20 points, must also have a continuing inability to work to qualify for DSP.
Now (I have to get a little lawyer-like), as per s 6(9) (this means section 6, sub-section 9) of the Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011:
(9) There is no Table dealing specifically with pain and when assessing pain the following must be considered:
(a) acute pain is a symptom which may result in short-term loss of functional capacity in more than one area of the body; and
(b) chronic pain is a condition and, where it has been diagnosed, any resulting impairment should be assessed using the Table relevant to the area of function affected; and
(c) whether the condition causing pain has been fully diagnosed, fully treated and fully stabilised for the purposes of subsections 6(5) and (6).
The statements in BOLD are what is important to us. We can use ALL the tables to get a total of 20 as we have a number of conditions that cause our impairment!
Section 10(5) states:
(5) Where two or more conditions cause a common or combined impairment, a single rating should be assigned in relation to that common or combined impairment under a single Table.
(6) Where a common or combined impairment resulting from two or more conditions is assessed in accordance with subsection 10(5), it is inappropriate to assign a separate impairment rating for each condition as this would result in the same impairment being assessed more than once.
Now, I don’t expect you to read all the tables (although I did) but have a look at the headings for each:
- Table 1 – Functions Requiring Physical Exertion & Stamina
- Table 2 – Upper Limb Function
- Table 3 – Lower Limb Function
- Table 4 – Spinal Function
- Table 5 – Mental Health Function
- Table 6 – Functioning Related to Alcohol, Drug & Other Substance Use
- Table 7 – Brain Function
- Table 8 – Communication Function
- Table 9 – Intellectual Function
- Table 10 – Digestive & Reproductive Function
- Table 11 – Hearing & Other Functions of the Ear
- Table 12 – Visual Function
- Table 13 – Continence Function
- Table 14 – Functions of the Skin
- Table 15 – Functions of Consciousness
This is where, in your letter/statement, you get personal. Address each and every one of these tables, if they affect you. Give examples. Explain how it affects your life. the more information that you give, the better.
- Attach every piece of information that you have from any doctors (you can ask them for copies of correspondence to other doctors)
- Write EVERYTHING down – don’t leave something out because you don’t think it’s important.
- Try not to write emotionally – it will probably make you very upset to write down how badly you feel but, they don’t care. Centrelink needs it written down clearly, concisely, even impersonally.
- Spell check (AND have some-one else read through the letter). Basically, Centrelink doesn’t see you as an individual, so this is a letter from one professional to another
I am attaching the letter that I sent to Centrelink as an example. It may not be perfect but it achieved my goal and I received DSP.
I hope it can help some others.