This session was part of the Advocacy Sector Conversations Forum series held online on 15 October 2020.
Overview
Applications for the DSP are too often rejected due to the lack of sufficient medical evidence. DSP Help has a medical evidence bot that helps you to get the best supportive documentation from your medical specialist which gives you the best chance of having your application approved.
Dermott Williams is a Community Lawyer at Social Security Rights Victoria who has been involved with the development of DSP Help and he introduces you to the bot and many other features of this exciting new online resource.
Links to resources mentioned in this presentation can be found at the bottom of this post.
Audio & Transcript
MELISSA HALE:
Good morning everyone. Welcome to the third session of the October 2020 advocacy sector conversation series. My name is Melissa Hale and I’m the co‑ordinator of the disability advocacy resource unit. Before I begin, I would like to acknowledge the traditional owners of the land we meet and pay respects to elders past present and emerging. Once again, we are delivering forums online in this new format due to the new normal we find ourselves in due to COVID‑19.
We are pleased to still bring the advocacy sector conversation to you online, we are seeing unexpected benefits in this type of program delivery and we will be coming back to you to get your feedback on what you like and dislike about this format so that we can continually improve and provide the best experience we can for you so please let us know what you think.
You will note we have Auslan interpreters today and we also have captioning that you can access. If you go to the chat box, you will see a link that you can click to access the closed captioning in a separate browser.
We encourage your active participation today. Please type your questions in the Q & A box not the chat box and at the end of the session I will be facilitating a Q and A session with our presenter. I hope you’ve all settled in comfortably and ready for a great session ahead.
The disability support pension we all know what a headache that can be to apply for. Applications for the DSP are too often rejected due to the lack of sufficient medical evidence. DSP help is a fantastic tool that helps you get the best-supported documentation from your medical specialist, which gives you the best chance of having your application approved.
Dermott Williams is a Community Lawyer at Social Security Rights Victoria who has been involved in the development of DSP Help and he introduces you to this exciting new online resource, please welcome Dermott Williams.
DERMOTT WILLIAMS:
Thanks Melissa and thank you everyone for coming today.
Today I’m going to be talking a little bit about the disability support pension and as Melissa says, the DSP help resource that we’ve developed.
Just quickly, I would like to say thank you to Melissa and the team at DARU for making today possible. I would also just like to acknowledge the knowledge and experience of disability advocates with us today. SSRV knows how knowledgeable and experienced you all are and as part of DSP Help we’ve consulted with disability advocates and it’s been valuable for us to draw together the knowledge and use it to put together the resource that we have.
Briefly, a little bit about Social Security rights Victoria. We are an independent statewide community legal centre we specialise in Social Security law, policy and procedure. We aim to help vulnerable and disadvantaged Victorians appeal wrongful Centrelink decisions that’s the core of the work we do. We also engage in systemic advocacy to try and get things particularly in Social Security law made more fair and we provide training to workers such as yourself.
Just a quick note on how we view Social Security. We view it as a fundamental human right as noted in the universal declaration of human rights and the international covenant on economic social and cultural rights.
To today’s session, I’m going to talk about DSP eligibility I’ll give a high level overview of what that is but I will also be talking about some of the challenges we see people face when they’re trying to access DSP, I’ll them move on to talking about DSP help resources that’s the website but also the legal service that wraps around the website.
Finally, I will briefly mention how you can access SSRV if you want to get further assistance or you have a referral that you would like to make and then as Melissa mentioned we will have time for questions at the end.
So the disability support pension, the DSP is an income support payment for people who cannot work due to illness, injury or disability. To get the DSP you need to have a physical, intellectual or psychiatric condition that is permanent, you need to be rated as having 20 points under the impairment table and you need to have a continuing inability to works there’s a bit of nuance to each of those points though.
So if we start we’re looking at permanent conditions, a permanent condition isn’t a permanent condition as we normally think of it., A permanent condition is a condition that’s been fully diagnosed, treated and fully stabilised. So what does each of those mean?
A fully diagnosed condition is a condition that doctors who have been treating it know what’s going on, and have given a diagnosis. They’ve formally said this is what the condition is.
That’s not normally too controversial what’s one of the simpler aspects to show in a DSP application, fully treated means that everything that’s reasonable to treat the condition has been done, there’s nothing left to do to treat the condition. One common thing that comes up is people on waiting lists for surgery for example may not be considered until they’ve had the surgery.
One interesting matter we worked on recently was a young person who had autism spectrum disorder, he had managed to get NDIS funding with the support of his family and as part of that, he had a long report explaining a bunch of different things and supports that would help him and improve his life. When he applied for the DSP Centrelink jumped on that and said this is not fully treated, you have all these things you need to do before we can consider you fully treated.
As you will know NDIS support, is not given to treat conditions it’s given for people who have already been assessed as having a permanent condition albeit through a different mechanism that the NDIS uses. We took that argument to the tribunal and said this is not treatment this is supports that are going to help this person with their quality of life but they’re not going to improve the condition, and we won that one.
I’m trying to highlight, whether something is fully treated or not is a complex question, and Centrelink doesn’t always get it right. You need to dive in to it to actually work out hang on is the treatment reasonable is it something they should access is it something that prevents the person from being fully treated.
A condition is fully stabilised if it will show no significant functional improvement even with reasonable treatment or the reasonable treatment has been had over the next two years.
Another interesting matter that we have seen is a person who had MS, of course that is a degenerative condition and as a general rule is only going to get worse and will always get worse. Centrelink again took a very simplistic view and said this is not fully stabilised, it is not going to stay the same and get worse and rejected the DSP on that basis. Of course we argued that that’s not how it should be viewed, it is degenerative, it’s not going to stay the same but it’s not going to get better either and we were again successful there.
One important thing to note here is that permanent again does not mean permanent. It means permanent over the next two years and that’s it. If you manage to get past that point in the DSP eligibility, you then need to have 20 points under the impairment tables.
I’ve got the list of impairment tables there and you can see they cover a wide range of impairments starting with things that affect particular parts of the body like the upper limbs lower limbs, spine moving to things like mental health, brain function to hearing and visual function, and even down to things like consciousness for conditions such as epilepsy where you have seizures.
One thing to note here and one challenge that we see is there is no table for pain. Someone who is experiencing chronic pain which can be quite debilitating and can prevent them from working will need to have the condition or the pain assessed, the impact of the pain assessed under one of the other tables whether it’s upper limb because the pain is affecting their arms and hands or generally affecting them and needs to be assessed under table one it’s preventing them from being able to perform actions consistently.
In terms of what the table looks like, we’ve got an example here for table three, for lower limp function for the 20 points rating. To get 20 points under this table a person must be unable to do any of the following. Walk around a shopping centre or super market without assistance, walk from a carpark in to a shopping centre or supermarket without assistance, stand up from a sitting position without assistance and they must require assistance to use public transport.
This table provides some clarification about who it applies to and notes that people who require assistance to move around in a wheelchair or transfer to and from a wheelchair may fit under this category, people who require assistance to move around even while using walking aids such as a stick or crutches could also fit into this category.
One word that I’ve mentioned there is assistance, I’ve mentioned that several times for each of the criteria and I think this highlights another challenge people face with a disability support pension. To the average person or to the average disability support pension applicant, assistance may include things like using a wheelchair, or using a walking stick or using crutches but in these impairment tables assistance generally has a specific meaning and it means assistance from another person. If you need a walking stick for example that’s relevant to the impairment tables but it does not count as assistance for the purpose of the impairment table, it has to be from another person.
For me I think this highlights the challenge of just people understanding what they’re being assessed on because it’s not clear from what we are reading on the screen right now that’s what assistance means it’s in the preamble to the tables where it says that in quite a rounds about way as well.
For me as a lawyer who deals with legislation all the time this maybe relatively easy to pass and understand and to comprehend and it may be relatively easy for you as a disability advocate to do the same having had experience with it and looked at these tables over and over and regularly. But for a person who is not trained who does not have the experience who may have come across the disability, who may have needed the disability support pension suddenly because they’ve had an accident that’s what’s caused their disability they’ve never had to engage with the system before, that it’s really difficult to then go in here and understand it for yourself what you’re being assessed on.
Finally, if you are assess as having a fully diagnosed treated and stabilised condition and it’s rated as 20 points under the impairment tables, you will need to show you have a continuing inability to work, again this means over the next two years and it means you are unable to do work of at least 15 hours per week.
It’s important to note when we are talking about work, talking about work at or above the minimum wage so if there is work that someone can do, but it is not at or above the minimum wage, it’s not going to count for this test.
The fourth and final criteria for the disability support pension, which I haven’t mentioned earlier because it is a conditional thing is the program of support. Some people will need to participate in a program of support and they’ll normally need to do 18 months in the three years before applying for the disability support pension.
A program of support is a program which is completed through an employment service provider so that could be a job active provider for people who are on on new start or job seeker payments or it could be a disabilities employment service again for people on new start or job seeker payment but for people who have been assessed at needing that extra support. What it looks like is it may include applying for jobs doing training, having other support activities to improve a person’s work capacity.
What’s really important to note is that if someone has a medical exemption from those activities associated with job seeker or new start while they’re on that medical exemption that time will not count towards the 18 months.
To give an example: Sam has a back injury and depression and had to stop working. He’s been on new start and enrolled in a program of support for 18 months. Sam got a medical exemption for about six months because he didn’t feel up to going to his employment service provider for the training, Sam will need do a further six months of a program of support before he can claim the DSP.
When does a program of support not have to be completed? When a person has a severe impairment. So that means if you get 20 points under a single table you don’t have to do a program of support if you have 20 points but they’re spread across several tables you will have to do the program of support. And this again, highlights another challenge people have when they access the disabilities support pension that I’ve seen in my own work.
The challenge is that it seems to be that the expectation is that a person who has several minor impairments is going to be better able to improve their ability to find and keep work than a person who has one big impairment. But that may not be the case.
A person who has several impairments, several conditions that are affecting their life may in fact be less able to engage with the program of support and improve their work capacity because they’re effected in a number of different ways versus the person who is affected in one way. Of course everyone’s individual circumstances is different and there’s no general rule but I think that the general rule that appears to be applied is not taking that into account.
It also creates some weird situation where you have situations where someone who may have 30 or 40 points overall so they have significant impairments in their life but because they’re spread out across four tables with ten points each they too have to participate in the program of support.
When a person is enrolled but unable to improve their ability to find work through the program because of their impairment they may not have to complete the 18 months. When the employment service provider makes that assessment and says, we can’t assist this person because of their impairment we’re not going to be able to do anything to make their chance of finding work better they again may not have to complete the 18 months.
If a person is applying for the disability support pension it is important to enrol to show active participation and then it’s important if they don’t finish the 18 months to get information about why that is link and link it to their impairment.
So I’ve spoken a bit about some of the challenges and some of the high level eligibility criteria for the DSP, what I’d like to speak about now is medical evidence.
Medical evidence is vital to the likely success of applications and appeals. It is essentially what is being assessed, when Centrelink are making a decision about the DSP. It is also the thing that is most in the control, though not completely in the control, of the DSP applicants. It’s something they can approach doctors and specialists and try and get to improve their chances of success.
It’s important to note that when gathering medical evidence the date of the application and the 13 weeks following is the qualification period. So when Centrelink are making a decision about whether a person is eligible they’re looking at that 13-week period and determining whether they’re eligible then.
For a new application, this is not too controversial, they’re putting in the information and making an assessment at the time. For an appeal, this can become quite relevant. Often appeals can happen months or even years after the initial application and the person running the appeal and making the decision will have to look back and determine whether the person was eligible when they applied.
This is also challenging for applicants who may not have understood fully what they were applying for or what they needed to do to be successful and when they’ve put in an application they’ve been rejected. They’ve gone through the appeals process and its several months later and they may come to us for example and say, “look I don’t know what’s going on here, I think I should be on the DSP, they haven’t given it to me though. What do I do?”
We may look at their documents and say, “look your medical evidence is not actually showing that you are eligible, the best thing you can do is go and get new medical evidence but you have to ask your doctors to tell you what your condition was like several months ago otherwise it may not be considered. “
That said medical evidence doesn’t have to come into existence during the application period or qualification period it just needs to be referable to it. If a person can get their doctors to say I have been treating this person for years, at the time they applied their conditions were like this that can be helpful.
One final note before I move on to talking a little bit about DSP help itself is just multiple conditions and impairments. I’ve spoken a bit about this for programs of support it’s important to note that conditions are separate from impairments when it comes to disability support pension eligibility.
A condition is condition, an impairment is the impact of that condition on the person and what they can do. Where one condition causes multiple impairments, each impairment should be considered separately and have its own rating.
A good example of this is diabetes, which could have an impact on general stamina, it could also have impact on the digestive system, it could also have an impact on the limbs lower limbs and upper limbs and that kind of thing.
On the other side of things where you have multiple conditions causing a combined impairment they should be given a single impairment rating.
For example a person may have osteoarthritis in their hands. They may also have a condition with their upper arms that impacts where they can do how they can move their arms around. Both of those conditions will contribute to the upper limb table. In other words impairment ratings are given for impairments not conditions.
Okay so DSP help, this is the resource that we’ve put together to try and help people that are facing some of issues in particular people having trouble getting medical evidence to support their application.
I won’t be doing a demonstration of DSP Help today. I won’t bring up the website on screen but I do have some screen shots in my slides. I have put the link to DSP help on the slides there and I would encourage everyone to have a look at it and see for yourself what we have got there and how we’ve laid out the information. And one thing I’ll note, I should give some background here.
The process that we’ve gone through for DSP help is one that’s been using human centred design and technology. Those were the two key parts of our design process here.
We’ve engaged with DSP applicants. We’ve also engaged with people who are supporting applicants to access the DSP including disability advocates. We’ve used the information from those consultations to try and make this as fit for purpose as we can but it is a first iteration. It’s not as our designers said, it’s not the rolls Royce it’s the Mazda, the serviceable car that does what we need it to do but can be improved on to make it better in the future.
That was a very long winded way of saying, if you look at this and you see something that could be improved, or something that can be done better or you want to see something changed for some reason, let us know, feedback is super important to us for this, and it’s going to be super important for our ongoing design process.
That said I’m going to go through a few things about DSP help and explain how it’s supposed to work. The idea is we can guide people through the DSP process when they come to the website. When they land on the home page they are given these options here.
They can either choose to go specifically to the option they’re after. Maybe they know they have issues getting the right medical evidence, they can go straight to that page, or they can start understanding the disability support pension and work through it in order to understand the process completely.
We’ve tried to cover everything that a person would need to know about the DSP when they’re applying, so we’ve included information about eligibility, about gathering the right medical evidence, about applying actually getting the application form and putting it in, and what to do if there is a rejection what options there are.
As I noted the information is presented in an order that users can access information they need directly or go straight to the information they want. At the ends of the each page, there’s a suggested next page so we are trying to be very clear about how people can move through this information.
At the core of the DSP help is the medical evidence chat pod and this is the heart of the resource. We’ve used the Joseph platform to create an automated chat pod, which users can engage with to help understand their conditions and their impairments, help collect that information or put that information down in a central place and produce a customised medical evidence kit they can use when gathering medical evidence.
The idea is that people land on this page, the Bot starts asking questions, starts with what’s your name what would you like us to call you and then asks them some questions about their impairments. Particularly what kind of impairments do they have. Might ask do you have impairments of your arms and upper limbs do you have impairments of your legs and lower limbs, do you have mental health conditions do you have digestive conditions those sorts of questions. It then gives users an opportunity to talk about how their conditions affect them day‑to‑day what they can and can’t do what they’re living with.
It will then take that information and put it in to the medical evidence kit which is essentially a letter and instructions for doctors to give medical evidence. It also includes some information for the user themselves so they have something they can take away from the website as a reminder about what they need to do and how they can help support their application.
As you can see, the first page, which I include an excerpt from, gives some information for the doctors about why the DSP is important and why it is this person is coming to them and asking for this information and why they’re the gatekeepers to the DSP in many ways.
We include information for the doctors so they can get help directly. If they want they can jump on DSP help themselves and see the information themselves, or they can even contact SSRV and chat to one of our lawyers about what they need to do.
In personalization, the two main things that the kit does is first it helps a person identify and then list the tables that could affect them. The tables as I mentioned earlier are an opaque and difficult instrument to engage with. We are hoping that if a person can narrow down which tables are relevant to them they may have an easier time of diving in and grappling what they need to show we are hoping that applies to the doctor as well.
The second main way this is personalised, it records and compiles the information that the user has entered in. In the second excerpt on the screen there I’ve got John has done a self-assessment, this is a mockup, John has done a self-assessment and we have included this below.
In relation to table one, ‘Functions requiring physical exertion’: “I can’t walk very far. I need help to get around the shops. I can only get around with a walking frame even that’s difficult to use most of the time.”
In relation to table two ‘Upper limbs’: “I struggle to do up buttons. I can’t lift things or do much above my head. My partner has to get things from the top shelf for me. “
The idea here is that having this information all in one place, and being able to hand that to someone, to the doctors, rather than explain it verbally may make it easier for people to communicate to their doctors about what they need from them to support their application.
As I mentioned earlier DSP help is not just a website, it is also a wraparound legal service. At the top of every page on DSP help we have an option for people to get help. DSP help is aimed at people who have some capacity to self-advocate, people that are able to help themselves but may not be equipped with the right information and tools to do that effectively.
There are going to be people that this website, that need more support than a website can offer and for those people they can contact us directly and we can give them information, advice and further assistance.
We also acknowledge that some people aren’t going to want to come to a legal service, or talk to a lawyer, they may be intimidated by that. I hope not by me personally! For those people we’ve included links to other services including a link to DARU’s advocate finder so they can get in touch with a disability advocate.
Support workers are welcome to use DSP help as well not only for the information, though that’s obviously useful, but we found and heard from some support workers using the medical evidence chat pod can be helpful with clients. This is something that I’ve done myself, in my own casework. It can be helpful to sit down with the client and ask them the questions that the bot is asking, and enter the answers for them, and then use that to produce the medical evidence kit, and then of course send it to them so they have it there.
In that way people who may not be comfortable logging on to the website and doing this themselves, but could still benefit from having a customised medical evidence kit, can still access the service in that way.
I’m going to go back two steps. I’ve run through most of the content that I had planned much quicker than I thought I would, so I’m going jump past the question slide and quickly mention how you can get in touch with us. As disability advocates you can access our worker help line, basically you can give us a call and have a chat about any Centrelink legal problems, but specifically you can talk to us about the disability support pension.
If you would like to make a referral, if you would like us to take a matter over this is the best way to access that. Give us a call tell us about the issues and let us know you would like to make the referral. If you would like to make a cold referral you can give us the general advice line, I know I haven’t left this up on the screen but they are available on our website and we can send out information later if you would like you can give them the general advice line and they can come and call us directly.
We do have an opportunity for questions but I’m mindful we have a bit of extra time there. Melissa would you like to do the questions? Have we got many? Or I can possibly talk about case studies if you want me to do more content.
MELISSA HALE:
Thank you very much Dermott that was really useful, and no doubt people are book marking this site as we speak.
I think before we go to questions, the first thing I let people know is the whole recording of this session plus the slides associated with it will be available on the DARU website at a later date for you to look at, as well as all the contact details and options to call for help as well.
I have a couple of questions, I’m cueing them live now. If you have a question you would like to ask, remember to type them in the Q & A box on your screen and I’ll pop them up. This is a long one…
QUESTION:
When Centrelink rejects a DSP claim and people ask Centrelink for a review is it right when Centrelink say you can only get a review when you provide more evidence and if you do not have more evidence they do not review the decision?
DERMOTT WILLIAMS:
That is completely incorrect. Everyone has a right to have Centrelink review decisions that they make. And that applies to any decision that they make and the best way to access that in the first instance is to ask for an authorised review officer to review it. You don’t need to provide any information or documents or evidence or anything to access that review process. It is enough to call them up and say I disagree with this decision I want it reviewed.
That said in some cases it is going to be very helpful if you can get documentation and evidence to show why it’s wrong. But that’s going to depend on individual circumstances of the case.
MELISSA HALE:
Thank you. Next question…
QUESTION:
The eligibility seemed almost discriminatory. Is there anyway of changing the act to make the tables fairer?
DERMOTT WILLIAMS:
I think there are many ways to change the act to make the tables fairer. One thing that I should note, which I haven’t touched on yet, is there is potentially an impairment table review in the works. I’m not personally going to get political about that today but I will note that whether that’s going to make it fairer or unfair is going to depend on how it’s drafted and what changes they actually make.
For my personal view I think one of the unfairest almost challenging parts of disability support pension eligibility, is the program of support requirement, that extra requirement that you have if you don’t get 20 points under one table. And as a bit of a thought exercise, I considered what the tables would like look if you don’t have that requirement, and I do think they look fairer or less challenging to engage with.
You still need to get 20 points but it can be spread out over multiple tables, that seems a lot easier and it will be a lot easier to understand because often program of support is one of the most tricky bits to explain to a client who is having trouble with the DSP.
MELISSA HALE:
Thank you. Next one, this is an interesting one…
QUESTION:
Will a WHODAS assessment assist in evidence for DSP?
MELISSA HALE:
I wonder what the acronym stands for do you know?
DERMOTT WILLIAMS:
I’m not sure myselF, I’m glad that’s not just me.
MELISSA HALE:
WHODAS I’m not sure what that acronym is. While we wait for hopefully clarification from the person asking the question, I’ll move to the next one…
QUESTION:
Could you use the medical help to assist with NDIS medical evidence?
DERMOTT WILLIAMS:
I have to admit that I’m not sure about the NDIS medical requirements because we don’t deal with NDIS ourselves at SSRV. I’m tempted to say probably not because the medical help pod is very much focused on the DSP criteria and specifically on the impairment tables for the DSP.
That said, I doubt it’s something that we are ever going to do. Like I said NDIS is a bit out the scope of what we do, but maybe that’s something that someone could explore to have a similar set up to help people with the NDIS.
MELISSA HALE:
I just got clarification – I believe the WHODAS refers to NDIS assessment. I think that is all the questions that we have today. It says the world health organisation disability assessment schedule, there you go. I learned something new myself. They’re the questions we have today,
I thank you Dermott for giving us your time today. I have no doubt this tool will be very much used in the sector and make life a lot easier, thank you for the work and effort your team put in.
DERMOTT WILLIAMS:
Thank you Melissa. Thank you for inviting me.
MELISSA HALE:
Everybody we’ve come to a close today. I would like to thank the Social Security Rights Victoria and Dermott Williams for his time to bring this presentation to you today, and for the great work that is happening in this space.
Thank you to the Auslan interpreters and captioners for their hard work today thank you to Show Division for bringing the production to you today.
Please stay safe wear your mask, wash your hands and stay home! See you next time.
Download slideshow presentationGo to DSP Help (off-site)- Topics:
- Centrelink
- Author:
- DARU
- Date published:
- Thu 15th Oct, 2020