Social Welfare Problem

GPs are regularly asked to complete Centrelink medical forms supporting a patient’s claim for a payment or service. Completing a form does not guarantee eligibility — the final decision rests with Services Australia (Centrelink) based on all information collected, including any independent Job Capacity Assessment (JCA). The time taken to complete a medical report can be claimed as part of a consultation under the relevant Medicare item.

Disability Support Pension (DSP)

Financial support for people with a permanent physical, intellectual or psychiatric condition that stops them working at least 15 hours/week for the next 2 years. A temporary condition, or one still being diagnosed/ treated, does not qualify.

Applicants must also meet non-medical rules (age, residency, income/asset limits).

Manifest medical rules — automatic eligibility if the person:

• Is permanently blind
• Needs nursing-home-level care
• Has a terminal illness with a life expectancy of less than 2 years
• Has an intellectual disability with an IQ under 70
• Has category 4 HIV/AIDS
• Receives a DVA Special Rate Disability Pension

If the manifest medical rules aren’t met, the person needs to satisfy both the non-medical rules and general medical rules:

• The condition will last more than 2 years
• It is fully diagnosed, treated (all reasonable treatment options tried) and stabilised
• It results in an impairment rating of 20 points or more under the Impairment Tables for the Assessment of Work-Related Impairment for DSP
• It will stop the person working at least 15 hours/week in the next 2 years
• “Fully diagnosed” requires the doctor to have examined and diagnosed the condition, documented in the medical evidence

If the impairment rating comes in under 20 points, the person should instead be enrolled in a program of support to help them obtain employment.

The Centrelink Medical Report

The main form GPs complete for new or reviewed DSP claims. It also informs Centrelink about employment-assistance programs (e.g. referral to Disability Employment Services) that may benefit the patient.

• One question asks whether the patient has a terminal condition with a prognosis under 24 months — answering “yes” (along with meeting the other eligibility criteria) allows Centrelink to grant DSP quickly without a JCA. The same fast-track applies to permanent blindness, HIV/AIDS Stage 4, severe intellectual disability, and “nursing-home-level care” need.
• If the patient has only a temporary reduction in function, the medical report can instead serve as a medical certificate.
• If there’s something in the form the doctor feels the patient shouldn’t see (e.g. a terminal prognosis), it can be posted directly to Centrelink rather than handed to the patient.

Mobility Allowance

A separate medical report form. The doctor documents the patient’s disabilities/illnesses/injuries, their effect on the ability to use public transport, and how long these difficulties are likely to last. Eligibility: aged 16+, unable to use public transport without substantial assistance, and a need to travel for work, job seeking, training, study or voluntary work (people can still qualify even where no public transport is available).

Carer Payment and Carer Allowance

Different Centrelink medical reports apply depending on whether the carer is claiming Payment and/or Allowance, and whether the care recipient is a child (under 16) or an adult (16+).

• Child: the medical report covers medical and behavioural information about the child, plus whether they have a terminal illness (not expected to live substantially longer than 24 months, requiring continuous personal care). A separate Disability Care Load Assessment (child) (CCLA) form, covering a list of Recognised Disabilities, can only be completed by a specified allied Treating Health Professional.
• Adult: the treating health professional completes a report based on the Adult Disability Assessment Tool (ADAT), which measures the care needed because of the person’s disability — again only completable by an allied treating health professional.

Other carer payments: Carer Supplement (annual, cost-of-caring assistance); Child Disability Payment (annual, for carers of a disabled child); Carer Adjustment Payment (one-off, for families adjusting after a child’s catastrophic illness/injury/major disability — assessed by an independent expert panel, may require a supporting medical report).

Other Centrelink forms

• Medical certificates — determine eligibility for Sickness Allowance or an exemption from participation requirements for an unemployed patient. An incapacity exemption requires the person to be temporarily unfit for all work; the doctor must state diagnosis/prognosis, that work capacity is under 8 hours/week, and the expected duration (maximum 13 weeks). If the patient can work in a reduced capacity, detail the type and hours of suitable modified duties.
• Crisis, Disaster and Bereavement payments — completed by the claimant themselves; useful for GPs to know about for patients recently bereaved or affected by a natural disaster or personal crisis (e.g. domestic violence).

From an AFP article on completing Centrelink forms for GPs (2000s-era), by Kath O’Connor, Medical Editor of Australian Family Physician.