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13.02 Investigating eligibility for Special Rate Disability Pension

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Last amended 
30 November 2018

A former member is eligible to make a choice to receive a SRDP if the delegate is satisfied the following criteria in subsection 199(1) of the MRCA [5] are met:

a) as a result of one or more service conditions (refer to Chapter 2 Incapacity Payments [6]), the former member

  1. is receiving incapacity payments; or
  2. would be receiving incapacity payments if the amount of his or her compensation calculated under section 126 was greater than nil; or
  3. has converted his or her incapacity payments to a lump sum under section 138;

b) the former member has suffered an impairment that is likely to continue indefinitely (refer to Chapter 5 Permanent Impairment [7]);

c) the former member's impairment constitutes at least 50 points (refer to Chapter 5 Permanent Impairment [7]); and

d) the former member is unable to undertake remunerative work for more than 10 hours per week, and rehabilitation is unlikely to increase the person's capacity to undertake remunerative work.

The assessment of a person's eligibility for SRDP can be initiated by a delegate or by a person making a claim in writing to the Department (i.e. a written request for assessment of their SRDP eligibility).

 

 

13.02.1 Clarification of the meaning of section 199(1)(d)

Phrase

Clarification

Remunerative Work

Any work for which labour is compensated. It does not include volunteer work for which non-labour costs are reimbursed, which may be used as a form of rehabilitation.

Rehabilitation

Inclusive of all three of medical management, psycho-social and vocational forms of rehabilitation.

Unlikely

Based on the probability over a five year period. Taken to have been satisfied if the relevant specialist believes that the probability that a person will improve (from any one of a vocational, medical and psycho-social perspective) in the next five years as a result of rehabilitation is less than even.

Increase

Understood to be inclusive of any improvement (medical, psycho-social or vocational) in the capacity to undertake remunerative work, and not just the ability to work more hours per week.

 

13.02.2 Investigating whether a person meets criteria (d)

 

Establishing a person cannot work for more than 10 hours per week with a less than 50 percent probability that rehabilitation will improve the person’s capacity, within a 5 year period, for remunerative work, must be supported by evidence from the person's relevant specialist/s.

Any improvement in the person’s capacity (medical, pyscho-social or vocational) must be considered in the context of their capacity to undertake remunerative work.

In most cases, the person’s treating specialist would be considered the relevant specialist (i.e. psychiatrist, orthopaedic surgeon etc). A ‘specialist’ does not include a general practitioner (GP). Medical evidence should only be accepted from a registered or licensed medical practitioner.

A delegate may determine eligibility based on existing evidence or may choose to seek specific or additional evidence from the person’s relevant specialist in order to be satisfied that the person meets criteria 199(1)(d). There are no set time limits on how long medical evidence remains relevant for.   Relevancy depends on the person’s conditions and circumstances, and the information provided at the time by the specialist i.e. whether the specialist set a review period. When considering and evaluating evidence, delegates may seek the opinion or guidance of a Contracted Medical Advisor (CMA). 

A person does not have to have undertaken a DVA rehabilitation program or assessment in order to meet criteria 199(1)(d). A rehabilitation assessment specifically for determining SRDP eligibility is not required by the legislation in order to make a decision.

Where the person does not have a treating specialist or the treating specialist is unable to provide an opinion on whether the person’s capacity for employment could be increased by rehabilitation, a rehabilitation assessment by a DVA rehabilitation advisor or provider may be used to assist a delegate to make a decision. A DVA rehabilitation advisor or provider can facilitate engagement with the relevant specialist/s to consolidate medical and rehabilitation evidence. Together with information on the person’s current circumstances and capacity for employment, the advisor or provider should report on whether rehabilitation will likely increase this capacity.

SRDP eligibility should be determined based on consideration of the available evidence and all relevant factors, including the person’s circumstances and their level of impairment (i.e. impairment points). Delegates have flexibility to obtain further evidence, including a second opinion from a relevant medical specialist, or an opinion from a DVA rehabilitation advisor or provider where the existing evidence is in conflict or does not clearly support a decision to accept or deny eligibility for SRDP.

 

13.02.2.1 Example 1
A person is 45 years of age, has 81 impairment points from a number of conditions including psychological, and receives a class A CSC pension. The treating psychiatrist has stated that no form of rehabilitation is likely to improve the person’s capacity for remunerative work to more than 10 hours per week in the next 5 years. The psychiatrist does indicate that the person could benefit from medical and psychosocial rehabilitation so that the person’s conditions do not further deteriorate and the person is able to better engage socially. Although a rehabilitation assessment has not been undertaken, and the person has not participated in rehabilitation, there would be sufficient evidence to consider the person SRDP eligible. The person should also be referred for a rehabilitation assessment to assist their general wellbeing.