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How to get your disability claim approved

Have you become disabled? You may be wondering what type of disability benefit to apply for, and how to get your disability claim approved. Here’s what you need to know about getting approval on a disability claim in Australia.

What qualifies as a disability?

Australia has a point system in place to determine levels of impairment, and parameters for what can be considered a disability that qualifies for monthly or lump sum payments. You should have undergone a medical exam and have documentation from your doctor detailing your disability. You’ll need the medical evidence to support your disability claim.

Disability support pension (DSP) claims

The most common type of disability claim is for a disability support pension. You may also be required to undergo a separate evaluation for disability to qualify for DSP. If both the doctor who diagnosed you and the evaluation are in agreement and your level of impairment qualifies you for disability, you can apply for DSP.

DSP claims require that you meet medical and non-medical rules before you can apply. Meeting these requirements doesn’t guarantee your disability claim will be approved, but it means that your claim must at least be considered. If you meet all of the rules and your claim is rejected, you can appeal the disability determination.

Medical and non-medical rules for DSP claims

There are two types of medical rules that must be met for DSP qualification. You must either meet general medical rules or one of the manifest medical rules.

General medical rules include:

  • A condition to be fully diagnosed, treated and stabilised
  • An impairment rating of 20 points or more
  • The expectation that your condition will last more than 2 years
  • Predictions that your condition will stop you from working at least 15 hours a week in the next 2 years

Manifest medical rules include:

  • A terminal illness (average life expectancy less than 2 years)
  • Permanent blindness
  • A requirement for nursing home level care (round-the-clock, not at-home care)
    Intellectual disability (including an IQ lower than 70)
  • A diagnosis of Category 4 HIV/AIDS
  • Totally and permanently incapacitation and receiving a Department of Veterans’ Affairs special rate disability pension

Non-medical rules include:

  • Claiming while between 16 and Pension age
  • Meeting residency rules
  • Meeting income and assets tests

What are your other options for filing a disability claim?

You have many options for filing a disability claim, starting with the DSP and moving on to claims you can file with your employer or your superannuation fund.

Workers' compensation claims

If you can’t qualify for a disability support pension, you may be able to file a workers’ compensation claim with your employer if your disability was caused by an incident at work. A workers’ compensation claim may be the best option if you have what can be expected to be a short-term disability.

You can file a workers’ compensation claim with your employer, and follow up with documentation from your doctor (your employer may require a second evaluation by their own doctor, but you can still use your own doctor for your initial evaluation, treatment, and follow up.)

Workers’ compensation claims may provide a lump sum you can use for paycheck protection and to cover medical costs. You may also be able to file for pain and suffering under some circumstances.

Total and permanent disability (TPD) claims

You may also pursue disability claims under one or more insurance policies held through your super(s.) Part of your employment income is likely being put toward cover for various care needs, including superannuation fund policies for total and permanent disability (TPD.)

You’ll need to find out if your disability insurance policy applies simply if you are disabled and cannot work your original jobs, or (more common these days) if it says that you must not be able to work any job. You may have more than one super, so make sure to check with all of your superannuation funds to see what TPD policies you have as well as what they say about their rules.

TPD benefit payouts are separate from the rest of your superannuation, although they are paid into your fund directly. You can withdraw them without penalty before reaching eligible age and can choose how much (if any) you want to withdraw to cover the cost of living and medical expenses. Some people choose to leave TPD payments from one or more supers intact to earn interest in their funds.

Other disability programs

If you can’t work and don’t qualify for a major disability claim, you can apply for the Australian JobSeekers program, which can provide a disability allowance if you are unable to work because of sickness or injury for a time. You’ll have to show you are looking for another job that you can do with reskilling or retraining.

If you are disabled enough that performing your original job is impossible, but still want to work, you may be able to find work through government-sponsored programs that incentivise employers to hire workers who have a disability. There are a lot of options open to you, no matter what level of disability you are experiencing, or how long it is expected to last.

What does the disability claims process look like?

Applying for disability starts with finding a good disability attorney who can advise you on what type of claim to file or if you may be able to file several different types of claims.

Next, you’ll need to gather all of your proof of disability, including medical evaluations and evidence. This will form the backbone of your case. You’ll also need to look at the rules for DSP and make sure you can meet them if you plan on filing for a disability pension.

Your claim will be reviewed, and either approved or rejected. In some cases, you may be asked to provide more paperwork. If you apply for disability but have your claim denied, you can appeal. If you are denied and your condition has worsened, you may need to file a completely new claim.

Your disability benefits will vary depending on the type of claim. Workers’ compensation and TPD claims benefits can vary widely. For an approved DSP claim, if you are single, over the age of 21, and not supporting a child, your pension may be set at $950.00 per fortnight. If you are able to return to work at a reduced number of hours, you may qualify for a reduced disability payment.

How can a disability lawyer help me with my claim?

The first thing to do if you need to file a disability claim is to engage a disability lawyer who can help you with the process. This applies whether you are filing a DSP, a workers compensation, or a TPD claim.

Your lawyer will help you gather all of your documentation, including your medical evidence, and file the claim. If for some reason your claim is rejected, they can help you with your appeal. Gerard Malouf & Partners works on a no-win, no-fee basis, so you don’t owe us any legal fees unless you receive your compensation.

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