This article has been written by Noel Ellis, Benefit Rights Advocate. Noel wants you all to know that there is a Disability Allowance available to New Zealanders from Work and Income. He explains what might be available to you, and what information is needed to support your application.
From Noel Ellis, Benefit Rights Advocate
26th April 2018
If you find that your income is insufficient to meet your costs, you may be eligible for extra benefit assistance for your medical expenses by way of a Disability Allowance.
This is a discretionary allowance paid under Section 69C of the Social Security Act if the other forms of assistance are insufficient to meet the need.
It is not that you have to be “disabled” to qualify. In this context, disability means an ongoing health condition. It is normal for people in their senior years to experience a decline in health with the associated costs arising from that.
The Disability Allowance is subject to an income test, and there may be a number of Superannuitants with extra income who are ineligible if their weekly income exceeds a limit of $648.92 gross for a single person, or $963.80 for a couple (as of 1 April 2018). There is no assets test, although the interest earned on savings counts as extra income.
Maximum Allowance $63.22 per week
The current maximum for Disability Allowance is $63.22 (for each person with a disability). If you meet a test for financial hardship you may be able to receive more by way of Temporary Additional Support (TAS) based on all your overall costs.
Because the Disability Allowance is a discretion, Work and Income needs to be satisfied that you have necessary health costs, and more importantly, how much your costs are.
Get a Certificate, and verify extra costs
The first step is to get a Disability Certificate from a registered health practitioner (usually your GP) that you have an ongoing health condition that is likely to last six months or more, and that you have extra costs associated with that health condition.
Next you need to verify the costs. Work and Income like to see average costs based on the past 52 weeks, so ideally this should include a print-out from the medical centre and chemist. The logic is that they cannot predict what you will spend in the coming 12 months, so they like to base it on what you have spent.
If this is a problem in that cannot afford to start the treatment without the extra assistance you are applying for, then you may be able to apply for assistance for anticipated costs. It would help if you are able to get a quote or invoice for treatment that you are starting but cannot afford. Then you may have to provide verification afterwards that you used the money for the purpose intended.
Work and Income have a list of cost categories that can be approved, but legally there is no cost that cannot be approved if we have the right medical support.
Typical costs allowed include medical fees and prescriptions. Transport can also be allowed to necessary appointment, but if you are eligible for free public transport using your Gold Card then they will want to know why. It may be that your appointments are outside of the times covered by public transport.
Your car, taxis, or public transport?
If you use your own car then you need to provide the registration papers to verify the cc rating and you may get paid based on the cc rating of your car, usually 35 cents a km, or 40 cents for a bigger car. This may be challenged if you can show that the car is solely or largely required because of the health condition.
If a family member uses their own car to drive you, then you may have a problem, in that Work and Income will say that is not a cost to you.
If you are unable to use public transport and need taxis, then this needs to be verified by your GP, and you may be referred to the Regional Council for discount taxis under Total Mobility. Once discount taxis are approved then this should be straight forward: it is agreed that taxis are necessary, and you only have to pay half price. You can then try and claim back the remaining 50%, with a print out of the necessary journeys. This may not include all trips, such as social visits to friends and family, or the like. Unless these are linked to you “mental wellbeing” these are likely to be treated as your choice.
Also depending on your location, travel to shopping may not be a health related cost, in that it may be a normal cost of everybody where you live.
Gyms and Swimming Pools
One useful cost to get approved is attending a gym or swimming pool. Some Case Managers are known to argue that exercise is a normal cost that everybody has. We would argue that someone on a limited income would not pay for this expense if they did not have to.
Also sometimes Case Managers get it confused and try and say that your exercise is not “supervised by a doctor”. This does not mean that you doctor has to watch you swim up and down the pool, supervised means that at your medical check up, the doctor reports as to whether or not the exercise has “therapeutic effect”.
There is also a curious logic that sometimes Work and Income may say that swimming cannot be approved unless it is “part of a structured exercise regime” like an aqua-jogging class.
Extra power and special food present another difficulty in that this requires an assessment of how much your food or power is more than someone without your particular health condition.
For power, Work and Income’s Policy has a procedure where they want you to provide 12 months worth of power bills, so that they can compare with the average usage using Consumer Powerswitch. If you have not saved all your bills, you may be able to request them from the power company (some may charge a small fee for this), or if you are only missing one or two non-consecutive months then you can easily work it out, as each power bill has the current months usage, plus the previous invoice paid.
The problem with using these generic figures is that you are likely to end up with an assessment that you are not using more than average (on not much more than average).
The official policy says that this is only Steps 1 to 6. If the client disagrees with this they are required to go to Step 7 to find a different way to assess power usage. In fact the policy says that you must do this for a single person living alone, because the generic figures on Powerswitch are for a “one to two person household”.
Special Appliances and Heating
One of the Policy guidelines is to consider if the cost is for running a particular appliance, such as a nebuliser, dehumidifier or electric scooter, then assess the cost of running that appliance.
In this case, the person could have been economical with their power (so that they are using less than average), but still have an extra unavoidable cost of running an appliance. So if you can get the specifications of the appliance (kilowatt rating) then use the charge for a kilowatt hour to assess how much extra has been used.
If the cost is for extra heating, the same argument can be used: if the person is home 40 hours a week more than average wage or salary earner, then try calculating the cost of running a heater 40 hours a week.
One is to find the specifications of your heater. Alternatively use Powerswitch to compare using electric heating to gas or wood heating will show the difference.
Others have used a summer/winter differential to compare the power used during the six winter months to the six summer months. This has been paid as a weekly allowance for some.
Special food also requires some haggling to get an agreed figure for the amount which your food costs are over and above that require by someone without your health condition, such as lactose intolerant, gluten free or organic.
So you may have to draw up a list of your food costs, and compare it with “ordinary food costs” for someone who does not have your particular food allergy. Then if you can get actual weekly receipts for your food purchases, compare that to a price check for the “normal” food items that you cannot buy to show the difference as a weekly cost.
Unsubsidised pharmaceuticals are an issue as the legal guidelines require Work and Income to consider the availability of a subsidised or partial subsidised alternative that might be available to meet the need. Our argument is that the reason that you need the unsubsidised version is because the generic alternative is not suitable to meet the need. Work and Income want you (or rather your doctor) to write to Pharmac to ask if you can get a subsidy for your variant. Once this has been done, and as Pharmac are unlikely to make an exception for one individual, then your medication can be approved as there is no alternative.
Once disability costs are approved they may not have to be checked again, unless there is a reason to re-assess. For Seniors over 65, Work and Income Policy Guidelines ay that there is no need to re-assess, as at that stage in life there is not expectation that your health condition is improving with age. There may be a need to confirm your medical condition, but not if your doctor has confirmed permanent never re-assess.
Work and Income’s Health & Disability Advisers
In deciding if your cost can be approved, Work and Income rely on the Health and Disability team. These usually include a nurse or even someone with no medical training at all. Officially their role is “to give advice”, but the reality is that the Case Managers are told to take advantage of the advice given, so if they are found to be thinking for themselves and have not taken advantage of the support of their Health and Disability Advisers, they may find themselves re-assigned ot other duties.
If you disagree with a decision about your Disability Allowance then you can always challenge the decision in writing by lodging a Review of Decision. Then Work and Income has to either pay what you are asking for, or write a report to say why not. As Benefit advocates we would encourage people to do this.
From Noel Ellis, Benefit Rights Advocate
26th April 2018
Benefits Rights Service
04 210 2012
Anvil House, Level 6, 138 Wakefield St, Wellington
PO Box 9491
Information about the Disability Allowance can be seen at Disability Allowance – Work and Income (https://www.workandincome.govt.nz/products/a-z-benefits/disability-allowance.html).
Googling “Benefit Rights Service” or Graham Howell also gets quite a bit of useful information. The author of this article, Noel Ellis, is also part of the Benefit Rights Service.