Identifying and making suitable referrals to the Complex Assessment Officer (CAO) 101-05070010

A referral to a CAO is not required for the following payments/benefits:

• Commonwealth Seniors Health Card (CSHC)
• Carer Allowance (CA)
• Family Tax Benefit (FTB)
• Child Care Subsidy (CCS)
• Paid Parental Leave (PPL)

Are the customer and their partner only in receipt of, or claiming one of the above payments/benefits?

• Yes, procedure ends here.
• No, a CAO referral is required. For:
  • new claims (including where the customer and/or partner is already getting an income support payment, and claiming a different payment), go to Step 2
  • reassessments, go to Step 4
  • transfers to Age Pension, go to Step 4

Was the claim previously rejected FRC (failed to reply to correspondence) or FSD (failed to supply documents) based on a CAO recommendation and the customer has provided requested documents within 13 weeks of the date the notice was given to reject the claim?

• Yes, see Request to reassess a rejected claim
• No, go to Step 3

If the claim for income support payment or Low Income Health Care Card (LIC) will be rejected due to not meeting qualification reasons, do not refer the case to a CAO.

If a CAO assessment is needed to determine payability, the CAO report must be completed and the recommendations applied before assessing the claim

Will the claim be rejected for a qualification related reason?

• Yes, reject the claim. Procedure ends here
• No, go to Step 7

If the reason for the contact is to:

• respond to a:
  • program review of a private trust and/or company, go to Step 5
  • CAO request for information, go to Step 6
• advise of:
  • new involvement in complex income and/or assets for a valid CAO assessment reason, go to Step 8
  • a change in circumstance for previously assessed complex income and/or assets for a valid CAO assessment reason, go to Step 8

If none of these reasons apply, do not refer to CAO. Procedure ends here.

Private trusts and companies may be selected for a program review:

• the program review will issue a letter to the organisation contact person in the entity record, see the History Summary (HS) screen of the entity record in environment A for more details
• a reminder will be issued to the contact person and in addition, letters to each of the current customers linked to the trust or company record if there is no response within 35 days
• a third letter is sent after a further 28 days if the previous requests have not been responded to
• if no response is received within the next 28 days, payments will be suspended FRT (Fail to return trust and company correspondence) and cancelled FRT after 13 weeks

A CAO referral is not required for these reviews, see Customer contact regarding trusts and companies program review.

Procedure ends here.

If the customer is contacting in response to a CAO request for information, and:

• requesting an extension of time to provide the requested information:
  • check if requesting CAO is available via MS Teams for discussion
  • if requesting CAO is unavailable, use Fast Note - select Complex Assessment > Request for CAO action > CAO Assessment General and add text to advise customer requires an extension
  • advise the customer they will be contacted if unable to extend as requested
• requesting clarification of requested information:
  • check if requesting CAO is available via MS Teams for discussion
  • if requesting CAO is unavailable, use Fast Note - select Complex Assessment > Request for CAO action > CAO Assessment General and add text to advise customer is seeking clarification on requested information
  • advise the customer they will be contacted to discuss further
• providing the requested information:
  • scan documents to record
  • check if requesting CAO is available via MS Teams and if so, advise documents have been scanned to record
  • advise customer that the Complex Assessment Officer will complete their assessment and contact if further information is required
  • if payment is suspended or cancelled FRC or FSD, use Fast Note - select Generic > CAO Escalation > Immediate Processing CAO and add text to advise all documents have been provided

Has the customer provided all documents requested through the claim and are requested documents completed and signed?

• Yes, go to Step 8
• No:
  • issue a request for information. See Step 14 for additional supporting documentation to request
  • place new claim on hold
  • procedure ends here until documents provided

Note: only one referral is required, including for partnered customers.

Staff must check for existing CAO referral. See Table 2 in Work Optimiser for staff to complete a customer search for both the customer and partner Customer ID numbers. If there:

• are duplicate or multiple referrals, close the newest referral ensuring only the oldest referral remains open, see Table 7
• is an existing CAO referral for a 'reassessment' and a 'new claim' referral is now required and the referral was created in:
  • Process Direct, complete the WLM Technical Assistance Form > New Item to request recategorisation (in the Programme field, select Older Australians’ > in the Sub-Programme field, select Complex Assessment Officer)
  • Customer First, add the keyword CAONCL to the open CAO Ref DOC via the Activity List (AL) screen in Customer First or Customer Record (key V next to the activity to add keyword)

Is there an existing CAO referral?

• Yes, and:
  • additional CAO referral reason(s) now identified, complete the WLM Technical Assistance Form to make sure that work is directed to appropriately skilled CAOs (in the Programme field, select Older Australians’ > in the Sub-Programme field, select Complex Assessment Officer). Continue with this process for additional considerations but do not complete a new referral
  • additional details have been provided, annotate the first referral with the details. Continue with this process for additional considerations but do not complete a new referral
  • related activity has come off hold and CAO assessment not yet completed, go to Step 20
  • urgent CAO action is needed, see Table 6
• No, go to Step 9

Is a CAO referral being considered for a deregistered private company or vested private trust?

• Yes, go to Step 10
• No, go to Step 11

Check if customer and/or partner:

• are already linked to the Company/Trust's CRN and the Company/Trust CRN has not already been coded as 'Wound Up'. Check the Wound Up field on the Trust and Company Miscellaneous (TRMD) screen (in Environment A) via the Company/Trust CRN
• have declared gifting/deprivation in relation to the deregistered private company or vested private trust in the last 5 years before claiming
• have declared an involvement in relation to the deregistered private company while receiving an income support payment

Is the entity a deregistered private company or vested private trust and any of the above has occurred?

• Yes, go to Step 11
• No, a CAO referral is not required. Procedure ends here

Has the customer advised they have ceased involvement in a private company or private trust?

• Yes, go to Step 12
• No, go to Step 13

Check all linked private trust and private company records to determine if the CAO has documented the cessation of the customer’s involvement in the entity.

Note: access each entity from the Link Summary (LS) screen of the customer’s record using Customer First or Customer Record. Company and Trust records are available in Environment A.

Does the Document List (DL) screen within the linked Private Trust and/or Private Company show that the involvement of the customer and partner has ceased?

• Yes, a CAO referral is not required. Procedure ends here
• No, go to Step 13

A CAO assessment may vary depending on the relationship status of the customer. The Service Officer is required to review and update the relationship status prior to referring to CAO.

Are updates to the customers relationship status required?

• Yes:
  • complete the update to the relationship status
  • if the referral is part of a new claim, complete the relationship status update outside of the claim activity
  • Note: for Parenting Payment Single (PPS) benefit transfers, linking cannot be completed before the referral. Include 'New partner not linked - Partner CRN is [insert partner CRN]’ within the CAO referral notes
  • go to Step 14
• No, go to Step 14

Service Officers are required to ensure documents to support the complex assessment are provided before completing the referral.

Documents that may be required include:

• for private companies:
  • Private Company MOD PC fully completed and signed, and
  • appropriate documents from the module Checklist, see Documents and financial statements required for assessment in Documents needed to assess a private company for guidance
• for private trusts:
  • Private Trust details in the MOD PT fully completed and signed, and
  • appropriate documents from the module Checklist, see Required documents and financial statements in Documents needed to assess a private trust for guidance
• for other valid complex assessment reasons:
  • relevant forms
  • appropriate documents from the form checklists
  • relevant bank/investment statements
  • any other relevant supporting documentation

Note: CAOs may require additional information that is not evident to a Service Officer. If discussing referral/claim progress with a customer, Service Officers should advise the customer, that when allocated to a specialist officer additional documents/information may be required.

Where customers advise they are unable to provide any documents indicated within the checklists, include details of this discussion within the CAO referral notes.

Has the customer provided required modules and supporting documents or advice as to why they cannot provide certain documents?

• Yes, go to Step 15
• No:
  • issue a request for information
  • place the new claim/reassessment on hold
  • procedure ends here until documents have been provided

If the CAO referral is from the Payments and Integrity Group, go to Step 18.

For all other referrals, if using:

• Process Direct, for:
  • new claims, go to Step 16
  • non-new claim assessments, go to Step 17
• Customer First, go to Step 19

CAO referrals in Process Direct for new claims must be created in the new claim activity. For claims previously rejected, re-index the claim before referring.

To launch the referral workflow:

• select > Referral
• Referral Type, select Complex Assessment Officer (CAO)
• Payment type, check this matches the payment type of the claim
• Assessment type, defaults to New trust/company. This option is correct, even if the referral is not related to a private trust or private company
• Referral Reason(s), select the appropriate referral for the CAO to assess (for example, 'Trusts', 'Asset Hardship Claim', 'Private Companies'). Multiple options can be selected if applicable
• select Next, the CAO Referral page displays
• Document List, check the box against all documents provided, noting that the list will update when the referral reason(s) are updated
• What is Required? add details in the free text box:
  • if scanned documents are relevant to the referral, nominate the date of scan and scan number in the referral notes. This will help the CAO locate supporting information
• Have all necessary documents been provided?, select:
  • Yes, or
  • No and key details in the Why? field
• select Next, the Referral Summary screen displays
• Additional comments, include a reason for requiring a CAO assessment. A reason is required regardless of having nominated the Referral Reason
• select Finish, the referral is created and an automatic Note will be added advising a CAO referral has been created

Go to Step 20.

To launch the referral workflow:

• from Customer Summary, select > Referral
• Referral Type, select Complex Assessment Officer (CAO)
• Assessment type, select appropriate option from the dropdown menu
• Referral Reason, select the appropriate referral for the CAO to assess (for example, 'Trusts', 'Asset Hardship Claim', 'Private Companies')
• select Next, the CAO Referral page displays
• Document List, check the box against all documents provided, noting that the list will update when the referral reason(s) are updated
• What is Required? add details in the free text box:
  • if scanned documents are relevant to the referral, nominate the date of scan and scan number in the referral notes. This will help the CAO locate supporting information
• Have all necessary documents been provided?, select:
  • Yes, or
  • No and key details in the Why? field
• select Next, the Referral Summary screen displays
• Additional comments, include a reason for requiring a CAO assessment, a reason is required regardless of having nominated the Referral Reason
• select Finish, the referral is created and an automatic Note will be added advising a CAO referral has been created

Go to Step 20.

For referrals from teams within the Payments and Integrity Group (system tool description Business Integrity).

Within the referral, add relevant notes including:

• details of the team making the referral. Include all information relevant from the Review Summary (IRRS) screen and the requirements of the CAO assessment, including the scope of the review/assessment
• if there are any restrictions on outbound contacts or requests for information (if no restrictions, include this). Note: where there are restrictions, the CAO will liaise with referring officer if more information is needed to complete their assessment
• if there are any additional documents relevant to the assessment that are not scanned to the record

If using Process Direct:

• select > Referral
• Referral type, select Complex Assessment Officer (CAO)
• Assessment type, select Reassessment
• Referral reason, select relevant options (can select multiple options), select Next
• select Next > Business Integrity referral
• select the Business Integrity referral reason:
  • Authorised Review Officer, for ARO referrals (includes keyword AROCAO)
  • Random Sample, for Payment Accuracy Review referrals (includes keyword RSSCAO)
  • Yes - Other, for any other Payments and Integrity referral, including those from Debt teams (includes keyword BICAO). Note: for Payments and Integrity referrals as part of Taskforce Integrity, after the CAO referral is created, manually add the keyword TKFCAO
• in the What is required free text field, add relevant notes
• go to Step 20

If using Customer First:

Run the CAO Referral guided procedure:

• Assessment Type, select BI Referral
• Referral Reason, select:
  • Authorised Review Officer, for ARO referrals (includes keyword AROCAO)
  • Random Sample, for Payment Accuracy Review referrals (includes keyword RSSCAO)
  • Other, for any other Payments and Integrity referral, including those from Debt teams (includes keyword BICAO). Note: for Payments and Integrity referrals as part of Taskforce Integrity, after the CAO referral is created, manually add the keyword TKFCAO
• in the Reason for Referral include relevant notes
• go to Step 20

Run the CAO Referral guided procedure.

For a new claim or LIC renewal:

• Assessment Type, select New Claim
• update the:
  • KPI Due Date. For help with Key Performance Indicators, see Timeliness standards - Claims processing
  • Date payment is due to commence. This is the date of event that the claim is expected to be granted from. For LIC claims, record the date 8 weeks before the date of grant

CAO referral required for non-new claim assessment:

• select Assessment Type: Reassessment
• if the customer is suspended FRC or FRT, as failed to reply to a CAO request for information, select Customer Suspended: Yes

For new claims and reassessments:

• select the Case Type to populate the document list (noting not all Case Types require documents)
• more than one Case Type can be identified to add documents. Make sure to select all documents provided and scanned for each identified Case Type
• use Other Referral to identify additional Case Types and free text is also available to list other supporting documents supplied
• if scanned documents are relevant to the referral, nominate the date of scan and scan number in the referral notes. This will help the CAO locate supporting information
• update Reason For Referral and DOC Details with reason for requiring CAO assessment. The reasons are required regardless of having nominated the referral Case Type

Note: for Farm Household Allowance (FHA) review referrals, select the Payment Type Exceptional Circumstances Relief Payment. When referral is created manually add the keyword CAOFHA. If the referral is in relation to a compliance activity also add the keyword FHACMPRV. Keywords can be added by viewing (v) the activity from the AL screen.

If there is a CAO referral in Process Direct, the new claim status will automatically change to On Hold with reason Referral to CAO. A Note/DOC will be recorded on the Document List (DL) screen with Customer Referral work item ID. The claim will remain On Hold until the CAO referral is completed.

If the activity (including new claims) status has not updated automatically, place the activity On Hold for 100 days. The activity status will update when the CAO referral is completed. This does not reflect expected processing time.

If the activity ceases to be on hold and the CAO referral remains open:

• confirm the CAO referral is required. If the referral was created inappropriately, close the CAO referral, see Table 7
• check that the CAO assessment is not completed
• refer to progress notes and determine if the assessment is pending a CAO request for information
• return the status to On Hold for an additional 28 days, for the assessment to be completed
• DOC on hold reason. If an open DOC is necessary, hold for the same duration
• if the customer makes a request for immediate processing and meets the criteria, see Table 6. Note: before any escalation is undertaken, the CAO referral must be made and all required documents provided

If the CAO was unable to make a determination because the customer failed to provide requested information, the CAO will record a DOC including details of the outstanding information. See Rejecting a Centrelink claim.

When the CAO assessment is completed, the Service Officer must check the CAO assessment DOC for any actions that they must complete.

Changes post CAO assessment

Make a new CAO referral and escalate for immediate processing if one of the following applies:

• the customer provides further information related to the CAO assessment and before the claim finalisation
• the CAO was unable to complete the assessment as the customer failed to respond to a request for information and the customer has provided information before the claim is rejected, or
• the Service Officer makes a determination that an earlier Date of Event is to apply

See Immediate new claim and non-new claim priority processing.