Rejecting a claim for Low Income Health Care Card (LIC), Foster Child Health Care Card (FST) or Ex-Carer Allowance (child) Health Care Card (EHC) 101-06040060

When a customer lodges a claim for LIC, FST or EHC and they do not meet the qualification criteria, the claim will be rejected. A letter is issued to the customer explaining why the claim was rejected, including their review and appeal rights.

If the claim is to be rejected, record all relevant details from the claim on the customer's record. In most cases, the system will automatically reject the claim (for example, not residentially qualified or income is over the threshold). For some rejection reasons, the rejection will need to be recorded manually via the system. For example, failed to supply documents (FSD) or fail to reply to correspondence (FRC).

Online LIC or FST claims may be streamline rejected ‘FSD’ or ‘FRC’ without all claim updates applied to the record from the claim.

EHC online claims to be rejected FRC need to manually rejected, not streamline rejected.

If the rejection reason is 'FSD' or ‘FRC’, the decision DOC must list all documents not provided at the time of the rejection.

Visa, citizenship and movement information provided directly from the Department of Home Affairs datalink may cause the claim to be rejected. If the datalink with Department of Home Affairs has provided the information, this takes precedence over any conflicting information provided by the customer.

When an unfavourable decision is to be made, such as a rejection, the Decision Maker (DM) must provide the customer with an explanation of the decision and an opportunity to provide more details or evidence relevant to the decision. The DM must also tell the customer of their review and appeal rights. This includes unfavourable decisions made by Service Officers in smart centres.

If the DM is not speaking to the customer at the time of making a decision, they need to make genuine attempts to contact the customer before finalising an unfavourable decision.