Assessing claims for Carer Payment (CP) 009-04050000

Qualification for CP (child) when a care receiver is aged under 16 is based on the circumstances of both the carer and the care receiver, information is provided by the child's Treating Health Professional (THP) and the carer, to determine the level of care required and the level of care provided.

In addition to the general qualification provisions, the child must be assessed under the Disability Care Load Assessment (child) Determination (DCLAD) (2020).

Provisions where CP (child) can be paid if the carer provides constant care on a daily basis in the home of the child they care for.

CP child

• Where a parent or carer provides full-time personal care of supervision for a child aged under 16 with a severe disability or severe medical condition

CP combined care

• Where a parent or carer provides full-time personal care or supervision for 2 to 4 children aged under 16 with a disability or medical condition, whose combined care needs are equal to that of one child aged under 16 with a severe disability or severe medical condition

CP multiple care

• Where a parent or carer provides full-time care or supervision for a disabled adult and 1 or 2 children whose combined care needs are equal to that of 1 child aged under 16 with a severe disability or severe medical condition

CP more than 1 carer

• Where a child with a severe disability or medical condition may qualify 2 carers for CP

CP short term or CP episodic care

• Where a parent or carer provide care for a child with a severe disability or medical condition requires constant care for at least 3 months but less than 6 months.

CP exchanged care

• Where separated/divorced parents exchange care of 2 and up to 4 eligible children but not the same child/ren every day

CP terminal illness

• Where a child under 16 years of age has a terminal condition and is not expected to live more than 24 months

Note: where a medical practitioner has certified the child care receiver is terminally ill, they do not need to undergo the DCLAD child assessment as they are granted CP automatically, provided they meet all other eligibility criteria.

CA (auto) is available to all recipients of (CP) (child).

If CP (child) cancels, CA (auto) will cancel automatically at the same time. The carer must lodge a new claim for CA (child) if the care receiver still requires and receives additional daily care and attention due to their disability or medical condition.

Carers who are current or suspended on 30 June 2010 and were:

• granted CP (child) under the DCLAD (2009) or CA (child) under the Child Disability Assessment Determination (CDAD) (2001) will maintain qualification and payability under their existing provisions. This remains until they are selected for review under DCLAD 2020 or lose qualification on or after 1 July 2010. This group of care receivers will not appear on the Carer Payment Grandfathered (CRGF) screen
• granted CP (child) due to caring for a Profoundly Disabled Child (PDC), or 2 children who require the equivalent care of a PDC, will maintain qualification and payability under PDC provisions. This remains until they are selected for review under DCLAD 2020 or lose qualification on or after 1 July 2010. Carers in this group who reclaim CP (child) for the same care receiver from 1 July 2010 to 17 August 2020 will be required to provide a DCLAD (2020) care load assessment and medical report. These groups of care receivers will appear on the CRGF screen

The CRIA test for CP is administered in addition to the pensions income and assets test.

When carers are claiming CP for a child or adult care receiver, eligibility is in part based on the care receiver's income and assets. A carer may be paid or continue to be paid CP if the care receiver has income and assets below the relevant limits. Some income and assets are disregarded, see Components of the Care Receiver Income and Assets (CRIA) test.

The carer will have to meet all other qualification provisions in order to be granted CP.

Qualification for CP (adult) when a care receiver is aged 16 years or over is based on the circumstances of both the carer and the care receiver. Information is provided by the carer receiver's Treating Health Professional (THP) and the carer completes the carer's questionnaire; these are used to determine the level of care required.

In addition to the general qualification provisions, the carer must provide constant care for an adult with a qualifying Adult Disability Assessment Tool (ADAT) score, in the care receiver's private home.

Provisions where CP (adult) can be paid if they provide constant daily care in the home of the care receiver:

CP adult

• Where a carer provides full-time personal care of supervision for a care receiver aged 16 or over with a severe disability or medical condition or someone who is frail aged

CP lower ADAT

• Where a carer provides full-time personal care or supervision of a care receiver aged 16 or over with moderate care needs and has a dependent child who is either under 6 years of age, or is aged 6-16 years and is eligible for CA

CP more than 1 carer

• Where a person with a severe disability or medical condition may qualify 2 or more carers for CP

If a carer receiver is in respite (not hospital) at the time a carer lodges a CP and/or CA claim, see Complications to Grants of Carer Payment and/or Carer Allowance.

Where the carer is caring for an adult and 1 or 2 children whose combined level of care is equivalent to one qualifying child, consideration should be given to CP multiple care.

It may not be reasonable for a carer to complete all their Required Tasks before submitting their claim.

These include exceptions where certain vulnerabilities exist. Claim submission exceptions apply to

• a care receiver with a terminal illness who is not expected to live for more than 3 months and
• a carer under 18 years of age

Carers submitting a claim for CP terminal illness may be submitted under the exception category, where the claim cannot be rejected until 22 days (14 days plus the additional 8 days) have been reached.

Where a Treating Health Professional (THP) has certified the adult care receiver (16 years of age or over) is terminally ill, they do not have to undergo the Adult Disability Assessment Tool (ADAT) assessment. The care receiver must be in the final phase of a terminal illness and is not expected to live more than 3 months. Payment may be granted automatically if the carer meets all other eligibility criteria.

Carers receiving CP terminal illness for an adult care receiver (16 years of age or over) will be reviewed. For more information see Terminal illness reviews for Carer Payment (CP) (adult)

Carers receiving CP terminal illness for a child care receiver (under 16 years of age) will be reviewed. For more information see Terminal illness reviews for Carer Payment (CP) child

Claims from carers must be referred to a social worker, when the carer is:

• under 18 years of age, (before processing the claim)
• over 80 years of age

Social workers will assess the care situation to ensure the carer:

• has the physical and emotional capacity to provide the level of care needed
• is given information and help to access support services and resources

Re-use and reclaim provisions

Re-claim provisions allow qualifying THP medical reports and Care Needs Assessments previously supplied to be used for a CP and/or CA subsequent claim.

Re-claim provisions are automatically assessed when a carer claims online, Assisted Customer Claim (ACC) is used, or the First Contact Service Offer (FCSO) workflow is run.

Re-use provisions allow eligible THP medical reports and/or CNAs previously supplied to be used for a subsequent claim. Information previously gathered under the Adult Disability Assessment Determination (ADAD 1999) or terminal condition assessment for CP (adult) and/or CA (adult) may also be re-used. Re-use provisions for CP and/or CA child and adult are automatically assessed when a carer claims online, ACC is used or FCSO is run.

For more information, see:

• Re-use and re-claim provisions for Carer Payment (CP) (child) and Carer Allowance (CA) (child) claims
• Adult Disability Assessment Tool (ADAT)

Carer or care receiver has recently died after lodging a claim

If a carer or care receiver passes away before the claim is finalised, additional coding is required within the claim to end-date any Electronic Messaging (EM) subscriptions. For more information, see Centrelink - Notification, confirming and recording a death.

Under some circumstances, claims lodged after the death of a carer would also be assessed.

In some cases, this may involve undoing the death action on the carer or care receiver's record, ensuring arrears/advices are inhibited and then recoding the death action. See Undoing a death action for further information.

Grant or rejection of claim

On completion of recording the claim all the carer's details will be registered on the system and their record should be linked to the care receiver's record. The system will process the information and will grant or reject the claim accordingly.

Under some circumstances, claims lodged after the death of a carer would also be assessed.

A carer who has lodged a claim for CP and does not meet basic eligibility qualification and payability for CP may have the claim rejected. Sometime the claim lodged is an inappropriate or incorrect claim. In all these circumstances, the claim is rejected.

If the carer:

• withdraws a claim, this should be cancelled not rejected
• claims CP and does not meet basic qualification criteria, the claim will be automatically rejected
• claims and is rejected for a residence related reason based on information provided on their claim. In some cases visa, citizenship and movement information, which is provided directly from the Department of Home Affairs datalink, may cause the claim to be rejected. Where the datalink with Department of Home Affairs has provided the information this will take precedence over any conflicting information provided by the carer

When manually rejecting a claim, ensure that an advice is sent to the carer giving reasons for the rejection, and detailing the steps to follow in the review of decision process.

For a list of rejection codes, see Cancellation, suspension and rejection codes for Carer Payment (CP).

For situations where claims have been lodged after the death of a carer, see Claims lodged after the death of a carer.

Note: where a customer claiming CP is rejecting for income and assets and they have lodged a claim for the Home Equity Access Scheme, contact the Home Equity Access Scheme National team. Contact through a Fast Note before rejecting the CP claim to determine whether carer assessment details are required for the Scheme purposes. Use Fast Note - select Auto text, use > Complex Assessment > Request for CAO action> CAO Home Equity Access Scheme.

When a carer applies for CP and they are already receiving CA and have an existing absence recorded on the system due to any of the following reasons, the existing absence must be deleted and then re-recorded so it can be considered for CP and CA.

• hospitalisation
• respite care
• education
• training or
• treatment

Follow this procedure when a claim is being considered for backdating and there are periods where the carer was not qualified. For example, exceeding portability/respite.

In these situations, the system could not calculate the correct arrears, the Service Officer must manually calculate the correct arrears.

Qualification for bereavement assistance depends on whether the carer receives CP and/or CA. Before granting a claim for CP and/or CA, ensure the carer is eligible during the bereavement period and that arrears are not paid for more than 14 weeks from the date of death.

If the carer receives:

• CA, bereavement assistance may be payable:
• if the care receiver was a child
• under certain circumstances if the care receiver was an adult
• CP, bereavement assistance is payable

Note: Bereavement Payment for CA (adult) customers depends on whether the carer receives other payment and their payment type.

In these situations, the death action on the care receiver's record should not be actioned until the CP and/or CA claim is finalised. It may be necessary to suspend the deceased care receiver's payment and inhibit the advices, until the CP and/or CA claim is ready to be finalised. If the date of death is not recent, it is important to calculate the correct arrears owing and to zero out any arrears of CA past the date of death to avoid overpayment.

If granting or rejecting a CP and/or CA claim for the carer of a deceased care receiver, a manual Q888 must be issued.

The grant or rejection letter must be addressed to:

• the Executor of the Estate (if applicable), or
• the 'Estate of the Late <customer's name'

Once the CP and/or CA claim is granted (or rejected) and arrears have been adjusted, the Service Officer can then code the death action on the care receiver's record.

If the care receiver is a child, the death action should cancel the CA and the system will assess the carer's eligibility for a lump sum bereavement payment of CP and CA. It will also assess entitlement for CP for the bereavement period.

If the care receiver is an adult and the carer is in receipt of:

• CA only, the system will automatically cancel CA. The carer will not be eligible for a bereavement payment
• both CP and CA, the system will automatically cancel CA and assess the carer's entitlement to CP during the bereavement period and eligibility for a lump sum bereavement payment for that care receiver
• both CA and an income support payment (other than CP) that does not qualify them for a bereavement payment, the system will cancel CA at the end of the bereavement rate continuation period and assess the carer's eligibility for a lump sum CA bereavement payment
• both CA and an income support payment that qualifies for a bereavement payment, the system will automatically cancel CA

The death action should generate an appropriate bereavement letter ensuring the carer is sent a grant letter and a bereavement letter.

If the death action has already been actioned on the care receiver's record before the CP and/or CA claim is processed, the care receiver's record should be resurrected, taking care not to pay arrears past the date of death. Once the claim is finalised, the death action should be recoded, taking care not to duplicate any lump sum bereavement payments if already paid or to resend any letters that have already been sent.