Special circumstances provisions for customers receiving compensation payments 117-04020010

A person contacts Services Australia to seek a reduction of their:

• calculated preclusion period and/or
• debt for a compensation affected payment (CAP) which resulted from a preclusion period

Has the person's claim or CAP been cancelled or rejected within the previous 13 weeks due to compensation?

• Yes, go to Step 2
• No, tell the person:
• to lodge a claim for a CAP
• explain to the person their claim will be rejected and they will need to request a review at that time
• they will need to provide evidence for their review
• procedure ends here

Applying the normal compensation provisions to a person's situation may:

• have an unintended effect
• lead to extreme hardship, or
• create an inequitable or unjust situation

This will be a new decision based on the change in circumstances and will be subject to the normal review and appeal provisions.

Interview the person to determine the exact nature of the change in circumstances and financial situation.

The person must provide evidence of hardship and this may be documentary or professional advice.

The timeliness standards for resolving a person's request for a review of decision is five working days from the date of receipt of all relevant information.

Has the person established hardship and provided evidence?

• Yes, go to Step 3
• No, go to Step 6

Have circumstances altered significantly since the preclusion period commenced due to factors wholly or partly out of their control?

• Yes, go to Step 4
• No, go to Step 9

A Display on Access (DOA) Fast Note ‘Special Contact Considerations (SCC) - Sensitive Issue - ‘FDV Concern Identified’ ‘will show for customer records with a family and domestic violence (FDV) concern.

See Identifying customer vulnerability and risk issues.

• Yes, special circumstances apply, go to Step 8
• No, special circumstances do not apply, go to Step 5

Can the person's hardship be alleviated in some way other than by applying special circumstance provisions?

• Yes, go to Step 9
• No, go to Step 6

Ask the person to supply evidence in support of their claim within 14 days. Ask them to complete a Compensation Recovery Statement of Financial Circumstances (SoFC) SS484 form. See Resources for a link to the form.

• Yes, go to Step 8
• No,
• using the Internal Review/Explanation script update the Appeal System to affirmed
• record details on a DOC
• send the Q449 'To Customer - SME unable to contact/Refer to ARO' letter
• procedure ends here

Before making a decision:

• review SoFC and supporting evidence
• research similar case histories in the AustLII database. See the Resources for a link to the AustLII database
• examine the overall personal circumstances of the person
• review the ‘factors to consider’ in the Social Security Guide. See the References for links to the Guide

Does the person have grounds for special circumstances?

• Yes, go to Step 10
• No, go to Step 9

Based on the decision, record the SME outcome using the Internal Review/Explanation script.

• record the decision on a DOC including reasons for the decision
• include all relevant details of the issues that were considered
• go to Step 13

It must be established:

• there are extraordinary factors, or a combination of circumstances
• the person could not have foreseen or budgeted for these circumstances, and
• the circumstances leave them in hardship or in an unreasonable situation when the compensation provisions are applied

Special circumstances exists, go to Step 11.

• deduct any amount to be disregarded from the gross lump sum amount
• recalculate the customer's social security debt and/or preclusion period

There are no prescriptive rules for calculating the amount to be disregarded.

Go to Step 12.

Amend the customer's:

• debt, see change the debt details, or
• preclusion period, see change the preclusion period details

Go to Step 13.

Make genuine attempts to contact the person by phone to advise them of the decision. Give them the chance to ask any further questions and record all details of the conversation in the review of decision DOC.

There are language and interpreter services available for customers who may need an:

• Immediate telephone interpreter
• Indigenous language interpreter

See Interpreter Services.

Where special circumstance do not exist, tell the person of their review and appeal rights. If the customer is satisfied with the explanation, finalise the review using the Internal Review/Explanation script.

If the customer is not satisfied with the decision, they may request a formal review. See Request for an explanation or application for a formal review.

If contact cannot be made, finalise the review using the Internal Review/Explanation script and send the Q449 'To Customer - SME unable to contact/Refer to ARO' letter.