Implementing the outcome of a failure review or appeal 001-10130020

Once the decision has been finalised, the decision statement and implementation instructions will be returned to the:

• Participation Solutions Team (PST)-skilled Service Officer if not a priority review, or
• Appeals Support Team if a priority review

This decision must be implemented within 7 days of the instructions being sent. The PST-skilled Service Officer (WNPPD)/Appeal Support Team Service Support Officer (WNPPD) is responsible for:

• arranging for the necessary updates to be made to the customer record as per the implementation instructions
• running the Appeal Decision Implementation script which will update the Appeals (APL) system and create a DOC on the customer record

For decisions relating to:

• Participation suspension following a mutual obligation failure or work refusal failure, go to Step 2
• Financial penalty for a first or second mutual obligation failure in a failure group, go to Step 3
• Cancellation of payment due to a third mutual obligation failure, work refusal failure, unemployment failure, or a failure to re-engage within 29 days, go to Step 4
• An unemployment preclusion period, go to Step 5

If a currently affecting participation suspension must be lifted as a result of a review of a decision that payment is not payable as a result of a mutual obligation failure or work refusal failure:

• select the associated outstanding suspension report in the Participation Compliance Hub
• select the re-engagement link
• select the reason No re-engagement, appeal outcome (RNT)
• finalise the activity
• clear out of the customer record to trigger background processing

Procedure ends here.

The PST-skilled Service Officer (WNPPD)/Appeals Support Team Service Support Officer (WNPPD) is responsible for ensuring the outcome of a review of decision is implemented by:

• accessing the Participation Compliance Workflow Summary screen via the Participation Compliance Hub menu
• selecting the failure event date, and then selecting Review Decision on the Completed Compliance Actions screen
• using the Review Decision workflow, update review status, decision date, action required and reason for change on the Review Decision screen
• when a decision has been made to revoke a mutual obligation failure, select the appropriate revoke reason from the drop down menu, this reason will also be electronically forwarded to the provider
• finalise the Review Decision workflow
• discuss the outcome of implementing the decision with the job seeker and record outcome in the Appeals (APL) system

If the decision to apply a first or second mutual obligation failure is revoked:

• the job seeker's financial penalties for any subsequent penalties in the same failure group will be adjusted automatically by the system once the mutual obligation failure has been revoked. Financial penalties for failures that are in subsequent failure groups are not adjusted, this is to ensure a retrospective payment cancellation does not apply
• when a first mutual obligation failure is revoked and a second penalty exists in the same failure group, the second penalty will automatically convert to a first penalty. Any over-recovered penalty amount must be returned to the job seeker if the 13 week favourable determination rules have been met
• when a decision is made to revoke either, or both, the first or second mutual obligation failure in the failure group and a third mutual obligation failure has also been applied in the same failure group, the third penalty will automatically convert to the appropriate first or second failure

Procedure ends here.

The PST-skilled Service Officer (WNPPD)/Appeals Support Team Service Support Officer (WNPPD) is responsible for ensuring the outcome of a review of decision is implemented by:

• accessing the Participation Compliance Workflow Summary screen via the Participation Compliance Hub menu, and
• selecting the failure event date, then selecting Review Decision on the Completed Compliance Actions screen
• using the Review Decision workflow, update review status, decision date, action required and reason for change on the Review Decision screen
• when a decision has been made to revoke, select the appropriate revoke reason from the drop down menu, this reason will also be electronically forwarded to the provider
• finalise the Review Decision workflow
• discuss the outcome of implementing the decision with the job seeker, deliver key messages reinforcing personal responsibility and compliance with compulsory requirements and record outcome in the Appeals System

Revoking a decision to cancel participation payment

If the outcome of the review of decision is to revoke a decision that has resulted in a participation payment cancellation, payment will be reinstated from the date of effect of the decision to cancel provided the 13 week favourable determination rules have been met.

The non-compliance cancellation and post cancellation non-payment period are automatically lifted after the Review workflow has been finalised. To allow background processing to take effect, clear out of the customer record.

Where the background processing has not been successful, an MFU activity with keyword TCFRES will be created. For more information, see Participation Compliance Manual Follow Up Review guide.

Procedure ends here.

Unemployment failure is an affirmed decision

Contact the job seeker if possible to:

• discuss and record the outcome of review/appeal in the Appeals (APL) system
• explain further review/appeal options

Unemployment failure is revoked

If the decision to apply a UNPP or serious failure is revoked:

• access the Participation Compliance Workflow Summary screen via the Participation Compliance Hub, and
• select the unemployment failure event date, then select Review Decision on the Completed Compliance Actions screen
• using the Review Decision workflow, update review status, decision date, action required and reason for change on the Review Decision screen
• select the appropriate revoke reason from the drop down menu, this reason will also be electronically forwarded to the provider when the unemployment failure was generated by the provider
• finalise the Review Decision workflow
• discuss the outcome of implementing the decision with the job seeker, deliver key messages reinforcing personal responsibility and compliance with compulsory requirements and record outcome in the Appeals (APL) system

Note: provided the 13 week favourable determination rules have been met, the unemployment preclusion period is automatically lifted after the Review workflow has been finalised by background processing. This may affect the new claim start date.

Procedure ends here.

Review/appeal outcome forwarded to:

• Participation Solutions Team (PST)-skilled Service Officer if not a priority review, or
• Appeals Support Team if a priority review

The PST Subject Matter Expert (SME) is responsible for ensuring outcomes of review/appeal decisions relating to Non-Attendance Reports (NAR), connection, non-attendance failure, reconnection or No Show, No Pay failures are implemented.

A service centre SME is responsible for ensuring outcomes of review/appeal decisions made by service centre Service Officers with security resource UNPP relating to an Unemployment Non-Payment Period (UNPP) with a start date prior to claim are implemented. This includes implementing decisions relating to hardship provisions for these UNPPs.

The PST SME is responsible for ensuring outcomes of review decisions made by PST Service Officers relating to a UNPP while a job seeker was receiving a participation payment and serious failures are implemented, including implementing decisions relating to hardship provisions during a UNPP or serious failure period.

Once the decision has been finalised, the decision statement and implementation instructions will be returned to the PST-skilled Service Officer or the service centre Service Officer with UNPP resource or for a priority review an Appeals Support Team Service Support Officer (WNPPD) for implementation. This decision must be implemented within 7 days of the instructions being sent.

If the decision was a result of a review of decision by a review officer or the Administrative Review Tribunal (ART):

• arrange for the necessary updates to be made to the customer record as per the implementation instructions
• run the Appeal Decision Implementation script which will update the Appeals (APL) system and create a DOC on the customer record

For decisions relating to:

• payment under hardship provisions, go to Step 3
• Non-attendance Report (NAR), go to Step 4
• connection, non-attendance failure, reconnection or No Show, No Pay failures including payment suspension (participation), go to Step 5
• cancellation of payment due to ongoing non-compliance, go to Step 6
• UNPP or a serious failure, go to Step 7

A service centre SME is responsible for ensuring the outcome of reviews of decisions made by service centre Service Officers with security resource of UNPP not to make payment under hardship provisions for a UNPP that occurred prior to claiming a participation payment is implemented.

A PST SME is responsible for ensuring the outcome of reviews of decisions made by PST-skilled Service Officers not to make payments under hardship provisions during a serious failure period or UNPP is implemented.

If the decision not to make payment under hardship provisions is an affirmed decision:

• Contact the job seeker:
• discuss outcome of review/appeal
• explain further review and appeal options
• if job seeker is serving a serious failure penalty, explain waiver provisions where job seekers agree to participate in a Compliance Activity
• Record conversation with customer on a DOC

If the decision not to make payment under hardship provisions is revoked:

• Access the Participation Compliance Workflow Summary screen via the Participation Compliance Hub
• Locate the failure under review in the Completed Investigations section. Select the failure event date then select Review Decision on the Completed Compliance Actions screen
• Using the Review Decision workflow, record eligibility for hardship provisions from the date the job seeker meets the eligibility criteria on the Waiver Consideration screen. For further information, see:
• Unemployment due to a voluntary act or misconduct
• Serious failure hardship provisions
• Contact the job seeker:
• discuss outcome of review/appeal
• explain the need to continue to meet their mutual obligation requirements while receiving payment under hardship provisions, and
• re-engage with Employment Services Provider
• Finalise the Review Decision workflow
• Record relevant details of implementation of review/appeal outcome and conversation with customer including any notification provided via DOC
• Record details in appeals system to confirm implementation

Procedure ends here.

If a NAR is found to be invalid:

• Select Re-engagement on the Completed Compliance Action screen
• Select the reason No re-engagement, appeal outcome (RNT)
• Complete the activity

This will result in the following:

• when the NAR was not already finalised, the NAR and any outstanding reconnection requirement will be finalised
• when the NAR was already finalised, finalisation reason will be updated and any outstanding reconnection requirement from the NAR will be finalised
• if a non-attendance failure (NAF) has already been generated within the same sequence of events the NAF can only be rejected
• if a non-attendance failure (NAF) has already been applied, the result will be changed to revoke
• if a reconnection failure has already been generated it can only be applied without penalty or rejected
• if a reconnection failure has already been applied with penalty, the result will be changed to 'applied without penalty'

The PST SME is responsible for ensuring the outcome of a review of decision is implemented by:

• accessing the Participation Compliance Workflow Summary screen via the Participation Compliance Hub, and
• selecting the failure event date, and then selecting Review Decision on the Completed Compliance Actions screen

If the decision to apply a connection failure for non-attendance at a third party provider appointment or failure to enter into a Job Plan, is an affirmed decision:

• check to see if the job seeker has already been re-engaged.
  If the job seeker has not already been re-engaged:
• schedule appropriate reconnection requirement via the Re-engagement screen, and
• notify job seeker of the requirement to comply including consequences of non-compliance

If the decision to apply a connection, non-attendance failure or reconnection failure is revoked:

• For a connection failure or suspension failure revoked as being 'invalid', and this was the only valid failure in the failure sequences prior to a reconnection failure being 'applied with penalty', then any reconnection failure penalty amount already recovered must be returned to the job seeker.
  Note: the reconnection failure is not revoked, but instead becomes a connection failure
• For any non-attendance failure penalty amounts already recovered, this must be returned to the job seeker
• Using the Review Decision workflow, update review status and date on the Review Decision screen
• Contact the job seeker:
• discuss and record outcome of review/appeal in the Appeals (APL) system
• if re-engagement has not already occurred, re-engage with Employment Services Provider via the Re-engagement screen
• Finalise the Review Decision workflow

Note: the Review Decision workflow will assist the PST SME to identify when adjustments to penalties are required. In some cases, an MFU will also be created if manual calculation of a penalty amount or arrears is required.

Manually calculate the job seeker's net entitlement for the affected periods. If necessary, correct the arrears or debt amount displayed.

If the decision to apply a reconnection failure penalty is varied and the reconnection failure should be applied without penalty, the reconnection failure status should automatically change to 'applied without penalty' as long as the previous failures in the failure sequence have been assessed as invalid. A failure is considered to be invalid if it has been rejected or revoked using one of the following rejection/revocation codes:

• Returned for update - insufficient evidence/documentation (IVA)
• Returned for update - incorrect incident date (IVH)
• Withdrawn by provider - PR invalid (WRA)
• Undertaking other requirements included in Job Plan - unable to comply (ERD)
• Notification was not given or recorded (NOA)
• Job seeker not notified properly (NOB)
• Requirement not supported by Activity Agreement (URA)
• Inappropriate activity or program referral (URB)
• Unreasonable commuting distance (URC)
• Unreasonable requirement - not supported by policy (URD)
• Job seeker exempt from requirement at time of failure (URF)
• Failure incorrectly reported (IRA)
• Other pending connect/reconnect failure for this provider (IRE)
• Other applied NSNP failure for this date (IRF)
• Nil entitlement for failure period (IRG)
• Failure occurred during Recon failure period (IRH)
• Connection failure revoked (IRI)

Updating the status of previous failures

If the rejection reason for a failure needs to be changed to indicate it is invalid:

• go to the Incident Summary (BIIS) screen
• select the failure, and
• 'C'hange the Status Reason on the Breach Investigation (BIDE) screen

To change the revoke reason recorded for a failure, use the Review Decision workflow.

Note: when the rejection reason is updated on the BIDE screen to indicate a failure is now invalid the system may not automatically change the subsequent reconnection failure status from 'Applied' to 'Applied without penalty'. If this occurs, a PST SME is responsible for manually updating the reconnection failure status in the Review Decision workflow. This action must only be taken when all the previous failures in the same failure sequence are invalid.

For further information, see Non-compliance with compulsory requirements - review and appeals.

Implementing outcomes of a decision relating to a payment suspension (participation).

If the outcome of the review/appeal is to restore payment when a payment suspension (participation) exists, then payment will be restored back to the date of suspension.

Is either party seeking further review of the decision?

• Yes, go to Step 8
• No, procedure ends here

The PST SME is responsible for ensuring the outcome of a review of decision is implemented.

Payment will be reinstated from the date of effect of the decision to cancel if the outcome of the review/appeal is to overturn the decision to cancel a participation payment for:

• failing to re-engage, either when the person has not re-engaged after being given a re-engagement requirement or the person has not made suitable arrangements to re-engage following a participation suspension
• failing to contact their provider, or
• failing to enter into a Job Plan

Refer to Cancellation of payment after a compliance related suspension for details of the workaround required for restoration.

Is either party seeking further review of the decision?

• Yes, go to Step 8
• No, procedure ends here

A service centre Service Officer with security resource UNPP is responsible for implementing review and appeal outcomes relating to UNPPs that occurred prior to claim when the decision maker (DM) was a service centre Service Officer with security resource UNPP.

A PST-skilled Service Officer (WNPPD) is responsible for implementing review and appeal outcomes relating to serious failures or UNPPs when the decision maker was a PST-skilled Service Officer (WNPPD).

• Access the Review Decision workflow via the Participation Compliance Hub
• Locate the failure under review in the Completed Investigations section. Select the failure event date then select Review Decision on the Participation Compliance Actions screen

Serious failure or UNPP is an affirmed decision

If the decision to apply the UNPP or serious failure is subject to Payment Pending Review (PPR) and is an affirmed decision, and no party is taking further review and appeal action, or, the next stage of review is the Administrative Review Tribunal (ART) second review and a stay order has not been issued, the UNPP or serious failure penalty period generally recommences from the start date of the entitlement period following the one in which the decision was recorded provided it is recorded within 13 weeks of the new decision being made.

If a decision to apply a UNPP is an affirmed decision following PPR and the job seeker has already 'self-served' part of the UNPP prior to claiming or before the start date of their participation payment, the job seeker will only be required to serve the remaining balance of the non-payment period. In all other cases that were subject to PPR, the job seeker will be required to serve the full UNPP.

• If the decision was subject to PPR, using the Review Decision workflow, update review status and date on the Review Decision screen. When the decision is being recorded within 13 weeks of the new decision, the 'Status Decision Date' is to be set to the date the decision is being recorded
• Contact the job seeker if possible:
• discuss and record the outcome of review/appeal in the Appeals (APL) system
• explain further review/appeal options
• advise when the UNPP or serious failure penalty period will commence from if it was previously subject to PPR
• for serious failures, explain job seeker can attend a waiver re-engagement appointment in lieu of serving the serious failure penalty
• consider eligibility for payment under UNPP hardship provisions or serious failure hardship provisions
• Record details on the Waiver Consideration screen and if job seeker has agreed to attend a waiver re-engagement appointment or is eligible for payment under hardship provisions use the Re-engagement screen to schedule a re-engagement appointment with the provider
• Finalise the decision on Assessment Results (AR) screen

Serious failure is revoked

If the decision to apply a UNPP or serious failure is revoked:

• Using the Review Decision workflow, update review status and date on the Review Decision screen
• Contact the job seeker:
• discuss and record the outcome of review/appeal in the appeals system
• remind the job seeker meeting their mutual obligation requirements is a condition of their payment, and
• check if re-engagement with a provider is required. Record using Re-engagement screen
• Finalise the decision on Assessment Results (AR) screen

Note: manually calculate the job seeker's net entitlement for the affected periods. If necessary, correct the arrears or debt amount displayed.

The provider will be advised electronically that the failure (including serious failures for persistent non-compliance) has been re-applied or revoked. The customer will be issued a letter advising the outcome.

Is either party seeking further review of the decision?

• Yes, go to Step 8
• No, procedure ends here

A customer should be encouraged to make their appeal directly to the ART in person, by phone, via an application form or online. If an ART request for review form is lodged with Services Australia, forward to the ART immediately. Further information can be found on the ART website. See the Resources page for a link to the website.

Note: if a further review of a UNPP or serious failure has been requested, the job seeker may be eligible for Payment Pending Review (PPR). For further information, see Payment Pending Review (PPR) of decision to apply a penalty for non-compliance.