Request for an explanation or application for a formal review 109-02000000

When discussing a decision that has been made, internal review options must be given to a customer before a request for an explanation or an application for a formal review can be recorded. Service Officers should see Initial contact about a decision and the review of decision process for important information to help when having a conversation with a customer about their internal review options.

If a customer does not understand the reason/s for a decision, they may request an explanation.

A Subject Matter Expert (SME) will investigate the decision and try to contact the customer. For more details, see SME explanations, ARO referrals and implementing ARO decisions.

Customers cannot request an explanation by a SME if they:

• have applied for a formal review of the same decision, or
• previously requested an explanation of the same decision and a SME has provided an explanation. Tell the customer they have the right to apply for a formal review if they do not agree with the decision
  Exception: there is no formal review option for COVID-19 Disaster Payment, Pandemic Leave Disaster Payment and High-Risk Settings Pandemic Payment decisions. See Reviews of grants and ex-gratia payments

If a customer does not agree with a decision, they may apply for a formal review. This may be without requesting an explanation, or after a SME explanation has been provided.

An Authorised Review Officer (ARO) will review the decision and try to contact the customer. For more details, see Reviews by an ARO.

Note: customers cannot apply for a formal review of COVID-19 Disaster Payment, Pandemic Leave Disaster Payment and High-Risk Settings Pandemic Payment decisions. See Reviews of grants and ex-gratia payments.

Customers cannot apply for another formal review once an ARO has reviewed the decision. Tell the customer they may have the right to seek another review, for example by the Administrative Review Tribunal (ART).

Customers:

• can do this verbally or in writing to any staff member, or
• they may complete the relevant form:
• Explanation or formal review of a decision (SS351), or
• ABSTUDY and Assistance for isolated Children (AIC) Explanation or formal review of decision (SY054)

Note: an application for a formal review of some decisions must be made in writing. See Payment specific reviews of decision.

If a customer indicates they do not agree with a decision, check if they want an explanation, a formal review, or something else. If there is any doubt, try to contact the customer. If unable to contact them, record a DOC and send a letter inviting them to contact. Do not make assumptions about what they want.

The customer does not have to provide new information. If they would like to provide new information, tell them to do so as soon as they can, preferably within 7 days.

If there has been no decision, do not record a request for an explanation or application for a formal review. For example, if the customer's claim has not been determined. Tell the customer a decision must be made before they can request an explanation or apply for a formal review.

Customers cannot request a SME explanation or apply for a formal review of a decision that has:

• not been made. For example, a claim has been lodged but not determined, or a debt shell created but a debt not raised. (The customer can request an explanation or apply for a formal review of the decision that caused the debt shell)
• no operative effect on the customer. For example, a decision that a customer is subject to a compensation preclusion period, but the customer has not made a claim. The compensation decision has not been put into operation and so has no effect on the customer. There can be no SME explanation or formal review

See the Resources page for examples.

There is no time limit for applying for a formal review of most decisions.

However, there are time limits for applying for a formal review of these decisions:

• some decisions under family assistance law, see Customer initiated review of decision
• some decisions under the Paid Parental Leave scheme, see:
• Parental Leave Pay (PPL) employee initiated reviews and appeals
• Paid Parental Leave (PPL) employer initiated reviews and appeals
• Reviews and appeals for Dad and Partner Pay (DAP)
• decisions about Jet Child Care fee assistance (JETCCFA)
• within 90 days of the decision date of a Student Financial Supplement Scheme (SFSS) decision under the Student Assistance Act 1973
• within 13 weeks of being notified of the original decision for
• LPG Vehicle Scheme
• Pension Bonus Scheme (PBS)
• Essential Medical Equipment Payment (EMEP)

Still record the application if the customer applies for a formal review after the time limit. The ARO will check if they can undertake a formal review and will tell the customer.

The date of effect of the review outcome may be affected if there is a delay in applying for a formal review.

A request for an explanation or application for a formal review can only be withdrawn at the customer’s request. For example, the customer phones a Smart Centre to advise they do not want to proceed with their application for a formal review.

If withdrawn, the request or application is taken to have never been made.

Tell the customer that if they withdraw their request or application and later request an explanation or apply for a formal review of the same decision, back payment may be limited if the outcome is in their favour.

Services Australia aims to complete:

• an explanation of a decision within 14 days from the date of the customer’s request
• a formal review of a decision within 49 days from the date of the customer’s application

If a customer contacts about the progress of:

• an explanation of decision, see the Process page > Table 2
• a formal review, see the Process page > Table 3

If the Administrative Review Tribunal (ART) sets aside and remits a decision (sends it back to the agency for reconsideration), the new decision made by the agency can be reviewed.

Any findings made by the ART on aspects for the decision must be applied to the new decision made by the agency.

For example, the ART sets aside and remits a debt decision, requesting the debt be recalculated based on an assessment of income for a period. The ART also finds that the new debt amount cannot be waived. Once the debt is recalculated and changed, the new debt amount/period is a new decision. The ART’s finding about the waiver must be applied to the new decision.

The customer can request an explanation or apply for a formal review of the new decision. However, the SME/ARO must apply the ART's findings about the income assessment and waiver.

The customer may request an ART second review of the findings of the ART first review.

Family assistance care decisions

For more information on explanations and formal reviews, see Internal review process for care decisions.

Departure Prohibition Order (DPO) or Departure Authorisation Certificate (DAC) decisions

These decisions are not subject to the normal internal review process. See Review or appeal a DPO or DAC decision.

Paid Parental Leave (PPL) employer initiated reviews

All applications for a formal review of an employer decision are managed by the PPL Employer Processing Team (PPLEPT). See PPL employer initiated reviews and appeals.

Grants and ex-gratia payments

For more information on explanations and formal reviews, see Reviews of grants and ex-gratia payments for the following:

• Disaster Recovery Payment for New Zealand non-protected Special Category (Subclass 444) Visa Holders (NZ DRP)
• Tertiary Access Payment
• Pandemic Leave Disaster Payment
• High-Risk Settings Pandemic Payment (HRSPP)
• COVID-19 Disaster Payment
• MH17 Family Support Package

Other payments

See Payment specific reviews of decisions.

A customer who requests an explanation or applies for a formal review of a decision may also:

• make a complaint about the service they received, or
• request release of documents under the Freedom of Information Act 1982

A customer who requests an explanation or applies for a formal review of a decision may also make a claim for compensation under the scheme for Compensation for Detriment caused by Defective Administration (CDDA).

Compensation may not be payable if there is a legislative mechanism that can remedy the mistake (a legislative right of review), however, all available review and appeal options do not need to be exhausted before lodging a claim for compensation.