Request for an explanation or application for a formal review 109-02000000
Expand allIf a customer contacts about formal review delays, staff must read this Operational Message: Formal review delays
Examples - referral of requests for an explanation of a decision
Table 1
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Item |
Description |
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1 |
Decision to attribute income from a trust Example 1 A customer is requesting an explanation of the decision to reduce their rate of payment and raise a debt due to the attribution of income from a trust. The customer does not understand how a Complex Assessment Officer (CAO) calculated the attribution amount. A Service Officer in a processing team actioned the rate reduction. A Service Officer in a debt raising team raised the debt. A SME in the CAO team explains the decision as it is the CAO assessment the customer does not understand. Example 2 A customer is requesting an explanation of the decision to reject their claim for payment due to income. Their income includes income attributed from a trust. The customer does not dispute the attribution amount a CAO assessed. They do not understand what other income was included in the assessment of their claim. A Service Officer in a processing team rejected the claim. A SME in the processing team explains the decision. A CAO SME is not involved, as the customer understands the CAO assessment. |
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2 |
Debt due to undeclared income from employment A customer is requesting an explanation of the decision to raise and recover a debt due to the undeclared income. A Service Officer in a compliance team raised the debt as the result of a Data-Matching Program (DMP) review. As a compliance team raised the debt, a SME in the compliance team explains the decision. |
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3 |
Debt due to cancelled payment A customer is requesting an explanation of the decision to raise and recover a debt due to cancellation of their payment. The customer does not understand why their payment was cancelled. A Service Officer in a processing team cancelled the payment. A non-compliance debt raising team raised the debt because of the payment cancellation. As a processing team cancelled the payment, a SME in the processing team explains the decision. |
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4 |
Compensation decisions Example 1 A customer is requesting an explanation of the decision to cancel their payment due to a compensation preclusion period. The customer does not understand how the length of the preclusion period was calculated. A Service Officer in a processing team cancelled the payment. A SME in the compensation team explains the decision as the customer does not understand the compensation assessment. Example 2 A customer is requesting an explanation of the decision to cancel their Low Income Health Care Card (LIC) due to income. Their income includes compensation income. The customer does not dispute the amount of compensation income assessed. They do not understand what other income was used in the assessment. A Service Officer in a processing team actioned the cancellation decision. A SME in the Low Income Health Care Card (LIC) processing team explains the decision. A SME in the compensation team is not involved, as the customer understands the compensation income assessment. |
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5 |
Member of a couple assessment A customer is requesting an explanation of the decision to reject their claim for Parenting Payment Single. The claim was rejected after a Member of a Couple (MOCA) processing team assessed the customer to be a member of a couple. The customer does not understand why they are considered a member of a couple. A Service Officer in a processing team actioned the claim rejection. A SME in the MOCA processing team explains the decision as the customer does not understand the member of a couple assessment. |
Running the Internal Review/Explanation script more than once
Table 2
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Item |
Description |
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1 |
Run script to create a formal review APL record for each customer affected by the decision Run the script to create an APL record for each customer affected by the decision, except for reviews of shared or disputed care decisions. Examples:
Do not run the script for people who are not customers, or who are not affected by the decision, for example, not receiving payment. Do not run the script on the other customer’s record if the customer has only requested an explanation of the decision. This process should only be followed if one of the customers has applied for a formal review of the decision. Note: running the script on the other customer's record creates a DOC. Include in this DOC that the script was run because another customer has applied for a formal review of the decision that affected this customer. Include the other customer's CRN, but not their name. Example: Internal Review/Explanation script run as another customer (CRN 000 000 000A) applied for a formal review of a decision that affects this customer. The decision is the CAO trust assessment of DD/MM/YR. |
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2 |
Multiple debt decisions If a customer requests an explanation or applies for a formal review of multiple debt decisions, run the script for each debt. Examples:
Do not run the script for debts the customer does not want explained or formally reviewed. Clarify which debts they want explained or formally reviewed. |
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3 |
Multiple applications for formal reviews of the same debt There are circumstances in which a customer can apply for a formal review of a debt decision an ARO has already reviewed. This includes when a subsequent decision has been made after the debt was formally reviewed. For example:
When the customer applies for a formal review of the new decision, run the script for that decision. Example A debt is raised, the customer applies for a formal review and an ARO affirms the decision. A year later, the customer asks about having the debt waived due to new circumstances. A new decision is made to deny the waiver request. The customer applies for a formal review of the new decision. |
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4 |
Run the script once For a decision affecting a primary payment and an add on payment, run the script once to create 1 APL record if a customer requests an explanation or applies for a formal review of the decision. Example A customer's Family Tax Benefit (FTB) is cancelled. The FTB included Rent Assistance. Run the script once for the cancellation decision. |
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5 |
Run the script more than once Run the script to create more than one APL record if an explanation or formal review is needed for more than one decision. Examples
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Examples where a decision has not been made or has no operative effect
Table 3
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Item |
Description |
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1 |
No decision made A customer has made a claim but it has not yet been determined. There can be no review about the claim until the claim has been determined. A deemed rejection is a reviewable decision. Under section 39 of the Social Security (Administration) Act 1999, if a claim has not been determined within 13 weeks of the date it was made, it is deemed that a determination has been made to reject the claim at the end of that period. A customer applies for a formal review because they cannot claim a social security payment that has been closed to new claims. For example, Widow Allowance, Pension Bonus Scheme. As there is no claim, there can be no decision under social security law and the customer cannot apply for a formal review. |
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2 |
No operative effect Some types of decisions do not on their own, have an operative effect on a customer until they are applied in the making of another decision about entitlement or rate. These decisions are considered not to have an effect on the customer and are therefore not reviewable. For example:
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3 |
Operative decision where there is no change to rate or entitlement Sometimes a decision with operative effect may be made which does not change a customer’s rate or entitlements. These decisions are reviewable. For example:
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