First contact about a decision and the internal review process 109-03000000

The internal review process to ensures that customers:

• who do not understand the reasons for a decision can request a Subject Matter Expert (SME) explanation of decision
• who do not agree with a decision, can apply for a formal review by an Authorised Review Officer (ARO)

A request for a SME explanation or an application for a formal review must be based on what the customer wants. If there is any doubt, ask the customer.

A request for a SME explanation or an application for a formal review must not be recorded:

• unless the customer has requested a SME explanation or applied for a formal review
• to manage a challenging, complex, or lengthy enquiry
• to manage a customer complaint

Note:

• once a SME explanation has been provided, the customer cannot request another SME explanation of the same decision. However, if the customer contacts about the SME explanation, a Service Officer must apply First Contact Resolution principles to assist the customer. This includes
• checking the decision for errors
• checking for new information
• reassessing the decision if appropriate, and
• offering the customer the opportunity to submit a new claim, if appropriate
• if the customer does not agree with the outcome of a SME explanation, they can apply for a formal review
• a customer does not have to request a SME explanation before applying for a formal review
• a customer cannot apply for a formal review of some decisions. See Reviews of grants and ex-gratia payments

When making a decision, a decision maker must:

• contact the customer before finalising an unfavourable decision
• discuss and explain the decision to the customer
• ask the customer if they can provide new information before finalising the decision
• provide internal review options
• arrange other appropriate referrals or assistance, including:
• continuing payments pending review of the decision (for a formal review only)
• debt recovery arrangements
• referral to a social worker

When a customer contacts the agency about a decision that has been made, Service Officers must

• make every attempt to resolve the customer’s enquiry, applying First Contact Resolution principles and
• follow the First contact about a decision and the internal review process

The SME is an experienced officer independent of the original decision. They are responsible for providing an explanation when a customer has requested a SME explanation of decision.

See SME explanations, ARO referrals and implementing ARO decisions.

The ARO is a senior officer, independent of the original decision. They are responsible for reviewing the decision when a customer has applied for a formal review.

See Reviews by an Authorised Review Officer (ARO).

When a customer contacts the agency to discuss a decision that has been made, Service Officers must make every attempt to resolve the customer’s enquiry, applying First Contact Resolution principles.

• discuss and explain the decision using information on the customer’s record
• ask the customer if they can provide new information
• reassess the decision where an error is identified or new information is received that would change the decision. If this is not done, there can be adverse date of effect issues for the customer if the decision is later changed under the internal review process
• follow approved business processes to transfer the customer to a staff member with the required training/skills, escalate for policy advice or an ICT/system fix as appropriate
• provide the customer with their internal review options
• document details of the discussion and action taken

Service Officers who are recognised as a SME but are not scheduled as a SME at the time of the discussion, must offer the customer their full internal review rights, including the option to request a SME explanation of the decision.

A customer may give new information about a decision that has been made.

If the customer has not requested a SME explanation or applied for a formal review of the decision, Service Officers should reassess the decision taking into account the new information.

If the customer has requested a SME explanation or applied for a formal review, the SME or the ARO will consider the new information.

Note: a reassessment undertaken as a result of new information is done under the authority of a Secretary initiated review. It must be documented on the customer’s record. These reassessments are not recorded in the Appeals (APL) system and the Internal Review/Explanation script is not used.

Note: the lodgement of new information must not automatically be taken to be a request for a SME explanation or an application for a formal review of the decision. Follow approved business processes to assess the new information.

After a formal review by an ARO, a customer may apply to the Administrative Review Tribunal (ART) for an ART first review of the decision. Certain decisions are excepted.

The ART cannot review the following decisions:

• ABSTUDY entitlement and eligibility decisions. See Review of ABSTUDY and AIC decisions
• JET Child Care fee assistance (JETCCFA) decisions. See Reviews of JETCCFA decisions
• Grants, formerly known as ex-gratia payments. Appeal rights following an ARO review depend on the guidelines for each grant. See Reviews of grants and ex-gratia payments

If a customer does not agree with an ART first review decision, they may apply for an ART second review.

All parties to an ART first review, ART second review or Guidance and Appeals Panel (GAP) final review have a further right of appeal to the Federal Court. Decisions of the Federal Court may be appealed, by special leave, to the High Court.

All customer records can be provided to the ART or to a Court as evidence for an appeal. Staff must make sure that records are factually correct, complete and professionally worded.

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 a SME 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).