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

The internal review framework aims to make sure that customers:

• understand decisions that affect their entitlements
• are given the chance to provide new information to have a decision reassessed
• can exercise their right to apply for a formal review of a decision they disagree with

Document a discussion about a decision on the customer’s record. This will make sure that:

• there is a record showing what was discussed with the customer
• the contact can be acknowledged if the customer contacts again

A customer may lodge new information about a decision that has been made. The information can be considered, and the decision changed without the customer requesting an explanation or applying for a formal review of the original decision.

If the customer has not requested an explanation or applied for a formal review of the decision, Service Officers should consider the new information and if the:

• decision can be reassessed and the outcome will be fully favourable, undertake a reassessment
• new information will not change the decision, or if the decision can be reassessed but the outcome will not be fully favourable, make genuine attempts to contact the customer to discuss the new information and provide internal review options

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.

If a customer lodges new information and has requested an explanation or applied for a formal review, a Subject Matter Expert (SME) or Authorised Review Officer (ARO) will consider the information.

Note: the lodgement of new information is not automatically taken to be a request for an explanation or an application for a formal review of the original decision. If in doubt, contact the customer and ask them what they want.

After a decision has been made, the customer has the following internal review options:

• request an explanation
• apply for a formal review

Notes:

• a customer cannot apply for a formal review of some decisions. See Reviews of grants and ex-gratia payments
• a referral for an explanation or a formal review must be based on the customer’s choice. If there is any doubt, ask the customer

After an internal review, the customer may have the right to a further external review or appeal.

Options in the internal review process should not be referred to as appeals, they should be referred to as explanations or formal reviews. External review options may be referred to as reviews or appeals.

When a customer contacts the agency to discuss a decision that has been made, Service Officers should make every attempt to resolve the customer’s enquiry.

• Discuss the decision using information on the customer's record
• Use the support resources available if the matter is complex, or if support is needed to finalise the customer's enquiry
• Fix any errors and assess any new information
• Give the customer information about their options to request an explanation or apply for a formal review of the decision

The customer can choose to:

• request an explanation of the decision, which will be provided by a SME. They may choose this option if they do not understand or would like more information about the decision
• apply for a formal review of the decision, which an ARO will undertake. They may choose this option if they do not agree with the decision

Note: a referral for an explanation or a formal review should be based on what the customer wants. If there is any doubt, ask the customer.

When discussing a decision, Service Officers who are not undertaking the SME role at that time must still offer the customer the option to request an explanation, even if they are recognised as a SME. For example, if they are not scheduled as a SME at the time they are discussing the decision with the customer, they must offer that option.

The internal review process should be straightforward for customers. Fix errors and assess new information as quickly as possible. Customers do not have to provide new information to request an explanation or apply for a formal review. If a customer wants to provide new information, tell them to do this as soon as they can (preferably within 7 days).

The Process page contains the steps staff must follow when giving customers their internal review options. This includes using the payment-specific automated messages available in Services Australia Workspace.

Decision makers must:

• contact the customer before finalising an unfavourable decision
• discuss the decision with the customer
• allow new information to be provided
• correct errors and undertake reassessments
• provide internal review options

Service Officers must:

• discuss the decision with the customer
• document the discussion with the customer
• allow new information to be provided
• correct errors and undertake reassessments
• 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
• provide internal review options

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

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).

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 second review have a further right of appeal to the Federal Court. Decisions of the Federal Court may be appealed, by 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