Assessment of circumstances for a couple separated due to illness 277-50070020
This document explains the definition and assessment of a couple separated due to illness. Customers who advise they are no longer able to live in their home with their partner due to illness, but who still consider themselves to be partnered or in a member of a couple relationship with that person, are treated as an illness separated couple.
On this page:
Customer advises separated due to illness
Update customer's record following assessment of illness separation
Customer advises separated due to illness
Table 1
Action | |
Determine action requiredAction may be required from a previous contact. If a Service Officer is allocated a work item:
If a customer contacts and is advising:
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Relationship Qualifier (RQ) codes being automatically appliedWhen the customer advises in their online or ACC they are unable to live with their partner due to illness, the system applies the following RQ codes inappropriately:
Check the relationship information in the claim and the Marital Status (MS) screen for any RQ codes, see Relationship Qualifier codes automatically applied. Note: if a code has been applied from a customer’s online or ACC claim, Service Officers must undertake an assessment to confirm the customer qualifies as an illness separated couple and if not, must remove the code. | |
Determine if the customer and partner have separated on a permanent or indefinite basis (genuine separation)When assessing a customer’s circumstances, it may become clear that a customer may be living separately and apart (genuinely separated), due to one member of a couple entering into care and where a physical and emotional breakdown of the relationship has occurred. See Illness separation vs genuine separation. Considerations when assessing a customer as living separately and apart (that is, a genuine separation has occurred) due to one member of a couple entering a care situation:
Make a genuine attempt to contact the customer if the customer is not already on the phone. If the contact attempt was:
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Unsuccessful outbound contact – determining if separation on a permanent and definite basis has occurredAs the outbound contact was unsuccessful, issue a Q164 letter to the customer requesting they make contact. If the customer:
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Discussion with customer to determine if the separation is on a permanent and definite basisDiscuss the circumstances around the customer’s separation to determine if the separation is permanent, that is there is a physical and emotional breakdown in the relationship. Advise the customer about the impacts of assessing them as living separately and apart before unlinking them from their partner. This may include consultation with a FIS Officer. Is the customer living separately and apart (that is, a genuine separation has occurred) due to one member of a couple entering care and a breakdown of their relationship has occurred?
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Customer is living separately and apart on a permanent basis (a genuine separation has occurred)Support the customer to separate safely When a customer separates, changes to their record must be made to reflect their new circumstances. These changes can result in a potential privacy breach if they are not done correctly. Customers must be supported to separate safely. Discuss separating safely with the customer before updating any personal information. For customers:
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Residential Care Assessment (RCA/CUR) customer separatesThere is no requirement to get a MOD S or verify separation when a non-income support RCA/CUR customer separates. A RCA/CUR only customer may advise on the Residential Aged Care Calculation of your cost of care form (SA457) that they do not have a partner. If the customer is linked on the Marital Status (MS) screen to another person, the advice from the SA457 allows the customer details to be coded as separated. As the SA457 does not get the date of separation, use the date of entry to the aged care home in the Event date field, if the date of separation is unknown. The RCA Institution (RIS) screen can be used to verify entry into residential care by checking Admission Date and Care Type: Residential. Go to the MS screen and update the following:
Other updatesIf a customer in residential aged care had a partner living in their former principal home, it would be exempt as an asset for the Aged care means assessment. If a determination has been made that a customer in residential care is now single, this exemption no longer applies. Further updates are critical to make sure aged care fees remain correct. If a customer or partner are currently in residential aged care:
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Assess if the customer is a member of an illness separated coupleA couple is considered to be an illness separated couple where:
Aspects to consider when assessing if the customer is a member of an illness separated couple:
Is there sufficient information to assess the illness separation?
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Insufficient information to assess illness separationAs there is inadequate information available to confirm the couple are separated due to illness, the customer will need to provide supporting evidence from a treating doctor or relevant health professional. If the customer is:
Pending the return of evidence for the illness separation, it is possible the customer may be living in separate accommodation and eligible for rent assistance. See also, Temporary accommodation and Rent Assistance (RA),to determine if the customer is eligible to receive a higher rate of RA. If the customer moved and it has been determined they are eligible to receive a higher rate of RA, go to Updating address details. Procedure ends here. | |
Make determinationThe customer's circumstances indicate the customer is:
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Unfavourable decision - new claimant is not a member of an illness separated coupleAdvise the customer:
Can the claim be finalised (no further documentation required)?
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The customer is a member of an illness separated coupleWhere the customer is assessed as a member of an illness separated couple, tell the customer to supply details of their or their partner's accommodation arrangements. This includes:
See Table 2 > Step 1. | |
Work item to review the customer's illness separation rateService Officers can use discretion to determine if there is the possibility a change of circumstances may occur and set a manual review if deemed appropriate. For example, where the customer enters a rehabilitation facility, and the length of time is not known and therefore possibly indefinite. When the review activity matures, check the customer's record to determine the reason for review and confirm whether the customer is still eligible for the illness separated rate. Go to Step 8 to help check if they meet the illness separated criteria. Is the customer eligible to continue to be paid the illness separated rate? Yes:
No, go to Step 15. | |
A work item has presented in relation to evidence to be returned or evidence has been returnedWhen the work item has presented, check the customer's record to confirm if they have returned supporting evidence. For entry to an aged care home, the RCA Institution (RIS) screen can be used to verify entry into residential care by checking Admission Date and Care Type: Residential. Has supporting evidence been returned?
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Unfavourable decision – current customer is not a member of an illness separated coupleWhere the customer and their partner do not meet the requirements to be considered as an illness separated couple or there is no supporting evidence to grant the illness separated rate, the customer is to continue to be paid the partnered rate.
Procedure ends here. | |
Customer advises they will be a member of an illness separated couple in the futureIf a customer advises their relationship status will change at a future date:
Procedure ends here. |
Update customer's record following assessment of illness separation
Table 2
Action | |
Verify Date of Receipt (DOR)Verify when Centrelink was told of the change in circumstances and source of information. The customer may have already entered, or is in hospital awaiting admission to, a care facility. To check the DOR for aged care, see Change of address to an aged care home. If the customer:
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Favourable decision - MS screen update (currently receiving a payment)When it has been established the customer and their partner are an illness separated couple, Service Officers must update the MS screen with the appropriate relationship qualifier code. This makes sure customers entitlements are treated differently to their recorded relationship status. Go to the MS screen in Customer First and update the following:
Note: after entering the appropriate 'illness separated' code on the MS screen, the records of the customer and their partner will continue to be linked and correctly display as 'member of a couple'. | |
Customer has an outstanding claim for paymentCheck the MS screen, has the system automatically applied a provisionally applied a Relationship Qualifier (RQ) code of ILC, ILP or ILB to the record?
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Favourable decision – MS screen update (new claim)Select the claim from the Transaction Summary (TS) screen and select process. Update the following details on the MS screen:
Note: after entering the appropriate 'illness separated' code on the MS screen, the records of the customer and their partner will continue to be linked and correctly display as 'member of a couple'. | |
Establish if the customer or their partner are in aged careHas the customer or their partner entered an aged care facility or are in hospital awaiting admission to an aged care home?
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Address Details (AD) screenFor current customers, update the following details within Customer First. For new claimants, these details will be updated within the claim:
For more information on changing a customer's address, see Updating address details. | |
Accommodation Details (AC) screenIllness separated customers who own their principal home and enter a care situation are not ineligible homeowners for Rent Assistance (RA) purposes. They may be entitled to RA if paying rent at their new address. See Rent Assistance (RA) for care receivers. If the customer was a homeowner, assess the treatment of their principal home, vacated due to illness. Complete the following fields on the AC screen within the same activity:
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Does the customer have children?If the customer has children, they will need to revise their current Families income estimate and advise choices available to help reduce the chance of an overpayment during the reconciliation process. See Updating income estimates for the current financial year. If the customer:
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Finalise the activity and issue a decision letter Q888Advise the customer:
Document the decision and issue letter
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Manual reviewService Officers can use discretion to determine if there is the possibility a change of circumstances may occur and set a manual review if deemed appropriate. For example, where the customer enters a rehabilitation, and the length of time is not known and therefore indefinite. Where required, in Customer First, create a manual review on the Review Registration (RVR) screen and complete the fields as follows:
The review will mature on the Due Date coded in the RVR activity. Workload Management will allocate the review for manual action. | |
Continuing entitlementAs the customer and their partner are an illness separated couple, check that they are receiving or claiming the appropriate income support payments and are aware of outcomes and obligations. For example:
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Customer is no longer illness separatedHas the change of circumstances already occurred?
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