Complex Assessment Officers (CAO) 101-05070000

CAO assessment can be requested for:

• new claims processed using Process Direct and non-new claim referrals in Process Direct via Referrals
• other claims and non-new claim referrals in Customer First using CAO Referral guided procedure
• escalations via CAO Fast Note

For instructions on CAO referrals and escalations, see Identifying and making suitable referrals to the CAO.

Immediate priority processing

If immediate priority processing criteria are met, an escalation can be sent after a CAO referral has been made.

Asset hardship

For reassessments of a payment under the asset hardship provisions, see Assessment of assets hardship. Staff must contact the Assets Hardship team before making a CAO referral.

CAO work items are allocated via 'ready for work' in either Customer First, Work Optimiser or Process Direct.

To view details of the referral for:

• New claim referrals created in Process Direct:
  • open Customer First
  • key in the CRN > [Enter]
  • select the CRN/BP hyperlink > Activities tab
  • locate the CAO referral work item and select the referral ID hyperlink
  • select the Notes tab > Text hyperlink to view all notes
• Non-new claim referrals created in Process Direct:
  • open Process Direct and select Inbox
  • select Referrals option from the Main Category dropdown menu
  • key the transaction ID in the Referrals ID field and select Go or [Enter]
  • select the customer’s name to display the record
  • the Referral landing page screen displays
  • select Next at the bottom of the screen to view the notes on the CAO Referral page
  • Select Next again to view the Referral summary page for Referral data and additional comments
• Referrals created in Customer First:
  • view Notes on the DL screen in Customer First
• Escalations via Fast Note are to be closed after an existing or a new CAO referral work item (activity or DOC) has been created or allocated to the CAO. If the customer’s circumstances do not meet the escalation criteria, CAOs must:
  • check to see if there is a related CAO referral, or
  • create a CAO New Claim referral or non-new claim referral. See Table 1 > Step 11 in Identifying and making suitable referrals to the Complex Assessment Officer (CAO). If creating a referral, use the date of the priority processing request as the date of receipt (DOR) and include details of this instruction
  • leave the CAO referral open
  • send feedback using the Staff Feedback Tool
  • close the escalation Fast Note
  • unassign any bundled CAO work items using reason second contact required
• Level 2 Complaint and Ministerial request Fast Notes
  • CAOs must action these requests in line with Fast Note - processing Escalated, External and MPASCO Complaint Fast Notes (CLK) in the Complaints and feedback index

Is the CAO referral for a valid CAO assessment reason and needs a CAO assessment?

• Yes, go to Step 3
• No, go to Step 14

Only one CAO referral is needed, including for partnered customers.

Check Work Optimiser for duplicate referrals:

• Select Worklist
• Change My Work to Customer Search
• Key the customer’s CRN into Customer ID

Is there a duplicate CAO referral in Work Optimiser?

• Yes, duplicate referrals to be cancelled or closed before continuing, see Table 2
• No, go to Step 4

Note: this does not apply where the new claims process was selected in a referral for current customers with new trust/company involvement or Low Income Health Care Card (LIC) renewal.

Was the CAO assessment requested for a new claim and the new claim has since been withdrawn or rejected?

• Yes, and:
  • the claim was rejected as Failed to reply to correspondence (FRC) or Failed to supply documents (FSD) on the recommendation of a CAO, go to Step 5
  • the customer/partner has lodged multiple claims where at least one other claim is In Process/On Hold and will require a CAO assessment, go to Step 6
  • there are no other outstanding claims for the customer and/or partner, go to Step 14
• No, go to Step 6

Were all previously requested documents provided within 13 weeks of the date the notice was given to reject the claim?

• Yes, go to Step 6
• No, see Table 1 > Step 11 on the Process in Request to reassess a rejected claim. Procedure ends here

For Payment and Integrity referrals, also check for Payment Accuracy or Compliance Office Review notes within the:

• Random Sample Survey DOC
• Integrated Review System – via Activity List in Customer First
• Review Summary (IRRS) screen. CAOs do not update the IRRS but can view information

Has all the information and documents needed to complete the CAO assessment been provided?

• Yes, go to Step 12
• No, and referral is for:
  • Payments and Integrity CAO assessment, go to Step 7
  • other CAO assessments, go to Step 8

Referring officers will indicate in the referral notes whether they have any additional documents that are not scanned to the record. If this is noted, the CAO should liaise with the referring officer to access additional information.

Has the referring officer documented within the CAO referral or elsewhere on the record whether there are restrictions on outbound contact or requests for information?

• Yes and:
• there are no restrictions, go to Step 8
• there are restrictions. The CAO must liaise with the referring officer to obtain outstanding information. Make contact via MS Teams or if unavailable email the referring officer and their team leader with details. Place referral on hold for an appropriate timeframe pending return of documents
• No, the CAO must confirm with the referring officer whether there are any restrictions. Make contact via MS Teams or if unavailable email referring officer and their team leader and request details be noted on the customers record. Place referral on hold for an appropriate timeframe pending update from referring officer if there are any restrictions on contacting customer.

If scanned documents are indicated in the referral, wait until they are available before calling the customer.

If the documents are not available within 2 working days, make genuine attempts to contact the customer by phone to clarify what has been lodged. Send a pre-call notification SMS if the customer is subscribed to electronic messaging. See Calling a customer or returning a customer’s call.

If the contact is unsuccessful, annotate the Process of Claim Note/DOC or the CAO referral DOC recording all contact attempts.

Could the customer be contacted?

• Yes, go to Step 9
• No, go to Step 10

Confirm the referral reason and documentation requirements:

• If additional supporting documents are needed, request information and documents
• Get third party contact details and authority to contact third party as needed. If necessary, ask the customer to tell the third party we may contact
• Tell the customer:
  • the due date for the return of information and documents
  • their claim will be rejected if not provided by the due date
  • if a letter will be sent to formally request the additional documents
• Annotate the Progress of claim Note/DOC or the CAO referral DOC to record the phone conversation:
  • Record details of the phone conversation with customer and or/third party
  • If a letter is issued, record date issued and the due date for the return of information and documents
  • If verbal request for information was completed, record details and the due date for the return of information and documents

Go to Step 10.

The customer must be told if additional information or documents are needed. This includes when a third party (for example, accountant) has been contacted for information and/or documents.

Request further information/documents from the customer using the most appropriate channel. See Requesting information (CLK):

• Verbal request
• Request Documents workflow in Process Direct
• Request for Information (RFI) guided procedure in Customer First
• Manual Online Advice (OLA) QSS32 or XOBS32 (customers outside Australia) letters

Note: for Aged Care Means Test assessments where the Request Documents or RFI does not contain all required options use the AC RFI Complex Assessment Officer (CAO) template, see Centrelink - Aged care letter templates. If the letter template is used, ensure a copy of the request is uploaded to the customer's record. See Attaching electronic documents to a Centrelink customer's record.

Where a customer has requested the CAO obtain documents through a third party, this may be considered express or implied consent providing the CAO with the authority to contact the third party. See Implied consent regarding third parties for more information.

Contact with third parties is by telephone only.

Document the record with details of the request i.e. annotate the Progress of claim Note/DOC or CAO referral DOC with details of the request. For example:

• Verbal request for information
• Request for information sent, asking for [insert details]
• Customer advised accountant's details as [insert details]
• Unable to contact customer [include phone number(s), date and time(s) of contact attempts]

Place the activity on hold and allow extra time for surface mail delivery.

Go to Step 11.

Have all the information and documents needed to complete the CAO assessment been provided?

• Yes, go to Step 15
• No, for:
  • Payment and Integrity Group Referrals, go to Step 12
  • all other referrals go to Step 14

Is the referral ‘match data’ for Private Company dividends or Private Trust distributions?

• Yes, go to Step 13
• No, go to Step 14

The Payment Accuracy Review or Compliance Officer is required to request documentation to complete the assessment of the trust, including a MOD PT and relevant supporting documentation.

Note: Payment Accuracy Policy and Compliance teams have access to the ATO Liaison Officer who can request customer and entity tax returns via their quality officers. See Scenarios on Resources.

Where all avenues to obtain all required information for a P&I Group referral have been exhausted and match data is available for private company dividends and/ or private trust distributions, CAOs:

• apply the match data for any customer/partner that has not previously been assessed as an attributable stakeholder
• assess dividends and distributions using the date of event (DOV) as the date the Australian Taxation Office (ATO) advised that the tax returns were prepared

When the assessment is completed, the CAO must include in their report:

• if an attribution decision was unable to be made as all information was not provided
• match data was applied, for any review of decision the customer is required to provide documents as previously requested (include details of outstanding documents)

Service Officer Action DOC is sent to the referring Payment Accuracy or Compliance team as per the CAO referral DOC for all finalised CAO assessments.

The resulting debt shells from a CAO activity will need to be transferred to the referring Payment Accuracy or Compliance team, not XWA.

Go to Step 15.

A CAO assessment is not to be completed where:

• a new claim has been withdrawn or rejected for any other reason than FRC or FSD
• the request is not for a valid CAO assessment referral reason

If an inappropriate CAO referral has been created, send feedback using the Staff Feedback Tool.

A CAO assessment is unable to be completed where:

• insufficient details have been provided to complete the assessment, and
• the customer fails to respond to a request for information

For current ISP customers, the CAO must make genuine attempts to contact the customer by phone prior to suspending payments. Each attempted phone call must be recorded on a DOC. Note: for Payment and Integrity referrals any contact restrictions should be considered and if required liaise with referring officer via MS Teams prior to contact/suspension.

When the payments are suspended FRC, the CAO must hold the CAO referral for 14 days. On day 15 if the customer is yet to provide outstanding correspondence the referral can be closed.

Note: CAOs must not use the suspension code Failed to return trust and company correspondence (FRT) for manual suspension. This code is an automatic code where customers fail to respond to TAC annual review letters. See Program, discretion and estimate reviews and reminders for private trusts and private companies.

Go to Step 16.

Before completing, decide if CAO assessment will be a major factor in an unfavourable decision

An unfavourable decision reduces, cancels, suspends or rejects a payment. CAO decisions that may be a major factor in an unfavourable decision include but are not limited to:

• Loans owing to customer by private trust or company that will impact rate under the income and/or asset test
• Attribution income that will impact rate under the income test
• Distribution income that will impact rate under the income test
• Attributable assets that will impact rate under the asset test
• Non allowable deductions against business income
• Adjusted or not recognised liabilities
• Adjustment of assets to market value
• Assessment of Wages and Director Fees

If the CAO assessment will be the major factor in any adverse decision that affects the customer's payment, the CAO must make genuine attempts to contact the customer by phone before completing the assessment. See Advising verbally of an unfavourable decision.
Note: for Payment and Integrity referrals any contact restrictions should be considered and if required, liaise with referring officer via MS Teams prior to contact.

If the contact attempts are unsuccessful, CAO must document the customer’s record with the details of all contact attempts.

Go to Step 16.

Complete any required system coding for the CAO assessment, if applicable. Go to the relevant Operational Blueprints for each assessment type.

Create a record for the entity, link the customer to the entity, and set up the service profile review on the Future Activity List (FAL) screen as per normal CAO assessment procedure.

Code an activity on the Activity Registration (AYR) screen:

• ServRsn: TRF
• Activity Type: TRV
• Review Reason: TAN
• Source: INT
• Receipt Date: [enter correct date of receipt]:
  • The first date of event (DOV) for the income assessment is the date the entity commenced trading. If this was not for a full financial year, the income must be annualised, see Steps to assess an interim profit and loss statement.
  • The first date of event (DOV) for the asset assessment is 30 June of the financial year.
  • Subsequent financial year event dates are 1 July for income assessments and 30 June for asset assessments. See Scenarios on Resources.
• Action: FMI
• Action Date: (Today’s date)

Select the activity

Only code the TRMD and the Trust/Company Attribution (TRA) screens and complete the activity on the Assessment Results (AR) screen.

In a separate activity, navigate to the Trust/Company Task Selector (TRTS) screen and select the appropriate screens that need to be coded.

Code the relevant screens and complete the assessment.

Include an explanation in a DOC on the entity record (for example, ‘NB: TRMD has not been coded within this activity to allow the Compliance Officer the ability to select the activity to claim the correct result in the IRRS system in the customer’s record. TRMD was coded by CAO in a separate activity.’)

Go to Step 17

As this assessment is a P&I compliance referral for an already declared entity, the TRMD screen will not be updated in the CAO activity so that the Payment Accuracy or Compliance Officer can select the activity to claim the correct result in the Integrated Review System (IRS) on the customer’s record.

To code the assessment, go to the TRTS screen in the entity record. Select the screens relevant to your assessment. Do not select the TRMD screen.

Code each screen according to your assessment and complete the activity. Leave the ripple ‘STA’ if you need to complete any coding in the customer’s record, such as Employment Income Paid Details (EAPP) screen, or leave the ripple status as ‘COM’.

In a separate activity, code the Activity Registration (AYR) screen:

• ServRsn: TRF
• Activity Type: TRV
• Review Reason: TAN
• Source: INT
• Receipt Date: (Correct date of receipt)
• Action: FMI
• Action Date: (Today’s date)

Select the activity

Only code the TRMD and the TRA screens. Complete the activity on the AR screen.

Include an explanation in a DOC on the entity record (for example ‘NB: TRMD has not been coded within this activity to allow the Compliance Officer the ability to select the activity to claim the correct result in the Integrated Review System (IRS) on the customer’s record. TRMD has been coded by CAO in a separate activity as an after action.’)

Go to Step 17.

For a private trust, private company, or special disability trust assessment

DOC the full details of the CAO entity assessment on each entity record using the appropriate CAO assessment Fast Note. This is the only DOC recorded on an entity record.

For other CAO assessments

DOC the full details of the CAO assessment on each customer record using the appropriate CAO assessment Fast Note.

See Resources page > Table 1 for the list of Fast Note templates.

Go to Step 18.

DOC a summary of all CAO assessments on all customer records related to the assessment and linked to the entity. Use Fast Note - select Auto text, use either:

• Complex Assessment > CAO Use Only > CAO Assessment Completed
• Complex Assessment > CAO Use Only > Asset Hardship Assessment Completed
• Complex Assessment > CAO Use Only > FHA CAO Assessment Completed
• Complex Assessment > CAO Use Only > SDT – CAO Assessment Completed
• Complex Assessment > CAO Use Only > CAO Referral Inappropriate

HEAS/Asset Hardship assessments should use Fast Notes as directed by the relevant Operational Blueprints.

Do not record the CAO Assessment Completed, FHA CAO Assessment Completed or CAO Referral Inappropriate DOC on an entity record.

The 'subject line' for the CAO DOC must be CAO Assessment, so it is easy for processing staff to identify.

Include the appropriate additional Service Officer information/actions in the Fast Note.

See Resources > Table 2 for the Fast Note text options.

Record if the CAO was unable to make an assessment because the customer has not provided the requested information. Include details of the outstanding information.

Finalise the CAO Assessment DOC by selecting Completed.

Go to Step 19.

In Process Direct:

• edit the Referral Details assignment block to update the status to Completed
• select Save to finalise the changes

In Customer First:

• Finalise the CAO referral activity by selecting from the Activity List (AL) screen and completing the started DOC

Note: if a process requires a specific work allocation action, follow the instructions provided.

Is there a claim/activity related to the referral on record (Customer First, Customer Record or Process Direct)?

• Yes, go to Step 20
• No, go to Step 21

In Process Direct:

When the CAO referral work item is set to Completed, the claim or reassessment activity status should automatically change from On Hold to In Process where there are no other referrals with a Status of In Process.

Confirm the activity status:

• Select Customer Summary from the Process Direct Landing page
• On the Search Criteria screen:
  • key the CRN and select Go
  • select the customer’s record from the Search Results table
• In the record, select the Transactions icon > All transactions
• If the relevant claim or reassessment transaction status has not automatically changed to In Process, check if there are any other referrals still In Process.
• If there are none, select the claim or reassessment hyperlink:
  • select Status icon
  • select Edit
  • use the dropdown to update the status to In Process
  • select Save
• If immediate new claim and non-new claim priority processing criteria are met, follow the processes to escalate

Note: if the referral to the CAO is via the Request CAO to reassess rejected claim Fast Note and the Fast Note is Completed, the CAO must update the claim Status to In Process.

In Customer First or Customer Record:

• For activities (including claims), manually take the associated activity off hold on the Activity List (AL) screen
• If the customer's partner also has a claim held for the same referral reason, make sure the partner's claim Status is no longer On Hold
• If immediate new claim and non-new claim priority processing criteria are met, follow the processes to escalate

Note: taking the activity off hold will result in it being allocated, based on previously established priorities. The user logon on this activity does not impact work allocation.

Go to Step 21

More action is required in the following circumstances:

If more action is needed and no activity about the referral is on record (Customer First, Customer Record or Process Direct), create an open work item:

• use Fast Note - select Auto Text using either:
  • Complex Assessment > New Claim > CAO requests SO action for New Claim
  • Complex Assessment > UPD > CAO requests SO action for Reassessment
• insert date CAO assessment completed and claim type or service reason
• select Confirm
• add keyword to the activity for claim type/service reason:
  • ACTABY - ABSTUDY
  • ACTAGE - Age Pension
  • ACTAUS - Austudy/Youth Allowance (Student)
  • ACTCAR - Carer Payment
  • ACTDSP - Disability Support Pension
  • ACTFHA - Farm Household Allowance
  • ACTJSP - JobSeeker
  • ACTLIC - Low Income Health Care Card
  • ACTPPP - Parenting Payment Partnered
  • ACTPPS - Parenting Payment Single
  • ACTRCA - Aged care means assessment
  • ACTSPB - Special Benefit
  • ACTYAL - Youth Allowance (JobSeeker)

Note: the claim type/service reason keyword must be added at the time the Fast Note hand off is created. If this is not done, an Unfinalised Activity - Immediate Action required work item will appear in the Inbox. If this happens, complete the original Fast Note, then re-create the hand-off in line with the process above.

Procedure ends here.

Place a Display on Access (DOA) DOC on the record if the customer was receiving income support payment or a Low Income Health Care Card:

• granted before a CAO assessment, and
• has since been cancelled, and
• has not provided the documents needed, and
• all reasonable attempts have been made to contact the ex-recipient to request the information needed

Use Fast Note > Complex Assessment > New Claim > CAO Assessment unable to be completed:

• DOA Code: NSE Non-standard earning assessment
• Expiry Date: leave blank
• Transfer to Region: CAO
• Keywords: CAOCAN
• Extra Details: CAO Assessment Incomplete:
  • Complex Assessment Officer (CAO) assessment unable to be completed for (PAYMENT TYPE) claim period xx/xx/xxxx – xx/xx/xxxx
  • Payments cancelled before CAO assessment and customer failed to reply to CAO request for information
  • If the customer claims an income support payment or a Low Income Health Care Card, continue new claim process including any required CAO referrals as per business as usual requirements
  • Do not close the DOA DOC until the action needed for past claim period has been determined

Procedure ends here.

Forward the CRN by email to Business Process CAO, where:

• the customer claims an income support payment or a Low Income Health Care Card
• an annual review is due for the DOA DOC

Business Process will escalate reported cases to the payments type programme team.

Procedure ends here.