Processing Low Income Health Care Card (LIC) claims 101-18042300

Customers in vulnerable circumstances who have a genuine difficulty providing documents with the claim can lodge a claim and provide the documents later.

The actual claim date will be the lodgement date and the deemed claim date (under sections 13 and 14 of the Social Security (Administration) Act 1999) will be the contact date where applicable.

Examples of vulnerable circumstances include (but are not limited to) where the customer is:

• in a crisis situation and is unable to fully complete a claim due to being homeless
• affected by a major disaster
• impacted by family and domestic violence
• a recent humanitarian entrant
• recently released from prison or psychiatric confinement
• a young person who is unable to live at home (ongoing situation)

Customers may be presented with pre-filled Single Touch Payroll (STP) data during their online claim. Employer details, including name and ABN, will be presented to the customer if STP data has been provided to the Australian Taxation Office (ATO) within the 8 weeks prior to claim.

The system will also request a customer to update income if the assessment period changes due to delay in claim submission.

Straight through processing is where a claim for a social security payment or service is assessed using criteria to identify if it is suitable for an automated grant outcome.

The system may process LIC claims automatically if they meet certain criteria.

If a claim meets the criteria for an automated assessment, DOCs or Display Notes on the customer's record will show that ROXY has created these.

Customer contact

If a customer asks for an explanation or applies for a formal review of the decision, the Service Officer must enter their own logon as the Decision Maker and the customer's local service centre when running the script.

If the claim was incorrectly granted, give feedback via Digital Assistant ROXY.