Assessing claims for Carer Allowance (CA) 009-03040000

Carer Allowance (CA) is an income supplement available to carers who provide daily care and attention for adults or children with a disability, medical condition, or those who are frail aged.

CA is not taxable or assets tested. There is an income test. To be eligible for CA, the carer's and their partner's combined adjusted taxable income must be under $250,000 a year. This includes deemed income from account-based income streams if the account holder is 60 years of age or older. The same income limit applies if the carer does not have a partner.

The income test does not affect the rate of CA.

CA may be paid on top of wages, Carer Payment or other payments.

The income test does not apply if the carer or their partner receive an income-tested income support payment, Family Tax Benefit paid in fortnightly instalments or the holder of a Commonwealth Seniors Health Card (CSHC). The carer is exempt from providing their income details for the CA income test.

Service Officers now have the ability to backdate a claim for CA that was received more than 12 months in the past. A warning message will display to remind staff to check that the correct date has been recorded.

Carers can complete an online claim for Carer Payment (CP) and/or Carer Allowance (CA) including lodgement of supporting documents.

All forms issued by First Contact Service Offer (FCSO) need to be completed and lodged by the carer to assess a claim for CA. Service Officers can determine which forms were issued by FCSO by referring to the FCSO Finalisation Note on the carer's record. A CA adjustable taxable income details form (SA489), will always be issued with a CA or combined Carer Payment and CA new claim without checking if the carer is exempt from providing their income details or if the existing CA income details can be reused.

Paper claim for CA (Child)

If the carer has claimed both CP (child) and CA (child), the CA claim should be determined before the CP claim. If the carer is not eligible for CA (child) payments, they may be eligible for CA (auto) payments if CP (child) has been granted. Coding a claim for CP may automatically assess eligibility for CA (auto).

If CA Health Care Card (HCC) only has been granted, and during the CP claim the Disability Care Load Assessment score has increased (such as via the Care Load Validation process), a manual assessment of eligibility for CA auto or CA manual may be required. CA (auto) child care receivers are eligible for an HCC in their name in addition to any Pensioner Concession Card or HCC held by the carer. Normal concession card hierarchy rules apply.

Paper claim for CA (Adult)

For CA for an adult care receiver to be assessed, a claim for CP and/or CA (SA404/SA409) or Claim for CA following CP Review (SA341) must be lodged. A CP and/or CA Medical Report for a person (SA332a) may also be required. CA is assessed under the Adult Disability Assessment Tool (ADAT). The carer does not have to complete an SA332(a) if they already receive CP for the same care receiver and the care receiver has qualified for CP.

Child

For CA (child), a child with a recognised disability is automatically considered to be a disabled child and does not have to be tested against the Disability Care Load Assessment Determination (2020).

However, the Treating Health Professional must state the condition is either permanent or temporary for at least 12 months and the child must still receive care and attention from the carer on a daily basis in a residence that is the home of both the carer and care receiver.

A recognised disability is a condition or disability which is considered to be a severe disability or a chronic medical condition with severe impact.

A severe disability is defined as one which is severe, moderate or profound that is permanent or likely to be permanent.

Some disabilities are included on the list only when a young person reaches a certain age. To be included there must be clear diagnostic criteria that are widely accepted, and the disability must be reasonably prevalent.

Adult

CA is assessed under the Adult Disability Assessment Tool (ADAT) which measures the functional ability and care needs and allows the care receiver to be assessed and have their level of disability objectively determined.

Re-use of a previous ADAT may be possible under specific provisions. The SA332(a) can be completed by a Treating Health Professional if the care receiver is aged 15 years and 9 months or older.

Claims from carers must be referred to a social worker when the carer is:

• under 18 years of age, (before processing the claim)
• over 80 years of age

Social workers will assess the care situation to ensure the carer:

• has the physical and emotional capacity to provide the level of care needed
• is given information and help to access support services and resources

A carer who has lodged a claim for CA may not be eligible because they do not meet the basic qualifications or payability for that payment. Sometimes carers may have lodged an inappropriate or incorrect claim.

In all these circumstances, the claim is rejected. The system uses information provided by the carer when a decision to reject a claim is made. While many rejection reasons will automatically reject the CA claim after a carer’s details have been input onto the system, there are some other rejection reasons that need to be coded manually. For example, the care and dependency requirements may not be met, or for failing to reply to correspondence.

When manually rejecting a CA claim, ensure that an advice of the decision is sent to the carer giving them reasons for the rejection of their claim, and detailing the steps to follow in the Initial contact about a decision and the review of decision process.