Processing claims for Carer Payment (CP) and/or Carer Allowance (CA) 009-04040000

Scenario

Action

Outcome

Carer claiming CP receives CA for the adult.

Make sure all permanent conditions have been covered on the latest medical report.

Cancel CA from the date of determination.

Go to the:

• care receivers record to record the new medical report/carer questionnaire outside of the claim from the determination date and finalise the activity
• carers record to cancel CA from the date of determination. DOC the record
• care receivers record and correct the effect date of the medical report/carer questionnaire to the DOE of the new claim and finalise the activity
• claimants record and reject the claim

Carer claiming CP and another carer received CA for the adult.

Make sure all permanent conditions have been covered on the latest medical report.

Cancel CA for other carer after contact. See Advising verbally of an unfavourable decision.

Go to the:

• care receivers record to record the new medical report/carer questionnaire outside of the claim from the determination date and finalise the activity
• current carers record to cancel CA from the date of determination. DOC the record
• back to care receivers record and correct the effect date of the medical report/carer questionnaire to the DOE of the new claim and finalise the activity
• claimants record and reject the claim

Only one form lodged.

Check if the reuse provisions apply.

Reuse provisions apply:

• process the CP claim

Reuse provisions do not apply:

• do not record the new medical report/carer questionnaire
• cancel CA from the date of determination
• reject the CP claim - FRC

Scenario

Action

Outcome

The care receiver has a recognised disability, which is of a permanent nature, but the condition(s) is not listed on the current medical report.

Carer claiming CP receives CA for the child or another carer receives CA for the child.

Clarify with the Treating Health Professional (THP) why the recognised disability was not listed on the latest report.

If not confirmed, check DOCs on the carer record, and if needed check the previous report to confirm the condition was correctly recorded.

Continue CA if the recognised disability is confirmed.

Refer to the Level 2 Policy Help Desk if the recognised disability had been correctly recorded and the care receiver no longer has this condition.

The care receiver has a recognised disability, which is not of a permanent nature, and the condition(s) is not listed on the current medical report.

Carer claiming CP receives CA for the child.

Clarify with the THP why the recognised disability was not listed on the latest report.

If not confirmed, check DOCs on the carer record and if needed check the previous report to confirm the condition was correctly recorded.

Continue CA if the recognised disability is confirmed.

Otherwise, cancel CA, from the date of determination.

The care receiver has a recognised disability, which is not of a permanent nature, and the condition(s) is not listed on the current medical report.

Another carer receives CA for the child.

Clarify with the THP why the recognised disability was not listed on the latest report.

If not confirmed, check DOCs on the carer record, and if needed check the previous report to confirm the condition was correctly recorded.

Continue CA if the recognised disability is confirmed via a new THP.

Cancel CA for other carer after contact. See Advising verbally of an unfavourable decision.

The care receiver does not have a recognised disability.

Carer claiming CP receives CA for the child.

Make sure all permanent conditions have been covered on the latest medical report.

Cancel CA from the date of determination.

• in the carers record code the new medical report/carer questionnaire outside of the claim from the determination date and finalise the activity
• Cancel CA from the date of determination. DOC the record
• if the customer is now only eligible for CA HCC this will take effect from the date of determination
• correct the effect date of the medical report/carer questionnaire to the DOE of the new claim and finalise the activity
• go to the claimants record and reject the claim

The care receiver does not have a recognised disability.

Another carer receives CA for the child.

Make sure all permanent conditions have been covered on the latest medical report.

Cancel CA for other carer after contact. See Advising verbally of an unfavourable decision.

• in the carers record code the new medical report/carer questionnaire outside of the claim from the determination date and finalise the activity
• cancel CA from the date of determination. DOC the record
• correct the effect date of the medical report/carer questionnaire to the DOE of the new claim and finalise the activity
• go to the claimants record and reject the claim

Only one form lodged.

Check if the reuse provisions apply.

Reuse provisions apply:

• process the CP claim

Reuse provisions do not apply:

• cancel CA from the date of determination
• CA can continue if the child has a recognised disability
• do not record the new medical report/carer questionnaire
• reject the CP claim - FRC

Scenario

Action

Outcome

Carer claiming CA receives CP for the adult.

Make sure all permanent conditions have been covered on the latest medical report.

Cancel CP from the date of determination.

Go to the:

• care receivers record to record the new medical report/carer questionnaire outside of the claim from the determination date and finalise the activity
• carers record to cancel CP from the date of determination. DOC the record
• care receivers record and correct the effect date of the medical report/carer questionnaire to the DOE of the new claim and finalise the activity
• claimants record and reject the claim

Carer claiming CA and another carer received CP for the adult.

Make sure all permanent conditions have been covered on the latest medical report.

Cancel CP for other carer after contact. See Advising verbally of an unfavourable decision.

Go to the:

• care receivers record to record the new medical report/carer questionnaire outside of the claim from the determination date and finalise the activity
• carers record to cancel CP from the date of determination. DOC the record
• care receivers record and correct the effect date of the medical report/carer questionnaire to the DOE of the new claim and finalise the activity
• claimants record and reject the claim

Only one form lodged.

Check if the reuse provisions apply.

Reuse provisions apply:

• process the CA claim

Reuse provisions do not apply:

• do not record the new medical report/carer questionnaire
• cancel CP from the date of determination
• reject the CP claim - FRC

Scenario

Action

Outcome

Carer claiming CA receives CP for the child.

Make sure all permanent conditions have been covered on the latest medical report.

Cancel CP from the date of determination.

• in the carers record to record the new medical report/carer questionnaire outside of the claim from the determination date and finalise the activity
• cancel CP from the date of determination. DOC the record
• correct the effect date of the medical report/carer questionnaire to the DOE of the new claim and finalise the activity
• go to the claimants record and reject the claim

The care receiver does not have a recognised disability.

Another carer receives CA for the child.

Make sure all permanent conditions have been covered on the latest medical report.

Cancel CP for other carer after contact. See Advising verbally of an unfavourable decision.

• in the carers record to record the new medical report/carer questionnaire outside of the claim from the determination date and finalise the activity
• cancel CP from the date of determination. DOC the record
• correct the effect date of the medical report/carer questionnaire to the DOE of the new claim and finalise the activity
• go to the claimants record and reject the claim

Only one form lodged.

Check if the reuse provisions apply.

Reuse provisions apply:

• process the CA claim

Reuse provisions do not apply:

• do not record the new medical report/carer questionnaire
• cancel CP from the date of determination
• reject the CP claim - FRC

Qualifying care receivers

Example

Nil

Customer qualifies for Nil of the care receivers claimed for.

Before rejecting the claims check if any of the following are applicable:

• Carer Payment (CP) (child) when caring for 2 to 4 children each with a disability or medical condition (combined care)
• Eligibility for Carer Payment (CP) under the Lower Adult Disability Assessment (ADAT) Tool
• Carer Payment (CP) (child) when caring for a disabled adult and 1 or 2 children with a disability or medical condition (multiple care)

Rejection is to be completed for both/ all receivers claimed for.

Carer has lodged CP claim for more than one care receiver. See Table 2, Step 6.

Carer is current on CP

• Claim for the new care receiver is to be made 'Not required'
• Claim is considered 'Rejected'
• Review CP in respect of the existing care receiver

One

Carer has lodged CP claim for more than one care receiver and qualifies for one of the care receivers claimed for. See Table 2, Step 6.

More than one

Customer:

• qualifies for more than one care receivers claimed for, or
• is in receipt of CP, and qualifies for CP for the new care receiver claimed for

Contact customer to confirm care receiver being claimed for.

Carer has lodged CP claim for more than one care receiver

• Finalise all claims. See Table 2, Step 6 being claimed for

Carer is current on CP

• Reject claim for new care receiver, or
• Process change in care receiver (cancelling original care receiver and processing claim for new care receiver)

Section

Scenario and text

Paragraph 1

Multiple care receivers claimed for:

We have received a Carer Payment claim for (care receiver’s name A) and (care receiver’s name B). Carer Payment can only be assessed and paid for one care receiver.

Current CP carer claims for second care receiver:

We have received a Carer Payment claim for (care receiver’s name B). You are already in receipt of Carer Payment for (care receiver’s name A). Carer Payment can only be assessed and paid for one care receiver.

Question A

Multiple care receivers claimed for:

Please confirm the names of all care receivers you provide care to.

Current CP carer claims for second care receiver:

Please confirm the names of all care receivers you provide care to.

Question B

Multiple care receivers claimed for:

Carer Payment can only be assessed and paid for one care receiver. Please confirm the care receiver you wish to be assessed for Carer Payment for:

Current CP carer claims for second care receiver:

Carer Payment can only be assessed and paid for one care receiver. Please confirm the care receiver you wish to be assessed for Carer Payment for:

Question C

Current CP carer claims for second care receiver:

If you have chosen to receive Carer Payment for a new care receiver, have you recently ceased caring for any care receiver/s?

Question D

Current CP carer claims for second care receiver:

If so, please confirm the care receivers name, from what date the care ceased and the reason for the change in care.

The care receiver receives

Outcome for carer claiming

Outcome for existing carer

CP for adult care receiver

There is no legislative bar to both carers receiving CP.

However, a Social Worker referral should occur to confirm the existing carer needs constant care and is able to provide constant care.

Following the Social Worker referral a medical review of the existing care receiver may be required.

There is no legislative bar to both carers receiving CP.

However, a Social Worker referral should occur to confirm the existing carer needs constant care and is able to provide constant care.

Following the Social Worker referral a medical review of the existing care receiver may be required.

CP for child care receiver

There is no legislative bar to both carers receiving CP.

However, a Social Worker referral should occur to confirm the existing carer needs constant care and is able to provide constant care.

Following the Social Worker referral a medical review of the existing care receiver may be required.

There is no legislative bar to both carers receiving CP.

However, a Social Worker referral should occur to confirm the existing carer needs constant care and is able to provide constant care.

Following the Social Worker referral a medical review of the existing care receiver may be required.

CA for an adult care receiver

The standard start date provisions apply

Consider if the new carer should be encouraged to claim CA for the existing care receiver.

Consider if their condition(s) would preclude them from providing daily care to the care receiver.

If so, arrange a Social Worker referral.

If the existing carer is a child, a Social Worker referral is likely.

A medical review of the existing care receiver may be required.

CA for child care receiver

The standard start date provisions apply.

Consider if the new carer should be encouraged to claim CA for the existing care receiver.

Consider if their condition(s) would preclude them from providing daily care to the care receiver.

If so, arrange a Social Worker referral.

If the existing carer is a child, a Social Worker referral is likely.

A medical review of the existing care receiver may be required.

The care receiver is an adult or a child

The care receiver receives

Outcome of carer claiming

Outcome for existing carer

Either

CP for an adult care receiver

The standard start date provisions apply.

Consider if the new carer should be encouraged to claim CA for the existing care receiver.

Consider if their condition(s) would preclude them from providing constant care to the care receiver.

If so, arrange a Social Worker referral.

If the existing carer is a child, a Social Worker referral is likely.

Either

CP for a child care receiver

The standard start date provisions apply

Consider if the new carer should be encouraged to claim CA for the existing care receiver.

Consider if their condition(s) would preclude them from providing constant care to the care receiver.

If so, arrange a Social Worker referral.

If the existing carer is a child, a Social Worker referral is likely.

Adult

CA for adult care receiver

The standard start date provisions apply.

Consider if the new carer should be encouraged to claim CA for the existing care receiver.

If continuing to provide daily care, CA is cancelled from the day the decision is made to grant CA to the new carer.

If not providing daily care, the standard cancellation provisions apply.

Child

CA for adult care receiver

The standard start date provisions apply.

Consider if the new carer should be encouraged to claim CA for the existing care receiver.

Consider if their condition(s) would preclude them from providing daily care to the care receiver.

If so, arrange a Social Worker referral.

A Social Worker referral is likely.

A medical review of the existing care receiver may be required.

Either

CA for child care receiver

The standard start date provisions apply

Consider if the new carer should be encouraged to claim CA for the existing care receiver.

Consider if their condition(s) would preclude them from providing daily care to the care receiver.

If so, arrange a Social Worker referral.

If the existing carer is a child, a Social Worker referral is likely.