Re-use and re-claim provisions for Carer Payment (CP) (child) and Carer Allowance (CA) (child) claims 009-05030020

Re-use and re-claim provisions for adult care receivers can be found in Adult Disability Assessment Tool (ADAT).

For CP and/or CA (child) claims and re-claims, the most recent CNA and medical reports for new and current carers may be re-used if the carer, care receiver and the report meet re-use or re-claim eligibility criteria and the information is gathered under any of the following:

• Child Disability Assessment Determination (CDAD) 2001
• DCLAD 2020
• List of Recognised Disabilities (LoRD)
• terminal condition assessment for CP (child) including those under pre July 2009 Profoundly Disabled Child (PDC) provisions

Re-claim provisions allow qualifying THP medical reports and CNAs previously supplied to be used for a subsequent claim. Re-claim provisions are automatically assessed during the Carers Online Claim or Assisted Customer Claim (ACC).

Re-claim provisions may be applied if all of the following are met:

• a carer loses qualification for CP and/or CA
• the carer re-applies (re-claims) for the same CP and/or CA combination
• the care receiver/s for the original claim are the same as for the re-claim
• the care receiver/s still meet the age requirements of the original CP and/or CA (they are under 16)
• the re-claim is not more than 26 weeks from the date qualification for CP and/or CA was lost. Only the most recent qualifying THP medical report and/or CNA may be used

Re-claim provisions apply for 26 weeks from the date qualification for the previous CP and/or CA is lost. If claim forms are lodged outside the 26 week window, re-claim provisions cannot be applied. The date the THP signed the medical report is not relevant for re-claim provisions.

Note: intent to claim provisions were amended on 1 July 2018, and only apply to carers in vulnerable circumstances.

A child care receiver who was previously assessed with a terminal illness, which qualified the carer for CP (child), will not be required to provide a new THP medical report or CNA for a CP (child) re-claim.

If the child care receiver was previously assessed in the most recent assessment as having a List of Recognised Disabilities (LoRD) condition which does not have an age qualification, a new medical report and CNA are not required for a CA (child) re-claim.

Carers not eligible for re-claim provisions may be eligible under re-use provisions (see below).

Note: re-claim provisions cannot be applied where a carer's record has been cancelled for not providing a Medical report or CNA required for a medical review.

The medical report cannot be used again under re-claim provisions for child care receivers who:

• have been identified with the following age specific List of Recognised Disabilities (LoRD) condition
• severe multiple or physical disability (including controlled seizures), once the child is aged 6 months or older
• were granted CP (child) under the episodic or short term claim conditions

A medical report used to qualify a carer for CP (child) under Profoundly Disabled Child (PDC) provisions cannot be used under re-claim provisions unless the care receiver has been assessed with a qualifying terminal condition

The re-claim assessment will not be subject to Validation or Carer Specialist Assessment Team (CSAT) processes.

Note: re-claim provisions cannot be applied where a carer's benefit has been cancelled as a result of the carer failing to provide a medical report or CNA which was required for a medical review.

Re-use provisions allow eligible THP medical reports and/or CNAs previously supplied to be used for a subsequent claim. The Carers Online Claim and Assisted Customer Claim (ACC) will identify the option to re-use this previous data for the child care receiver if the most recent reports meet the re-use provisions.

If 1 carer is in receipt of CA for a child care receiver and a second carer claims under the shared care provision, the care receiver does not have to be tested a second time against the list of recognised disabilities (LoRD) or Disability Care Load Assessment Determination (DCLAD). The second carer is not required to provide another medical report for the same care receiver, but will need to complete a CNA.

The online claim and ACC cannot determine if the care receiver is in shared care unless there is a previous or current link with the second carer, so a medical report may be incorrectly issued. If the child is not linked to the second carer, the child's details cannot be accessed via the current carer's record due to the privacy provisions. It is not possible to stop the online claim or ACC from issuing the medical report, so if it is known that another carer already receives CA, the second carer should be advised that the medical report is not required.

Re-use provisions may be applied if the following are met:

• The care receiver is under 16 years of age at the time of claim
• The most recent:
• recorded THP medical report was assessed under Child Disability Assessment Determination (CDAD) 2001 or DCLAD 2020, and/or
• CNA was assessed under DCLAD 2020
• The most recent recorded THP medical report sign date is either:
• within the last 26 weeks, or
• within the re-use time window (THP medical report sign date) when the carer contacts to claim payment. See the Resources page for a table showing when a THP medical report can be re-used
• The THP and/or CNA scores qualify the carer for the benefit being claimed under re-use provisions

A CNA lodged to support a CA (child) claim under CDAD 2001 cannot be used to support an assessment under the re-use or re-claim provisions. If the most recent CNA was to support a claim under CDAD 2001 any subsequent claim or re-claim will require a new CNA.

Service Officers have the discretion to waive the validation process for 1 or more questions when re-using THP medical reports or CNAs.

Re-use and re-claim provisions are not applicable for CA Health Care Card only (HCC) re-claims. Re-use provisions do not apply to medical reviews.

If a claim or re-claim is granted with a re-used medical report, any subsequent reviews will be deferred for 3 months from the date of determination.

CA carer claims CP: the above provisions apply when a carer is in receipt of CA and claims CP for the same care receiver. Although the CA medical report does not ask the constant care question, the re-use provisions can apply. If the Service Officer has concerns they can issue an SA428 form, or clarify with the carer that constant care is provided.

Only the most recent qualifying THP medical report and/or CNA may be re-used.

If the re-use provisions apply to a carer and the carer lodges a new medical report, the latest medical report must be used. Eligible care receivers must have a current or non-current link with the prospective carer, and if no link exists, the Carers Online Claim or Assisted Customer Claim (ACC) will request/issue carers with a new medical report and CNA.

Re-use provisions cannot be applied where a carer's benefit has been cancelled for not providing a THP medical report or CNA required for a medical review.

CA (child)

If a child care receiver was most recently assessed with:

• a terminal illness, a new THP medical report and CNA assessment is not required for a subsequent CP (child) claim. This applies irrespective of the THP sign date at the time of claim or re-claim
• a non-age-specific List of Recognised Disabilities (LoRD) condition, a new THP medical report and CNA assessment will not be required for a subsequent CA (child) claim

The above rules apply irrespective of the THP sign date on the medical report at the time of claim or re-claim.

Period of condition: when applying the re-use provisions, the Carers Online Claim and ACC do not consider the period of a child's condition. If the THP medical report and CNA scores satisfy eligibility, the online claim or ACC will not request/issue a new THP medical report. If there are concerns, the Service Officer may contact the THP to determine whether the period of condition meets eligibility and document this on the carer’s record and proceed with the claim.

CP (child)

A carer receiving CP (child) under Profoundly Disabled Child (PDC) provisions, who has not been assessed with a CP (child) qualifying terminal condition, will require a new THP medical report and a new CNA. The previously supplied PDC medical report cannot be used under re-claim or re-use provisions as the care receiver is now required to be assessed under the DCLAD (2020).

Where there has been a change in carers and the new carer had previously not tested their entitlement, the re-use provisions may apply to the THP medical report. However, the re-use provisions will not apply to the CNA which must be completed by the carer for the CP (child) claim.

Combined and multiple care claims may only re-use a previously supplied CNA if the following conditions are satisfied:

• the same carer and care receiver combination is applies, and
• the CNA report is for the same age re-use bracket as the care receiver(s) age at the latest claim. See the Resources page for a table showing when a THP medical report can be re-used

If the most recently provided CNA does not satisfy all qualification requirements for re-use a new CNA is required.

Where a carer qualifies for CA (child) using the combined scores for 2 children, the re-use provisions only apply to the care receiver/s for whom the original CA was payable (the same 2 care receivers).