Coding Compensation and damages (MOD C) to request a clearance 117-01040010

When a customer and or their partner uploads a Compensation and damages (MOD C) form, a work item ID of ZDMS_MODC with work type description MOD C Compensation and Damages Scan is created.

• Check the Activity List (AL) screen to identify the form code on the left hand side of the activity
• Check the Document List (DL) screen to identify if there was a triggering event that created this activity
• Action the scan for the purposes of a compensation assessment
• When actioned and completed:
• Select the Transaction ID from the AL screen
• Select Edit
• Change Status from Document Added to Completed

A customer can advise of their compensation claim verbally or via a MOD C. Check the information is complete and supporting documents have been provided. Customers must complete a separate MOD C for each injury or claim.

If the customer and/or correspondence nominee has not provided all documents or there is missing information, the Service Officer must tell the customer and/or correspondence nominee:

• what they need to provide, and
• missing information may delay a compensation clearance

For the compensation claim, check:

• All questions are complete
• MOD C is signed by the compensation claimant, and
• Supporting documents are supplied and scanned to customer's record. Examples:
• Income replacement/protection policy
• Sickness and accident policy
• Sporting injury policy
• Assessment letters from the compensation payer or insurer
• Lump sum settlement documents
• Periodic payment remittance documents or payslips

For more details, see Completing the Compensation and damages details via MOD C or verbal lodgement.

Is the MOD C complete and supporting documents provided?

• Yes, go to Step 2
• No, do not run the Compensation Clearance Request workflow:
• Ask the customer and/or their partner to complete a new MOD C
• Tell them they have 14 days to complete and supply supporting documents
• Record details of MOD C request in a DOC
• Procedure ends here

Is the customer receiving disability benefits from an income protection policy attached to a superannuation fund?

• Yes,
• do not run the Compensation Clearance Request workflow. Go to Income from personal injury insurance schemes and disability benefits for coding instructions
• procedure ends here
• No, go to Step 3

Process Direct

• Select Customer Summary from the Landing Page
• Enter the customer's CRN
• Select Enter
• Key CMPS in the Super Key, and [Enter]
• To determine if the customer has an existing claim for the same incident:
• Check the Action item table and Claim summary table
• Select Summary View for additional information

Customer First

Search the Workspace for the Compensation Management Summary and select the relevant link to display the CMS overview.

The CMS overview displays 4 sections:

• Expand All
• Action Items
• Summary
• Claim Summary

Under Claims Summary, check for any recorded claims.

Does a claim ID already exist for the same incident?

• Yes, go to Step 4
• No, to record details in the Compensation Management system in:
• Process Direct see Table 2
• Customer First see Table 3

Check if any updates to the existing claim ID are required. For example:

• Updates to solicitor/compensation payer
• Lump sum not previously advised/recorded
• Commencing periodic payments
• Arrears of periodic compensation
• Reassessment of customers entitlement to a CAP

Does the existing claim display Clear to pay and updates are not required?

• Yes, clearance is not required. Do not run the New Compensation and Damages Notification (MOD C) workflow. Procedure ends here.
• No, go to Step 5

Do not run the New Compensation and Damages Notification (MOD C) workflow

In Customer First:

To change or stop already recorded periodic payments see Coding and raising debts for periodic compensation payments.

To request a compensation clearance, go to the Activity Registration (AYR) screen. Manually key the fields:

• Service Reason: CMM
• Activity Type: CLE
• Source: MOD C or other valid source (for example LET, FAX, PHO)
• Date of Receipt: date the MOD C document or information was received
• Proceed with Activity: select Yes to generate the activity on AL screen
• Transfer to Region: key CTN to transfer the activity to Compensation Recovery Team (CRT)
• Notes: key 'Clearance request'. Add any relevant information about the compensation claim in the free text box. For example:
• Updates to solicitor/compensation payer
• Lump sum not previously advised/recorded
• Commencing periodic payments
• Arrears of periodic compensation
• Reassessment of customers entitlement to a CAP
• Select Continue to generate CMM/CLE activity

Scan supporting documents to the customers record, such as:

• lump sum settlements
• income replacement
• policy sickness and accident policy
• sporting injuries documents from the compensation payer or insurer

For more details, see Compensation clearances (CLK).

Procedure ends here.

In Process Direct go to the compensation recipient's record:

• Select > Referral
• Referral type: select Compensation Clearance Request
• The Payment Type will default based on the customer's benefit status
• Select Next

Is the source of compensation Australian?

• Yes, complete the mandatory fields
• Channel
• Receipt Date (dd/mm/yyyy)
• Go to Step 3
• No, complete the mandatory fields:
• Channel
• Receipt Date (dd/mm/yyyy
• Go to Step 4

Note: compensation payer details are extremely important.

Failure to code this information can impact on the Compensation Recovery Team's (CRT) ability to provide a clearance in a timely manner.

Check the Compensation Payer Details table for the compensation payer. A search can also be completed using the Organisation Summary tile on the Process Direct landing page, using the Stakeholder code CMM.

Can the Compensation payer be identified?

• Yes:
• Select Search compensation payer
• Search using the Organisation CRN if known
• Search using the Organisation Name (*asterisk can be used as a wildcard) and State if CRN is not known
• Select Search
• See the provider list
• Enter any external reference before proceeding
• Go to Step 5
• No, go to Step 4

When no compensation payer can be identified or the source of the compensation is outside Australia, complete the Liable Party Details screen. Use available details such as:

• compensation payer
• defendant's name or
• customer's employer details

The Liable Party's Name and Country fields are mandatory.

Complete the following fields:

• What is the date of the injury or illness? (dd/mm/yyyy): enter the applicable date
• What is the start date of the loss of earnings because of the injury or illness? (dd/mm/yyy): enter the applicable date
• Where did the injury or illness occur?: select the applicable option
• In what state or territory did the injury or illness occur?: select the applicable option

Complete the mandatory questions.

CRT will require a copy of the settlement documentation for any lump sums the customer has been paid (where available).

Is a solicitor acting for the claimant?

• Yes, complete the mandatory Solicitor's details and date the solicitor started acting for the claimant, then select Next. Go to Step 8
• No, select Next. Go to Step 8

The Referral summary page will display Referral data and Notes.

An Additional comments field will display for additional information relevant to the Compensation Clearance Request.

Select Finish.

Note: If there is a Single MOD C document on the record, the document will be automatically completed. If there are any other open documents on the record, the system will go to the Open Documents (OD) screen. Review and complete the Documents if necessary.

In the compensation recipient's record:

• Select Compensation Management Summary
• Select New Compensation and Damages Notification (MOD C) link (last heading). Note the Compensation Payer's CRN
• The Compensation and Damages Notification Start includes the following fields:
• Compensation Payer's CRN
• Is the source of the compensation Australian?
  This field will default to Yes. If the source is not Australian, select No

If the Compensation Payer’s CRN is not known see Advanced Organisation Search tool for staff Process page Table 1 Step 1 to do a General Organisation search, use the stakeholder code CMM.

Does the compensation payer have a CRN?

• Yes:
• Enter compensation payer's CRN
• Complete the Source: field (select MOD C, Compensation Payer or Solicitor) and Receipt Date: field
• Select Continue. Go to Step 5
• No:
• Complete Source: field (select MOD C, Compensation Payer or Solicitor) and Receipt Date: field
• Select Continue
• Go to Step 2

Note: compensation payer details are extremely important.

Failure to code this information can impact on the Compensation Recovery Team's (CRT) ability to provide a clearance in a timely manner.

Can the compensation payer be identified?

• Yes, complete the following fields:
• Compensation Payer's Organisational CRN: if known or select Continue to show the Compensation Payer's Name: field
• code Compensation Payer's name with an *asterisk.
• all valid options will show with variations of the compensation payer's name. For example WorkCover*, Work Cover*
• if the compensation payer uses an acronym for their name, search using the acronym. For example, AAMI* or Aust*
• select State from drop down box
• select Search
• go to Step 3
• No:
• select No
• select Continue to go to the Liable Party Details screen
• go to Step 5

A list of compensation payers that meet the search criteria will be displayed.

Is the correct compensation payer displayed?

• Yes, select the appropriate compensation payer. Note: insurer's will have different CRN's for Workers, CTP and Public Liability:
• Compensation Payer's External Reference: field. Enter the claim reference number
• Select Continue
• The Compensation Payer Details screen will display details
• The workflow will go to the Incident Details screen
• Go to Step 6
• No, go to Step 4

Another search can be undertaken.

Select Refine Search. This will go back to Compensation Payer Details screen.

Refine the search using different Compensation Payer Name options.

If:

• the correct compensation payer is identified, select the appropriate payer. Go to Step 6
• no compensation payer can be identified:
• select Refine Search. The workflow will go back to Compensation Payer Details screen
• select No for Can the Compensation Payer be identified
• select Continue to go to Liable Party Details screen
• go to Step 5

When no compensation payer can be identified or the source of the compensation is outside Australia, complete the Liable Party Details screen. Use available details such as:

• compensation payer
• defendant's name or
• customer's employer details

The Liable Party's Name and Country fields are mandatory.

Select Continue. The Incident Details page will show.

Select Continue. The Claim Details page will be displayed.

Any unanswered Yes/No questions will default to No.

CRT will require a copy of the settlement documentation for any lump sums the customer has been paid (where available).

Select Continue. The Solicitor Details page will display.

Is a solicitor acting for the claimant?

• Yes:
• Complete the solicitor's details
• Select Continue. The Compensation and Damages Notification Summary page will show
• Go to Step 9
• No:
• Select No
• Select Continue
• Go to Step 9

The Compensation and Damages Notification Summary page will show a summary of details entered.

Are all details correct?

• Yes, select Continue:
• The Compensation and Damages Notification Summary page will display
• Go to Step 10
• No, return to the relevant screen by selecting the hyperlink:
• Update where appropriate
• Select Continue to go back to the Compensation and Damages Notification Summary page
• Go to Step 10

Transfer the started CMM/CLE activity to the region code CTN.

• If the customer advises they are claiming from an employer:
• Create a Fast Note detailing the employer's business name and address
• Scan the MOD C and any documentation to the customer's record and store as per records management guidelines. See Scanning a document

When a clearance is required before processing a new claim, place the claim on hold for 14 days pending the clearance request outcome.

Once the clearance action is completed, Compensation Recovery staff will take the claim off hold to allow allocation.

Is this an urgent clearance?

• Yes, go to Step 12
• No, go to Step 13

The customer must provide reasons why the clearance is urgent.

The clearance may not be processed if information is incomplete.

An urgent clearance may be for one of the following reasons:

• Customer identified as vulnerable
• Customer identified as in hardship
• Ministerial/Ombudsman complaint

For an urgent clearance, create a Comp Clearance Escalation Request and transfer to region CTN

Create a Fast Note - select Auto text, use > Compensation > Referral to Compensation Team > Comp Clearance Escalation Request

• Select Confirm
• Select 'N' so the Fast Note does not auto complete
• Key urgent clearance details into the Fast Note text box
• Transfer the Fast Note to region CTN

This is an automated process. Do not add any additional keywords to work items.

The CRT will:

• investigate the compensation details and provide clearance outcome in a Clearance Action Fast Note
• check if the clearance has been requested as part of a new claim activity. If so, the CRT must manually take the new claim off hold resulting in the new claim being allocated, based on previously established priorities
• check the Activity List (AL) screen for any activities generated as a result. If any CMM activities exist on AL, the CRT must complete or cancel the activities before exiting the customer record

When the CRT completes the compensation clearance assessment, the system automatically generates a CLE activity of either Clear to Pay or Not Clear to Pay displayed on the Activity List (AL) screen.

Generally the work item is intended to advise the referring area of the compensation clearance decision.

There are two different work item types that could be allocated for manual completion:

• ZDMS_MODC, and
• ZIAM_CLE_GEN

The work items may be duplicated, therefore it is important to check for and complete both the:

• Integrated System (ISIS) activity (viewable via AL screen), and
• any associated Customer First (CF) SAP Interaction Record/s or Process Direct = Workload Management System

To complete the activity:

• Check the Document List (DL) screen for a DOC advising of the Compensation Clearance decision
• On the AL screen, select the CMM/CLE activity
• Finalise the activity via the AR screen or cancel the activity and annotate the Compensation Clearance decision DOC.

Procedure ends here.