Actioning a compensation clearance 117-01040020

Has the CMM/CLE activity become due and/or request for further information been returned?

• Yes, go to Table 2 Step 4
• No, go to Step 2

For a list of compensatory payments, see The effect of compensation on Social Security payments.

Is this compensation claim for an exempt compensation claim type?

• Yes, go to Table 2 Step 1
• No, go to Step 3

In Customer First, search the Workspace for the Compensation Management Summary and select the relevant link to show the CMS overview screen.

Select the Claim Summary section followed by relevant Claim ID hyperlink.

Check all details are correct and update if needed:

• Incident Date
• Incident Details in the Claim Summary section
• Claim ID
• Claim Details
• Solicitor Details
• Compensation Payer Details
• Liable Party Details

Is a new Organisational Customer Reference Number (CRN) required?

• Yes, go to Step 4
• No, go to Step 5

A new Organisational CRN is only needed when compensation payer notices will be issued.

• Complete the Compensation payer organisational request form, including:
• Payer name
• ABN
• Addresses (postal and physical)
• Phone number
• Fax number
• The completed form will be reviewed by the Compensation Helpdesk who will decide if a new Organisational CRN is to be created
• Compensation Helpdesk will reply to the request by email
• Once the Organisational CRN has been created, update the Compensation Payer Details screen

Go to Step 5.

Compensation Review Officers (CRO)s must:

• review all available information to determine if a clearance can be completed
• Consider any potential impact on the customer and/or partner's past, present or future social security payments or concessions
• If there is no impact, consider if requesting further information is appropriate
• record their decision in the Compensation Clearance Action Fast Note

Is the customer claiming Personal Sickness and Accident or Income Protection, go to Step 6.

If no further information is required, go to Table 2 Step 2.

If further information is required, CRO must make genuine attempts to phone the customer to get the information.

If successful and:

• customer can give the required information over the phone, update screens, go to Table 2 Step 2
• customer cannot give information and is in financial hardship, go to Step 8
• customer cannot give information over the phone and is not in financial hardship:
• Send a Q919 letter to the customer
• Tell them they need to reply to this request within 23 days
• Tell them if they do not respond, their payment may be suspended or rejected
• Place the CMM/CLE activity on hold for 23 days
• Record all action taken in a Compensation Progress Doc Fast Note
• Procedure ends here

If not successful and:

• customer is in financial hardship, go to Step 8
• customer is not in financial hardship:
• Send the Q919 letter to the customer
• Place the CMM/CLE activity on hold for 23 days
• Record all action taken in a Compensation Progress DOC Fast Note
• Procedure ends here

Compensation Review Officers (CRO)s must assess how income from Personal Sickness and Accident or Income Protection claims are treated. See Assessing compensation payments from personal injury schemes.

Is more information needed?

• Yes,
• Where possible, phone the compensation payer to verify the required information verbally and record the conversation in a DOC
• If the information cannot be supplied verbally, send SS485 form to the compensation payer or ask them to complete the online form located on the Service Australia website. See Resources page for form
• Do not scan blank SS485 to customer record
• Place the CMM/CLE activity on hold for 23 days
• Record all action taken in a Compensation Progress DOC Fast Note
• Procedure ends here
• No, go to Step 7

If the Personal Sickness and Accident or Income Protection to be assessed as

• Ordinary income
• Do not record the income in CMS
• Go to Table 2 Step 1
• Compensation
• Complete the compensation assessment
• Go to Table 2 Step 2

If the customer cannot give the information over the phone, or the phone contact was unsuccessful, and the customer meets financial hardship criteria.

CRO can phone the compensation payer to obtain the:

• Date last paid
• Compensation payers reference number
• Current ongoing rate

If the compensation payer cannot give information over the phone:

• Send a Q908 letter to the compensation payer requesting details
• send letter by the appropriate method see Compensation letters
• Place the CMM/CLE activity on hold for 23 days
• Record all action taken in a Compensation Progress DOC Fast Note

Procedure ends here

For Criminal Injuries and Sporting Injuries:

• Go the Clearance Details screen
• Select the Clearance Reason that matches the Claim Type from the drop-down box
• Do not issue Rights and Obligation or Preliminary Notice
• Select Finish
• Select Continue for the claim to auto-finalise

For all other exempt compensation:

• Go the Clearance Details screen
• Change the Clearance Reason using code 'Sufficient information to grant' from the drop- down box
• Do not issue Rights and Obligation or Preliminary Notice
• Select Finish
• Select Continue
• Go to Finalise Claim screen
• Change the Finalise Reason using code 'Not affected under the compensation provisions' from the drop-down box

Is the exempt compensation to be assessed as other income?

Yes:

• Record the payments on the relevant screen
• Record all actions taken in the Comp Not Affected/Other Income Fast Note
• See Recording other income on the Other Income (OIN) screen and Assessing compensation payments from personal injury insurance schemes
• Once updates are complete, check for any compensation activities created because of the assessment and action where appropriate. Cancel activities where they are not required. Do not refer to a service centre, other Zone teams or smart centre.
• If a clearance has been requested for a new claim, the CRO must manually take the new claim off hold in Process Direct. This is done by updating the ‘Status’ of the claim to ‘In Process’. The CRO should also perform a ‘SAP refresh’ on the record. This will result in the new claim being allocated for processing, based on previously established priorities. See Process Direct navigation, common screens and functions
• Procedure ends here

No:

• Complete the Compensation Clearance Action Fast Note
• Procedure ends here

Compensation Recovery Team (CRT) must make sure the customer has taken reasonable action to claim compensation. Failure to take reasonable action to claim compensation for a compensable event can be a breach of section 1166 of the Social Security Act 1991.

Compensation Review Officers (CRO) must investigate the customer's record to establish the reason a claim for compensation has not been pursued. See Reasonable action to claim compensation.

The CRO must make genuine attempts to phone the customer when:

• The reason for not pursuing compensation is unclear, or
• It is clear the customer is not pursuing compensation

CRO must consider any vulnerabilities or sensitivities that may impact the customer. See Identifying customer vulnerability and risk issues.

Has the customer taken reasonable action?

• Yes, go to Step 4
• No, go to Step 3

If the CRO is satisfied that the customer may be entitled to compensation, and the customer has not taken reasonable action to claim or get compensation:

• Tell the customer of their obligation to pursue compensation
• Ask the customer to provide evidence of either
• a compensation claim has been lodged
• they are not eligible for compensation
• Advise the customer that their income support payment may be suspended/cancelled/rejected as a result
• Issue a Q912 Enforcement of Compensation Rights letter
• Record all information in a Compensation Clearance s1166/1167 Fast Note and place the CMM/CLE activity on hold for 23 days to allow the customer to respond.

Procedure ends here.

Has all requested information been returned and/or there is sufficient information to clear the record?

• Yes, go to Step 8
• No, no reasonable action to claim compensation, go to Step 5
• No, sufficient information not returned from the:
• compensation payer, go to Step 6
• customer, go to Step 7

When a CRO makes the decision that a customer has not reasonably pursued their compensation claim, the CRO must seek approval from a delegated officer. The delegation to determine if the customer has not taken reasonable action is held by an APS5 or above within Compensation Recovery operational teams.

Once approval has been given:

• CRO must
• make genuine attempts to phone the customer and advise them of the outcome. See Advising verbally of an unfavourable decision
• record the decision detailing all action taken in the Compensation Clearance s1166/1167 Fast Note
• The approving delegated officer (APS5 or above) must also record their decision within the Compensation Clearance s1166/1167 Fast Note

Review all details on the Clearance Details screen:

• Select Clearance Reason of No reasonable action to claim from the drop-down box
• Where applicable, select Advice Not Issued for:
• Issue Rights and Obligations Notice Customer
• Issue Rights and Obligations Notice Solicitor
• Issue Preliminary Notice
• Complete Source and Receipt fields
• Select Continue to go the Assessment Results (AR) screen
• Check the result is correct

Once updates are complete, check for any compensation activities created because of the assessment and action where appropriate, including activities:

• CLE 'clear to pay’ or ‘not clear to pay'
• CLR 'Compensation Management System/Clerical Review'
• REA 'Review net amount received for assets and investment income'

Cancel activities where not required. Do not refer to a service centre, other Zone teams or smart centre.

The compensation claim will remain open for 28 days. If no action is taken in this time, the CMS will finalise the compensation claim and update the status to ‘closed’. The compensation claim will remain in CMS with a status of ‘closed’ until it is reactivated and the clearance reason changed.

If the customer or partner are current and receiving a CAP, the CRO must suspend payment FCC (Failed to claim compensation). Record the suspension details in the Compensation Clearance s1166/1167 Fast Note.

Does the payment need to be suspended?

• Yes, go to Step 9
• No, procedure ends here

On day 23, after information has been the held CMM/CLE activity becomes due.

CRT are to check the customer record to confirm that whether more information is required. Where CRT has sufficient information to assess the clearance request, go to Step 8.

If the information is still required, phone the compensation payer to confirm the Q908 has been received.

• If compensation payer advises they have received the form but have not responded, or they have not received the request for information:
• Confirm contact information
• Advise legal requirements for providing the information - the request has been made under section 196 of the Social Security (Administration) Act 1999 and that the Agency has determined that we have a business need for the details
• Advise a 2nd request will be issued, to be completed and returned within 23 days
• Record the discussion in the Compensation Progress DOC Fast Note
• CRT are to issue a 2nd request Q908 by the most appropriate method. Do not resend the original request. See Compensation letters
• Place the CMM/CLE activity on hold for 23 days.
• Where the 2nd request has not been returned after 23 days, do not send further requests. Case must be escalated to a Team Leader in CRT. See Table 3, Step 3 in Centrelink Compensation Recovery – customer/third party contact about a claim

Team Leader in CRT will provide advice on what further action may be required. Record details of the action taken in the Fast Note.

Can the clearance action be completed?

• Yes, go to Step 8
• No, go to Step 7

When the customer has failed to return the requested information and/or there is insufficient information to complete the clearance, the CMM/CLE activity will become due on day 23.

On the Clearance Details screen, select Clearance Reason of 'Insufficient information' from the drop-down box

• A CLE 'Not clear to pay' activity will generate and must be completed or cancelled
• Create a Compensation Clearance Action Fast Note on the customer's record, detailing what action has been taken and what further information is required
• If the clearance has been requested as part of a new claim activity, CRO must manually take the new claim off hold. This will result 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, CRO must complete or cancel the activities.

The compensation claim will remain in CMS with a status of active.

When a current customer has failed to return the requested information, CRO must suspend the customer’s payment. To suspend the customer, go to Step 9

For non-current customers, procedure ends here

Where the customer and/or partner has ongoing weekly compensation payments, code the ongoing compensation before finalising the clearance. See Coding periodic compensation payments and raising debts.

Rights and Obligations and Preliminary Notices are issued when finalising the clearance, except for the following circumstances:

A Preliminary Notice is not to be sent:

• without the correct reference number
• to the defendant solicitor
• where periodic payments are ongoing
• to an overseas liable party
• when the compensation recipient is not claiming or receiving a CAP, or
• the compensation recipient’s claim is closed or settled
• the compensation recipient is not pursuing further compensation

If the non-current customer (compensation recipient) is partnered, and their partner is claiming or receiving an income support payment:

• Send the Rights and Obligations letter to the non-current customer
• Do not send a:
• Rights and Obligations to solicitor
• Preliminary Notice to the compensation payer

Go the Clearance Details screen:

• Select the Clearance Reason that matches the Claim Type from the drop-down box
• Issue advices where appropriate:
• Rights and Obligation to Customer
• Rights and Obligation to Solicitor
• Preliminary Notice
• Select Finish
• Select Continue for the claim to auto-finalise
• Select Yes in the Finished field
• Select Continue to go to the Assessment Results (AR) screen
• For non-current customers, cancel the generated CLE 'Clear to Pay' activity and finalise the CMM record
• Record the compensation clearance in a Compensation Clearance Action Fast Note
• If a clearance has been requested for a new claim, the CRO must manually take the new claim off hold in Process Direct. This is done by updating the Status of the claim to 'In Process'. The CRO should also perform a ‘SAP refresh’ on the record. This will result in the new claim being allocated for processing, based on previously established priorities

Once the CMM/CLE activity is completed:

• Code Periodic payments for past periods (where required). See Coding periodic compensation payments and raising debts
• Code Lump sum payment. See Assessing lump sum compensation payments and calculating debts
• Non-economic loss Lump sum - CRO must determine if the non-economic loss lump sum will impact the customer and/or partner’s past, present or future social security payments or concessions. If there is no impact, the CRO must consider whether coding the Lump sum is appropriate. This decision must be recorded in the Compensation Clearance Action Fast Note

If additional information is needed to investigate a debt for a period in the past, go to Step 10

Procedure ends here

Each payment type has its own suspension rules. Before actioning suspension make sure the customer's correct system and environment is selected, then follow the correct suspension process for the payment type being suspended, see Suspension of payments (CLK). Create a separate Suspension Fast Note on the customer's record.

Staff should make genuine attempts to contact customer to explain the adverse decision. See Advising verbally of an unfavourable decision

CRO must consider any vulnerabilities or sensitivities that may impact the customer. See Identifying customer vulnerability and risk issues.

For partnered customers, where weekly compensation payments have been determined and not declared, and impacts both customer and partner CAP, suspend both.

Where suspension applies to both customer and partner, the process must be done in each customer's record.

• Annotate the Compensation Clearance Action Fast Note on the customer's record detailing what action has been taken and what further information is required to complete the Clearance and restore the customer payments

To suspend the customer's payment in Customer First, go to Benefit Action (BA) screen and code the following fields:

• Svc Rsn: payment type customer is receiving
• Action: SUS (suspend)
• Reason: choose the correct suspension reason
• FRC (Failed to return correspondence)
• FCC (Failed to claim compensation)
• Press [Enter] and the date of effect will default or enter the date of effect of the suspension in the Effect Date: field. See Suspension of payments (CLK)
• Complete Source and date of receipt
• Go to the Assessment Results (AR) screen
• Finalise the activity
• Automatic notification of suspension letter will be sent to customer and partner (where applicable)
• Document the FRC suspension by recording all relevant details use Fast Note - select Auto text > Generic > SUS > Suspend Cancel Reason. The FRC Suspension Fast Note must:
• Decision made, payment type and Act/Guide reference upon which decision was based
• Date of effect of decision
• Reasons for decision, including why the person was not qualified or why the payment is not payable, for decisions made under section 80
• Follow up action required before restoration can take place, 'Do not restore customer and/or partner until compensation details are provided. Refer to compensation clearance Fast Note DOC dated xx/xx/xxxx'
• The FCC suspension was recorded in the Compensation Clearance s1166/1167 Fast Note

Procedure ends here

The agency can request information from claimants, current and ex-recipients or their partners where applicable. See Requesting information (CLK).

After completing the clearance, decide if further information is required to raise a debt. Check if the customer has received compensation payments during previous CAP periods. Contact can be made with the customer to clarify this.

If further information is needed to raise a debt, contact the customer to advise:

• What information is required
• What the consequences are of failing to comply with the request (including suspension and cancellation)
• The timeframe allowed to respond

After contact with the customer or if contact with the customer is unsuccessful:

• Send a Q919 letter requesting the information
• In Customer First, create a manual review on the Review Registration (RVR) screen and complete the fields as follows:
• Service Reason: CMM
• Review Reason: FOR
• Date: 23 days from the date of request
• Source: select most appropriate reason
• Date of Receipt: e.g. 'today's date'
• Notes: brief description of the reason for the request and action required at maturity
• Keywords: CMM0053
• Workgroup: leave blank
• Position: leave blank
• Transfer to Region: CTN
• The review will mature on the Due Date coded in the RVR activity. Workload Management will allocate the review for manual action
• Record all action taken in the clearance Compensation Progress DOC Fast Note

When the activity falls due, see Step 10 in the Request information from a claimant/recipient table on the Customer First tab.

Go to Step 11.

Once the information is returned and the customer's CAP is restored, the claim will remain in CMS with a status of finalised until:

• it is reactivated, and
• the clearance reason is changed

See Reactivating a compensation claim.