Special circumstances provisions for customers receiving compensation payments 117-04020010

Is this an implementation of an ARO or ART decision?

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

A customer may ask for a reduction of their:

• future preclusion period, and/or
• debt due to the receipt of a compensation payment

Note: compensation special circumstance provisions under s1184K apply to the compensation payment only, which may result in a recalculation of any associated compensation debt(s). Debt waiver will not result from s1184K decisions. Debt waiver alone is assessed under s1237AAD. See Special circumstances debt waivers.

If the customer is experiencing vulnerability, consider if a referral to a social worker is appropriate. See Social workers' role in debt, payment assurance and compensation.

Until a future preclusion period has an operative effect, there can be no review of the decision. This means the compensation preclusion period will have no effect on the customer until they make a claim for a CAP and a determination made. See SME explanations, ARO referrals and implementing ARO decisions for a further explanation and examples.

Is the customer claiming a CAP, or had a CAP cancelled or rejected within the previous 13 weeks due to the effects of compensation?

• Yes, go to Step 3
• No, and the compensation has only affected a past CAP, go to Step 3
• No, and the request relates to a future preclusion period, tell the customer:
• before there can be a review, the preclusion period decision must have an operative effect
• to lodge a claim for a CAP
• their claim will reject as a result of the preclusion period
• to complete a Compensation Recovery Statement of Financial Circumstances (SoFC) SS484 form and provide supporting evidence

Record the information in a DOC.

Procedure ends here.

Tell the customer they must do the following within 7 days:

• Complete a Compensation Recovery Statement of Financial Circumstances (SoFC) SS484 form, and
• Supply any available evidence in support of their claim

Record the request in a DOC.

See Resources page for a link to the form and examples of supporting evidence.

Has the customer returned the SS484 and supporting evidence?

• Yes, go to Step 4
• No:
• Document the record in a Fast Note - Compensation Special Circumstances 1184K
• Complete any related SME explanations if completed as part of an Explanation of Decision
• Procedure ends here

Staff must:

• review the completed SoFC form and make sure the customer has answered all questions. Discuss any incomplete information with the customer
• examine the overall personal circumstances of the customer. This includes checking the time remaining on the preclusion period
• review any documentary evidence the customer has been able to supply about the unforeseen or special circumstances that put them in hardship
• read the factors to consider in the Social Security Guide. See the References page for links to the Guide
• include any Social Worker recommendation in their decision

Consider:

• if the customer has sufficient liquid assets or realisable assets to support themselves and their family for the duration of the preclusion period
• the value of all cash and realisable assets by comparing this with the fortnightly rate of pension

Financial circumstances need to be severe and worse than the majority of social security recipients.

Factors to consider include:

• health
• mental health
• gambling
• the presence of family and domestic violence, financial abuse or coercion
• homelessness
• decision making capacity
• substance abuse issues
• incorrect or insufficient legal advice
• impacted by a natural disaster

Other considerations include:

• expenditure of compensation funds due to fraud by another person
• reduced life expectancy
• excessive legal costs involved in the settling of a claim for compensation

To meet the provisions for compensation special circumstances, staff must establish that:

• there are extraordinary factors, or a combination of special or unusual circumstances
• the customer could not have foreseen or budgeted for these circumstances, and
• if they apply the compensation provisions, the circumstances leave the customer in hardship or in an unreasonable situation

Does the customer have grounds for special circumstances?

• Yes, go to Step 5
• No, go to Step 9

The delegation to apply compensation special circumstance provisions is at the APS5 level or above. If the staff member does not have the delegation to apply the special circumstance decision, they must:

• record the special circumstance recommendation in Fast Note - Compensation Special Circumstances 1184K
• request approval from an appropriately delegated officer in the Compensation Recovery Team (CRT). Discuss the case and/or email the request to a:
• Quality Development Officer (QDO), or
• Team Leader

The delegated officer must annotate the Fast Note with their approval.

Does the delegate support the recommendation and has given their approval?

• Yes, go to Step 6
• No, go to Step 9

If delegated staff decide to apply the special circumstance provisions to a compensation lump sum, this will reduce the preclusion period. To reduce the preclusion period by:

• disregarding a specific portion of the lump sum and recalculating the preclusion period based on the amended lump sum amount, go to Step 7, or
• manually changing the preclusion period so it ends on a new date, go to Step 8

See Resources page for examples.

There are no prescriptive rules for calculating the amount to disregard. The CRT officer must:

• determine the amount to disregard from the compensation lump sum settlement
• deduct any disregarded amount from the gross lump sum settlement amount, and
• recalculate the customer's social security debt and/or preclusion period

See Resources page for an example

Go to Table 2.

Determine the new end date of the preclusion period. See Resources page for an example.

Go to Table 2.

If special circumstances do not apply, and the request:

• was part of an Explanation of Decision:
• A Subject Matter Expert (SME) must complete the explanation. See SME explanations, ARO referrals and implementing ARO decisions. Procedure ends here.
• was not part of an Explanation of Decision:
• Document the decision in Fast Note - Compensation Special Circumstances 1184K. Include any discussion with the customer
• Do not  select Document decision discussion in the Internal Review/Explanation script. Go to Step 10

Make genuine attempts to contact the customer by phone to tell them what the decision is. Give them the opportunity to ask any further questions and record all details of the conversation in a DOC.

There are language and Interpreter Services available for customers who may need an:

• Immediate telephone interpreter
• Indigenous language interpreter

Where special circumstance do not exist, give the customer their options within the internal review process. See First contact about a decision and the internal review process.

If the customer wants to:

• request a Subject Matter Expert (SME) explanation, record the request for a SME explanation
• apply for a formal review, record the application for a formal review

Procedure ends here.

When staff apply compensation special circumstance provisions, they must do a recalculation and reduction to any debt resulting from the compensation assessment.

Note: debt waiver will not result from compensation special circumstance decisions under section1184K. These provisions apply only to the compensation payment and may result in a recalculation and reduction of any associated compensation debt. Waiver of a debt due to special circumstances is applied under section 1237AAD. See Special circumstances debt waivers.

Will the special circumstance decision result in a recalculation of a related debt?

• Yes, go to Step 2
• No, to:
• change the lump sum amount, go to Step 4
• manually change the preclusion period end date, go to Step 5

Staff must delete the previous lump sum coding. If there was a debt due to the lump sum, the system will zero the debt in the Debt Management and Information System (DMIS). This may take up to 24 hours to occur. Complete this step first to avoid a negative adjustment result.

Note: If the claim is closed in CMS, reactivate the claim. See Reactivating a compensation claim.

In the Compensation Management Summary (CMS):

• Select the relevant Claim ID > Lump Sum Payments
• Select Delete Lump Sum by ticking the box
• Select Continue then Submit
• Record details in a DOC

Go to Step 3.

Check DMIS to make sure the compensation debt has reset to zero. If not, manually adjust the debt to ‘no debt’:

• Go to the Debt List (OPDL) screen - select the compensation debt
• Next: field – key OPDA
• Reason code: field - key relevant code, or select valid codes from drop down box (for example, 'ARO' - Result of ARO review, 'UER' - User error, 'FIG' - further information given)
• Amount: field – key 0.00
• Notes: field - key reason for deletion, for example, 'due to further information received debt has been deemed "no debt" and will be recalculated'

Go to Step 4.

Staff must code the amended lump sum after calculation of the amount to disregard:

• Select the Claim ID from the Claim Summary
• Select Lump Sum Payments:
• If adding a lump sum when the previous coding was deleted, select Add Lump Sum
• If editing a lump sum, when there is no associated debt or there is no change to the debt, select Edit Lump Sum.

Complete the following fields:

• Settlement Date - shows the date of the settlement (no change)
• Settlement Type - shows the relevant code (no change)
• Gross Settlement Amount - code the new gross compensation payment amount, which has been reduced by the amount to be disregarded
• Payback of Periodic Compensation
• Economic Loss amount – for claims settled by judgement, code the new economic loss amount, which has been reduced by the amount to be disregarded
• Change Reason - select valid option from drop down box
• Issue Advice must be 'Manual advice issued' or 'No advice issued'
• Complete the Source and Receipt Date
• Select Continue to display the Lump Sum Assessment Results screen
• Check CMAR has included all payments in the preclusion period
• Add any supplementary payments (where applicable)
• Complete Source and Receipt Date
• Select Continue
• The Assessment Results (AR) screen will show
• Select Submit to finalise the lump sum

Go to Step 6.

If the claim is closed in CMS, reactivate the claim:

• Select Claim Summary twisty
• Select Claim ID
• Select Reactivate Claim
• The Reactivate screen will show

After calculation of the new preclusion period:

• Select Preclusion Periods under the Summary twisty
• Select the correct Incident Date. The system will go to the Preclusion Period Summary screen
• Select Edit
• Amend the preclusion period by updating the following:
• Preclusion Period Start Date: field - change start date if required
• Preclusion Period End Date: field - enter new end date
• Change Reason: field - select valid codes from drop down box (for example, 'ARO' - Result of ARO review, 'UER' - User error, 'FIG' - further information given)
• Finished: field - code Yes
• Complete the Source and Receipt Date
• Select Continue. The activity will automatically complete. The Preclusion Period Summary screen will display the new preclusion period details

Go to Step 6.

Does the compensation debt associated with the lump sum need manual correction?

• Yes, and the debt:
• no longer exists, go to Step 7
• amount needs reducing, go to Step 8
• No, go to Step 9

Staff must zero the debt amount if:

• the preclusion period no longer exists, or
• all of the debt now falls outside the preclusion period

Use the Debt Action script, or code manually:

• Select the Debt ID from the Debt List (OPDL) screen
• Go to the Debt Amount (OPDA) screen
• Record the new debt amount and reason for change
• Go to the Assessment Finalisation (OPAF) screen and select Y to finalise the activity

Note: do not issue a Q053 or Q417 letter. They are not appropriate for these cases.

See Changing account details on debts raised in the Debt Management and Information System (DMIS).

If part of the debt now falls outside the preclusion period, reduce the debt amount.

Use the Debt Action script, or code manually:

• Select the Debt ID from the Debt List (OPDL) screen
• Go to the Debt Amount (OPDA) screen:
• Record the new debt amount and reason for change
• Go to the Component Amount (OPCA) screen, and record the:
• new component end date
• new component amounts
• Go to the Assessment Finalisation (OPAF) screen and select Y to finalise the activity

Note: do not issue a Q053 or Q417 letter. They are not appropriate for these cases.

See Changing account details on debts raised in the Debt Management and Information System (DMIS).

Staff must check if any tax or payment summary adjustment done for the original debt needs reversing. See Adjusting amounts on a payment summary.

Check the Component Amount (OPCA) screen. Make sure the debt raised is:

• apportioned for the financial years for which the compensation affected payment (CAP) was paid, and
• broken down by component

Is the debt over recovered?

• Yes, go to Step 10
• No, go to Step 11

If the record has an over-recovered compensation debt, investigate whether the refund is payable to the customer or the compensation payer.

See Investigating a Refund of debt repayments.

Go to Step 11.

If a new claim for a CAP is pending the outcome of a special circumstance assessment:

• staff must manually take the new claim off hold in Process Direct - update the status of the claim to In Process.
• the CRO must perform a SAP refresh on the record. This will result in the new claim being allocated for processing, based on previously established priorities
• and the claim needs urgent processing, see Immediate new claim and non-new claim priority processing

If the customer’s CAP was:

• rejected within the past 13 weeks, staff must request reassessment of the rejected claim. See Request to reassess a rejected claim
• cancelled within the past 13 weeks, a suitably skilled officer must restore the payment. See Restoration of payments (CLK)

Go to Step 12.

If the Service Officer is:

• completing a Subject Matter Expert (SME) explanation, see SME explanations, ARO referrals and implementing ARO decisions > Process page > Table 1
• implementing an Authorised Review Officer (ARO) decision, see SME explanations, ARO referrals and implementing ARO decisions > Process page > Table 4
• implementing an Administrative Review Tribunal (ART) decision, see Administrative Review Tribunal (ART) > Process page > Table 1 > Step 7

For all other cases, staff must:

• make genuine attempts to contact the person by phone to give them the decision
• use the available language and interpreter services for customers who may need an:
• Immediate telephone interpreter
• Indigenous language interpreter
• give the customer their internal review options. See First contact about a decision and the internal review process. If the customer wants to:
• request a SME explanation, record the request for a SME explanation
• apply for a formal review, record the application for a formal review
• record details of the decision and customer contact in a Compensation Special Circumstances 1184K Fast Note. Include:
• any changes to the lump sum preclusion period debt amount and debt reduction
• the period of the debt and tax adjustment
• send a letter to the customer (see Compensation manual letters and Online Advice (OLA)) when:
• a new preclusion period has been calculated, and/or
• there is a change to the debt

Procedure ends here.