Calculating the start day for an incapacitated customer 106-05010030

Incapacitated customers claiming payment may have the start day for payment backdated in certain circumstances if they have been incapacitated continuously from the day they became incapacitated for work to the day they make the claim.

It is the customer's responsibility to make a claim in a timely manner. It is reasonable to expect them to instruct a friend or relative to inquire about eligibility for payments or services or to make a claim on their behalf unless the nature of their incapacity prevents them from doing so. For example, the customer's ability to manage everyday affairs is substantially limited by traumatic illness.

Application of backdated start day rules for incapacitated customers depends on whether the customer claims payment within 5 weeks of becoming incapacitated for work.

A person claiming payment within 5 weeks of their date of incapacity can have their payment backdated to the first day they were qualified for the payment after the day they became incapacitated for work.

A person claiming payment more than 5 weeks after their date of incapacity can have their payment backdated to the first day they were qualified within the 4 week period before lodging the claim if their medical condition was the sole or principal cause of their failure to make the claim. If there is more than one possible cause for the delay it is necessary to establish the main cause. It must be considered whether:

• the medical condition prevented the customer from lodging a claim, and
• the customer had control of their personal affairs and was capable either of making a claim or instructing others to make a claim on their behalf

The system will calculate and record a provisional start day based on whether the customer has claimed within 5 weeks of their date of incapacity.

If a claim has not been made within 5 weeks, the reason for the delay in claiming must be assessed to determine if the claim can be backdated. If the start day is to be backdated, it must be manually recorded.

From 1 July 2018, eligible customers will receive payments or concession cards from the date they actually submit a complete claim with all relevant supporting documentation.

Note: different processes apply for customers in vulnerable circumstances, see Intent to claim and vulnerable customers.