Rejecting a claim for JobSeeker Payment (JSP) or Youth Allowance (YA) (job seeker) 106-07130210

To reject a claim, ensure:

• the customer does not meet the qualification, payability, customer obligation, or mutual obligation requirements for the JSP or YAL (job seeker) other they are applying for, and
• the decision to reject the claim is correct
• the customer does not have a UTLAH assessment in progress

Note: if a UTLAH assessment is in progress, do not reject the claim FSD (failed to supply documents). If it is not already, place the claim on hold pending the outcome of the assessment.

Where the customer does not meet the eligibility requirements for payment, the claim should reject automatically due to details coded in the claim. If an automatic rejection does not occur and all coding is correct, manually reject via the Benefit Action (BA) screen may be required.

If rejecting a customer's claim for one of the following reasons, check the customer is not vulnerable, at risk, or in crisis:

• Failed to respond to correspondence (FRC)
• Failed to supply documents (FSD)

If rejecting a customer's claim for one of the following reasons, refer the claim to the DVA Clearance Team for review. See Step 7 on the Process page of Payments from the Department of Veterans' Affairs (DVA) and referrals to the DVA Clearance Team:

• Service Pension/ Income Support Supplement (DVA)
• DSS Age Pension paid by DVA (AGC)

If the customer is receiving an Adjusted Disability Pension from the Department of Veterans' Affairs (DVA) and the claim start date is before 1 January 2022, do not reject their claim based on income before checking if they may be entitled to Defence Force Income Support Allowance (DFISA). The system can identify these customers if the claim is correctly coded, including DVA Adjusted Disability Pension details.

Before implementing the decision, the Service Officer must contact the customer to advise the reason for the rejection.

Make one genuine attempt to contact the customer. If the customer is subscribed, issue a pre-call notification (SMS only) between 8:00 am to 8:00 pm using the customer's local time. Let them know a Service Officer will call them today from a private number.

Discuss with the customer:

• explain the decision
• give them a chance to provide more information, and
• advise their review and appeal rights

If rejecting for reason FSD or FRC:

Ask the customer to upload documents while on the call and finalise the claim:

• if the customer does not have access to documents requested during the call, advise them they must upload the evidence via the requested task in the online claim on the day. This is so their claim can be processed as soon as possible
• the claim will be rejected if they do not provide the evidence
• if the customer cannot supply the documents advise them to upload the required documents with 13 weeks for reassessment of the claim

If the customer uploads the documents within 13 weeks of rejection, a work item allocates to a Service Officer who is skilled in claims assessment.

Is contact successful?

• Yes, and the customer:
• can provide requested documents now or current information that will change the claim outcome, continue assessing the claim. See Processing YA (job seeker) claims or Processing JobSeeker Payment (JSP) claims. Procedure ends here
• cannot provide requested documents now but can upload on the day annotate the progress of claim DOC, with the contact outcome. Place the claim on hold for 1 day. If the requested documents are not provided when the claim is re-allocated, continue with claim rejection. Go to Step 3
• cannot provide requested documents now or current information that will change the claim outcome, continue with claim rejection. Go to Step 3
• No, annotate the progress of claim DOC confirming the time contact was attempted and, list any additional documents required. Continue with claim rejection. Go to Step 3

Note: if a UTLAH assessment is in progress, do not reject the claim FSD (failed to supply documents). If it is not already, place the claim on hold pending the outcome of the assessment.

Rejection of payments can also occur when the claim has been finalised (record is assessed) but the customer is no longer qualified. For example, they have returned to work before their start day, or they want to withdraw their claim.

If the customer wants to withdraw their claim before it is processed (whether or not they have attended an appointment), see Withdrawal of claims. Procedure ends here.

Is the claim status 'In Process'?

• Yes, go to Step 4
• No, go to Step 7

Where the customer does not meet the qualification or payability provisions, the rejection should occur automatically for the most appropriate reason.

A streamlined rejection can only be coded if:

• the customer is in receipt of precluding payment (CPP)
• another payment is more appropriate (COP), or
• the customer failed to supply documents (FSD)

If the customer has failed to supply their Tax File Number or Proof of Identity (POI), do not streamline reject FSD.

See Cancellation, suspension and rejection reason codes for Newstart System (NSS).

Can the rejection reason be automatically determined by the system?

• Yes, code the claim to reject for the appropriate reason. Procedure ends here
• No, to reject the claim:
• via streamline reject, go to Step 5
• manually, go to Step 6

From the Transaction Summary (TS) screen.

• select Process
• key 'BA' in Super Key to go to the Benefit Action (BA) screen
• select Add New
• on the Create Benefit Action screen, Benefit Type Code, Benefit Action, and Date of Effect will automatically default
• select the streamline indicator box. A tick will appear
• in the Reason field select appropriate reason code from the drop-down box
• select Save
• select Assess
• SWE screen displays. Address any errors
• select Assess
• Entitlement (ELD) screen displays. Make sure the correct rejection reason is displaying
• select Finalise
• finalisation DOC displays. If extra information is required, add this to the DOC. For reason FSD, list all outstanding documents
• select Finish

Note: changes to circumstances that may affect the customer and/or partner's current payments or benefits must be updated after completing the streamline rejection. For example, update the marital status and any other information provided in the claim. Go to Step 8.

Where the rejection reason cannot be automatically determined by the system:

• key 'BA' in Super Key to go to the Benefit Action (BA) screen
• select Add New
• on the Create Benefit Action screen, Benefit Type Code, Benefit Action, and Date of Effect will automatically default
• in the Reason field select appropriate reason code from the drop-down box
• select Save
• select Assess
• SWE screen displays. Address any errors
• select Assess
• Entitlement (ELD) screen displays. Make sure the correct rejection reason if displaying
• select Finalise
• finalisation DOC displays. If extra information is required, add this to the DOC
• select Finish

Go to Step 8.

If a customer has been granted a benefit or allowance but has not yet received a payment, manually reject the claim if:

• they advise they have returned to work. or
• they want to withdraw their claim

Note: if the customer's payment status is current, cancel the payment at the customer's request.

Go to the Benefit Action (BA) screen and code these fields:

• Srv Rsn:'JSP' or 'YA'
• Action field, 'REJ' or 'CAN'
• Reason field, 'CLR' for a withdrawn claim or 'NUE' for returned to work
• Source and DOR
• select [Enter]. If the Date of Effect (DOE) does not default to the start day, enter the DOE. This is usually the date of claim

Record details of the decision in a DOC, including details of any waiting periods applied to the claim.

Check if the rejection reason needs a manual letter.

A manual letter will be required if a Manual Follow-up (MFU) activity was created on the Activity List (AL) screen after finalising the rejection activity.

Is there an MFU for a manual letter?

• Yes, go to Step 9
• No, go to Step 10

Send a manual letter (Q134) to the customer giving the reason(s) for rejecting the claim and advising their review and appeal rights.

Sometimes an automatic letter will reject. This creates a letter activity on the AL screen. Selecting the activity may display the letter. Others must be selected from the Text Find (TF) screen.

If a claim is finalised in a service centre earlier than scheduled, check Participation Interview (PI) appointment profiles in Customer First and cancel the appointments.

Record details in a DOC, including:

• details of any waiting periods applied to the claim
• documents/information required for claim reassessment

Make sure the customer is fully aware of the implications of not claiming. For example, entitlements and access to a Health Care Card (HCC)

If there is a change of circumstances in the claim, which relates to a current payment, refer to the process relevant to the change of circumstances. For example, children have left care.