Rejecting a claim for Age Pension 065-03030030

Where a customer has been identified as being in a crisis situation, or requiring special assistance, care needs to be taken to make sure the customer's circumstances are considered before making a decision to reject a claim.

For online claims determine if the customer has self-identified as being in crisis or needing special help, by checking for keywords applied with the claim. See the Claim submission exceptions table.

Evidence that the customer is in crisis or needing special help may be available on the customer's record. See Identifying customer vulnerability and risk issues.

Is there evidence that the customer may be in a crisis situation or requiring special assistance?

• Yes, go to Step 2
• No, see Table 2

An online claim submitted under an exception category cannot be rejected until 22 days is reached.

Was the claim submitted less than 22 days ago under a claim submission exception, and are there outstanding required tasks?

• Yes:
• hold the claim until day 22 (21 days +1)
• procedure ends here until the allowed time has passed
• No, go to Step 3

Check:

• prior contact with customer has been made, additional time to meet the requirements due to their circumstances has been provided and the extended timeframe has passed, or
• two attempts to contact have already been made and documented, and
• a request for information was sent for additional, or outstanding required documents, and
• a time which includes allowing extra time for mail delivery has passed

Have these criteria been met?

• Yes, see Table 2
• No, go to Step 4

Two attempts to contact must be made to determine if the customer requires an extension of time if:

• the claim is assessed under an intent to claim provision, see Intent to claim and vulnerable customers, or
• the customer has lodged online claim and is not subscribed to EM and there are outstanding required tasks or more information required to assess the claim. Note: in certain circumstances, a verbal request for information may be quicker and more effective. See Requesting information

The 2 contact attempts can be made at different times on the same day, where applicable. A pre-call SMS should be attempted prior to contacting customer. See the Calling a customer table.

Is contact with the customer successful?

• Yes, go to Step 5
• No, issue request for information allowing for extra time for mail delivery. See also Requesting information

Determine how much time is required to provide the required documentation. Document the decision for the extension of time and place claim on hold for the required timeframe.

Procedure ends here until the allowed time has passed.

The customer's residence qualification will be auto-assessed as long as the residence information is correctly recorded. See Residence assessment for customers claiming Age Pension.

Residence information must be recorded, even if the rejection is for any other reason. If residence details are not recorded, the system will reject the claim for an incorrect reason.

Check the customer's travel movements (if available) using the Travel Outside Australia Summary (TOAS) and Immigration Movements (RSIM) screens.

Was the customer in Australia on the date of lodgement?

• Yes, customer was in Australia on the date of lodgement, go to Step 3
• No, customer was outside Australia on the date of lodgement but:
• meets the exception to the lodgement inside Australia rule, go to Step 3
• does not meet the exception to the lodgement inside Australia rule, application will auto-reject for reason NIA, do not request documents. Procedure ends here

If the customer does not satisfy residence requirements or lodgement in Australia rules for Age Pension, but they have lived or are in an Agreement country when they claim, they may be qualified to be assessed under an International agreement.

Has the customer lived or is in an Agreement country or an E510RS message 'Assessment under agreement country required before rejecting (XXX)'' displays?

• Yes, the customer may be qualified under an Agreement. Do not reject the claim:
• Make sure the Agreement country is recorded on the Country of Residence (CRES) screen
• Make sure only required work items are left open
• For Age Pension (AGE) claims - take the claim off hold and categorise in Work Optimiser to a CIS new claim work item
• For transfer to Age Pension (TTA) clams - complete the WLM Technical Assistance Form - New Item for priority allocation assistance
• Note: no separate referral is necessary. Procedure ends here
• No, go to Step 4

Rejection reasons are:

• Age Pension age, and
• Residence requirements for Age Pension

See Cancellation, suspension and rejection codes for Age Pension.

Note: where the customer is likely to meet the qualifying criteria for Age Pension within 13 weeks of claim lodgement, place the claim on hold and assess under early claim provisions.

Is the claim to be rejected as customer does not meet the qualifying criteria for Age Pension?

• Yes, go to Step 8
• No, go to Step 5

Where the customer has provided inappropriate or irrelevant documentation to allow the submission of their online claim and no additional request for information, written or verbal has been made, the claim can be rejected Failure to Supply Documents (FSD).

Note: this only applies where the claim process states a request for information must not be sent.

Is the claim to be rejected Failure to Supply Documents (FSD)?

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

Check the correspondence provided by the customer before rejecting the claim. See Viewing Centrelink customer's digital images.

Where a claim is already rejected (reason FRC or FSD) and the customer has not provided all requested or outstanding information, do not reopen or reassess the claim. See Table 1, Step 7 of Request to reassess a rejected claim.

Is the claim to be rejected Failure to Reply to Correspondence (FRC) as the customer has been sent a request for information and failed to provide all the documents (including supporting documents requested in a form) within the time allowed to respond? Note: this includes where the request for information was for documents required to confirm identity or to provide tax file number(s).

• Yes, go to Step 9
• No, go to Step 7

Does the customer qualify for Age Pension but claim is to be rejected as customer is not payable?

Check that the customer's income & assets have been correctly coded and the rejection outcome reason is correct.

Where a customer is qualified for Age Pension but not payable on the date they lodged their claim, start day rules may apply where a change of circumstances occurs within 13 weeks of claim lodgement. See Calculating the start day general rule.

Note: employment income is assessed in the entitlement period in which it is paid. Where the income is too high for the customer to be payable, but the customer will become payable within 13 weeks of the date they lodged the claim, the start date should be moved to the earliest Entitlement Period Start Date from which the customer is payable. See Processing claims for Age Pension and Pension Bonus.

If rejecting a customer’s claim for one of the following reasons, refer the claim to the DVA Clearance Team for review. See Step 6 in the Checking DVA income coding and referring work to the DVA Clearance Team table:

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

Go to Step 8.

Where the customer is not qualified or payable for Age Pension, action the following:

• Contact customer before finalising the claim to explain the decision. Make 2 attempts to contact, at different times on the same day where possible
• consider entitlement to an alternative Centrelink payment
• tell the customer of their review and appeal rights, possible alternative entitlements and issue any publications relevant to alternative payments or concessions
• check the customer's and partner's eligibility to Commonwealth Seniors Health Card (CSHC) and if they wish to claim, provide advice on available claim options
• make sure all information provided by the customer has been coded correctly on their record, including change of circumstances notified within the claim or during the claim assessment period that may affect the partner's payment rate and where verification has been provided, or is not required. This will auto-reject the claim for payments due to qualification or payability. For example income over the threshold

If neither the customer nor their partner (where they have a partner) are currently on a means tested income support payment (including where the customer/partner are exempt from the means test due to permanent blindness), income and asset coding is not required if rejecting due to residence qualification or if they are not age pension age, within 13 weeks of submitting their claim. Claim outcome is auto-assessed when the residence information is correctly recorded.

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 whether they may be entitled to receive  Defence Force Income Support Allowance (DFISA). The system will be able to identify these customers if the claim is correctly coded, including DVA Adjusted Disability Pension details.

Go to Step 9.

Does the claim require manual rejection via the Benefit Action (BA) screen?
Note: if the claim is a combined claim, the BA screen may need to be coded for both customer and partner claims. Combined claims may have a different eligibility outcome, as one may be granted and the other rejected.

• Yes, go to Step 10
• No, where the claim will auto-reject due to qualification or payability reasons, e.g. NSR, INC, ASS. Go to Step 15

Note: manual rejections for FRC include where identity documents have not been provided.

For claim rejections processed in:

• Process Direct:
• Streamline rejection, go to Step 11
• Manual rejection, go to Step 12
• Require handover to Customer First/Customer Record, go to Step 13

Streamline rejection allows rejection of a claim in Process Direct, without coding all of the information provided in the claim.

This function will only display if the claim will not be rejected for residency reasons. For combined claims, both the customer and partner must meet residency requirements in order for the streamline reject function to be available. Note: if the claim is a combined claim, the BA screen may need to be coded for both customer and partner claims. Combined claims may have a different eligibility outcome, as one may be granted and the other rejected). If streamline rejection does not display, go to Step 12.

Claims subject to Circumstance Change Monitor (CCM)

Where the customer has not provided the required documents at the time they submitted their claim, it can be rejected Fail to Supply Documents (FSD) using the streamline rejection function.

Where the customer has intentionally provided inappropriate documentation to allow their claim to be submitted under Circumstance Change Monitor (CCM). For example, non-claim related documents or images, reject the claim FSD with no request for information or documentation requests to be issued.

To streamline reject the new claim:

• Check that all customer verified personal details have been coded with a 'Confirmed' status to make sure the notice of rejection is issued to the correct address
  Note: if the update is not 'Confirmed' this needs to be updated outside the claim activity
• From the Claim Application screen, go to the Transaction Summary (TS) screen
• Select Process
• Go to the Benefit Action (BA) screen using Super Key
• Select Add New
• On the Create Benefit Action screen, Benefit Type code, Benefit Action and Date of Effect will default:
• Select the Streamline Rejection tick box
• Reason: select either FSD or FRC
• Select Save
• Select Assess to go to the Errors (SWE) screen
• Select Assess to go to the Entitlements (ELD) screen
• Check the correct rejection reason displays

To undo a streamlined rejection in the claim, regenerate the claim from the TS screen.

If customer and/or partner are receiving a means tested Income Support Payment and they have had a change of circumstances, see:

• Coding income and assets for Centrelink payment and services, and
• Verifying income and assets for details on whether verification is required/requested

Go to Step 15.

A claim is manually rejected as follows:

• Make all necessary updates required within the claim
• Before finalising the claim, delete all provisional data that requires verification so the data is not applied to the customer record
• Go to the Benefit Action (BA) screen using Super Key
• Select Add New
• In the Create Benefit Action screen, select:
• Benefit Type: AGE
• Benefit Action: REJ - Reject
• Streamline Rejection - do not tick the indicator box
• Reason: select appropriate reason code, for example, FRC
• Date of Effect: in most cases this is the deemed date of claim or date of receipt, only change if the pre-populated date is incorrect
• Save
• Use the Super Key to go to the Errors (SWE) screen
• Once all errors have been addressed, select Assess
• The Entitlements (ELD) screen will display, check that outcome is correct
• Go to the Assessment Consequences (ASC) screen
• Check and if required complete debt actions or inhibit advices

Note: for a manual rejection, all customer verified personal details must be coded to make sure the notice of rejection is issued to the correct address. If the customer and their partner (where they have a partner) are not currently on an income support payment, income and asset coding is not required if rejecting FSD or FRC.

If customer and/or partner is current ISP and they have had a change of circumstances, see:

• Coding income and assets for Centrelink payment and services, and
• Verifying income and assets for details on whether verification is required/requested

Go to Step 15.

Sometimes a claim activity may need to be processed in Customer First/Customer Record and the Handover to CF/CR function may be required. Generally, this is to apply an approved workaround for a known issue/error or gaps in Process Direct.

Prior to utilising the Handover function, staff must refer to the Using Digital Assistance Roxy in Process Direct and the Handover function table for required actions.

Is a handover to Customer First or Customer Record required?

• Yes, to commence a handover, see the Handover function table. Once completed, go to Step 14
• No, go to Step 15

A claim is manually rejected as follows:

• Make all necessary updates required within the claim
• Code fields on the Benefit Action (BA) screen:
• Svc Rsn - 'AGE'
• Action - 'REJ'
• Reason - FRC or select the appropriate rejection code (use field help)
• Effect Date - this usually defaults to Date of Commencement and may not need to be coded
• before finalising the activity, go to Step 15

For a manual rejection, all customer verified personal details must be coded to make sure the notice of rejection is issued to the correct address. If the customer and their partner (if they have a partner) are not currently on an income support payment, income and asset coding is not required if rejecting FSD or FRC. If customer and/or partner is current ISP and they have had a change of circumstances, see:

• Coding income and assets for Centrelink payment and services, and
• Verifying income and assets for details on whether verification is required/requested

For claims rejected in Process Direct:

• Select Finish to finalise claim
• A finalisation DOC template will display with claim outcome
• Select Finalise

For claims processed in Customer First/Customer Record:

• Use Fast Note select Auto Text use Older Australians > Claims > Reject AGE NCL
• Attach the Fast Note DOC to the NCL activity
• Finalise activity via the Assessment Results (AR) screen

If the rejection reason is FSD/FRC:

• DOC 'Note: income and assets have not been updated. A full assessment is still required if customer provides requested information within 13 weeks of rejection'
• Make sure Notes/DOC lists all documents not provided at the time of rejection including where customer has not provided supporting documents from a form
• Include the reason if no request for information was made

Follow-up actions in Process Direct for claims finalised in Customer Record and Customer First:

• check claim status in Process Direct
• if claim status has not automatically set to Complete, upon finalisation of the claim:
• select the claim transaction and raise an Incident through Roxy
• chose option 'No, the issue is blocking me' so that claim is placed On Hold for System Investigation/Issue
• retain the work item by using the hold to user function in Work Optimiser
• claim status will be set to Complete by ICT

Home Equity Access Scheme (the Scheme) applications:

• If the customer has lodged an application for the Scheme in addition to an Age Pension claim, where the Age Pension is rejected, update the Scheme claim Status to 'In Process'

If the customer is deceased, a manual letter (Q999) must be issued. The grant or rejection letter must be issued to the:

• 'Executor of the Estate' (if known) address,
• 'Estate of the Late [customer's name]' at the deceased customer’s last known address.

The Resources page contains an example of suitable text for these letters.

For other cases where no auto-reject letter is generated, send manual letter Q134 (select the 'undetermined' option) to the customer giving the reason(s) for rejecting the claim and advising their review and appeal rights.

Record the details of decision on a DOC.