Payment pending review (PPR) of decision to cancel Disability Support Pension (DSP) due to loss of medical qualification 102-01080060

Consider PPR when a customer:

• applies for a formal review of the decision by an Authorised Review Officer (ARO)
• requests PPR after applying for a review by the AAT (first review). The AAT is obliged to finalise the review as soon as possible

If PPR was not applied at those times and should be considered:

• request action using a Fast Note - select Auto Text, use Appeals > Consider Payment Pending Review - DSP > Consider PPR for ARO/AAT - DSP
• record the relevant information in the body of the Fast Note

If a customer has been granted another income support payment and they apply for a formal review of a DSP medical cancellation decision:

• do not take action on the PEN/PPR activity
• email Disability Payments Team for processing help, with the email subject line:
  'URGENT: DSP Medical Review Grant PPR for customer on Alt ISP'

PPR can be applied while the review is in progress, but the customer must request PPR within 13 weeks of:

• being notified of the original decision if they applied for a formal review, or
• being notified of the ARO decision if they requested an AAT first review

Has the customer requested PPR after applying for an AAT first review?

• Yes, go to Step 5
• No, go to Step 2

When the customer applies for a formal review of the decision to cancel DSP, check the customer's record to determine the reason for the cancellation. See the Resources page for relevant cancellation codes.

Has the customer applied for a formal review of a decision to cancel DSP due to loss of medical qualification?

• Yes, go to Step 3
• No, PPR does not apply under loss of medical qualification provisions. However, PPR may apply under general PPR provisions. See Continuing payments pending review (PPR)

PPR can only be applied if the customer requests PPR within 13 weeks of being notified of the original cancellation decision

Did the customer request PPR within 13 weeks?

• Yes, go to Step 4
• No, PPR does not apply:
• DOC the record to note the customer asked for PPR, and that the decision has been made not to apply PPR because the request was made more than 13 weeks from when the customer was notified
• Issue a Q888 or Q999 letter to the customer. See the Resources page or example letter text. Procedure ends here

Consider the customer's circumstances, including:

• Will they be in financial hardship?
• Do they have dependent children or caring responsibilities that may be significantly affected?
• Do they have a medical condition that may be significantly affected, for example, because the customer cannot afford treatment?
• Are they likely to be evicted or will they be unable to pay rent or board?
• Will they be negatively affected in any other way?

Considering all the customer's circumstances, should PPR apply?

• Yes, go to Step 6
• No,
• Advise the customer
• DOC the record stating that the decision has been made not to apply PPR and why
• Issue a Q888 or Q999 letter to the customer. See the Resources page for example letter text. Procedure ends here

PPR can be applied when a customer has requested an AAT first review.

Evidence is required that an AAT review has been requested before applying PPR. This will be an 'AAT request for statement' (AAT1REQ) uploaded into document tools and an AAT1 request DOC on the customer's record.

Is there an 'AAT request for statement' (AAT1REQ) or an AAT1 request DOC on the customer's record?

• Yes, go to Step 6
• No, PPR does not apply:
• DOC the record stating the customer asked for PPR, and that the decision has been made not to apply PPR because there is no evidence of an AAT first review being requested
• Issue a Q888 or Q999 letter to the customer. See the Resources page for example letter text. Procedure ends here

• If applying PPR when running the Internal Review/Explanation script:
• Code the PPR indicator (MED or POS) in the APL system when prompted by the script
• This will generate a PPR activity with keyword PPRSTA. Select the PPR activity and take the required action to reverse the cancellation decision
• If applying PPR when not running the Internal Review/Explanation script:
• Manually code the PPR Indicator (MED or POS)
• Access the APL system through Customer Record. Select the APL system record and update the PPR field on the Modify Reconsideration (MR) screen
• This will generate a PPR activity with keyword PPRSTA. Select the PPR activity and take the required action to reverse the cancellation decision
• Make all relevant updates, including changes in income (including earnings), rent, or any other changes in circumstances. Generally, the medical information upon which the decision is based will not require an update or override for PPR to begin
• Finalise the activity to start PPR. The benefit status will display as DSP/CUR-PPR, unless the customer is in a period of grace (benefit status DSP/CUR-POG). In that case, PPR will start once the POG ends.
  Note: if the customer's benefit status is not DSP/CUR when reviewing the assessment results (AR) screen, go to the Benefit Action (BA) screen and restore within the PEN/PPR activity before finalising
• Create a DOC on the customer's record and include the following:
• the decision being reviewed
• the APL number
• that PPR is being applied
• the level of review (ARO or AAT first review)
• why PPR is being applied, e.g. why the decision would cause the customer financial hardship
• Advise the customer PPR will be applied
• Issue a Q888 or Q999 letter to the customer. See the Resources page for example letter text
• When the review is complete or there is a change in circumstance see Table 2

PPR ends if:

• the customer’s circumstances change and they are no longer facing the same level of financial hardship, or
• a new determination results in lower or no entitlement

DSP is cancelled from the later of:

• the date the 42 day period of grace (POG) ends, or
• the date on which the decision to cease PPR is made

Is the PPR ending due to a change in circumstances?

• Yes,
• Take the required action to reapply the DSP cancellation decision
• Delete the PPR indicator from the 'PPR' field on the MR screen in the APL record
• DOC the customer's record to note that PPR is ended and why
• Advise the customer of the decision to end PPR
• Issue a Q888 or Q999 letter to the customer. See the Resources page for example letter text. Procedure ends here
• No, go to Step 2

When the ARO review or AAT first review is complete, a PEN/PPR activity and work item generate to end PPR. These are actioned by delegated staff.

If the outcome of the review is:

• to set aside the cancellation decision, go to Step 3
• any other outcome, go to Step 4

A PPR activity and work item will generate on the record for action by a delegated officer.

Select the PEN/PPR activity from the Activity List (AL) screen and take it through to the Assessment Results (AR) screen. Once finalised, the customers benefit status line should appear as DSP/CUR, without the PPR extension.

Annotate and finalise the Display On Access (DOA) DOC with the outcome of the review and that PPR is ended.

Do PPR details need to be viewed?

• Yes, go to Step 5
• No, procedure ends here

A PPR activity and work item will generate on the record. When there is already a PEN/PPR activity on the record to be actioned, no new activity will be created. The existing activity should be finalised.

• If the decision is affirmed or varied:
• DSP is cancelled from the later of the day after the 42 day period of grace (POG) ends, or the date the review outcome is implemented if this is within 13 weeks of the date the review is completed
• If the review outcome is implemented more than 13 weeks after the review was completed, the cancellation date is the last day of the 13 week period after the review was completed
• if the decision is affirmed and DSP cancelled, payments made under PPR in the 13 week period following the review decision are not recoverable. If payment continues under PPR beyond 13 weeks of the review decision date, a debt will occur
• If the customer withdraws an appeal or review:
• PPR is ended from the date the customer withdraws their review request
• DSP is cancelled from the later of the day after the 42 day POG ends, or the date the customer withdraws the appeal or review
• If the AAT dismisses the case without a decision (e.g. if the customer does not appear at the hearing or cannot be contacted):
• PPR is ended from the date of the dismissal
• DSP is cancelled from the later of the date after the 42 day POG ends or the date of the dismissal
• Select the PEN/PPR activity from the Activity List (AL) and take it through to the Assessment Results (AR). This will end PPR and cancel the payment
• The customer's benefit status line should appear as DSP/CAN with the original cancellation code relating to medical qualification, e.g. NSI
• Record a cancellation DOC. Annotate and finalise the Display On Access (DOA) DOC with the outcome of the review and that PPR is ended
• Issue a Q888 or Q999 letter to the customer. See the Resources page for example letter text

Do PPR details need to be viewed?

• Yes, go to Step 5
• No, procedure ends here

To view the PPR information recorded, go to the Payment Pending Review (PPR) screen. This is a general view only screen that displays:

• the Appeal ID - each appeal stage is considered to be a separate PPR period and must be coded separately with the same appeal ID
• PPR Start Date - this is automatically determined to be the benefit cancellation date
• End Date - this will only apply if an appeal outcome has been made in the APL system
• Benefit Type
• PPR Reason - determined from the PPR: field code as updated in the APL system (for example, 'Medical Eligibility')
• appeal decision Outcome if one has been made (either, 'Set Aside' or 'Affirmed')
• Activity Management Reference (AMR) for the activity that updated the PPR data

Select the arrow to the left of the appeal ID to expand for more appeal information. For more details about the reason for the appeal and the decision to pay or not pay DSP PPR, see the relevant DOCs.

PPR is considered:

• at the time a customer requests a Subject Matter Expert (SME) quality check
• when the SME finalises the quality check and the customer requests a review by an Authorised Review Officer (ARO)
• when a customer requests PPR after lodging an appeal with the Administrative Appeals Tribunal (AAT) for first review

If PPR was not applied at those times:

• request action using a Fast Note - select Auto Text, use Appeals > Consider Payment Pending Review - DSP > Consider PPR for ARO/AAT - DSP
• record the relevant information in the body of the Fast Note

PPR can be applied while the review is in progress, but the customer must request PPR within 13 weeks of:

• being notified in writing of the original decision, or
• the SME quality check outcome, or
• the ARO decision

Has the customer requested PPR after lodging an appeal for AAT first review?

• Yes, go to Step 5
• No, go to Step 2

When the customer requests a review of the decision to cancel DSP, check the customer's record to determine the reason for the cancellation. See Resources for relevant cancelation codes.

A check must be conducted to determine if DSP has been cancelled as a result of a Medical Risk Based Review. If the DSP cancellation is the result of a Medical Risk Based review this procedure does not apply, see Medical Risk Based reviews of current Disability Support Pension (DSP) customers.

Has the customer requested a review of a decision to cancel DSP due to loss of medical qualification?

• Yes, go to Step 3
• No, PPR does not apply under loss of medical qualification provisions. However, PPR may apply under general PPR provisions. See Continuing payments pending review (PPR)

PPR can only be applied if the customer requests PPR within 13 weeks of being notified (in writing) of:

• the original cancellation decision, or
• the SME quality check, or
• an ARO's decision

Did the customer request PPR within 13 weeks?

• Yes, go to Step 4
• No, PPR does not apply:
• DOC the record to note the customer asked for PPR, and that the decision has been made not to apply PPR because the request was made more than 13 weeks from when the customer was notified
• Issue a Q888 or Q999 letter to notify the customer that a decision has been made not to apply PPR and include appeal rights. See Resources for Q888 or Q999 letter text. Procedure ends here

Consider the customer's circumstances including:

• Will they be in financial hardship?
• Do they have dependent children or caring responsibilities that may be significantly affected?
• Do they have a medical condition that may be significantly affected, for example, because the customer cannot afford treatment?
• Are they likely to be evicted or will they be unable to pay rent or board?
• Will they be negatively affected in any other way?

Consider all of the customer's circumstances when deciding whether to apply PPR.

Should DSP continue pending the outcome of the review?

• Yes, go to Step 6
• No:
• Advise the customer
• DOC the record stating that the decision has been made not to apply PPR and why
• Issue a Q888 or Q999 letter to notify the customer that a decision has been made not to apply PPR and include appeal rights. See Resources for Q888 or Q999 letter text. Procedure ends here

PPR can be applied when a customer has requested an AAT first review.

Evidence is required that an AAT review has been requested prior to applying PPR. This will be an 'AAT request for statement' (AAT1REQ) uploaded into document tools and an AAT1 request DOC on the customer's record.

Is there an 'AAT request for statement' (AAT1REQ) or an AAT1 request DOC on the customer's record?

• Yes, go to Step 6
• No, PPR does not apply:
• DOC the record stating the customer asked for PPR, and that the decision has been made not to apply PPR because there is no evidence of an AAT first review being requested
• Issue a Q888 or Q999 letter to notify the customer that a decision has been made not to apply PPR and include appeal rights. See Resources for what information to include in the Q888 or Q999 letter. Procedure ends here

• If applying PPR at the same time as running the Internal Review/Explanation script:
• Code the PPR indicator (MED or POS) in the APL system when prompted by the script
• This will generate a PPR activity with a keyword of PPRSTA. Select the PPR activity and take the required action to reverse the cancellation decision
• If applying PPR when not running the Internal Review/Explanation script:
• Manually code the PPR Indicator (MED or POS)
• Access the APL system through Customer Record. Select the APL system record and update the 'PPR' field on the Modify Reconsideration (MR) screen
• This will generate a PPR activity with a keyword of PPRSTA. Select the PPR activity and take the required action to reverse the cancellation decision
• Make all relevant updates including, changes in income (including earnings), rent, or any other changes in circumstances. Generally, the medical information upon which the decision is based will not require an update or override for PPR to begin
• Finalise the activity to start PPR. The benefit status will display as 'DSP/CUR-PPR', unless the customer is in a period of grace (POG). When a customer is in a POG, PPR will automatically commence once the POG finishes. If the customer is in a POG, the benefit status will appear as DSP/CUR-POG.
  Note: if the customer's benefit status is not DSP/CUR when reviewing the assessment results (AR) screen, the Service Officer will need to manually navigate to the Benefit Action (BA) screen and restore within the PEN/PPR activity before finalising
• Create a DOC on the customer's record and include the following:
• the decision under review
• the APL number
• the level of review
• that PPR is being applied
• why PPR is being applied, for example, the decision would cause the customer financial hardship
• Advise the customer PPR will be applied
• Issue a Q888 or Q999 letter to notify the customer that a decision has been made to apply PPR and include appeal rights. See Resources for Q888 or Q999 letter text.
• When the review is complete or there is a change in circumstance see Table 2

PPR is ceased when an unrelated change in circumstances means the customer no longer faces the same level of financial hardship or a new determination results in lower or no entitlement, regardless of the effect of the decision under review.

DSP is cancelled from the later of the date the 42 day period of grace (POG) ends or the date on which the decision to cease PPR is made.

Is the PPR ending due to a change in circumstances?

• Yes:
• Take the required action to reapply the DSP cancellation decision
• Delete the PPR indicator from the 'PPR' field on the MR screen in the APL record
• DOC the customer's record to note that PPR is ended and the reasons why
• Issue a Q888 or Q999 letter to notify the customer that PPR has ended. See Resources for what information to include in the Q888 or Q999 letter. Procedure ends here
• No, go to Step 2

When the internal review or AAT first review is complete, a PEN/PPR activity and work item are generated to end PPR. These are actioned by a SME.

If the outcome of the review is:

• to set aside the cancellation decision, go to Step 3
• any other outcome, go to Step 4

A PPR activity and work item will be generated on the record to be actioned by a SME.

Select the PEN/PPR activity from the Activity List (AL) screen and take it through to the Assessment Results (AR) screen. Once finalised, the customers benefit status line should appear as DSP/CUR, without the PPR extension.

Annotate and finalise the Display On Access (DOA) DOC with the outcome of the review and that PPR is ended.

Do PPR details need to be viewed?

• Yes, go to Step 5
• No, procedure ends here

A PPR activity and work item will be generated on the record to be actioned by a SME. When there is already a PEN/PPR activity on the record to be actioned, no new activity will be created. The existing activity should be finalised.

• If the decision is affirmed or varied:
• DSP is cancelled from the later of the date after the 42 day period of grace (POG) ends or the date on which the review outcome is implemented so long as implementation occurs within 13 weeks after the date the review is completed
• If the decision is implemented more than 13 weeks after the review is completed, the cancellation date is the last day of the 13 week period after the review was completed
• If the customer withdraws an appeal or review:
• The date PPR is ended is the date the customer withdraws their request for review
• DSP is cancelled from the later of the date after the 42 day POG ends or the date the customer withdraws the appeal or review
• If the AAT dismisses the case without a decision (for example, in cases where the customer does not appear at the hearing or cannot be contacted):
• The date PPR is ended is the date of the dismissal
• DSP is cancelled from the later of the date after the 42 day POG ends or the date of the dismissal
• Select the PEN/PPR activity from the Activity List (AL) and take it through to the Assessment Results (AR). This will end PPR and cancel the payment
• The customers benefit status line should appear as DSP/CAN with the original applicable cancellation code relating to medical qualification, for example, 'NSI'
• Record a cancellation DOC. Annotate and finalise the Display On Access (DOA) DOC with the outcome of the review and that PPR is ended

Note: if the original decision to cancel DSP is affirmed, payments made under PPR provisions in the 13 week period following the review decision are not recoverable. If payment continues under PPR beyond 13 weeks of the review decision date a debt will occur.

Do PPR details need to be viewed?

• Yes, go to Step 5
• No, procedure ends here

To view the PPR information recorded, navigate to the payment pending review (PPR) screen. This is a generic, view-only screen which may not be edited manually. This screen will display:

• the Appeal ID - each appeal stage is considered to be a separate PPR period and must be coded separately with the same appeal ID
• the PPR Start Date - this is automatically determined to be the benefit cancellation date
• the End Date - this will only apply if an appeal outcome has been made in the APL system
• the Benefit Type
• the PPR Reason - determined from the PPR: field code as updated in the APL system (for example, 'Medical Eligibility')
• the appeal decision Outcome if one has been made (either, 'Set Aside' or 'Affirmed')
• the Activity Management Reference (AMR) for the activity that updated the PPR data

Selecting the arrow to the left of the appeal ID will expand for extra appeals information. For more details about the reason for the appeal and the decision to pay or not pay DSP PPR, see the relevant DOCs.