Processing Essential Medical Equipment Payment (EMEP) claims 008-01040030

EMEP claims are assessed for a current residential address, and qualifying essential medical equipment and/or medically required heating/cooling. If the customer and/or equipment user acquires further qualifying medical equipment, they must lodge a new claim for each new assessment.

All information relating to the claim must be coded. This includes details of the:

• equipment user
• essential medical equipment
• medical conditions for medically required heating/cooling
• medical verification:
• medical evidence/information provided for the initial EMEP claim cannot be more than 2 years old
• consent provided by the medical equipment user
• energy account

This information determines whether the claim is to be granted or rejected.

If granted EMEP will:

• automatically pay every 12 months on the grant date anniversary, and
• continue until updates are completed which cause the medical equipment user to lose qualification

Where there is a change in circumstances, for example a change in residential address, the customer may lose qualification. The customer:

• must lodge a new claim and
• a new anniversary date is set according to the date of grant of the new claim

Proof of medical evidence/information is not required again if:

• the customer changes address but the new claim is for the same person with the same medical equipment/requirements
• a new carer claims, with no other changes to medical requirements

Customers only need to claim EMEP once for their current residence and qualifying essential medical equipment and/or medically required heating or cooling.

If a current customer lodges an EMEP claim less than 12 months from the most recent EMEP payment, Service Officers must cancel the claim unless the customer has:

• claimed for a new item of essential medical equipment they are not currently being paid EMEP for, or
• had a change of circumstances

Granting a duplicate EMEP claim for a customer already receiving EMEP without a change in circumstances:

• incorrectly resets the anniversary date, and
• delivers an unrecoverable incorrect payment

The Resources page contains eligibility scenarios.

A customer can apply for a formal review of a decision at any time. If they apply more than 13 weeks after the rejection notice, the payment may be affected by the date of effect rules. See Customer initiated review of decision.

Customers can request a reassessment of their rejected or cancelled EMEP.

EMEP claims may be reassessed where all outstanding requested documents have been provided within 13 weeks of the rejection notice. SO’s should consider the new information being supplied to determine if the claim outcome can be reassessed and the outcome will be fully favourable.

EMEP is paid under social security law.