3.1.8 Dates of Effect of Claim Determinations

Summary

This section concerns the dates of effect of determinations on claims for payment. This section covers the following matters:

  • criteria for granting a claim for payment,
  • date of effect for granting a claim for payment,
  • date of effect of determination granting a claim which was previously rejected,
  • date of effect for rejecting a claim for payment, and
  • act references for dates of effect relating to effect.

Criteria for granting a claim for payment

The basic rule is that if a claim is made for a social security payment or a concession card, the Secretary must either grant or reject the claim.

In general, when a person lodges a claim for payment, the claim MUST be granted IF the Secretary is satisfied that:

  • the person is qualified for the social security payment, and
  • the social security payment is payable (SS(Admin)Act subsection 37(1)).

Similarly, when a person lodges a claim for a social security payment, the claim MUST be granted IF the Secretary is satisfied that:

  • the person is qualified, or is expected to be qualified, for the payment, and
  • the payment would be payable if the person were not subject to an SWPP (SS(Admin)Act subsection 37(3)).

In this context, social security payment is taken to include:

  • MAA under SSAct Part 2.12A,
  • MAA under SSAct Part 2.12B,
  • newstart allowance,
  • parenting payment,
  • partner allowance,
  • widow allowance,
  • youth allowance,
  • special benefit,
  • disability support pension,
  • sickness allowance,
  • carer payment,
  • Austudy (SS(Admin)Act subsection 37(4)).

There are further exceptions to the requirement that the Secretary must be satisfied that the social security payment be 'payable' in relation to certain social security payments, including:

Payment SS(Admin)Act reference
Parenting payment subsection 37(1A)
Newstart allowance subsection 37(2)
Youth allowance
Austudy payment
subsection 37(6)
Social security pension or benefit
Crisis payment
subsection 37(7)

Date of effect of determination granting a claim

The date of effect of the determination for granting a claim is:

  • the date the determination was made, OR
  • an earlier or later date specified in the determination.

Date of effect of determination granting a claim which was previously rejected

The following table shows the date of effect of a determination to grant a claim when a review of the original decision has been sought:

If a notice advising of the decision to reject a claim… And the application to review the original decision is lodged… Then the date of effect of the determination is… SS(Admin)Act reference

HAS been given to the person,

WITHIN 13 weeks of receiving the notice, the day the original decision took effect. subsection 107(2)
MORE THAN 13 weeks after receiving the notice, the day they sought the review. subsection 107(3)
HAS NOT been given to the person, at any time, the day the original decision took effect. subsection 107(4)

Example 1: A claim is rejected on 4 May 2008 and a review is sought on 13 June 2008. A determination is made to grant the claim. Because review was sought within 13 weeks, the claim will be granted as from 4 May 2008. Also, under SS(Admin)Act Schedule 2 , the start day is 4 May 2008 and payment is payable from that date.

Example 2: A claim is rejected on 4 May 2008. A review is sought on 10 August 2008. A determination is made to grant. Because the request for a review of the decision was made more that 13 weeks later than the original decision, the claim will be granted as from 10 August 2008. Also, under SS(Admin)Act Schedule 2, the start day is 10 August 2008 and payment is payable from that date.

Example 3: Jane becomes qualified for CA on 13 November 2008. She lodges a claim for CA on 11 January 2009 that is rejected. She requests a review of the original decision, and the claim is subsequently granted. The date of the determination to grant becomes the date the claim was originally rejected. As the claim was originally lodged within 12 weeks of becoming qualified for CA, the start day for CA is 13 November 2008.

Date of effect of rejecting claim for payment

The date of effect of the determination rejecting a claim for payment is:

  • the date the determination was made, OR
  • an earlier or later date specified in the determination.

Note: If the Secretary does not make a determination either granting or rejecting a claim within 13 weeks of the day the claim was made, and the person does not become qualified for payment within this period, the Secretary is taken to have made a determination rejecting the claim at the end of the period (deemed refusal of claim).

Act references for date of effect

Date of effect for all payments are governed by SS(Admin)Act:

  • Part 3 Division 9 Date of effect of determinations,
  • section 37 Grant of claim,
  • section 39 Deemed refusal of claim,
  • section 107 General rule.

The rules for working out start days for all payments are contained in SS(Admin)Act Schedule 2.

Policy reference: SS Guide 8.3 Start Days

Last reviewed: 1 July 2016