8.1.1.70 Incorrect Claims

Summary - incorrect claims

A delegate may apply the incorrect claim provision in the SS(Admin)Act when a customer claims a payment for which they are not qualified and then claims a payment for which they are qualified. This topic covers:

  • factors to be considered when determining if it is reasonable to apply the provision,
  • time between initial and second claims,
  • qualification throughout the relevant period,
  • start day of the second payment, and
  • claims must be for similar payments.

Factors to be considered when determining if it is reasonable to apply the provision

The delegate must consider it reasonable to apply this provision. In deciding whether it is reasonable to treat the initial claim as if it were a claim for another payment, the following factors should be considered:

  • the period of time between the lodgement of the initial claim and the second claim, and
  • whether the person was qualified for the second payment throughout the period of time between the 2 claims.

Time between initial & second claims

Particular care must be taken when there is a gap of more than 13 weeks between the lodgement of the initial claim and the second claim. In these cases the customer would need to display strong reasons why they did not lodge the second claim earlier.

Examples:

In the following situations it can be accepted that the customer had strong reasons for lodging the second claim more than 13 weeks after the initial claim:

  • if this Department or another Department has taken more than 13 weeks to decide that the customer is not qualified for the payment that was the subject of the initial claim,
  • if the customer could not lodge the second claim because they lived in a remote area or one in which postal services are restricted,
  • if the customer could not lodge the second claim because they were hospitalised or immobilised by a medical condition or impairment.

Qualification throughout the relevant period

Delegates must consider whether all qualifications for the payment are met throughout the period of time between the 2 claims.

Example: Medical certificate coverage for SA.

Start day of the second payment

The second claim is taken to have been made on the day on which the person made the claim for the first (incorrect payment). The start day for the second payment is usually the date on which the first (incorrect) claim was made, but staff should check the start day backdating rules for the second payment in case an earlier start day is possible.

Act reference: SS(Admin)Act section 15 Deemed claim-incorrect or inappropriate claims

Claims must be for similar payments

If the first (incorrect) claim is for a social security payment other than a supplementary payment (1.1.S.427) then the second claim must also be for a social security payment.

If the first (incorrect) claim is for a supplementary payment (1.1.S.427) the second claim must also be for a supplementary payment.

Act reference: SS(Admin)Act section 15 Deemed claim-incorrect or inappropriate claims

SSAct section 23(1)-'social security payment'

Last reviewed: 13 May 2013