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 of determination granting a claim
- date of effect of determination granting a claim which was previously rejected, and
- date of effect of rejecting a claim for payment.
Act reference: 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, Schedule 2 Rules for working out start day
Policy reference: SS Guide 8.3 Start days
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
- 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
- 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:
- jobseeker payment
- parenting payment
- youth allowance
- special benefit
- disability support pension
- 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) |
| Jobseeker payment | 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: A claim is rejected on 5 May 2024 and a review is sought on 14 June 2024. A determination is made to grant the claim. Because review was sought within 13 weeks, the claim will be granted from 5 May 2024. Also, under SS(Admin)Act Schedule 2, the start day is 5 May 2024 and payment is payable from that date.
Example: A claim is rejected on 5 May 2024. A review is sought on 11 August 2024. A determination is made to grant. Because the request for a review of the decision was made more than 13 weeks later than the original decision, the claim will be granted from 11 August 2024. Also, under SS(Admin)Act Schedule 2, the start day is 11 August 2024 and payment is payable from that date.
Example: A claimant becomes qualified for CA on 13 November 2024. They lodge a claim for CA on 11 January 2025 that is rejected. They request 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 2024.
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).