6.1.7 Steps in the social security review & appeals system

Summary

The social security review and appeals system consists of internal and external review mechanisms.

Where an individual does not understand a decision, they can request an explanation of the decision, which will be provided by a Subject Matter Expert (SME). Where an individual does not agree with a decision, they can apply for a formal review of the decision which will be undertaken by an ARO.

The levels of review and appeal, in increasing order, are:

• internal review process
  • an explanation by an SME, and/or
  • a formal review by an ARO (1.1.A.350)
• an external appeal to the
  • ART - ART review
  • ART - second review
  • Federal Court, and
  • High Court.

Decisions made using computer programs

The Secretary may arrange for the use of computer programs in making decisions under social security law. Decisions made by computer programs are taken to be decisions made by the Secretary. This means, for example, where entitlement determinations are made using computer programs such as rate calculators, they can be reviewed as though the decisions were made by the Secretary or a delegate of the Secretary.

Review body may determine events to have happened

If the Secretary, delegate or ART (the review body) sets a decision aside and is satisfied that an event would have happened had the original decision not been made, then that event can be deemed to have happened for the purpose of the social security law.

Withdrawal of application for internal review of a decision

A person may withdraw their application for internal review of a decision under social security law at any time before the review has been completed.

An application that is withdrawn is taken to have not been made. An application may be withdrawn orally or in writing, or in any other matter approved by the Secretary.

Notice of decision to be given following an application for internal review of a decision

A notice must be provided to the applicant following the review of a decision. The notice must:

• be in writing
• state the effect of the decision
• set out the reasons for the decision
• set out the findings by the decision maker on material questions of fact
• refer to the evidence on which those findings were based
• provide further information about further rights of review to the ART, and
• have regard to the matters (if any) prescribed by the Rules.

The guidance & appeals panel

The guidance and appeals panel is a way of constituting the Tribunal at a more senior level. The guidance and appeals panel is able to conduct reviews of some administrative decisions made by agencies and re-review decision made by the ART.

The guidance and appeals panel will broadly be constituted to consider matters where there is either an issue of significance to administrative decision-making, or the ART decision contains an error of fact or law that materially affects the decision.

Applications for review of social services decisions cannot be made directly to the guidance and appeals panel, as the ART already accommodates for two reviews of such decisions (ART review and ART second review). However, the President of the ART may refer an application for an ART review or second review of an eligible social services decision to the guidance and appeals Panel on their own initiative.