22.214.171.124 Inappropriate claims
Summary - inappropriate claims
The purpose of this topic is to clarify when the inappropriate claim provision may be applied.
Where it is reasonable for the delegate to apply this provision
A delegate may apply the inappropriate claim provision in the SS(Admin)Act when a person makes an 'initial inappropriate claim' for an income support payment or a supplementary payment (1.1.S.427) under the social security law, or under an Act or program other than under the social security law and then some time later makes a 'later claim' for a different payment under the social security law for which the person was qualified.
If this is the case, the delegate may determine that the person has made a claim for the more appropriate payment under the social security law on the day on which the person made the initial claim (SS(Admin)Act section 15(4)).
In deciding whether it is reasonable to apply this provision, the delegate should consider the following factors:
- The initial claim and the later claim have to be similar in character: if the initial claim was for an income support payment, then the later claim must also be for an income support payment (see Payments considered to be similar in character to social security payments). If the initial claim was for a supplementary payment, the later claim must also be for a supplementary payment.
- The person must have been qualified to receive the later payment at the time that he or she claimed the initial payment.
- Whether the person will be disadvantaged by receiving the later payment, and if so, the person should be informed of this (and therefore the person may wish to remain on the initial payment).
Act reference: SS(Admin)Act 15(4) Deemed claim-incorrect or inappropriate claims
Payments considered to be similar in character to social security payments
For the purpose of SS(Admin)Act section 15, a payment other than under the social security law that is considered to be 'similar in character' to a social security payment includes:
Start day of the second (later) payment
Under this provision, the later claim is taken to have been made on the day on which the initial (inappropriate) claim was made. However, the start day backdating rules should be checked in case an earlier start day is possible.
Qualification throughout the relevant period
In order for payments to be backdated, delegates must consider whether all qualifications for the second (later) payment are met throughout the period of time between the initial and later claims.
Time between initial & second claims
Delegates should take particular care when there is a gap of more than 13 weeks between the making of the initial claim and the later claim. In these cases, the person would need to display acceptable reasons why he or she did not lodge the second claim within 13 weeks of lodging the first (see examples below).
Examples of acceptable reasons to allow the later payment when claim lodged more than 13 weeks after lodging the initial (inappropriate) claim
Example 1: If Centrelink or another Department has taken more than 13 weeks to decide that the person is not qualified for the payment that was subject of the initial claim,
Example 2: If Centrelink or another Department has reviewed the person's documentation at the time of the initial lodgement and has mistakenly or inadvertently paid the person an incorrect or inappropriate benefit and the delegate only discovers this error after 13 weeks have elapsed:
- If the inappropriate claim (first claim) results in the person owing a debt to Centrelink, depending on the circumstances, consideration should be given to waiving the debt.
- If the inappropriate claim (first claim) results in the person being owed a sum of money, the person should be paid this sum. The person's records should then be corrected so that the correct benefit is paid in the future.
Example 3: If the person could not lodge the later claim because they were hospitalised or immobilised by a medical condition or impairment.
Act reference: SS(Admin)Act section 15 Deemed claim-incorrect or inappropriate claims