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50.2 Review of incapacity payments

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A number of reviews of ongoing entitlement to incapacity payments will occur during the life of a claim. These include end of 45 week reviews, payment end date reviews and preservation age and Age Pension age reviews. These reviews are triggered by specific events and must be actioned at specific times to avoid an overpayment or financial hardship to the client. The following reviews must also be undertaken during the life of a claim and are mandatory:

  • 1St General Review- occurs after 6 cumulative pay periods
  • Ongoing General Review- every 26 cumulative pay periods for as long as the client remains in payment

 

At each review delegates are required to:

  • Send the Weekly Entitlement/Continuing Payments form for completion by the client.
  • Obtain up-to-date medical evidence of incapacity- see below for the medical certification requirements for each review.
  • Do a complete file review to determine if there are any outstanding actions or un-actioned correspondence. This should include a review of the client's rate of pay based on their rank and pay grade, the Commonwealth Superannuation Corporation, and other relevant information held on the file as well as the information on the weekly entitlements/continuing payments form.
  • Complete the Incapacity Assessment Checklist, sign and date it and place it on the file.

 

The review is not complete until all issues arising from the review are finalised, eg:

if there is a question regarding liability for the current condition, the review is not closed until the liability issue has been resolved and other checklist issues are completed;

  • if a medical report is required the review is not completed until the report has been received and actioned and other checklist issues are completed;
  • if change to rate of pay is required, the task is not completed until the new entitlement has been accepted/confirmed by PMKeyS and a determination issued and other checklist issues are completed; and,
  • where responsibilities for activities such as Third Party recovery, Rehabilitation Assessment, etc, are held by other parties, then action for that issue is completed upon referral.

 

 

 

Age Pension Age refers to pension age as defined under the Social Security Act 1991, that is, pension age for people other than veterans.