Consideration and Determination of a Claim

Last amended: Once a claim has been investigated and submitted to the Commission, the decision-maker must:

•    consider the claim,
•    consider the evidence relating to the claim, and
•    satisfy themselves with respect to all matters relevant to the determination of the claim.

Although the decision-maker must be satisfied on all matters relevant to the claim, an investigation for an income support pension need not be exhaustive for the claim to be determined.    

Example:  A service pension claim where the investigation is not exhaustive

A person lodges a claim for age service pension, knowing that he is to be granted superannuation in the near future, but does not know when or the amount he will receive. In this situation, if his eligibility for service pension is clearly established, pension should be assessed on the known assets and income. The letter advising of his determination will include his obligation to advise of any change of circumstances, such as the grant of superannuation.    

Determination

The decision-maker must determine the claim as follows:    

• determine whether the pension is to be granted to the person, and
• if the pension is to be granted to the person, they must then:
• calculate the person's pension rate,
• determine that the pension is payable to the person at that rate, and
• determine the date from which the pension is to be paid.

Disability Compensation Payment, dependants' pensions and increase in Disability Compensation Payment determinations

Disability Compensation Payment, dependants' pensions and increase in Disability Compensation Payment determinations are made on the basis of:

• the degree of incapacity suffered by the veteran, and
• whether this incapacity can be related to their service, or
• whether their incapacity has increased since the rate of pension was assessed or last assessed, or
• if the veteran is deceased, whether the incapacity contributed to their death.

The level of incapacity and the level of Disability Compensation Payment a person is entitled to are assessed using the Guide to the Assessment of Rates of Veterans' Pensions (GARP).    

Rejection of a claim for service pension

A person who has claimed service pension but has had that claim rejected, may be eligible for a pension or benefit from Centrelink. Such people should be advised to lodge a claim with Centrelink as soon as possible.

Subsequent claims following rejection of a claim

Where a claimant meets the eligibility requirements for service pension but a nil rate of payability is determined, the claim is to be regarded as rejected. When rejected, the claimant should be advised to apply for a commonwealth seniors health card. Claim form D3056 should be sent to the client along with notification of failure to qualify for a pension. Where the veteran's circumstances change and the income/assets subsequently allow some payability, a new claim is to be made. The new claim can be substantially based on the earlier claim documentation, but with an updated statement of income/assets and a new lodgement date. The date of grant of pension for the new claim will be the date of the informal claim, being the receipt of written or telephone notification of intention to reapply following a change in income or assets (provided the revised statement is received within three months).    

Delay in making a subsequent claim

Where the delay in a claimant providing an updated statement of income and assets exceeds twelve months, it is likely that other personal circumstances, in addition to income and assets, may also have changed during this time. Accordingly, in these cases a new claim form should be completed in full.

Right of review

A claimant may apply to the Commission for review of a determination of a claim.