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OKAY, SO NOW THERE IS AN OVERPAYMENT, WHAT DO YOU DO?

Everything has been done to avoid an overpayment occurring; nevertheless, you have discovered one.  It's not necessarily Comcare's fault but, as we have to recover, we might be the perceived 'bad guys'.  To help ease this situation, try the following steps:

  • know your facts.  Be clear about how the overpayment occurred and how you can best explain this to the claimant.

  • ring the claimant and clearly explain what has occurred.  Where possible, invite the claimant into the office or go to see him or her.  Have easy to understand written information with you to support what you will say.  Follow up phone calls with letters, endorsing what you said.

  • clearly understand repayment options which are available to the claimant (particularly periodic or lump sum repayment from future incapacity entitlements, and write off criteria).

  • most people genuinely want to repay overpaid amounts.  However, also be aware that most of our claimants do not receive large fortnightly payments and repaying even $50 a fortnight can have a significant impact on their lifestyle.  And don't forget - it is a fortnightly amount being received, not a weekly amount, even though we tend to talk in terms of weeks.  While $20 a week may not seem to be much, it can be quite significant for a claimant in receipt of a small fortnightly payment.

  • negotiate a recovery that is reasonable from the claimant's perspective.  Even recovery at $10 a fortnight is better than either nothing at all, or placing the claimant in an untenable financial situation.  Give the claimant time to absorb that an overpayment has occurred.  He or she may then come back to you with a repayment solution.

  • do not pressure the claimant to make payments that may not be able to be afforded.

  • consider setting periodic diary reminders on PRACSYS (say, every 6 months or so) to advise the claimant about recovery progress, where the overpayment is quite large.  Just like you would want to know how the repayments on a house mortgage or car loan are progressing, so the claimant will be interested to know how the repayment of the overpayment is progressing.

  • above all, don't leave the overpayment to fester.  The later you leave it and the longer you take to advise the claimant, the worse things get.  And the stronger are the grounds for the claimant to formally complain.  Again, think about how you would feel if you were advised some 3 years after the event that you had incurred an overpayment.  The immediate reaction is one of disbelief, anger and frustration - all against Comcare, and you.

SOME CONSEQUENCES OF OVERPAYMENT

So, why is it in everyone's interests to avoid overpayments?  Take this case in point:

An employee suspects he has been overpaid and rings Comcare to advise that he believes this to be the case.  He is assured that he is being paid his correct entitlement.

Six months later, he rings Comcare with the same concern.  Again, he is assured that his payments are correct.

A review is conducted on the employee's claim some two years after concerns were initially raised by the employee.  A substantial overpayment is discovered, which has accumulated gradually over the period from when the employee first alerted Comcare to the potential error with payment.

Sadly, this is based on a true story.  Not only do we look incompetent, it also impacts on the many good things we achieve.  Unfortunately, people tend more to remember the bad things we do, rather than the good.

Things to do which really put us on the 'front foot'

  • Have another staff member experienced in incapacity calculations verify overpayment amounts before a claimant is advised what that amount is.  It's bad enough having to advise someone that an overpayment has occurred, but it's worse advising them of an amount which is later found to be incorrect.  None of us are infallible.  Have calculations checked, and by someone with the skills to understand complex benefit payments.  Even then, do not formally guarantee that the fortnightly payment being made to the claimant is correct.  This can never be guaranteed and should never be done.  Unforeseen circumstances may well in fact mean that the payment being made to the claimant still needs updating (such as the employer not advising of adjustments to Normal Weekly Earnings).

  • Consider advising the claimant by phone first, rather than only by letter where larger overpayments have occurred (those which might take some time to repay).   How would you feel if you received a letter about owing $3000 you did not previously know about?  While notification in writing is also necessary, letters can be quite impersonal and non caring, even if that is not their intention.  While it may be a bit harrowing to call the person to provide initial advice about an overpayment, it provides not only a personal touch and acknowledgement of responsibility on our part, it also provides you with the opportunity to clearly explain the situation in a sympathetic manner.

  • Acknowledge that you feel pretty awful having to advise that an overpayment has occurred for which recovery will be necessary.  Breaking news of an overpayment has to be one of the hardest things a Claims Manager has to do.  There is nothing wrong with showing genuine concern for what has occurred.  Own up to the problem over the phone and work out ways with the claimant to best achieve recovery.  Consider inviting the claimant into the office to discuss the situation.  Alternatively, take the time to go to the claimant where this is possible.  If you make the effort, the overpayment may still be an issue, but you will be remembered for handling the situation professionally and in a caring manner.

  • When talking to the claimant, do not blame other Comcare staff for the overpayment.  Even if the overpayment had nothing to do with you, we all work for Comcare.  If we have made a mistake, you should apologise on behalf of Comcare.  Passing the blame onto someone else won't make the claimant feel any better and may even make him or her more annoyed.