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This topic explains the SA mail reviews. Phone reviews and rehabilitation reviews done by mail are covered in the referenced topics.
This topic covers the following:
Policy reference: SS Guide 6.2.5.60 SA - Field Reviews, 6.2.5.80 SA - Rehabilitation Case Reviews
All current SA recipients are reviewed by mail at 12, 40, 92 and 120 weeks, then every 16 weeks afterwards. A delegate may decide at any time, independently of the scheduled review process, that a review is necessary if there is information that suggests the recipient's circumstances have changed.
Examples: Recovery from an operation, expected return to work, payment of compensation, changed marital status.
Mail reviews are issued automatically and require a recipient to provide a TDR (1.1.T.160). A reminder list is produced 21 days after a review to:
The 2 parts of the mail review forms should be completed and returned within 21 days. If NOT a delegate cannot be satisfied that all eligibility criteria continue to be met. The following table shows the actions taken depending on when the parts of the review form are returned.
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If a recipient returns… |
Then… |
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no part of the form within 21 days, |
payment is: - suspended for 28 days, AND - cancelled if both parts have not been returned by then. |
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one part of the form within 21 days, |
they are advised that payment will: - continue for one more pay, AND - be suspended for 28 days. If both parts of the review form have not been returned by then, payment is cancelled. |
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both parts of the form while payment is SUSPENDED, |
payment is restored and arrears paid IF the delegate is satisfied that all eligibility criteria are met. |
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while payment is CANCELLED: - both parts of the form, OR - a medical certificate, |
payment is not restored. The recipient MUST lodge a new claim. |
These reviews are conducted to consider whether a recipient is still incapacitated for work, OR a change in circumstances has occurred.
Exception: 40 and 92 week reviews examine the most appropriate income support payment (SSAct section 23(1)-'income support payment') for the recipient.
The medical examination:
All mail reviews MUST be referred to a delegate for a recommendation on the recipient's temporarily incapacity for work. The recommendation should be accepted unless it contains an error of fact. If the recipient is:
SA continues while a review is conducted, subject to medical certificate coverage. If the recipient no longer qualifies for SA, payment is cancelled at the end of the review.
12 week reviews are undertaken to confirm recipient's eligibility for SA.
Recipients are usually examined by a job capacity assessor, UNLESS:
If a recipient is undertaking a vocational rehabilitation program that is to extend beyond week 208, DSP should be considered.
Except for recipients who are undertaking a vocational rehabilitation program, a mail review is issued after 120 weeks' payment. Further reviews are issued at 16 week intervals after completion of the previous review.
In assessing incapacity for work, it is essential that:
A JCA:
Act reference: SSAct section 667(3) A person is qualified for SA in respect of a period...
Policy reference: SS Guide 3.6.5.10 Qualification for SA, 3.6.5.40 Payability of SA, 3.6.5.30 Participation of SA Recipients in Rehabilitation Programs
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Last reviewed: 1 March 2010
