8.1.1.60 Deemed Claims

Summary

The deemed claim provision in section 13 allows the date of a contact about a claim for a social security payment (section 23(1)-'social security payment') or concession card to be taken as the date the claim is made, provided certain conditions are met.

Prior to 1 July 2001 the CSHC was the only concession card to which the legislation applied. Since then, the definition of concession cards includes HCCs and PCCs. As many of these concession cards are attached to payments and issued automatically, it is only the cards which require a claim to be made which are affected by the deemed claim provisions.

Act reference: SSAct section 23(1)-'social security payment'

Conditions for deemed claim

There are certain conditions that must be met if the date of contact is to be the date of claim for a payment or concession card:

• Centrelink must be contacted by, or on behalf of a person in relation to a claim,
• the person must be qualified on the date of the contact,
• generally, the person must lodge a claim within 14 days of the contact,
• if the person, or a person they care for, or their partner (1.1.P.70), is suffering from a medical condition having a significant adverse effect on the person's ability to lodge the claim, it may be lodged within 13 weeks after the contact provided the medical condition was continuous, or
• if special circumstances apply to the person's situation, which make it not reasonably practicable for the person to lodge the claim earlier, it may be lodged within 13 weeks after the contact, and
• Centrelink must give the person a written notice acknowledging the contact.

If these conditions are satisfied, the person will be deemed to have made their claim on the day on which they contacted Centrelink. If the claim is granted, the delegate must then go to SS(Admin)Act Schedule 2 to determine the person's start day. In most situations the start day will be the date of contact because the person's claim is taken to have been made on that day

Centrelink should ensure that people who have contacted Centrelink understand what they must do to take advantage of the deemed claim provisions.

Act reference: SS(Admin)Act section 13 Deemed claim (social security payment), section 14 Deemed claim (concession card), Schedule 2 clause 3 Start day - general rule

Contact by or on behalf of a person

Contact with Centrelink includes, but is not limited to:

• post,
• telephone,
• facsimile,
• computer equipment, such as by email, or
• other electronic means.

The intention is to allow anything that would be ordinarily understood as contact with Centrelink.

It is assumed that:

• a person making contact on behalf of another person in this context is authorised to do so, and
• Explanation: Unauthorised contacts will be detected through POI and verification requirements applied when the claim form is lodged. Authorisation does not need to be formal authorisation and people such as family members, a partner, or an advocate may be authorised to contact Centrelink on someone else's behalf.
• ANY contact that deals with assistance from Centrelink is a contact in relation to ANY payment for which the person is qualified. The person does NOT need to mention a specific payment or concession card.
• Example: Amir is 23 years old and has just finished working full-time so he can return to full-time study. He attends his local Centrelink office on 1 July 2002, and goes to the self help area. Amir selects a claim for YA and because it is immediately before closing time of the office, does not have time to complete it. Prior to Amir leaving the office he discusses his intention to make a claim with a Centrelink officer. Amir attends the Centrelink office again on 10 July 2002 to lodge his claim and supporting documents. His date of contact is 1 July 2002 because the date of his attendance at the office on 1 July 2002 was recorded.
  • It is important that a person who has contacted Centrelink in relation to a claim has this fact recorded. This will enable a written notice to be given immediately to the person or sent later by Centrelink to the person in relation to the making of the claim. Therefore it is also important that self help areas are well signed to encourage people to have their enquiry in relation to a claim recorded in order to take advantage of the deemed claim provisions.

Act reference: SS(Admin)Act section 13(4) Deemed claim (social security payment), section 14(4) Deemed claim (concession card), section 13 Deemed claim (social security payment), see subsections (1)(a), (2)(a), (3)(a) and (3A), section 14 Deemed claim (concession card), see subsections (1)(a), (2)(a), (3)(a) and (3A)

RapidConnect

Under RapidConnect, a person contacting Centrelink about a claim for NSA or YA (other) may be required to attend an interview with a JNM usually within 2 working days of initial contact.

Act reference: SSAct section 605(1) NSA:Requirement to enter into agreement, section 544A(1) YA:Requirement to enter into agreement

SS(Admin)Act section 63 Requirement to attend Department etc

Policy reference: SS Guide 3.2.1.40 RapidConnect- Impact on NSA Payability, 3.2.3.45 RapidConnect - Impact on YA Payability, 3.2.1.45 Exemption from Rapid Connect Provisions

Qualification on the day of contact

A claim CANNOT be deemed to have been made on the contact day if the person is NOT qualified on that day. If the person is NOT qualified, there is NO effect on the start day for the payment.

Explanation: Note that it is not necessary that the payment be payable on the day of contact for it to be taken as the day on which the claim was made. Payability is relevant to determining the start day of a payment but not the day on which the claim was made.

Explanation: The person may lose qualification for a period after contact on a day on which they were qualified, and before lodgement within the prescribed periods, without losing the right to have the date of contact taken as the date the claim was made. In these cases the person can be granted from the date of contact and, if appropriate, suspended for the period in which qualification is lost.

Qualification rules for individual payments as set out in Part 3 of the SS Guide should be applied.

Example: People claiming NSA would not be qualified for NSA on the day they cease full-time work. If a person phoned that day they would need to make contact again, such as by phoning back, or lodging a claim the following day.

If the contact is by mail or email, the delegate will retrospectively determine whether or not the person was qualified on the day of contact in the usual way.

If the contact is by telephone or in person, the staff member who deals with the person will not be in a position to formally advise whether or not the person is qualified. Therefore:

• the person must be advised to:
  • lodge a claim within 14 days after Centrelink was contacted, and
  • contact Centrelink again if there is any possibility that they are not qualified on the date of that contact but will be qualified on another date before they are able to lodge the claim.
• the standard letter acknowledging the contact will explain that the person must be qualified for a payment on the day of contact and will encourage prompt lodgement of a claim.

If a contact is made by fax or email the date the document reached Centrelink may be taken to be the date of contact even if it was not actually read by a staff member until a later date.

Explanation: The fax or email may have reached Centrelink on a weekend or public holiday.

Where there are multiple contacts the first contact date on which a person is qualified is the earliest date from which they may be paid provided all other conditions are met. Subsequent contact dates on which a person is also qualified may become relevant if the person does not meet the lodgement requirements for the first contact date. In such cases a new 14 day/13 week timeframe begins from the subsequent contact date.

If the person who has contacted Centrelink is disadvantaged by not being told of the need to lodge a claim by a particular date, or told not to lodge a claim, the case may be considered under Regulation 9 of the Financial Management and Accountability Act 1997 or the CDDA scheme.

Example: Tim is thinking about leaving his partner and taking the children with him. He contacts Centrelink on 1 July 2002 in relation to what assistance he may receive if he leaves his partner and is sent a claim and information in the mail (at his request). Tim leaves his partner and takes the children on 5 July 2002 and lodges his claim for PPS on 10 July 2000. His payment will start on 10 July 2002.

Tim was NOT qualified on the day he contacted Centrelink and as he did not recontact Centrelink between the time he became qualified and when he lodged his claim, his payments CAN ONLY be taken from the date his claim was lodged.

Act reference: SS(Admin)Act section 13 Deemed claim (social security payment), see (1)(b), (2)(b) and (3)(b), section 14 Deemed claim (concession card), see (1)(b), (2)(b) and (3)(b)

Lodgement within 14 days of the date of contact

The general rule is that a claim must be lodged on or before the 14th day after the date of contact with Centrelink.

Example: If the date of first contact is Tuesday 1 August, then the claim must be lodged on or before Tuesday 15 August.

If the 14th day falls on a weekend or public holiday, the next working day after the weekend or public holiday is taken to be the 14th day.

Example: Yvette contacts Centrelink to register an intent to claim on 11 April 2002 as she is now caring for her sick mother. She is qualified on this date. She does not get around to lodging her claim until 26 April 2002. If there are public holidays on 21, 24 and 25 of April (due to Easter and Anzac Day), Yvette is taken to have lodged her claim within the 14 days as the 14th day falls on a public holiday.

Lodgement within 13 weeks of the date of contact due to a medical condition

A claim may be lodged within 13 weeks of the date of contact if the delegate is satisfied that:

• between the date of contact and the date the claim was lodged, the claimant, their partner, or a person the claimant was caring for, was continuously suffering from a medical condition, and
• the medical condition or circumstances relating to it had a significant adverse effect on the claimant's ability to lodge the claim earlier.
• Explanation: Delegates should adopt a beneficial approach to the terms 'partner' and 'caring'. Anyone who is a partner for any other purposes under social security law is a partner for this purpose and the claimant may be taken to have been caring for a person for whom they were providing any significant support. A parent should be taken to be caring for a child.

Medical conditions must be supported by a medical certificate confirming that the condition was continuous between the date of the contact and the date the claim was lodged. The requirement that the medical condition be suffered continuously between the date of contact and the date of lodgement means that a medical condition caught after the date of contact does not allow any delay in the date of lodgement.

The medical certificate may also address the question of whether the condition had a significant adverse effect on the claimant's ability to lodge the claim. If the medical certificate does not answer this question, the delegate may determine the question.

Explanation: The test for this purpose is whether the condition had a 'significant adverse effect'. This sets a lower standard than the requirement in SS(Admin)Act Schedule 2, that a medical condition must be the 'sole or principal cause' of delay in lodging a claim. A medical condition that creates any real difficulty for the claimant in relation to any action required to lodge a claim may be regarded as meeting the requirement.

Example: Joseph broke his leg on 1 July 2002 and contacted Centrelink on the same day in relation to making a claim for a payment, as he is unable to do his normal job. Joseph is unable to catch public transport or drive a car. All Joseph's relatives live interstate and all his friends work full-time. The claim form is mailed to Joseph, which he completes. Joseph is unable to mail the claim back or attend a Centrelink office. Joseph finally lodges his claim on 15 August 2002 when his plaster is removed.

• Joseph is able to have his claim taken from 1 July 2002 (the date of contact which becomes the deemed date of claim) as the medical condition he was suffering had a significant adverse effect on his ability to lodge his claim. Joseph had a medical condition during the whole period.

Example: Ida separated from her husband on 1 July 2002. Ida contacted Centrelink on 5 July 2002 in relation to making a claim. When she contacted Centrelink her young daughter Kate had chicken pox. Ida was mailed a claim form. Ida lodges her claim on 20 July 2002:

• Ida's claim would be taken from 5 July 2002 (i.e. her date of contact). It is not possible for Ida to leave her sick daughter. It is also unrealistic to expect someone to mind the daughter while Ida visits Centrelink because the daughter has a contagious illness. However, if Ida had not lodged a claim until 5 or 6 weeks later, this would not satisfy the deemed claim provision as the child would have recovered from her chicken pox after approximately 3 weeks.

Act reference: SS(Admin)Act section 13(2) Deemed claim (social security payment), see subsections (2)(d), (2)(e), section 13(3) Deemed claim (social security payment), see subsections (3)(d), (3)(e), section 14(2) Deemed claim (concession card), see subsections (2)(d), (2)(e), section 14(3) Deemed claim (concession card), see subsections (3)(d) and (3)(e)

Lodgement within 13 weeks of date of contact due to special circumstances

A claim may be lodged within 13 weeks of the date of contact if the delegate is satisfied that there are special circumstances in the particular case which prevented the claimant from lodging the claim within 14 days of contact.

Special circumstances in which it may be reasonable to lodge a claim within 13 weeks of contact could include:

• a person having practical difficulties in meeting the 14 day time frame as a result of living in a remote area, or
• a person residing in a country with which Australia has a social security agreement, where there are reasons why the person could not lodge within the 14 day period, or
• Example: Where there are extended postal delays, and/or where the person was unable to lodge in time with the competent institution in the agreement country.
• an emergency interfering with a person's plans to lodge within the 14 day period, such as a natural disaster,
• Example: A person's home destroyed by a bushfire.

To determine if special circumstances apply to a situation, it is necessary to consider the totality of the circumstances relating to the particular case. If it is concluded special circumstances do not exist in a particular case consideration under Regulation 9 of the Financial Management and Accountability Act or the CDDA scheme could still be relevant.

Act reference: SS(Admin)Act section 13(3A)(e) Deemed claim (social security payment), section 14(3A)(e) Deemed claim (concession card)

Acknowledgement in writing

A claim CANNOT be deemed to have been made if the contact with Centrelink was NOT acknowledged in writing. However, if there was NO written acknowledgement from Centrelink, a retrospective acknowledgment can be issued if Centrelink is satisfied that contact was made in relation to the payment being claimed and that written acknowledgement of that contact is the only factor preventing the claim from being backdated.

Centrelink acknowledges all first contacts, either by giving the claimant a written notice immediately (if practicable where the contact is in person) or by using a standard letter as soon as practicable after the person contacted Centrelink and issues a second acknowledgement 2 weeks after the first, if there have been any further contacts and the claim has not been lodged.

Explanation: The acknowledgement may not have been sent immediately after the person contacted Centrelink because of a system breakdown or administrative error or the contact was made at a Centrelink office with no system access and the record of the contact has to be sent to a CSC.

If a contact was made but an acknowledgement was NOT sent, the acknowledgement should be issued for the purpose of meeting this requirement, as soon as the non-issue of the acknowledgement is identified.

Act reference: SS(Admin)Act section 13 Deemed claim (social security payment), see subsections (1)(c), (2)(c), (3)(c) and (3A)(c), section 14 Deemed claim (concession card), see subsections (1)(c), (2)(c), (3)(c) and (3A)(c)

Deemed claims & start days

Once a decision is made that the date of claim would be the date of contact under section 13, a decision can be made as to a claimant's start day in accordance with SS(Admin)Act Schedule 2, Part 2 that provides the rules for working out the start day. The general rule in clause 3 states that if the person is qualified on the day on which the claim is made, this day will be the start day.

Incapacitated claimants

Schedule 2, Part 3 provides exceptions to the general rule, where a person's start day may be earlier than the day on which the claim is made. Clause 11 provides an exception to the general rule in the case of incapacitated claimants.

Subclause 11(1) deals with situations where the claim is made within 5 weeks after the day the incapacity begins while subclause 11(2) deals with claims made more than 5 weeks after that day.

Example 1: Mr Brown contacted Centrelink on 15 April regarding the payment of SA. Mr Brown then lodged a claim for SA on 25 April. It is assumed Mr Brown has been qualified for SA at all times since becoming incapacitated for work as a result of a medical condition on 25 March. Section 13 can first be applied to deem the date of claim to be 15 April. Subsequently, Schedule 2, Part 3, subclause 11(1) can be applied to determine 25 March as the start day of Mr Brown's payment.

Example 2: Ms Jones contacted Centrelink on 9 November regarding the payment of SA. Ms Jones then lodged a claim for SA on 15 November. In the absence of conflicting evidence, it is assumed Ms Jones has been qualified for SA at all times since becoming incapacitated for work as a result of a medical condition on 30 September. Section 13 can first be applied to deem the date of claim to be 9 November. Subsequently, Schedule 2, Part 3, subclause 11(2) can be applied to determine 11 October as the start day of Ms Jones' payment.

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Last reviewed: 5 September 2011