LEX 49179 - Administrative Release Documents - Page 1
Reasonable action to claim compensation 117-01010020
Currently published version valid from 10/01/2019 10:56 am
Background
This document outlines information about the requirement for customers or partners to pursue
compensation when they have had an injury, illness or condition for which they could claim
compensation.
Failure to claim compensation
A compensation affected payment (CAP) can be withheld if a customer or their partner fails to take
action to claim or obtain compensation. This procedure provides an overview of the requirement to
take reasonable action to claim compensation.
Failure to take reasonable action to claim compensation can be considered as a breach of section
1166 of the Social Security Act 1991 and may result in the customer (or their partner) having their
compensation affected payment (CAP) withheld. However, once reasonable action has been taken
to obtain compensation, payments can either be granted or recommenced.
Customer contact
Debt Management Officers (DMO) in the Compensation Recovery Team must contact the customer
if there are grounds to believe the customer has not claimed compensation or has withdrawn a
claim for compensation. The DMO should ask what action the customer has taken and the
customer's reason for the action (or lack of) prior to any decision being made. If the customer is
required to take further action to pursue their claim for compensation, an Enforcement of
compensation rights (s1166) (Q912) letter must be issued. A
Clearance s1166/s1167 Fast Note should be recorded detailing the customer contact and the assessment of whether the customer is
required to take further action to claim compensation.
Assessment and determination process
Once a claim for compensation has been lodged, it cannot be withdrawn. The claim must go through
the entire assessment and determination process. If the compensation payer decides that the
customer and/or their partner are eligible for compensation payments and they refuse to accept
those payments, their CAP can be withheld.
Acceptable circumstances for not pursuing compensation
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There are circumstances where it may be considered acceptable to not pursue a claim for
compensation. Each case must be verified by a DMO working in a Compensation Recovery Team
(CRT) before any decision is made that there is no requirement to pursue compensation.
Department of Human Services payments
The Department of Human Services will only make payments of a CAP where the compensation
payer denies liability, or where the amount received for periodic compensation is less than the rate
that they would be paid by the department. In these cases, the customer and/or their partner may
be entitled to a 'top-up' payment from the department.
Related links
Compensation Recovery Teams (CLK)
Compensation affected payments (CAPs)
Treatment of compensation payments for ABSTUDY
References
This page contains links to policy and legislation.
Policy
Guide to Social Security Law, 3.1.9.10, Compensation & Payability
Guide to Social Security Law, 3.1.9.20, Requirements to Pursue & Obtain Compensation
Guide to Social Security Law, 1.1.E.10, Economic loss compensation
For an explanation on the range of issues that affect the payability of a social security payment, see
Guide to Social Security Law, 3.1.6, General Payability Provisions
Legislation
Links to the Federal Register of Legislation site point to a 'Series' page which lists all available
historical versions. Navigate to the appropriate legislative reference(s) listed below by selecting the
‘Latest’ compilation at the top of the list.
Social Security Act 1991
section 1166, Secretary may require person to take action to obtain compensation
section 1167, Failure to comply with a requirement to take action to obtain compensation
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Training & Support
Related training packages in the Learning Portal (LMS) in ESSentials:
CLK00249 – Introduction to Compensation
To find the relevant course, add the course number to the Search field.
