A person is always advised to lodge their claim for payment as early as possible to maximise the amount of backpay they can receive if their claim is granted. In addition to the general rules for backdating payments (see Chapter 4), special rules for backdating apply where a person has become “incapacitated for work” due to a medical condition.
Where a person claims a pension or allowance within five weeks of the date on which their incapacity began (usually the date of an injury or the date an illness began), payments may be backdated to that date (ie, up to five weeks).
Where a person’s claim for a pension or allowance was made more than five weeks after their incapacity began, payment can be backdated by up to four weeks if Centrelink is satisfied that:
A claim cannot be backdated where the delay in claiming is simply because the person did not realise that they were entitled to claim an income support payment.
If there is a delay in obtaining a doctor’s certificate, the claim should be made immediately and the certificate sent to Centrelink as soon as it becomes available. Similarly, where a waiting period applies, a person should still claim so that once the waiting period is over, the person can be paid as soon as possible (see Chapter 8 for further information on waiting periods).
Where a person claims after the five-week limit because a Centrelink officer wrongly advised the person that there was no need to hurry, the claimant may seek compensation for defective administration (see Chapter 53, section 2).
When a person claims Disability Support Pension (DSP), it may be wise to also claim Sickness Allowance or NSA (with an exemption from the “activity test”, see section 3) where:
When simultaneous claims are made, Centrelink will usually begin paying Sickness Allowance or NSA and, if the DSP claim is granted, will transfer the person to the pension. The person will then receive a back-payment of the difference between what they received from Sickness Allowance or NSA and what they would have received from DSP.
Where a person claims Sickness Allowance only and it turns out they were eligible for DSP, Centrelink should treat the claim for Sickness Allowance as if it was a claim for DSP and back-pay the pension to the date of the Sickness Allowance claim. This may only occur when a subsequent claim for DSP is made. However, it is safer to claim both Sickness Allowance and DSP from the outset.
Claims must be made by using the claim form available from Centrelink. Separate claim forms must be filled in if the claimant wants to claim both DSP and Sickness Allowance.
The claim will be assessed when the claimant has given a medical certificate signed by a doctor.
Where a person’s sickness or injury prevents them from going to a Centrelink office to make a claim, it can be made on their behalf by a relative, friend or other person.
Special rules about the date of claim for Sickness Allowance can apply where there is a telephone claim made by the person. These rules provide that:
then the person can be paid from the date of the telephone call. In other words, the phone “claim” (sometimes called an "intention to claim") can be treated as the first step in a claim for Sickness Allowance.
Medical certificates should be provided on a standard printed form available from Centrelink offices. Certificates that are not on the standard form may be accepted provided they contain all the information that the standard form requires. Payment may be delayed if all the details are not supplied as Centrelink may have to get the additional information from the doctor.
Certificates can only be given by a medical practitioner registered in Australia. They must be signed and dated by the practitioner. Certificates signed by naturopaths, chiropractors, acupuncturists, hypnotherapists or physiotherapists generally will not be accepted.
If the incapacity continues for more than the expected period of incapacity determined by the doctor or for more than 13 weeks, a further certificate will be required (see 4.5). Doctors who expect that an inability may last for more than 13 weeks may simply state that they expect the condition to continue to a date that is more than 13 weeks from the commencement of qualification for Sickness Allowance. A new certificate will still be required after 13 weeks.
Centrelink's consideration of any new claim for Sickness Allowance may involve referral to a Job Capacity Assessor (see Chapter 23, section 1.5).
Sickness Allowance can only be paid up to a maximum period of 13 weeks on any one medical certificate (see 2.4 for the exception where a person is in a rehabilitation program). The period during which a person is to be paid Sickness Allowance based on one medical certificate is called the “maximum allowance period”.
A person should be advised in writing of the need to lodge a new medical certificate. This advice should be given 28 days before the end of the “maximum allowance period”. A further notice should be sent seven days before the end of the “maximum allowance period”.
Payment of Sickness Allowance will be suspended in the two weeks after the expiration of the “maximum allowance period”. If a new medical certificate is provided to Centrelink within this two week period, payment will be restored and any arrears will be paid.
If no certificate is provided by the end of the two week period, Sickness Allowance will be cancelled and a new claim will be required. Where a person reclaims within four weeks of cancellation, then only an “abbreviated” claim form is required, no waiting periods are imposed and reviews (see section 5) are dated from the date the original claim was paid.
Where there is a gap of up to five days between the end of the “maximum allowance period” and the start of the new certificate, payment will be continuous.
When a new medical certificate is provided before the end of the previous “maximum allowance period” or during the two week period when Sickness Allowance is suspended, a new “maximum allowance period” of up to 13 weeks can be granted.
The “maximum allowance period” can be extended by up to four weeks where Centrelink considers that the person’s circumstances make it unreasonable to expect them to have obtained a new medical certificate before the end of the previous “maximum allowance period”. This extension is, however, solely for the purpose of giving time to provide a medical certificate.
Centrelink can extend the “maximum allowance period” by up to four weeks where the client has lodged a medical certificate but the Sickness Allowance was automatically cancelled due to some act (or failure to act) by Centrelink. For example, the new medical certificate may not have been processed in time by Centrelink.
Where a person does not lodge a further medical certificate before the expiry of their “maximum allowance period”, and none of the exceptions listed above to extend the “maximum allowance period” apply, a new claim for Sickness Allowance must be lodged for the person to qualify for further payments.
Where the new claim is within four weeks of cancellation: an “abbreviated” claim form is required, no waiting periods are imposed and reviews are dated from the date the original claim was paid.
Where the new claim is between four and six weeks of cancellation: a full claim form must be completed, normal waiting periods apply and reviews are dated from the date the original claim was paid.
Where the new claim is more than six weeks from cancellation: a full claim form must be completed, normal waiting periods apply and reviews date from the new claim.
Payment of Sickness Allowance may be delayed where a person has to serve one or more of the following waiting periods:
For information about waiting periods, see Chapter 8.
