Claims - rejecting: Rejecting a claim (Introduction)
A claim can be rejected at any time provided the claim
- is pre-award
- has not already been withdrawn.
The need to reject a claim may arise when you are
- capturing a claim
- working an entry on the Verification Failures work list or Incomplete Applications work list.
A family claim may need to be rejected if
- insufficient information has been provided by a customer to fully complete a claim or resolve a verification failure 28 days after requesting the information
- you establish that the customer doesn’t satisfy the eligibility criteria.
You must use one of the following functions to reject a claim
- CAPTURE APPLICATION
- REJECT APPLICATION for a verification failure.
If you use Function REJECT APPLICATION you must enter the reasons why the claim is being rejected, so that an appropriate message is entered on the Rejection Notice.
Note: There may be more than one reason why the claim is to be rejected. You must select all the relevant reasons.
Note: The Enter Reason for Rejection to be shown on notice field in the Rejection Application dialogue box, in Function REJECT APPLICATION is for use by Compliance and International teams only. Any entries made in this field are copied onto the Rejection Notice.
Note: If the claim is to be rejected because you haven’t had a response to your enquiries to resolve the verification failure, the reason for the rejection is the verification failure and not the fact that the claim is incomplete. An explanation message can be added to the Rejection Notice to let the customer know the decision is based on the fact that we haven’t had a response to our enquiries.
Note: If the claim is rejected because of the customer’s failure to provide you with the information you have requested within 28 days, and the information is provided after the claim has been rejected, you should treat it as a change of circumstances.
Note: Where the claim is being rejected due to no response and the customer is RLS, you must select the ‘Inhibit Rejection Notice’ box which will be displayed at the point of rejecting the claim.