IRT - Create an internal review case for compensation recoveries decision

DOCUMENT 34

IRT - Create an internal review case for compensation recoveries decision

This article provides guidance for Compensation Branch staff to:

• check authority to request an internal review
• create an internal review case for reviewing decisions relating to recovering an amount or special circumstances decisions relating to a recovery.

Recent updates

20 October 2025

New resource.

Before you start

You have:

• read and understood relevant sections of Our Guidelines (external), for example What are internal and external reviews?
• read and understood article [Understanding an internal review](#).

Check for a pre-existing internal review case

Prior to creating a new internal review case you will need check if there is a pre-existing internal review case or any open case enquiries in regards to an internal review.

Check authority to request an internal review

You will need to check if the person asking for an internal review has authorisation to do so. You can only start an internal review request from an authorised representative if they have valid consent to submit the request on behalf of the participant or applicant.

A directly affected party such as a compensation payer or insurer may submit a request without consent as they are not making the request on behalf of the participant. Refer to article Check consent, nominee, child representative or self-representation authorities.

You may receive an internal review request from:

• the participant

• their plan nominee or child representative
• a court or tribunal appointed decision maker
• a person who has express consent to act on behalf of the participant, this may include the participant’s legal representative or financial trustee
• another directly affected party, such as the compensation payer or insurer.

Validate consent

1. Navigate to the Person Account.

2. Select the Relationships tab.

3. From the Authorised Reps tab, in Roles & Relationships, confirm the person who requested the review is listed as an Authorised Person with a Status of Active.

   Note: Where the party requesting the review is not an authorised person within PACE, (the compensation payer or insurer), they will not have a relationship.

4. Select Check Authorities.

5. Make sure the Submit request to review a decision made by the NDIA (S100) authority is listed. If relevant consent authorisation cannot be verified, check Documents for any consent forms or legal orders that have yet to be processed. If a person has the correct roles and authorities, you can continue to the heading Validate the request lodgement date. If the person does not have the correct authorities, continue to step 6.

6. Make one attempt to contact the participant or their authorised representative to seek consent for the internal review to proceed. This attempt requires an SMS and either a phone call or email. If contact is successful and consent is not provided, or contact is unsuccessful, and you are unable to obtain consent, proceed to step 7.

7. Send the Internal Review Unauthorised Request Letter. Refer to the article IRT – Sending a manual letter.

8. Withdraw the Internal Review Case. Refer to the heading Withdraw an internal review case in the article IRT - Withdraw or cancel an internal review. A withdrawal letter is not required to be sent.

Create an internal review case

To create an internal review case, complete the following steps:

From the Person Account:

1. Select Cases tab.

2. Select New.

3. Select Internal Review, Review of a Reviewable decision.

4. Select Next.

5. Select relevant Case Origin.

6. From the New Case: Internal Review view, at Categorisation, for the Type select Compensation Recoveries Amount.

7. Log an internal note advising who requested the review and confirm they are a directly affected party using the template the below. Refer to article Log an activity or internal note.

   Requester is a directly affected party. Consent is in attached documents.

8. At System Information, in the Subject field, enter REC.

9. Select Save. The internal review will now show as Draft.

Initiate Request

From the Internal Review case:

1. Select Request tab.

From Initiate Request view:

1. Select Date review request received.

   Note: you can backdate the request by selecting a date in the past. If backdating, you must complete the mandatory free text field under Provide a reason why the request is being backdated and reference evi

dence.

2. At Who is requesting review?, select the relevant option. If the legal representative or compensation payer or insurer is requesting the review, select participant.

   Note: if selecting Authorised Representative, use Selected Contact field to record the relevant authorised representative making the request.

3. Select Next.

From Decisions view:

1. Select Decisions from SAP CRM.

2. At the Type drop-down list, select Compensation Recoveries Amount.

3. Select New.

4. At the Decision Name drop-down list, select Compensation.

5. Select New.

From the Reviewable SAP CRM decisions window:

1. At the Decision Name drop-down list, select the relevant option:

   • Recover an amount – select this option for a section 111 request. This will be a request for an internal review of a decision to recover a compensation amount under s111 of the NDIS Act.
   • Compensation payment – select this option for a section 116 request. This will be a request for an internal review of a special circumstances decision not to treat the whole or part of a compensation payment as not having been fixed by a judgement or settlement made under s116 of the NDIS Act.

Note: only select either of the above two options. Do not use the other 4 options in the dropdown menu.

Note: if a review of both an s111 and s116 decision, a separate internal review case will need to be created for each decision type.

2. At the Original Decision Date field, select the date the original decision was made. Confirm the correct original decision date by checking the date on the Recovery Notice or the Special Circumstances decision letter.

3. At Decision Reference, enter the Enquiry Case number that was created to record the original decision made by the Compensation Branch delegate, to give a Recovery Notice under s111 or the Special Circumstances outcome under s116.

4. At Original Decision User Name, enter the delegate name.

   Note: if original user is not showing, tick Unable to find original decision maker user ID. Record email address of original user in Decision user code.

5. Select Save.

6. Select Next.

From the Requests view:

1. In the Reason Information field, enter a summary of the request be specific about why the requestor is asking for a review, and what outcome they are expecting.

2. Select Save.

3. Select Next.

Add documents

You must add or link all documents that were used by the Compensation Branch delegate to make the original decision as well as any supporting evidence and relevant consent forms. Include as much information as possible about the original decision and the review request, including documents and file notes of phone calls containing relevant information. If further information is to be provided for the review, you’ll need to

record this in the request. All this information will allow for the review officer to better understand the review request.

1. For s111 Recovery Notice reviews, look at the Recovery Decision Form and the list of documents noted on here can be added or linked to the case, including:

   • Claim finalisation document - judgement, consent judgment, or deed/deed of release
   • Recovery notice
   • Recovery invoice
   • Recovery decision form
   • Medicare notice (if received)
   • Centrelink recovery notice (if received)
   • Statement of Claim
   • Heads of damages/Statement of particulars
   • Breakdown of Supports report
   • Updated Breakdown of Supports report with the same period
   • File notes of any phone calls containing information relating to pre- existing injury/recovery
   • Any emails containing information about pre-existing injury/recovery
   • Pre existing injury assessment
   • Medical evidence
   • Request for Technical Support outcome email.

2. For s116 Special circumstances reviews where it was decided not to treat the whole or part of a compensation payment as having been fixed by a judgement or settlement, look at the Request for Technical support (RTS) Submission and/or the Special Circumstances decision form (if there is one) and the list of documents noted on here can be added or linked to the case, including:

• Special circumstances request – this could be a Special Circumstances Application form (SCAF), a letter or email
• Supporting evidence provided with the special circumstances request or subsequent information provided
• File notes of any phone calls containing information relating to special circumstances
• Any emails containing information about special circumstances
• Statement of claim
• Heads of damages / Statement of Particulars
• Medicare notice (if received)
• Centrelink recovery notice (if received)
• Financial evidence (if applicable)
• Special Circumstances Decision Form (if applicable)
• Special Circumstances Outcome letter
• Request for Technical Support submission
• Request for Technical Support outcome email
• Breakdown of Supports report
• Updated Breakdown of Supports report with the same period.

From Documents view:

1. Select Add Documents to upload new documents. For more information, go to article Add documents to a case.

   Note: you must attach supporting evidence and include as much information as possible about the review request. This will allow the review officer to better understand the review request.

2. Select Next.

Risk matrix

From Risk Matrix view:

1. Select Yes or No when asked Has there been any risks identified that may impact the participant, no minee or NDIS associated with this request?. If you select No, continue to step 5.

2. If Yes, select the risks that most closely matches the risk you’ve identified.

3. Select Yes for each risk you identify, select No for the risks that aren’t applicable.

4. Select LOW, MEDIUM, HIGH or EXTREME for each of the risks you select. Select the level that most closely matches the risk you’ve identified.

5. Once you’ve completed the form, select Next.

Depending on the risks you’ve selected, PACE may prompt you to add further information about the identified risk.

Request summary

From Request Summary page:

1. Check the recorded information.

   Note: if any information needs to be corrected or added, select the relevant section to return to and enter the update.

2. If everything is correct, select Next.

Submit internal review request

From Submit Internal Review Request view:

1. If applicable, complete the Call Notes free text field.

2. Select Submit. The status of the internal review will change to New.

Note: once you select the Submit button, the Case Owner will show as PSR Intermediate System Queue. Refresh the page and then the Case Owner will change to Internal Review Routing Queue.

Next steps

The internal review will be automatically routed to the internal review routing queue to be allocated to a review officer with the appropriate skill tags to complete the work.