What is our approach to award reviews?

Award reviews ensure that individuals receive the right award for their level of need, and are not being under or overpaid assistance. 

When carrying out an award review, case managers should:

• familiarise themselves with the case
• consider existing information where still relevant, and use previous decisions to avoid asking the client unnecessary questions when we already have the relevant information at hand to inform our decision making
• use the principles of decision-making that underpin our disability benefits system and all decisions, such as taking a trust-based approach
• make use of appropriate decision-making tools, where needed, to further reduce the need for intrusive questions
• in reviews that do require supporting information, take our usual approach to gathering that information, including taking a collaborative approach and establishing good cause, where appropriate
• refer to the ‘Scheduled Reviews’ chapter for guidance on choosing an effective date of decision for a scheduled review
• refer to the ‘Change of Circumstance - change in mobility or care needs’ chapter for choosing an effective date of decision for an unscheduled review due to change in needs being reported
• refer to ‘Choosing an appropriate review period’ chapter for guidance on what to consider when setting and justifying a review period as part of your decision.

Our reviews are not a quick check but a full decision covering what award the individual is entitled to and what review period is appropriate. Although there may already be information available to support the review, it should still be approached in the same robust way as any other decision. It is important to follow the steps in this guidance when making a review decision.

How much work a review decision will require depends on their complexity of the individual case.

Award reviews might be more complex due to, for example:

• The individual reports something unexpected, such as an unexpected change in needs, or a lack of change where a change had been expected
• A new reported condition interacts with existing conditions, making it hard to establish the individual’s new level of need
• The reported change in condition is relatively recent and the individual is still adapting to new treatment or their new level of need.

This list is not exhaustive.

Case managers should use both the:

• general approach when carrying out award reviews; and
• specific review scenarios

to determine what approach to take.