Correcting an error that leads to an overpayment
A case manager must conduct an unscheduled review (legally known as a determination without application) to correct an error (including an official error) that results in an overpayment (PADP Regs, reg. 42(1) )
Before correcting an error, case managers must make sure that there has not been any of the following:
- request for a re-determination (PADP Regs, reg. 42(1)(c))
- request for an appeal (PADP Regs, reg. 42(1)(d))
- fraud investigation started
The case manager should contact the appropriate team to establish this:
- re-determinations team
- appeals team
- fraud team
If a re-determination or appeal has been requested, but not yet been determined, then the case manager cannot make a determination without application.
Completing a determination without application involves correcting previous errors in order to work out the individual’s correct entitlement to PADP. This involves:
- considering all the entitlement criteria, including applying the backwards test. The chapter on the backwards test explains the test in more detail
- working out when the change in entitlement should begin
The case manager may use any or all of the following when completing the determination without application:
- information provided in the application that led to the original determination (PADP Regs, reg. 42(2)(a)(i))
- any other information obtained with that application (PADP Regs, reg. 42(2)(a)(ii))
- any other information that they have obtained in connection with the individual’s entitlement to PADP (PADP Regs, reg. 42(2)(b))
- any other information available to them that is relevant to their consideration of whether the individual is entitled to PADP (PADP Regs, reg. 42(2)(c)).