Document ID: chunk:federal_register_of_legislation:F2018L01496:body:0:p17
Version: federal_register_of_legislation:F2018L01496
Segment Type: other
Provision Reference: 
Character Range: 43996–46812

have been Finalised or Withdrawn in the same Reporting Period as the claim being re-opened.
    The treatment of re-opened claims distinguishes between claims that have been previously withdrawn versus claims that have been previously finalised:
(a)          Only re-opened claims that were previously withdrawn should be included in the main collection, as reflected on the various claims sheets. They are recorded as Claim Re-opened (subsequent to being withdrawn) in the reporting form. Claim Re-opened (subsequent to being withdrawn) should be treated like any other received claim and be classified as Withdrawn, Finalised or Undetermined, as may be the case.
(b)          Re-opened claims that were previously finalised should be excluded from the main collection. Instead, these claims together with additional related information should be reported in the SUPPLEMENT_REOPENED sheet of the reporting form. Where a claim is re-opened after a partial benefit has previously been admitted, it should be included in this category.
    Where a claim is re-opened in the same Reporting Period as it was originally received, or if it was re-opened more than once during the same Reporting Period, it should be reported only once during the relevant Reporting Period, reflecting the latest outcome or status.
    For DII, claims that have been terminated and are re-opened for a possible continuation of benefit payments should be excluded from re-opened claims. It is possible for a new DII claim to be submitted in respect of the same policy and Life Insured, e.g. where a significant period has passed since termination of a previous claim and/or where the cause of the claim is unrelated to that which applied before. Such claims should be considered as a new claim, to be classified as a Received claim and not a re-opened claim.
47.         'Claim Withdrawn' refers to the instance where a received claim is withdrawn and closed before being assessed and finalised. Note that a claim should be recorded in the 'Withdrawn by the claimant' category if the claimant returned to work prior to the expiry of a waiting period (where applicable).
48.         'Claim Finalised' refers to when the insurer has made a final decision on the claim (e.g. whether to admit or decline the claim) and communicated this decision to the claimant. The 'Claim Finalised Date' is the date on which the insurer's claim decision is communicated to the claimant. This is not dependent on payment to the insured having been made. Communication by email, text message, facsimile or telephone is deemed to have occurred on the date it was sent. Communication by postal service is deemed to have occurred three business days after it was sent.
    The Claim Finalised Date for DII refers to the date that the claim is admitted, declined or