CCM4660 - Examinations: Pre-award or change of circumstances penalty cases: The claim or notification cannot be accepted

Where you do not accept the explanation provided we will reject the claim or notification of change of circumstances. You must consult your Band O manager and your manager will decide whether we charge a penalty.

The Band O manager will need to consider the type of discrepancy and the claimant’s behaviour which led to the incorrect claim – see CCM10710. In deciding the behaviour category of the penalty the Band O manager will take into account any explanation the claimant has given regarding the error. If there is not enough information to decide on the behaviour category or your manager is not certain there is at least neglect, either your manager or another Band O will need to contact the claimant to discuss why they made the error in their claim.

If your manager decides

• there is no fraud or neglect or
• considers the behaviour category is Failure to take Reasonable Care but the over-claim is less than £3500 or
• this case comes within the hardship criteria and the claimant cannot afford to pay a penalty

there will be no penalty. You (the Compliance Officer) must close the case as shown in CCM4335.

If your manager decides to charge a penalty the papers should be referred to a Band O caseworker to continue to work the case.

Action by Band O caseworker

Your first step is to make the S14 decision for pre-award cases or S15 decision for change of circumstances cases. You must write to the claimant(s) to let them know about your decision. You should always write to them even if you have spoken to them and explained the position on the phone.

For pre-award cases you must use the standard letter template TCC79. The letter explains that you will be rejecting the claim and they will soon receive a formal decision notice. It also explains we will be charging a penalty.

For change of circumstances cases you must use the standard letter template TCC89. The letter explains that you will be rejecting the change of circumstances. This letter carries the claimant’s appeal rights as no formal notification will be issued by the system. It also explains we will be charging a penalty.

In joint claims you must send a copy of the letter to each claimant.

If the claimant has authorised an agent to act for them remember to send a copy of the letter to the agent.

Once you have issued this letter you must then reject the claim or the notification of the change of circumstances – see CCOM20115 and then BF your papers for 30 days.

If the claimant appeals, see CCM4710. If the claimant does not appeal - see CCM4670

If the claimant objects to you charging a penalty – see CCM4730.