Can You Appeal A My Aged Care Assessment Decision?

Can You Appeal A My Aged Care Assessment Decision?

If a My Aged Care assessment decision does not seem right, it can feel frustrating and confusing.

Families may know the older person is struggling with showering, meals, medication, mobility, memory, safety or carer pressure, yet the assessment outcome may not seem to reflect what is really happening at home.

The important point is that an assessment outcome is not always the final word. If you disagree with the decision in the Notice of Decision, you may have the right to request a review.

Key Takeaway

If a My Aged Care assessment decision seems too low, incomplete or inaccurate, do not ignore it. Check the Notice of Decision carefully, identify what was missed, gather supporting information and act within the review timeframe.

What Decision Are You Appealing?

Before challenging an outcome, it is important to understand what decision you are actually questioning.

After an assessment, the older person should receive a Notice of Decision. This letter outlines the assessment outcome and explains whether the person is eligible for government-subsidised aged care services.

If support is approved, the letter may also include a support plan or information about referrals and next steps.

Internal Review Comes First

If you disagree with the outcome in the Notice of Decision, My Aged Care explains that you can request an internal review of the decision.

An internal review means the Department checks whether the right decision was made based on the person’s situation, the information available and the law.

You can also provide new information to support the request.

How Long Do You Have To Request A Review?

My Aged Care says you must ask for an internal review within 28 days of receiving the Notice of Decision.

This timeframe matters. If the outcome does not seem right, do not wait until family pressure becomes unmanageable or services fail to meet the person’s needs.

Read the Notice of Decision carefully and follow the review instructions included in the letter.

How Do You Request An Internal Review?

My Aged Care says you can request an internal review by completing the Request for an Internal Review of a Decision form and submitting it by email or post.

You can also write a letter to the System Governor at the Department of Health, Disability and Ageing asking them to review the decision. The Notice of Decision should explain how to do this.

The review request should clearly explain which decision you disagree with and why.

What Information Should You Include?

The strongest review requests are usually specific.

General statements such as “Mum needs more help” may not explain the full situation. It is better to describe what happens day to day, what risks exist and what support is already being provided.

Why Assessment Outcomes Can Feel Too Low

An assessment outcome may feel wrong for several reasons.

Sometimes the older person minimised their needs. Sometimes family support was not fully explained. Sometimes the assessment captured a good day rather than the usual pattern. Sometimes important safety risks were not clear during the conversation.

Can You Provide New Information?

Yes. My Aged Care says new information can be provided to support an internal review request.

This is important because the review is an opportunity to correct missing or incomplete information.

Useful information may include notes from family, GP or health professional information, hospital discharge information, medication concerns, falls history, examples of personal care needs, carer stress or evidence that needs have changed.

What If Needs Have Changed Since The Assessment?

If care needs have changed since the original assessment, the issue may not only be whether the first decision was wrong.

The person may now need an updated support plan, reassessment or further discussion with My Aged Care.

This can happen after a fall, hospital stay, worsening confusion, increased personal care needs, carer illness, rapid decline or a change in living arrangements.

What Happens If You Still Disagree After The Internal Review?

If you do not agree with the outcome of the internal review, My Aged Care says you may ask the Administrative Review Tribunal for an external review.

The Tribunal is an independent body that can review certain Australian Government administrative decisions.

You generally cannot seek external review until the Department has completed the internal review.

Internal Review, Complaint Or Reassessment?

Families often use the word appeal to describe different problems.

But the right pathway depends on what has gone wrong.

What You May Really Be Trying To Decide

The surface question is:

Can you appeal a My Aged Care assessment decision?

But the deeper decision is often:

Was the real level of need properly recognised, and what should we do if it was not?

That is the real pressure point. Families are not usually looking for a technical review process. They are trying to work out whether the outcome is safe, accurate and strong enough for the person’s actual situation.

Decision Support: Before You Request A Review

Before requesting a review, organise the concern clearly.

Related Old Age Plan Articles

Next Steps With Old Age Plan

FAQ

Summary

You can request an internal review if you disagree with a My Aged Care assessment decision in your Notice of Decision. This is usually required within 28 days of receiving the notice, and you can provide new information to support your request.

The strongest next step is to identify exactly what was missed or misunderstood, gather specific examples, make hidden family support visible and act before the review timeframe passes.

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