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Business Processes

Published Date: April 02, 2013
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Eligibility Determination and Benefits Calculation

Change in Circumstances

E10. Workflow 1 - Learner Overpayments

After a learner’s Income Support application has been assessed, their circumstances may change. Once the new evidence is created/applied, Workflow 1 (WF-1) – Learner Overpayments is automated. This workflow includes a reassessment that can result in an overpayment, underpayment or no change in the learner’s benefits. If an overpayment is incurred, the learner is notified and advised of appeal options.

Note
WF – 1 also includes Post-Verification and Training Provider Overpayments, but these workflows are described elsewhere.

Description

The following outlines the details of WF – 1 – Learner Overpayments.

Details

Pre-Condition(s)
Learner Income Support application has been assessed and there has been a change in their circumstances that may affect their benefits calculation.

Trigger
New evidence has been entered and applied and the Product Delivery Case (PDC) has been reassessed.

Mobius (Workflow 1 – Learner Overpayments)

E10.02.01
Automatically creates Liability (Overpayment) Case.

E10.02.02(a)
Calculates cumulative total of overpayments in the open Service Plan.

Employment and Financial Supports Division – Learner Income Support Office (LISO) Learner Benefit Coordinator

E10.02.02(b)
Manually generates Funding Decision (FD). (Correspondence content differs depending on whether overpayment amount is less than $500 or >=$500).

Mobius

E10.02.02(c)
If overpayment is =>$500, automatically generates a task to the LISO Overpayments work queue 40 days after date of FD correspondence (when appeal period is exhausted).

E10.02.02(d)
Resends task to the LISO Overpayment Escalation work queue if not cleared in 7 calendar days.

Employment and Financial Supports Division – LISO Learner Benefit Coordinator

E10.03
Reserves task.

E10.04
Checks notes on Integrated Case to see if there is no appeal, appeal pending, appeal withdrawn or appeal completed.

E10.05.01
If no appeal or appeal is withdrawn enters task comments and closes.

E10.05.01(a)
Copies and pastes task comments on Integrated Case Notes.

E10.05.01(b)
Activates Liability Case (and sets up recovery amounts).

E10.05.01(c)
Manually initiates Crystallized Debt, Statement of Debt and FD correspondence.

E10.05.02
If appeal pending, enters task comments and closes.

E10.05.02(a)
Copies and pastes task comments on Integrated Case Notes.

E10.05.02(b)
BF’s for outcome of appeal.

E10.05.03
If appeal has been completed and outcome is “Reversed” or “Varied” enters task comments and closes.

E10.05.03(a)
Copies and pastes task comments on Integrated Case Notes.

E10.05.03(b)
Adjusts/applies evidence.

E10.05.03(c)
Reassesses Product Delivery Case.

E10.05.03(d)
If adjusted evidence results in a cumulative overpayment =>$500, activates Liability Case (and sets up recovery amounts).

E10.05.03(e)
Manually initiates FD, Crystallized Debt and Statement of Debt correspondence.

E10.05.04
If appeal has been completed and outcome is “Confirmed” enters task comments and closes.

E10.05.04(a)
Copies and pastes task comments on Integrated Case Notes.

E10.05.04(b)
Activates Liability Case (and sets up recovery amounts).

E10.05.04(c)
Manually initiates FD, Crystallized Debt and Statement of Debt correspondence.

Business Rules/Criteria/Standards

When it is determined that a learner has been overpaid, the amount owing is considered an “overpayment” and the learner is given the option to appeal. If the learner doesn’t appeal within the timelines, or they do appeal but the appeal is upheld or varied, the “overpayment” is crystallized and becomes a “debt”. The recovery process is then initiated. For active learners, $35 (for singles) or $65 (for families) per month is deducted from future payments. If the learner is no longer receiving Income Support payments (and they have not made another application within 90 days of their last training end date, the debt is transferred to the Recoveries System for collection. The exception is if there is a Repayment Agreement. This amount is immediately crystallized into a debt as there is no appeal option.

Statement of Debt is enclosed with Crystallized Debt correspondence and can also be manually initiated upon request by learner.