How to Appeal an Aged Care Assessment in Australia

Your parent's assessment result came back, and it doesn't match reality. They've been classified at a level that won't cover the care they need, or they've been denied services you know they require. The good news: assessment decisions are not final. Australia has a structured appeals process, and families use it regularly.

When to Request a Reassessment vs Filing a Formal Appeal

Before launching into the appeals process, understand the difference between a reassessment and an appeal — they solve different problems.

Request a reassessment when your parent's health has deteriorated since the original assessment. This is not disputing the original decision; it's saying the situation has changed. Contact My Aged Care on 1800 200 422 and request an urgent Support Plan Review. Provide specific evidence of the change — recent hospital admissions, new diagnoses, documented falls, a GP letter confirming decline. If the request is accepted, a new SAS assessment is scheduled.

File a formal appeal when you believe the original assessment was wrong — the assessor didn't accurately capture your parent's needs, relevant information was overlooked, or the Integrated Assessment Tool (IAT) produced a result that doesn't reflect the clinical reality. This triggers the formal review process described below.

Stage 1: Internal Review by the Assessment Organisation

Start by contacting the SAS organisation that conducted the assessment. Request an internal review of the decision in writing. Include:

• Your parent's Client Record Number
• The specific decision you're disputing (e.g., the classification level, the approved service types)
• Why you believe the decision is incorrect, supported by evidence
• Any information the assessor didn't have or didn't consider (GP reports, specialist letters, the functional diary you should have prepared)

The organisation must acknowledge your request and conduct the review within a reasonable timeframe. If the original assessor missed key information — for example, your parent was having a good day and underreported their difficulties — providing that evidence now can change the outcome.

Stage 2: Department of Health and Aged Care Review

If the internal review doesn't resolve the issue, escalate to the Secretary of the Department of Health and Aged Care. Submit a written request for a formal priority review, including:

• A copy of the original Notice of Decision
• The outcome of the Stage 1 internal review
• All supporting medical evidence
• A clear statement of why the decision remains incorrect

This is an independent review of whether the assessment process was followed correctly and whether the classification decision was reasonable based on the available evidence.

Stage 3: Administrative Appeals Tribunal (AAT)

If the Department's review still doesn't produce the right outcome, you can escalate to the Administrative Appeals Tribunal (AAT). The AAT conducts an independent merits review — it reassesses the entire decision from scratch, not just whether the process was followed.

AAT applications involve:

• A filing fee (fee waivers are available for financial hardship)
• A conference or hearing where both sides present their case
• The right to bring a support person, advocate, or legal representative

The AAT can substitute its own decision for the original, which means it can increase, decrease, or confirm the classification level. While the process takes longer, it provides the strongest avenue for overturning a decision you believe is fundamentally wrong.

How to Strengthen Your Appeal at Any Stage

The most common reason assessments understate care needs is insufficient evidence at the time of the original assessment. Strengthen your position with:

Medical documentation: A letter from your parent's GP or specialist that specifically addresses functional capacity using the terminology the IAT recognises — falls risk, cognitive impairment severity, Activities of Daily Living (ADL) limitations, instrumental ADL deficits.

Functional evidence: A completed 7-day diary documenting specific incidents — the day your parent couldn't manage the shower, the medication they forgot, the meal they burned, the time they got lost driving a familiar route. Concrete incidents carry more weight than general statements like "she struggles."

Third-party observations: Statements from existing care workers, community nurses, or allied health professionals who have witnessed your parent's decline firsthand.

Assessment day context: If your parent was having an unusually good day during the assessment, or if they actively minimised their difficulties (a common behaviour older Australians call "putting on a brave face"), document this with specific examples of what the assessor didn't see.

The Complaints Process for Provider Issues

If your complaint is about a provider rather than an assessment decision — quality of care, fees, staff behaviour, safety concerns — the pathway is different. Contact the Aged Care Quality and Safety Commission on 1800 951 822 or through their online complaint form. The Commission investigates provider conduct and can impose sanctions.

For both assessment appeals and provider complaints, the Older Persons Advocacy Network (OPAN) provides free, independent advocacy support. Call 1800 700 600 to be connected with your local advocate.

Getting the Classification Right From the Start

The strongest position is getting the assessment right the first time. Preparing thoroughly — with a functional diary, GP letter, and a support person who can provide additional context — significantly reduces the likelihood of needing an appeal.

The My Aged Care and ACAT Assessment Guide includes an assessment preparation checklist, a GP letter template, and appeal letter templates for each stage of the formal review process, so you have the tools to challenge a decision that doesn't reflect your parent's real needs.

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