Legal Aspects Manual

0130.010.05 Handling Complaints From Claimant or His/Her Representative

If the Eligibility Specialist receives a complaint from the claimant or his/her representative, the Eligibility Specialist must:

  1. Review the complaint promptly and:
    • If the Eligibility Specialist can resolve the complaint, they should do so and record an EUMEMROL comment in FAMIS as to the issue and action taken, and discuss with immediate Supervisor.
    • If the Eligibility Specialist is unable to resolve issue, advise the individual that the complaint will be reviewed by the Eligibility Specialist Supervisor; and
    • Schedule a time for the Eligibility Specialist Supervisor to contact the complainant regarding follow-up.
  2. Forward this information as well as case record to the immediate supervisor, prior to scheduled conference with the complainant.
  3. Understand that the customer has the opportunity to discuss their complaint with the Eligibility Specialist Supervisor at any time.

The immediate supervisor will:

  1. Review the case record regarding the complaint issues; and
  2. Prepare for and schedule a conference with the Eligibility Specialist.

The Eligibility Specialist and the supervisor jointly decide upon the action to be taken.

The Eligibility Specialist will complete any necessary follow-up action, i.e.:

  • Notification of the individual of findings;
  • Record a complete, clear, and concise comment on EUMEMROL of the action(s) taken and resolution(s) reached; and
  • Submit the completed record to the immediate supervisor, for sign-off.