Dáil Éireann - Volume 654 - 14 May, 2008

Priority Questions. - Social Welfare Appeals.

Deputy Thomas P. Broughan asked the Minister for Social and Family Affairs how she proposes to address the high number of claims involving a medical decision that are initially refused but then allowed on appeal. [18604/08]

  Deputy Mary Hanafin: My Department processes almost 2 million applications for benefit, pension or allowance each year, only a small percentage of which result in an appeal to the social welfare appeals office. A claimant who is dissatisfied with the decision of a deciding officer of the Department, including a decision based on medical criteria, may appeal it to the social welfare appeals office. In addition to affording customers the right of appeal, all [352] customers who receive an adverse decision are advised of their right to have their claim reviewed by a deciding officer where new facts or fresh evidence come to light. These procedures can enable a speedy resolution of the appeal as the deciding officer may make a revised decision on foot of the new evidence received without the necessity to go through the appeals mechanism.

Confirmation of medical eligibility is critical in processing and maintaining illness benefit, invalidity pension, disability allowance, occupational injuries benefit and carers schemes. Figures for 2007, the latest year for which appeals statistics are available, show that 7,400 appeals were lodged regarding these schemes, although some of these may have related to non-medical conditions. It should be noted that this represents only a proportion of cases disallowed as many people do not appeal adverse decisions. Of the 7,400 appeals, almost 2,400 were revised by a deciding officer before proceeding to appeal. In many of these cases, the claimant had obtained additional medical evidence from his or her GP or consultant which formed the basis for a revised decision. In the balance of cases, almost 5,000, appeals were allowed in 1,767 cases, 147 appeals were partially allowed, 1,907 appeals were disallowed and 1,222 were withdrawn.

In cases which proceed to the social welfare appeals office where medical issues are involved, appeals officers, as well as taking account of reports from medical assessors of the Department, must also take account of medical reports furnished by the appellant and any other evidence, including evidence adduced at an oral hearing where appellants have the opportunity to explain how they are affected by their condition.

  Deputy Thomas P. Broughan: Is it not astonishing that almost half of the social welfare appeals were allowed in the system the Minister outlined? Up to 56% of invalidity pension appeals were fully allowed, 53% of occupational injury appeals were fully or partially allowed and 33% of respite care grants were allowed. Are these not very significant figures? Do they not put the spotlight on the frontline deciding officers? Is the Minister happy there is adequate training and guidelines for deciding officers? The Minister said that a deciding officer can do a review at the point of appeal but how often does that happen? Are there many more cases in addition to the 14,000 cases the Minister read out where an appeal is already operating?

Is it not true that many appeals relate to what one might call borderline injury benefit disability allowance type claims? There were 19,989 applications for disability allowance in 2007 and 2,754 appeals. That is a very significant and striking number. In these borderline cases, particularly where there is a medical element, do we need a new system? Anybody who has had long experience of this area, such as the four Deputies present, probably decided long ago that we should have an independent appeals system. Has the Minister thought about that? Does she believe there should be a statutory independent appeals system and will she take that initiative in her administration?

  Deputy Mary Hanafin: I am interested in the figures Deputy Broughan cited on disability allowance. Although he is correct in saying that 2,754 cases were appealed, of that number, 700 were not allowed and 568 were withdrawn.

  Deputy Thomas P. Broughan: However, 530 were approved so those people would have got no benefit.

  Deputy Mary Hanafin: That is the advantage of having an appeals process and it is an important part of the process. Given that 2 million applications are made every year, I thought the number of appeals was small. The major difference in making the appeal is that one is allowed to enclose additional medical information with the appeal. Sometimes that makes the [353] difference. Often people do not supply sufficient medical information in the first part of their application and when invited to send more it seems to make the difference. I cannot comment on putting social welfare appeals on a statutory basis.

  Deputy Thomas P. Broughan: Perhaps the Minister will review and look into it. Will she come back on the two points I raised, namely, whether she thinks we need better guidelines and more training for frontline officers, the people who make that decision, given that sometimes Deputies hear complaints that people were not listened to? For example, in the recent huge increase in the number of people seeking jobseeker’s benefit, I received those kinds of complaints. What is the total cost to the Exchequer of the appeals system?

  Deputy Mary Hanafin: Ongoing professional training is an important part of the work of the frontline people, particularly medical assessors. Medical assessors are full time, fully qualified and registered people. Medical education is carried out by national and international experts to ensure they are on top of their jobs. That is important, particularly in the area of disability. Some decisions on whether a person qualifies can be made as a desk examination based on the information supplied. Other applications require further information because of an examination. That is a central part of it. I have a figure of €539,500 for the cost of the appeals system.

  Deputy Thomas P. Broughan: Is that it?

  Deputy Mary Hanafin: I am not sure I am referring to the correct figure.

  Deputy Thomas P. Broughan: Perhaps the Minister will come back to us on that.

  Deputy Mary Hanafin: I will check the budget for the whole appeals process.