Dáil Éireann debate -
Tuesday, 5 Mar 1991

Vol. 405 No. 9

Ceisteanna—Questions. Oral Answers. - Social Welfare Benefits.

Paul Connaughton

Question:

7 Mr. Connaughton asked the Minister for Social Welfare if he has satisfied himself with many decisions given by medical referees in disability benefit cases where applicants are deemed fit for work but where it is obvious that persons are totally unfit for employment; the general directions which are given to such medical referees; if such guidelines are uniformally applied; if not, the action his Department have taken to rectify such matters; and if he will outline the terms of employment of medical referees.

Minister for Social Welfare (Dr. Woods):

Medical referees give an independent medical assessment which assists the Department's deciding officers in determining entitlement to disability benefit. When conducting an examination the medical referee is not making an initial diagnosis. He is providing a second opinion on the diagnosis of the person's own general practitioner and giving an independent assessment of the person's capacity for work.

All reports of examinations carried out by medical referees are submitted to the Department's chief medical adviser for approval. Detailed guidelines are issued by the Department to all doctors who participate in the medical certification scheme. The guidelines include full information for assessing and deciding incapacity for work as well as details of the medical referral system.

Every effort is made to ensure that the interests of persons referred for medical referee examinations are fully safeguarded. Their own medical certifiers are advised of the forthcoming examinations and invited to submit an appropriate medical report including references to any recent consultant examinations. In addition it is open to a medical certifier to attend an examination if he or she so wishes.

I am satisfied that the medical referee system is operating in a fair and reasonable manner and that the relevant guidelines are being fully complied with. Persons whose benefit has been terminated following assessment by a medical referee have a right of appeal. If they avail of this option, they are submitted for a second assessment by another medical referee. The number of cases going on appeal is an indicator of the way the system is perceived by the public. Following various changes that I made, the number of cases going to appeal dropped to 5,702 last year out of a total of over 55,000 examinations made by medical referees during the same year. This compares with a total of 8,169 appeal cases requiring a second medical examination in 1989.

An Ceann Comhairle:

The questions we are about to embark upon are governed by a pretty rigid time limit as laid down in our Standing Orders.

Mr. Connaughton:

In regard to a Priority Question I put down concerning the possibility of the social welfare scheme being extended to deserted wives and widows, you have informed me that that should be put before the Minister for Agriculture and Food. Why should something that has nothing whatsoever to do with agriculture and everything to do with social welfare be transferred to the Minister for Agriculture and Food? What has the Minister for Agriculture and Food to do with whether deserted wives or widows should get free beef? I cannot understand that position.

An Ceann Comhairle:

The Deputy has had a reply from me and it is for very good and cogent reasons.

Mr. Connaughton:

I cannot understand what the Minister for Agriculture and Food has to do with eligibility.

Dr. Woods:

It is an agricultural scheme.

Mr. Connaughton:

So, the Minister for Social Welfare has nothing to do with it?

Dr. Woods:

All we do is supply the information they require to operate the scheme.

An Ceann Comhairle:

If the Deputy wanted information he should have consulted my office in the matter.

Mr. Connaughton:

You did not consult with me until an hour ago, a Cheann Comhairle, so I could not do anything about it. I did not get that note in my office.

An Ceann Comhairle:

I shall look into every aspect of the matter to which you refer.

Mr. Connaughton:

I would be very grateful because I cannot see what the Minister for Agriculture and Food has to do with it.

An Ceann Comhairle:

I am completely satisfied about the replies from my office.

Mr. Connaughton:

I am not questioning that.

An Ceann Comhairle:

I would ask the Deputy not to waste time just now. This is priority time.

Mr. Connaughton:

Does the Minister share my concern about the treatment of some applicants for disability benefit at the heads of medical referees? It has happened that some referees differ in their interpretation from others and as a result recipients are deemed ineligible. In some cases doctors, consultants, etc., who have the same access to the applicant for disability benefit all agree that he is unable to work but for some strange reason the medical referees in the Department say that that person is able to work. Can the Minister give me some indication how than can happen?

An Ceann Comhairle:

I have to insist on brevity.

Dr. Woods:

This is why we provide a tripartite system. If a person is dissatisfied with the first medical referee we provide a second separate medical referee to give a separate opinion and that has been very beneficial. If a person then ends up in conflict with both of these medical referees there is an appeal system whereby a person can appeal to an administrative appeals officer. Broadly speaking, the system works very well. I accept what the Deputy says, that from time to time there are cases which to a Deputy in the field look a bit extraordinary when somebody is turned down. Normally in such cases a second medical referee will sort things out. Sometimes when a person is turned down it may be because he is nervous and does not explain the situation. As I explained, the doctor who is the certifier will communicate both verbally and in writing. The system is very fair but, as with any system, from time to time one will find cases where there can be difficulties but provision is made for that in the double appeal.

An Ceann Comhairle:

A final brief question from Deputy Connaughton.

Mr. Connaughton:

Is it acceptable to the Department for a person to bring their own medical practitioner with them when they go to the medical referee?

Dr. Woods:

Yes.

Mr. Connaughton:

That is not generally known.

Dr. Woods:

We have said it fairly often. I presume that most of the time the medical certifier may not want to go, but if he does, then he is completely free to do so. As I think I said in the reply, notification of this is sent out and the person is informed that it is possible to bring along the medical certifier. This would only arise in rare cases. Also, there may be a problem where the medical certifier feels it is time the person went back to work.

Mr. Connaughton:

That is a very important point. Where the medical certifier states on a medical certificate that that person was unfit and unable to work, is there anything to prevent a medical certifier from attending the appeal?

Dr. Woods:

No.