Austin Deasy
Question:8 Mr. Deasy asked the Minister for Social Welfare his views on whether the present system whereby medical referees decide on the eligibility or otherwise of applicants for disability benefit is working satisfactorily.
Ceisteanna—Questions. Oral Answers. - Disability Benefit Payments.
I should like to point out to the Deputy that decisions relating to the claims for disability benefit are taken by my Department's deciding officers, not by medical referees.
Deciding officers are appointed under section 295 of the Social Welfare Act, 1981 to determine questions which arise under the legislation, including whether or not a person is entitled to disability benefit. To assist them in this, certain cases are referred to a medical referee for a second medical opinion to that of the person's doctor.
Medical referees are qualified medical practitioners. They are recruited by the Civil Service Commission and a condition of their appointment is that they must have at least six years experience in general medical practice.
In carrying out examinations, the medical referee reviews the history of the case, including the initial diagnosis already made by the person's medical practitioner, considers any fresh reports received and expresses an opinion based on the results of his or her medical examination of the claimant. It is open to the claimant's medical practitioner to attend a medical referee examination if he or she so wishes.
Generally, a person is regarded as being incapable of work if he or she is unable to follow his or her usual occupation. However, if a person is ill for a long time, the question of whether he or she may be capable of doing other types of work may arise. Individual factors are taken into account such as age, physique, and work history.
If, following examination by a medical referee, payment of disability benefit is disallowed because the person is not regarded as incapable of work, he or she may appeal the case to the independent social welfare appeals office. In these circumstances, the normal procedure is to first refer the case to a different medical referee to carry out a further examination of the person.
If the second medical referee is also of the opinion that the person is not incapable of work, the case is referred to an appeals officer to determine. The appeals officer considers all the evidence, the reports of the medical referees, the evidence of the claimant's doctor, any other medical report and the client's evidence. If the appeals officer considers the case requires it, he or she may arrange for an independent medical consultant's report to assist in determining the case. An appeals officer's decision is final and may be revised only in the light of new facts or fresh medical evidence.
I am satisfied that the medical referee examination system works in a satisfactory manner. The role of the medical referees is to provide my Department's deciding officers and appeals officers with advice on matters about which they have professional expertise. They do this in a conscientious and impartial manner.
I am sure all Deputies will join with the Minister in his efforts to get rid of abuse in the social welfare system. We agree that the Minister has done quite a good job in that regard. However, people can be over zealous in their efforts to get things right. Is the Minister aware that quite a few cases are coming to light that show that officials, in their efforts to get people off the unemployment register or the disability benefit list, as in this case, are making bad mistakes? Will the Minister see to it that officials in his Department scrutinise cases more closely to ensure that grave injustices do not occur?
The Minister in his reply referred to medical referees consulting with the applicant's family doctor. I know of a case where the medical referee absolutely dismissed the views of the applicant's family doctor. That is a very serious circumstance. Will the Minister examine cases like that more closely particularly when Dáil Deputies bring these cases to his notice by way of Dáil Questions? The Minister said that the decisions can be appealed, but I find that, even on appeal, there are grave miscarriages of justice. I will give one instance which I have mentioned to the Minister. It concerns a woman who was virtually crippled who was unable to get a disability benefit allowance.
The question of overzealousness does not arise in the case of the medical referee. It may arise in terms of the frequency of interviewing. Because of computerisation there is more frequent checking of people in relation to the illness recorded for them. That is the only change. The system remains the same and the medical referee has only a professional opinion to give.
In relation to the question of scrutinising cases more closely, when Deputies highlight specific cases, we ask the appeals board to look closely at them and take into account what Deputies have said. As the Deputy will know, in some cases people have not presented all the evidence or did not present their case very well. Every effort is made, particularly on appeal, to ensure that people have an opportunity to present a full case. At the end of the day there may be disagreement. At that stage we are really in the hands of the medical people concerned.
We have a disability benefit system which goes beyond a year. This is not common in other countries. In other countries at the end of six months or 12 months one either receives an invalidity pension or payments cease. We purposely maintained a system which goes beyond that because some people would not qualify for invalidity pension. Invalidity pension is there as an alternative for people who are seriously ill or handicapped in one way or another.
The appeals officers do their utmost to be fair and impartial. The office was set up last September or October and they are performing their function on behalf of all of us.
(Carlow-Kilkenny): Would the Minister agree that if the medical referee makes a decision, it is basically a closed shop and it is difficult to have it changed? I can give the Minister proof of that. I asked one of my constituents to get a further medical report from a leading specialist in a Dublin hospital. When I opened the envelope I noticed the specialist had written on it, “the Office of the Ombudsman”. As far as he was concerned he was wasting his time in that case. The specialist had found this person unfit for work but his letter was being completely ignored by the medical referee. When I contacted the Office of the Ombudsman later, following this case through, the Office of the Ombudsman told me that if there was a medical dispute he could not make a decision on it. I presumed that the report of a specialist in Dublin, who has all the modern gadgetry to carry out all sorts of tests, would take precedence over the report of a little busy body going down with his travel bag to a dark empty room in any office in the country, sitting opposite a person, smiling and telling him that he is fit for work. There is something wrong with the system. One gets a raw deal when going before a medical referee who says one is fit for work simply because one's hair might be looking well on that day.
There is an element which I should have explained. If a person has been on disability benefit for a year or more, a time arises when he may be considered fit for other types of work than the work he previously did. The decision at that stage could be that generally speaking a person is fit for other work though, perhaps, not for heavy work. That causes difficulties at times. There is misunderstanding of the system and how it operates. There are probably quite a few people in this House whom specialists would confirm as not being fit for work, certainly not fit for lifting anything and so on, but they would be fit for other kinds of work.
A Deputy
Some of them are not fit to be here.
Some of them are very good as TDs.
The Minister has alluded to the question I want to raise, that is the difficulty of the description by medical consultants of people being capable of light work. Very often, the person involved is a builder's labourer who has injured his back or leg. He might be able to type but that is of no significance as he has no qualification in that sphere. That is one of the difficulties which the system does not deal with. I think the Minister needs to examine that because manual labourers are regularly excluded from disability benefit because a consultant has said they are capable of light work. They are not qualified for light work, they are only qualified for heavy work.
Unfortunately, the problem is that system probably needs to be developed further. That person is taken, given a payment and trained for something else. Obviously, age is a factor but, theoretically, the person should be put on a FÁS training course. So far as the determination of the sickness is concerned, it is an accurate determination.
Some people would be illiterate while others would be semi-illiterate.
That is correct but it comes down to a question of what other work would be appropriate or suitable for them. This would mean having a much closer working day-to-day relationship with the people who find themselves in that situation.
May I say before proceeding that progress at Question Time today has been particularly sluggish? Some eight questions——
A Cheann Comhairle, this constitutes 25 per cent of our constituency work.
That is not good enough, Deputies. It is not fair to other Members who have questions tabled. I will call Deputy Byrne; I trust he will be brief. I will also call Deputy Connaughton and Deputy Deasy for a final question.
Would the Minister not accept that once a person is equipped with documentation from a specialist no GP on his panel should override it or attempt to instruct someone to go back to work on the basis that the GP is not equipped medically to overrule certification from a specialist?
Ultimately, the appeals officer is an administrative officer and takes all the circumstances into consideration, including the medical circumstances. That is one of his functions and is broader than the strictly medical one. I know that these are matters of real concern for Deputies, as Deputy Deasy said. Just like everybody else, I have sent cases on to the appeals office——
What rate of success has the Minister had?
I have not calculated it but I have generally found them to be fair although I could not agree with the decision in some cases. Perhaps these could have been sorted out with a bit more time in that one could have got more evidence but in deference to the points made by Deputies, I will arrange to have a discussion with the director of the appeals office on this matter to see if there are any improvements which could be made in that respect.
Let us have a final question.
Would the Minister inform the House of the terms of employment of medical referees and indicate if it is possible for an applicant who genuinely believes that he or she is not getting fair play to bring their own medical doctor with them if they request this?
Yes, it is possible for them to bring their own medical doctor. With regard to qualifications, a minimum six years experience is required. Among the medical referees there are the following: a consultant — one of the specialists we have been talking about; an occupational physician; a doctor with a Master's degree in psychotherapy — another difficult area — ten doctors who have done extra studies in occupational medicine; a doctor who holds a special diploma in occupational health, and two others who are studying for it at present. A minimum six years experience is required but quite a number have further qualifications.
(Carlow-Kilkenny): Is there anyone with a diploma in commonsense?
A final question from Deputy Deasy.
Is it theoretically or practically possible for a person who has been disallowed disability benefit to be granted an invalidity pension? I have a client who has been disallowed disability benefit but who for all practical purposes is an invalid.
This is possible if further medical evidence is brought forward which shows that there is a definite and real medical problem which will be of long duration. This could result from an appeal with regard to disability benefit. The area that the Deputy is mentioning in particular is that of back problems and the question of how much work a person can do if they have a back problem. There is no doubt that this is one of the great problem areas.