The IT system used by the Department of Social Protection to accept and process illness benefit claims is the Integrated Short-Term Scheme (ISTS) computer system. This system provides an integrated IT service for the administration, processing and generation of payments in respect of illness benefit claims. This system also handles the processing of claims for all short term schemes. The ISTS system is integrated with the Department’s Central Records System and communicates with other systems as necessary.
Illness benefit claims are submitted to the Department following the customer’s consultation with their general practitioner via a written application form (MC1). These claims are then processed by deciding officers of illness benefit branch using the ISTS system. Claims are decided by deciding officers appointed by the Minister under section 299 of the Social Welfare (Consolidation) Act, 2005. A written notification of the decision is issued to the claimant automatically by the ISTS system. The average claim processing time for illness benefit claims is one week.
The customer is required to continue to provide certified evidence of their incapacity which is generally provided on a weekly basis in the form of a certificate completed by the customer and their GP (MC2). The claim is maintained on this basis.
During the course of a claim to illness benefit, a customer may be asked to attend for medical assessment by a Departmental Medical Assessor for a second opinion as to whether they are incapable of work. The opinion of the Medical Assessor following this assessment is submitted to a deciding officer for consideration regarding the customer's continued entitlement to illness benefit. Any person who is dissatisfied with a decision made by a deciding officer of the Department, may, by giving notice of appeal to the Chief Appeals officer within the statutory time limit, have the question referred to an appeals officer for determination.
An appeal may be sent directly to the Social Welfare Appeals Office or may be handed in to any office of the Department for transmission to the Appeals Office. In illness benefit cases the question normally at issue is whether the person is incapable of work. When an appeal is received against a decision that a claimant is not incapable of work it is normally referred for a second opinion of a different Medical Assessor. If this Assessor considers that the appellant is incapable the case is referred back to the deciding officer for a revised decision.
If the 2nd Medical Assessor also expresses the opinion that the person is capable of work, the appellant is notified of the result of this examination and is supplied with a form on which to set out the complete and up to date grounds of his/her appeal. The deciding officer may revise his/her decision at this stage in the light of new evidences provided or the case is passed to the appeals officer for consideration. An appeals officer may decide to hold an oral hearing of the appeal and will invite the appellant to attend. On the other hand the appeals officer may be able to deal with the appeal on the basis of the written evidence provided. The appellant will be notified in writing of the outcome of the appeal. The appeals officer will take account of all available evidence, including medical reports furnished by the appellant and evidence adduced at any oral hearing if one is granted.