asked the Minister for Social Welfare whether full medical examinations are undertaken by medical referees before decisions are arrived at to disallow disability benefit payments.
Ceisteanna—Question. Oral Answers. - Social Welfare Benefits.
2.
Medical referees provide a second opinion to that of the person's own doctor for the guidance of the Department's deciding officers and they carry out such medical examinations as are necessary in each individual case.
Every effort is made to ensure that the interests of persons referred for medical referee examination are fully safeguarded. Their own 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 certifier to attend a medical referee examination if he or she so wishes.
In carrying out examinations, the referee reviews the history of the case including the initial diagnosis already made by the person's own medical practitioners, considers any fresh reports received and expresses an opinion based on the results of his medical examination of the claimant. Where following the examination the claimant is deemed capable of work and appeals against a decision by a deciding officer disallowing payment of disability benefit, the claimant is normally referred for a second examination by a different medical referee. Medical referees are highly qualified professional medical personnel.
Where the "capable" finding is confirmed, the case is considered by an appeals officer who examines the case afresh and includes in his considerations any additional submissions received from the appellant or on his or her behalf.
I think it is clear from the procedures which are followed in these cases that a dissatisfied claimant is given every possible opportunity of putting forward evidence in support of his claim.
Will the Minister accept that in many instances the examination by medical referees is cursory? Would he also respond to the perception that is abroad that these medical referees may be under pressure to reduce the numbers drawing disability benefit? Will he further deal with the case of those people in receipt of disability benefit with complicated conditions for which they are being attended by consultants, and say whether medical referees who may have only GP qualifications are in a position to dispute the findings of the consultants who are treating the applicants in question?
I would like to make it clear that there is no question of pressure being applied to medical referees in regard to the decisions they make. The medical referees are under a medical adviser and a deputy medical adviser. They make their own decisions in their own way. What the Deputy may be referring to is the fact that because of improvements in the administration of the scheme people are referred on a more regular basis and this may give the impression that there is extra pressure being created. It is the improvement in the system which is bringing people forward at regular intervals.
As far as the medical referees are concerned, they make their decisions in a professional way. I would like to point out that medical referees are required to be medical practitioners who are registered in the general register of medical practitioners without holding an appointment. They must have at least six years satisfactory experience for appointment. They must also have the requisite knowledge and ability, including ability to communicate effectively. These decisions are made at the time of appointment and the appointments are independent. Finally, our panel of medical referees consists of one consultant physician, a doctor with a master's degree in psychology, members who are members of the faculty of occupational medicine, and three medical referees engaged currently in advanced courses. Most of the medical referees have been senior house registrars and have worked at junior consultant level. They have the technical qualifications and they make the decisions based on those qualifications.
A Cheann Comhairle——
A brief question please. I want to make some progress on other questions.
Could I ask the Minister if there are guidelines for the medical referees as to the definition of fitness for work? Some of the decisions that have emerged appear to be very perverse. What is the position regarding a manual worker who might be able to walk or write but obviously would not be fit for heavy work? What is the guideline in such a case?
The practice is that the person may be found to be unfit for work for quite some time because of a particular injury but in the longer term the person could be fit for some other kind of work. The question of long term disability may be raised at that point but it would be after a very considerable length of time. The Deputy mentioned the question of perceptions and I accept that there are various perceptions about this. I pointed out in the reply that, on their appointment, the medical referees are required to have the requisite knowledge and ability, including ability to communicate effectively. I have asked the staff development unit of my Department to make available to our medical referees the in-service training programmes which are available to all other staff in my Department who deal with the public. In-service courses are also provided by the Civil Service Training Centre and I will ensure that these also are made available to the medical staff as the needs are identified. The point I am making here is that initially this matter is covered at the appointment stage. There has not been an in-service training programme in operation but I am now making those facilities available to the medical staff.
There is a need for them.
3.
asked the Minister for Social Welfare if he has any plans to change the method of securing information from social welfare recipients with particular reference to interviews conducted by the special investigation unit; and if he will make a statement on the matter.
Information from social welfare recipients is secured by my Department in a number of ways ranging from the filling of forms to the furnishing of required information to officials, whether at offices of the Department or during the course of investigations outside of those offices.
Officers in the Special Investigation Unit have, as their main task, the duty of investigating cases of suspected abuse of the unemployment payments schemes. The abuse most often encountered is that of claiming, or being in receipt of, payments while working. Where there is reason to believe that an offence of this nature has been committed, the person concerned may be interviewed by an officer of the unit. The person is invariably made aware of the nature of the investigation and in general will also be cautioned that he is not obliged to say anything unless he wishes to do so but that anything he may say may be used in evidence.
Where, as the result of replies to questions put to him, it becomes apparent that there is, or has been, abuse of any of the social welfare schemes by him, the person is informed of the nature of the evidence held and of any statements or declarations made by him which have a bearing on the case. Any statement then made by him will be voluntary and, before signing it, he will be afforded an opportunity of reading over it and of making any alterations or amendments as he wishes.
Social welfare officers' reports and all statements obtained in the course of an investigation are submitted to a deciding officer where any question as to entitlement, or continued entitlement, to payment arises. If the person concerned is not satisfied with the decision of a deciding officer he has a right of appeal to an appeals officer. Decisions in these matters are not made by social welfare officers.
The interviewing procedures have been specifically devised to comply with basic legal requirements and to safeguard the rights of the person involved.
4.
asked the Minister for Social Welfare, given that out of a total combined workforce of 245 in three firms in the mining industry, 176 workers were claiming and being paid disability benefit while either working or on paid holidays between 1983 and 1987, the reason it took four years for this fraud to be detected; the steps he has taken to ensure that such irregularities do not occur in the future; and if he will make a statement on the matter.
Since 1986, and particularly since the present Government took office early in 1987, extra resources have been committed to the control of social welfare fraud and abuse in general and in the disability benefit system in particular. As a result the detection of fraud and abuse and the prevention of unwarranted claiming has increased substantially in 1987 and 1988.
There is now a very effective control system in operation. Given the resources now deployed on anti-fraud and abuse measures assisted by enhanced computer systems, I am satisfied that a rigorous system of checks obtains in regard to disability benefit claims. A system of random checking combined with specifically targeted examinations directed at areas which are perceived to be at risk ensures that a more thorough control is kept on fraud arising from concurrent working and claiming. I think the improved situation is best exemplified by comparing the number of new claims for disability benefit received in 1981 — over 290,000 — with those received last year — 180,000. This drop may be attributable to a number of factors but the control and anti-fraud measures have undoubtedly made a significant contribution.
In relation to the cases mentioned in the question, the Deputy will be aware that PRSI contribution records at an individual level are remitted after the end of each year and so it is only when these come to hand that it is possible to begin the job of comparing the work record of a person in a particular year with their claim record for that year. Thus, for example, PRSI contributions for the 1983-84 income tax year would only have been available to my Department for this type of specific analysis purpose from January 1985.
I should like to emphasise that the bulk of the infringements occurred in 1984, 1985 and 1986 and only a few small instances relate to 1983. Bearing in mind the description I gave of the timing of the arrival of the relevant PRSI data, there was nothing to indicate infringements of any significance until early 1986 when the full PRSI data for the 1984-85 tax year was available to the control staff.
Some of the infringements were very small. It was considered, however, that 113 cases should be prosecuted and, in fact, some of these cases are not yet completed, being on adjournment to court sessions coming up next June and July. For this reason I want to be careful not to say anything which might prejudice the outcome of the cases.
The programme of activities currently on hand is quite obviously yielding successful results and while it is not envisaged making any changes at this point in time, the system is kept under constant review and I will introduce appropriate new or improved measures as the need is perceived.
While accepting that there was a slight delay in PRSI records being submitted to the Minister's Department, could he say why there was such a long delay in detecting the payment of disability benefit when those records where received? Given that 71 per cent of the workforce concerned was involved, were the Department not in a position to see something unusual and carry out their own investigation? Is any legal action contemplated against the eight GPs who were involved in supplying certificates to these people who were working?
I feel I must alert the House to the fact that the time for priority questions is exhausted. Perhaps the Minister would give a brief reply.
The number of people claiming disability benefit in March 1987 was 82,000 and in 1986 it was approximately 80,000. It is now down to just over 60,000. I think the Deputy will realise that a great deal has happened in that timespan in terms of control. One of the principal matters relating to the question raised by the Deputy is the questionnaires sent to employers. They disclosed these particular cases. Having disclosed the cases, it was then a long, time-consuming task to investigate them fully and those investigations have led to a number of prosecutions.
The Deputy finally mentioned the question of the medical practitioners involved. It is extremely difficult to prove retrospectively whether a person was or was not sick on a particular day. It can often be easy enough to prove that the person was drawing a benefit and working on the same day. On the general question, obviously this matter led to a review of the practice in the particular cases and that review is still going on. It cannot be completed until the court cases are completed and that is one of the limiting factors. The procedure could involve a report to the Medical Council.