Dáil Éireann Debate, Wednesday - 23 March 2022
128. Deputy Bernard J. Durkan asked the Minister for Social Protection the exact procedure followed within her Department when making an assessment as to whether a person meets the medical criteria for an illness-related payment; if the deciding officers who assess these cases are medical professionals; and if she will make a statement on the matter. [15384/22]
Amharc ar fhreagraDecisions in relation to entitlement to social welfare payments are bound by the relevant provisions of the Social Welfare Consolidation Act 2005 (as amended) and associated regulations. The legislation provides for an equitable, fair and transparent decision-making process in conjunction with the control of social welfare schemes. Every claimant is entitled to have their claim considered in accordance with the principles of natural justice and in the context of determinations of entitlement under social welfare legislation. A number of conditions must be satisfied in order to qualify for any payment - these vary according to the payment.
Deciding Officers are not medical professionals. They are officers with the power to make a decision on a social welfare claim made under the Social Welfare Consolidation Act 2005.
In order to make a decision in respect of Illness Benefit, the Deciding Officer takes a number of different factors into consideration, including legislation, information provided by the customer, their GP's opinion, and the opinion of the Department's Medical Assessor. Illness Benefit is a scheme designed to provide support to those who cannot attend work in the short term due to illness.
To qualify for a payment under the terms of the Illness Benefit scheme a person must be under pensionable age, satisfy prescribed PRSI conditions and be certified by a doctor as being incapable of attending work due to illness.
Based on the type of incapacity submitted by their doctor and the duration of the claim, claims in payment may be selected for review to determine continued entitlement to an Illness Benefit payment. In such cases the following process applies:
A form issues to the customer asking them to provide an update on their condition/circumstances by way of a self-assessment. Upon receipt, the Deciding Officer may decide that continued payment is warranted or to refer the case to one of the Department’s Medical Assessors for their consideration
If a case is referred to a Medical Assessor a medical report form issues to the customer’s doctor for completion. The Medical Assessor considers the form completed by the customer’s doctor and may decide to carry out a further medical review either by way of a telephone assessment or an in person assessment with the customer.
If the Medical Assessor's opinion is that the customer should be capable of work, Illness Benefit Section provides the customer with a further opportunity to forward additional evidence/observations on the findings of the Medical Assessor.
The Deciding Officer considers all of this information when making a final decision. The customer, if they are not satisfied, can appeal the decision of the Deciding Officer.
I trust the above clarifies the position for the Deputy.
