Oireachtas Joint and Select Committees

Thursday, 7 December 2017

Public Accounts Committee

Comptroller and Auditor General 2016 Report
Chapter 16: Regularity of Social Welfare Payments
Chapter 17: Management of Social Welfare Overpayments
Chapter 18: Department Reviews of welfare Schemes, Social Welfare Appeals Process, Social Insurance Fund

9:00 am

Mr. John McKeon:

Of that growth, 15.3% of those claims were found to be ineligible on first review. When we did a fraud and error survey, all of those clients appealed to the appeals office that determination, and 15.3% succeeded at appeal. That is the figure before an appeal is taken into account, so that actually brought the net level down very significantly. I think the criteria for disability allowance is that a person must be substantially restricted in their ability to perform work which is suitable to their employment experience and education. That is a subjective assessment. We have very good medical assessors who are trained in occupational medicine. They reach a determination based on the evidence presented to them and the client is found to be ineligible. Often - and I referred to this in my opening statement - what then happens is that the client goes away to his or her consultant or doctor and gets additional evidence. If our medical assessor did not have that at the first review, it is reasonable then that when additional information becomes available, it would be reviewed either by the medical assessor or the appeals office and the decision should be reversed. That is a difficulty. We are working with various stakeholder groups in the illness and disability space to try to encourage them to get their clients to submit as much medical information at first claim. I do not want to give details on this, but, anecdotally, one or two of the stakeholder groups have made us aware that they almost advise their clients to hold back some information and keep it for the appeal. This just creates a situation whereby we are saying no at first appeal, and we need to fix that. That is fundamentally what is at issue.