Róisín Shortall (Dublin North West, Labour)
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Question 105: To ask the Minister for Social and Family Affairs if he is satisfied with the adequacy of procedures for determining social welfare claims in view of the fact that almost half of all appeals made to the Social Welfare Appeals Office in 2006 were successful; and if he will make a statement on the matter. [21098/07]

Martin Cullen (Waterford, Fianna Fail)
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Deputy Shortall shadowed me when I was the Minister for Transport and now she is the Opposition spokesperson on Social and Family Affairs. I congratulate her and wish her well.

The report to which the Deputy refers was produced by the Social Welfare Appeals Office, SWAO, of my Department in accordance with legislative requirements. It contains details of the activities of the office in 2006 as well as commentary on other issues which arose during the year. As previously stated by me on 29 June 2007, I welcome the continued commitment of the SWAO to provide an accessible and independent review mechanism for people who wish to appeal against decisions made by my Department.

My Department makes every effort to deliver entitlements to people in accordance with the legislation. However, considering that in 2006 my Department made over 1 million payments per week that benefit more than 1.5 million people, and received 1.75 million claims for statutory social welfare schemes, it is understandable that there will be some people who will not agree with decisions made on their entitlements. The 13,800 appeals received, when viewed in the context of the number of claims received is less than 1%, which is small. Of the 14,006 appeals processed in 2006, favourable decisions were made in 6,439 cases.

The report highlights that 46% of appeals had a successful outcome for the appellant. It refers to the fact that of the 6,439 favourable decisions on appeal cases, almost half of these decisions, 3,199, were in fact revised decisions made by statutorily appointed deciding officers of my Department, who reviewed the claim following the initial disallowance.

These revised decisions arose as a result, in many cases, of new facts or fresh evidence produced by the claimant after the original decision on his or her claim. In such cases an appeals officer decision was not necessary. In addition, it should be noted that of the 9,100 appeals actually decided by appeals officers, a total of 5,860,64%, upheld the original decision of the deciding officer.

Customers whose claims are disallowed or who are disqualified from payment or awarded social welfare at a reduced rate are informed that if they have any new fact or evidence that has a bearing on their case, they should send it in the first instance to the deciding officer for re-examination and, if appropriate, for revision of the decision. They are informed that this right is in addition to their right of appeal to the SWAO.

Additional information not given on the floor of the House.

They can seek a deciding officer review before making an appeal or can do both concurrently. The right of appeal to the SWAO remains an option if the review by the deciding officer is not fruitful.

The success of the deciding officer review process has been highlighted in a number of annual reports of the SWAO. In the annual report 2002, for example, the contribution which the deciding officer review process made in reducing the overall number of appeals that were received in the SWAO was noted. The 2005 annual report also highlighted the success of this strategy.

The role of the statutorily appointed deciding officer is to decide entitlement to statutory social welfare schemes and insurability of employment in accordance with the legislation. To assist deciding officers in their role, guidelines relating to all aspects of decision-making and social welfare legislation are issued and regularly updated by my Department. In addition, training is provided to deciding officers on their statutory obligations and the application of principles of natural justice and fair procedures.

The need for transparency in the decision-making process by deciding officers is also provided for in legislation. Regulations provide that decisions on social welfare claims must be set out in writing and, where the decision is unfavourable, the reasons for the decision must also be recorded and included in the notification to the person concerned. Therefore, when a deciding officer has reached a decision, which is unfavourable to the claimant, she or he must give the grounds for the decision, that is, the statutory condition which is not fulfilled; and the reason the grounds are not met.

The rules of natural justice and fair procedures are applied by deciding officers when making decisions that could have an adverse affect on the person concerned.

Given the legislative provisions and administrative guidelines and practices in place, I am satisfied with the procedures in place for deciding social welfare claims.

Róisín Shortall (Dublin North West, Labour)
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The annual report of the appeals officer which was published last June stated that a majority of the appeals heard were upheld. He referred to the serious problems arising from inadequate information being provided to clients on their entitlements. He drew attention to serious delays in the response from deciding officer to queries from his office. These are quite serious indictments. The appeals officer made a number of recommendations in his annual report. Does the Minister accept that his findings indicate that something is wrong down the line in the Department and in the decision process of deciding officers? Will he outline what action has been taken on foot of the appeals officer's report?

Martin Cullen (Waterford, Fianna Fail)
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When the number of appeals is put in context of the 1 million payments per week, I think the system is working extremely well. We can always learn from the issues that arise. There is constant contact between the officials from my Department and the Social Welfare Appeals Office to see how to improve and get consistency in the decision making process throughout the country. While there were more than 6,000 successful appeals, some 3,000 were made by the Department's deciding officers. In many of the cases, new information came to the fore, which allowed the deciding officer to make a different decision. Some years ago it was decided that an independent body was needed to deal specifically with appeals. We are encouraging our offices to make people aware of all information and to assist them in making their case in the first instance. We must remember that the Department deals with more than 1 million people per week throughout the country. The Social Welfare Appeals Office did not intend the report as an indictment of the Department. It simply highlights issues which need to be changed. Since the report was made, the officials in my Department and in the appeals office have enhanced procedures and training for staff throughout the country to try to achieve the consistency we would all like.

Róisín Shortall (Dublin North West, Labour)
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Does the Minister accept that there is a specific problem in respect of medical evidence? Most Members regularly come across the problem at constituency clinics of people with substantial medical difficulties who submit medical evidence but are refused the payment for which they are applying. The figures from the appeals office bear this out. Only 25% of appeals relating to disability allowance and only 15% of appeals relating to illness benefit were disallowed. The invalidity pension and injuries benefit figures are similarly poor. The issue of how medical evidence is viewed by officials of the Minister's Department and medical officers is a real one. I ask the Minister to examine this situation again, given the poor performance figures I have highlighted. This is a matter of concern to many people who have serious injuries or other medical problems. They are often subjected to excessive hardship by being asked for additional evidence from their medical practitioners and obliged to go through the appeals process. Hardship is imposed on people who already have medical problems. I ask the Minister to examine this area.

Martin Cullen (Waterford, Fianna Fail)
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This issue is encountered by all Members when we deal with people who have serious medical problems and are going through an appeals process. While the vast majority of appeals are dealt with satisfactorily, there are always some which are more complex. As a non-medical person, I find it difficult when one medical opinion gives one outcome and a second opinion gives a different outcome.

Róisín Shortall (Dublin North West, Labour)
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The vast majority of appeals are upheld.

Martin Cullen (Waterford, Fianna Fail)
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I am glad the Oireachtas appointed an independent body to make these assessments. I agree that it can be difficult for people who have serious medical conditions. I would like to see consistency wherever possible and I have raised this issue in the Department. We can achieve this by talking to the Social Welfare Appeals Office and I have done so. I would like consistency in the parameters adhered to by all social welfare offices throughout the country.