Kathleen Lynch (Cork North Central, Labour)
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Question 144: To ask the Minister for Social and Family Affairs the action he has taken to address the high number of decisions which are not upheld by the appeals office for payments where medical criteria were relied upon. [5246/08]

Martin Cullen (Waterford, Fianna Fail)
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A claimant who is dissatisfied with the decision of a Deciding Officer of my Department, including a decision based on medical criteria, may appeal it to the Social Welfare Appeals Office. In addition to affording customers the right of appeal, all customers who receive an adverse decision are advised of their right to have their claim reviewed by a Deciding Officer where new facts or fresh evidence comes to light. These procedures can enable a speedy resolution of the appeal as the Deciding Officer may make a revised decision on foot of the new evidence received. A requirement of confirmation of medical eligibility is critical in processing and maintaining Illness Benefit, Invalidity Pension, Disability Allowance, Occupational Injuries Benefit and Carers schemes.

The latest year for which appeals statistics are available, 2006, show that some 6,900 appeals were lodged in relation to these schemes, although some of these may have been in relation to non-medical conditions. It should be noted that this represents only a proportion of cases disallowed as many people do not appeal adverse decisions. Of the 6,900, almost 2,250 were revised by a Deciding Officer before proceeding to appeal. In many of these cases, the claimant had obtained additional medical evidence from their GP or consultant which formed the basis for a revised decision. In relation to the balance of cases, some 4,660, appeals were allowed in 1,523 cases, 113 appeals were partially allowed, 1,679 appeals were disallowed and 1,344 were withdrawn.

In cases which do proceed to the Social Welfare Appeals Office and where medical issues are involved, Appeals Officers, as well as taking account of reports from Medical Assessors of my Department, must also take account of medical reports furnished by the appellant and any other evidence including evidence adduced at an oral hearing where appellants have the opportunity to explain how they are affected by their condition. In total, 22% of decisions appealed in 2006 in relation to illness, disability or carer schemes were not upheld by the Appeals Office in 2006. This is consistent with the 20.5% of decisions not upheld by the Appeals Office in 2006 in relation to all schemes including those which have no medical criteria.