Clare Daly (Dublin North, Socialist Party)
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Question 166: To ask the Minister for Social Protection her views on the current procedure for claiming disability allowance, whereby claimants have to send their private medical records to a general address at the disability allowance department for their claim to be assessed, instead of attending a doctor appointed by the Department with their medical records and having their claim assessed on that basis; the percentage of disability claims that are denied; the percentage of denied claims that are appealed; the length of time the appeal process takes; the percentage of denied claims accepted during the appeals process; the percentage of all claims that are actually seen by a doctor; her plans to cut the initial waiting time for a decision to be made, which now stands at approximately five months; and if she will make a statement on the matter. [8335/11]

Joan Burton (Dublin West, Labour)
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Disability allowance is a weekly allowance paid to people with a specified disability who are aged over 16 and under 66. The disability must be expected to last for at least one year. To qualify, a claimant must satisfy a medical assessment, a means test and be habitually resident in the state.

The current procedure for determining if applicants satisfy the medical condition is that claimants submit a medical report completed by their doctor. The medical report is integrated into the application form for disability allowance. The medical report is desk assessed by medical assessors (MAs) who are qualified doctors employed by the department. This process involves the examination by a MA of all general practitioner and consultant reports provided on and with the application form. Following examination of all the available medical evidence, the MA provides a medical opinion of the claimant's eligibility for the scheme to a deciding officer. The deciding officer uses this opinion to assist in the decision as to a claimant's eligibility for disability allowance, taking account of the other eligibility criteria mentioned – income levels and residency.

All applications are desk assessed by a fully qualified doctor. However, in very exceptional circumstances, the medical assessor may decide that an in-person examination is required. In 2010, the number of disability allowance applications disallowed was 10,316. This represents 54% of all new disability allowance claims decided in 2010 and includes claims disallowed on income and residency grounds. Statistics are not kept of the numbers disallowed solely on medical grounds.

As regards appeals, the social welfare appeals office (SWAO) dealt with a total of 2,786 appeals in 2010. Of these, 2074 cases involved a refusal on medical grounds although there may have been multiple grounds for the refusal. Of these 2074 cases, 861 (41%) were allowed, 1196 (58%) were disallowed and 17 (1%) were partially allowed.

The average time taken to process disability allowance appeals decided by summary decision during 2010 was just under 31 weeks. The average time taken to process all disability allowance appeals involving oral hearings was just over 51 weeks. These processing times are calculated from the registration date of the appeal to the date of its finalisation. The times reflect all activities during this period including time spent by the Department providing comments by the deciding officer on the grounds of appeal put forward by the appellant, any further investigation by the Department's inspectors and any further examination or assessment by the Department's MAs that is deemed necessary in order to fully consider the appeal. A considerable period of time is added to the process when an oral hearing is required because of the logistics involved in this process.

As regards the processing of disability allowance claims, the processing time for individual claims may vary in accordance with their relative complexity in terms of the three main criteria which a claimant must fulfil in order to qualify. Certain claims have to be referred to social welfare inspectors for means investigation and this can add to the overall processing times. In addition, factors outside the Department's control can have an impact, for example, the supply of relevant information by the customer, employers or other third parties.

The average length of time to award a disability allowance claim in March 2011 was 16 weeks. People who have urgent income support needs while awaiting a decision on their DA claim can apply for the means tested supplementary welfare allowance (SWA) from their local Community Welfare Officer. The Department is committed to delivering the best possible service to its customers. Operational processes and procedures and the organisation of work are continually reviewed in all areas of the Department, including disability allowance section, to ensure that claims are processed and decided in the most efficient and expeditious way possible, having regard to the eligibility conditions that apply to each scheme.