Bernard Durkan (Kildare North, Fine Gael)
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127. To ask the Minister for Employment Affairs and Social Protection the Departmental regulations or legislation which govern and guide deciding officers when assessing medical evidence submitted by an applicant as part of an application for disability allowance and invalidity pension; the length of time such regulations and or guidelines have been in place; if recent changes have taken place in respect of same; and if she will make a statement on the matter. [15383/22]

Heather Humphreys (Cavan-Monaghan, Fine Gael)
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Decisions 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.

I will set out the main provisions to assist the Deputy; however, this is for information purposes and should not be considered a legal interpretation.

The legislation regarding eligibility for Disability Allowance is set out in section 210 of the Social Welfare Consolidation Act 2005, as amended. The relevant regulations are in sections 137-140 of the Social Welfare (Consolidated Claims, Payments and Control) Regulations 2007.

Following a recommendation in the Make Work Pay (for people with disabilities) report, a change in the legislation was introduced in 2019, which removed the requirement that work must be ‘rehabilitative’ in nature, in order for persons in receipt of Disability Allowance to take up employment.

There have been no recent changes in respect of the medical evidence required for this scheme in legislation or regulations.

The legislation regarding Invalidity Pension is sections 118-122 of the Social Welfare Consolidation Act 2005. The relevant regulations are in sections 76-78 of the Social Welfare (Consolidated Claims, Payments and Control) Regulations 2007.

There have been no recent changes in respect of the medical evidence required for this scheme in legislation or regulations.

Under the provisions of Section 311 of the Social Welfare Consolidation Act 2005, if a person is dissatisfied with a statutory decision of the Department including the outcome of a review, they can submit a request for an independent appeal of the decision to the Social Welfare Appeals Office.

Bernard Durkan (Kildare North, Fine Gael)
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128. To ask the Minister for Employment Affairs and 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]

Heather Humphreys (Cavan-Monaghan, Fine Gael)
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Decisions 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.

Bernard Durkan (Kildare North, Fine Gael)
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129. To ask the Minister for Employment Affairs and Social Protection when assessing if a person is permanently incapable of work for the purpose of an application for invalidity pension, if due regard is had for the age, experience and qualifications of the applicant when making a final decision; and if she will make a statement on the matter. [15385/22]

Heather Humphreys (Cavan-Monaghan, Fine Gael)
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Invalidity Pension (IP) is a payment for people who are permanently incapable of work because of illness or incapacity and for no other reason and who satisfy the pay related social insurance (PRSI) contribution conditions.

A person is regarded as being permanently incapable of work if;

For the period of 1 year immediately before the date of application the person had been continuously incapable of work and a Deciding Officer (DO) or an Appeals Officer (AO) is satisfied that the person is likely to continue to be incapable of work for at least another year,

OR

A Deciding Officer (DO) or an Appeals Officer (AO) is satisfied that the likelihood is that the person will be incapable of work for life.

When making a decision Deciding Officers are bound by the Social Welfare Acts and Regulations. This legislation includes provision for the DO to seek the opinion of a Medical Assessor (MA) in respect of whether or not a person satisfies the medical conditions for schemes such as IP, which include a medical qualifying condition.

When assessing an Invalidity Pension claim, an MA assesses the work capacity of the claimant for all categories of work in terms of job effort and skill level. In the assessment, the MA will consider the claimant’s impairment i.e. the illness or accident and the symptoms, investigations, treatment received to date and the prognoses of the condition(s). The MA will also consider any co-morbidity, in addition to their primary medical condition.

Where an MA provides an opinion, the DO shall have regard to that opinion in deciding if the person is permanently incapable of work. Both the MA and the DO take into account the vocational and educational experience of the claimant as well as their age and medical conditions when deciding if sufficient evidence has been provided to satisfy the qualifying criteria for IP.

I hope this clarifies the position for the Deputy.

Bernard Durkan (Kildare North, Fine Gael)
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130. To ask the Minister for Employment Affairs and Social Protection the circumstances within which section 76(1)(a) of the Social Welfare (Consolidated Claims, Payment and Control) Regulations 2007 can be disregarded by a deciding officer when assessing an applicant’s medical eligibility for invalidity pension; and if she will make a statement on the matter. [15386/22]

Heather Humphreys (Cavan-Monaghan, Fine Gael)
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Invalidity pension (IP) is a payment for people who are permanently incapable of work because of illness or incapacity and who satisfy the pay related social insurance (PRSI) contribution conditions.

The legislation referred to relates to the definition of permanently incapable of work which forms part of the qualifying criteria for IP. The qualifying criteria for IP is set out in social welfare legislation and eligibility for the scheme is assessed in line with these provisions. A deciding officer is obliged to follow the provisions specified and has no discretion to set aside these legislative requirements when determining entitlement to IP.

I trust this clarifies the matter for the Deputy.