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A major shake up of social security decision
making is starting this Summer as a result of the implementation of the Social
Security and Child Support (Decisions and Appeals) Regulations 1999. The new system
has been heralded by the Government as a simpler, streamlined service for the
public.
The changes are being phased in over the period June to November 1999.
Scope of the Changes
The new rules deal with the way decisions
are made, implemented and can be challenged. They do not deal with the process
of making a claim or the rules for entitlement to benefit. They cover all social
security benefits except for Housing Benefit and Council Tax Benefit, the rules
for which remain unchanged. The main changes are:
new and tighter deadlines (usually one month) at every stage of the process
a wider range of options for challenging decisions
a new tribunal system designed to process appeals quickly and efficiently.
New Deadlines
The deadline for
action by claimants at most stages will be one month. These deadlines may be extended
by up to a further twelve months if "special circumstances" apply. The rules for
what could constitute "special circumstances" are similar to the present very
strict rules for late appeals. As now, the key dates for calculating deadlines
are:
the day the Benefits Agency or Appeals Service post the notification - in practice, the date on the decision letter
the date the application or appeal is received at the Benefits Agency or Appeals Service office.
Decisions
Decisions will no longer be made by adjudication officers (AOs), but by the "Secretary
of State" - in reality DSS officers authorised by the Secretary of State to make
decisions. Most of these officers will of course be the same people under a different
job title. Decisions will have to be notified to the claimant in writing, although
there is no prescribed time within which the notification has to be issued. There
is no obligation for written reasons for the decision to be given with the notification,
although the claimant has a right to ask for them, within one month. The Secretary
of State must then respond in writing within two weeks. The Benefits Agency has
promised clearer jargon-free decisions.
Challenging Decisions
At present AOs' decisions can be challenged by appealing or by requesting a review,
for which specific grounds are needed. For Disability Living Allowance (DLA),
Attendance Allowance (AA) and Disability Working Allowance (DWA) there is a compulsory
review stage before appeal, with a 3 month deadline where no grounds for review
are needed, and a right of review on specific grounds outside the 3 month period.
In future rather more types of decisions than at present will carry a right of
appeal, but instead of reviews there will be:
revisions - broadly similar to the present "any grounds review" for DLA/AA/DWA,
supersessions - broadly similar to the present review on specific grounds.
Both revisions and supersessions can be initiated either by the claimant or the Secretary of State, and should lead to a new Secretary of State's decision, which can then usually be appealed. Even those decisions which do not carry a right of appeal can be revised or superseded.
Revisions
Following the issue of
a decision there will be a "dispute period" which will run for one month (or longer
in "special circumstances"). A claimant can request a revision of the decision
within the dispute period without needing to establish grounds for the request.
Where written reasons for the decision had been requested, the time limit for
requesting the revision is extended by two weeks. In considering the request for
revision, the Secretary of State may ask for further evidence or information from
the claimant or arrange a medical examination. Whilst revision will not be a compulsory
stage for any benefit (so, for example, it will be possible to appeal straight
to a tribunal from an initial decision on DLA) it is intended as an informal way
of sorting out a disagreement, and may often be a better option than an appeal
because it is likely to be quicker. However, the informality could cause problems.
It will be important to check that a new decision will be issued as a result of
the request for revision and, if there is any doubt, to appeal the original decision
within the time limit. Revisions are also possible at any time in certain circumstances.
These include official error, overpayment of benefit as a result of misrepresentation
or failure to disclose, and the award of a qualifying benefit where that qualifying
benefit had been claimed before the benefit now subject to revision had been claimed.
Benefit due following a revision is normally payable back to the date of the original
decision
Supersessions
The grounds for requesting that a decision
be superseded are similar to the current grounds for review - change of circumstances,
mistake as to or ignorance of a material fact, or error of law. A super- session
can be requested at any time. The general rule is that benefit awarded following
a supersession will only be payable from the date of the action initiating the
supersession. However -
if a claimant notifies a change of circumstances within a month of the change, benefit can be paid from the date of the change (the month can be extended in "special circumstances")
there are special rules to deal with benefit payable following the award of a qualifying benefit where the qualifying benefit had been claimed after the benefit subject to the supersession had been claimed.
The New Tribunal System
The Appeals Service, an executive agency of the DSS, is to replace the Independent
Tribunal Service (ITS). The two will run alongside each other until April 2000
by which time the ITS will have been phased out. Unified "Appeal Tribunals" will
replace Social Security Appeal Tribunals, Disability Appeal Tribunals and Medical
Appeal Tribunals. Panels are being set up, from which Tribunal members will be
drawn, made up of people with legal, medical, financial and disability qualifications
- lay members are being phased out. The Regulations prescribe the composition
of tribunals by "issue" - for example whilst DLA/AA cases will be heard by tribunals
constituted as at present, All Work Test cases will have a lawyer and one doctor,
and Industrial Injuries/Severe Disablement Allowance cases a lawyer and one or
two doctors (who, for these two benefits, can examine the appellant). Most other
tribunals will have a single lawyer member. In addition, Tribunals will have stronger
powers to make directions and new powers to summon witnesses. The deadline for
making an appeal will be one month unless "special circumstances" apply. It is
intended that appeals will be processed much more rapidly than at present. In
consequence -
For the first time, representatives are explicitly given the right to make and withdraw appeals on behalf of claimants, with written authority.
Claimants will lose the right to an oral hearing if they do not request one on the enquiry form within 14 days.
Only one set of papers will be sent out, usually to the claimant.
The minimum notice of a hearing date will be two weeks, which can be waived by agreement.
In addition, Tribunals need not consider an issue that is not raised on appeal. It is still not clear how this is going to be interpreted, but the Benefits Agency is being encouraged to look at new information and revise decisions while appeals are pending. Where this happens, the appeal will lapse unless the appellant indicates, within one month, that they still want to pursue it.
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