Case Studies » Sickness

Question at issue: Eligibility (medical)

Question at issue: Eligibility (medical)

Question at issue: Eligibility (medical)

Question at issue: (medical)

Question at issue: Eligibility (means)

Question at issue: Eligibility (medical)

Question at issue: Eligibility (medical)

Question at issue: Medical eligibility in terms of employment

Question at issue: Medical eligibility in terms of employment

Background: The appellant is 16 years of age and is in fifth year at his local Community College.  His mother had been in receipt of Domiciliary Care Allowance until he reached 16 years of age, when he was invited to apply for Disability Allowance.  When his claim was disallowed, he made an appeal and his parents also made a written submission on his behalf.

Background: The appellant, aged 16 years, attends secondary school and is in Transition Year.  Following the rejection of his Disability Allowance claim, the appellant’s father made an appeal on his behalf.

Background: The appellant is 16 years of age and applied for Disability Allowance in 2014.  He had completed a Transition Year programme in the secondary school he was attending and was in fifth year at the time of the oral hearing.

Annual Report 2014

Case Studies

Introduction

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Case studies: These case studies refer to appeals made in relation to Disability Allowance.  They have been edited so as to anonymise personal information but the text of the Appeals Officer’s decision, as it was issued to the appellant, is outlined.  It should be noted that in some cases, no decision reason was given where the appeal was allowed.

Question at issue: All the case studies featured in this report address the question as to whether the appellant may be regarded as substantially restricted in undertaking suitable employment, by reason of a specified disability, which has continued or may reasonably be expected to continue for a period of at least one year.  The relevant legislative provisions are outlined in the Social Welfare (Consolidation) Act, 2005 and the Social Welfare (Consolidated) Claims, Payments and Control) Regulations, 2007, S.I. 142 of 2007.

Index: The index provides a short reference to the case studies featured, and indicates whether the appeal was made following a decision in relation to a new claim or a claim which had been in payment and was discontinued following a review of entitlement.

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Background: The appellant made a claim for Disability Allowance when she was 19 years old, almost a year after she received a diagnosis.  She submitted medical evidence from a Consultant Neurologist, a Consultant Orthopaedic Surgeon and a Consultant Psychiatrist.    In completing the ability/disability profile, her G.P. assessed her mental health/behaviour as severely affected, her physical ability as moderately affected in two categories and profoundly affected in the areas of reaching and manual dexterity.  Her claim was disallowed and she made an appeal which was dealt with by way of summary decision.

Background: The appellant, aged 22 years, has a diagnosis of Learning Disability.  Evidence on file indicated that she was the victim of domestic violence as a young child and sustained significant head injury.

Background: The appellant, aged 22 years, had been in receipt of Disability Allowance for six years before having to serve a custodial sentence.  On her release, her claim was disallowed.  Her appeal against that decision was dealt with by way of summary decision.

Background: The appellant, aged 27 years, is a lone parent with one child and was in receipt of One Parent Family Payment and now making a claim for Disability Allowance.

Background: The appellant, aged 29 years, had applied for Disability Allowance in 2009.  Her G.P. certified her incapacity and referred to multiple operations.  He confirmed that the most recent operation at that time had taken place two years previously and that she was awaiting further surgery.

Background: The appellant, a 32 year old single man, had been in receipt of Disability Allowance until a date in 2013, when his claim was disallowed. His incapacity resulted from injury sustained in a road traffic accident in 2007.

Background: The appellant is 32 years of age.  In connection with his claim, his G.P. completed the ability/disability profile and assessed the appellant as being affected as follows:

Background: The appellant is 32 years of age and applied for Disability Allowance in 2013. He submitted a report from his G.P. which stated that he had lost his sight in one eye and suffered Post-Traumatic Stress Disorder, following an assault.

Background: The appellant, who is 36 years of age, came to Ireland in 2007.  She made a claim for Disability Allowance in 2014 and, following the decision to disallow that claim, she made an appeal.

Background: The appellant, aged 43 years, had been in receipt of Disability Allowance between 2005 and 2011 when payment was stopped.  He made a new claim in 2013 which was disallowed on grounds that he was not deemed to be substantially restricted from undertaking suitable employment, in line with the medical qualifying criteria.

Background: The appellant, an EU national, is 43 years of age and came to live in Ireland in 2012.  He had trained to be a steelworker but economic difficulties meant he had been unable to pursue that career.  Instead, he worked as an engine mechanic from 1995 until 2009, when he had surgery on his back.

Background: The appellant, aged 44 years, had been in receipt of Illness Benefit for two years when his entitlement ended (as payment is made for two years only where claims are made following legislative changes implemented with effect from January 2009).  He continued to submit medical certificates on a six-monthly basis, as before, and made a claim for Disability Allowance. 

Background: The appellant, aged 44 years, had been in receipt of Illness Benefit and was in receipt of a Diet Supplement of €6.50 per week under the Supplementary Welfare Allowance scheme.  He had an in-person assessment with a Medical Assessor of the Department of Social Protection.

Background: The appellant, aged 45 years, had been in receipt of Disability Allowance since 2009 and had participated in a number of Community Employment (CE) schemes.  Following a review, her claim was disallowed with effect from a date in 2014 as it was held that she no longer met the qualifying criteria.

Background: The appellant, aged 49 years, is separated.  He had been in receipt of Disability Allowance for ten years but, following a review of his claim, it was held that he was no longer eligible on medical grounds.  At the time of the oral hearing, he was in receipt of a basic income under the Supplementary Welfare Allowance scheme.

Background: The appellant, aged 49 years, made a claim for Disability Allowance in 2014. In completing the ability/disability profile on the claim form, his G.P. assessed the appellant as being moderately affected in eight of the categories outlined and affected to a mild degree in one other area. He stated that the appellant had sustained an accident some years previously, suffering a disc prolapse, and that he had been experiencing depression for three years. He advised that there had been no specialist referral, and that he had not prescribed medication.

Background: The appellant, aged 50 years, applied for Disability Allowance and submitted a medical report stating her diagnosis and indicating that this was expected to continue indefinitely.

Background: It was held that the appellant, an EU national aged 54 years, did not satisfy either the Habitual Residence Condition or the medical qualifying condition.  Subsequently, he made a claim for basic income support under the Supplementary Welfare Allowance scheme and he was deemed not to be habitually resident.

Background: The appellant, aged 56 years, is married and has children.  He came to live in Ireland in 2001 and had been working in a meat factory until 2012, when he got an Inguinal Hernia.  In completing the ability/disability profile, his GP assessed the appellant as being affected to a moderate degree in the areas relevant to his medical condition.  His claim for Disability Allowance was rejected and, at the time he made his appeal, he was in receipt of Supplementary Welfare Allowance.

Background: The appellant, aged 56 years, had been in receipt of Illness Benefit.  When her entitlement under that scheme (two years) was due to cease, she made a claim for Disability Allowance.

Background: The appellant, aged 58 years, had a cardiac stent fitted twelve months previously and also has a Prolapsed Lumbar Disc.

Question at issue: Causal association between accident and injury

Question at issue: Eligibility (medical)

Question at issue: Eligibility (medical)

Question at issue: Eligibility (medical)

Question at issue: Eligibility (medical

Question at issue: Eligibility (medical)

Question at issue: Eligibility (medical)