Case Studies » Domiciliary Care Allowance » Domiciliary Care Allowance - Case from 2016 Annual Report (ref: 2016/04)

2016/04 Domiciliary Care Allowance

Oral hearing (Section 317) Question at issue: Whether eligibility criteria met at an earlier date

Background: The appellant’s son has a diagnosis of ADHD, global delay and primary encopresis. He is one of twins, who were born prematurely. In 2011, the appellant made a claim for Domiciliary Care Allowance (DCA), submitting detailed medical evidence. The claim was refused, however, and an appeal against that decision was disallowed on a summary basis. In 2014, the appellant made a second claim in respect of her son and this was awarded. Subsequently, she requested a review by the Deciding Officer under Section 301 of the Social Welfare Consolidation Act 2005, seeking to have the claim awarded with effect from the date of the initial claim in 2011. The Deciding Officer held that the qualifying criteria were not met at the earlier date and the request was refused. A subsequent appeal was disallowed as the Appeals Officer held that good cause had not been established for the delay in making the claim and that there was no basis for backdating for a period of up to six months, as provided for in the governing legislation. The appellant then made a request for a review by the Chief Appeals Officer under Section 318 of the Act, submitting that the Appeals Officer’s decision was erroneous in relation to the facts of the case and asserting that the medical criteria had been met in 2011. In addition, she stated that she had not been offered an oral hearing in 2011 and that she had not been made aware at the time that she could have requested one. The Chief Appeals Officer directed that the appeal be reopened by way of oral hearing. An appeal on the same question was also re

Oral hearing: The question at issue was outlined and the Appeals Officer made reference to the considerable amount of documentary evidence which had been submitted by the appellant in support of the initial claim in 2011. This included hospital patient data referring to: Ophthalmology, Audiology, ENT, Nutrition and Dietetics; letters of referral, assessment and consultants’ reports; a letter from the Community After Schools Project, advising that the child had a ‘one-to-one worker’; a letter from a Consultant in Developmental Paediatrics supporting the appellant’s claim; a letter from Home School Liaison, supporting the claim and advising that the child had a Special Needs Assistant (SNA), and a letter from the local Child and Adolescent Mental Health Services (CAMHS) supporting the claim.

The appellant outlined the background to her son’s difficulties. She reported on a range of issues, including speech difficulties, developmental delay, behavioural issues and bowel problems. She referred to the process of assessment and diagnosis and his ongoing struggle with everyday activities, like dressing, eating, toileting, remembering simple instructions and doing homework. She reported that she has a Home Help on Monday and Friday to assist with laundry as a consequence of his bowel problems and advised that he has been referred to a specialist to be assessed for a colostomy.

The appellant reported that her son struggles in school and that he has always had an SNA; he also has resource teaching hours; she attends a meeting with his teacher every week to discuss issues and progress, and he is taking prescribed medication, including a dose which is administered at school. She advised that his developmental skills are not appropriate to his age and that he is likely to continue to need the support of an SNA in secondary school.

On the question as to his care needs in 2011 when the initial DCA claim was made, the appellant stated that things had not changed and she spoke of the demands of meeting his needs from day one. She said that following assessment and diagnosis by the local CAMHS, she had been advised to apply for DCA and a range of services and supports had been put in place. She said that, at the time, she had been unaware that she could have requested an oral hearing of her appeal and said that there had been too much going on in her life at the time in terms of caring for both boys. She advised that her local Citizens Information Centre (CIC) had put her in touch with a Disability Advocate who had offered advice and assistance, including the option of requesting reviews under Sections 301 and 318.

Consideration: Social welfare legislation provides that an Appeals Officer may revise a decision in light of new evidence or new facts, having regard to the provisions of Section 317 of the Social Welfare Consolidation Act 2005. The Appeals Officer examined the appeal with reference to those provisions.

The Appeals Officer noted that the original appeal had been determined on a summary basis, whereas she had the benefit of an oral hearing, at which the appellant clarified the nature of her son’s problems and the extent of the additional care he requires as a consequence. She noted that the documentary evidence served to support the appellant’s contention that a range of supports had been provided at the time she applied first for Domiciliary Care Allowance in 2011, an application which had been supported by a number of the specialists who had been involved with her son. Having particular regard to the evidence adduced at oral hearing, she concluded that the appellant’s son required continuous care and attention at a level which was substantially in excess of that normally required by his peers and that the qualifying criteria were met in connection with the appellant’s claim of 2011. Accordingly, the earlier decision was revised. (The Appeals Officer also revised the decision in relation to the appellant’s other son.)

Outcome: Appeal allowed.