Case Studies » Sickness » Illness Benefit - Case from 2016 Annual Report (ref: 2016/11)

2016/11 Illness Benefit

Oral hearing

Question at issue: Eligibility (medical)

Background: The appellant, in her late 50s, had worked as a chef in a nursing home prior to her Illness Benefit claim. She had a certified incapacity of stress and medical evidence referred also to epilepsy and uterine cancer. The G.P. had indicated that the expected duration of her illness was six to twelve months and advised that she attends a neurologist and a gynaecologist and that she was not taking medication. In completing the ability/disability profile, the G.P. assessed ‘Mental Health/Behaviour’ as mildly to moderately affected by her condition and all other categories as normal. In completing the Impact and Lifestyle questionnaire (issued in connection with a review of her claim), the appellant stated that her ability to interact with people had been affected, as had her concentration and memory, as well as her ability to cook, read and sleep. She reported that she was participating in a Vocational Training Opportunities Scheme (VTOS) course and that it was helping to restore her confidence.

The appellant was referred for a medical examination and, having regard to the Medical Assessor’s opinion, her claim was disallowed as it was held that she was no longer incapable of work under the provisions of the legislation governing entitlement to Illness Benefit (Section 40(3)(a) of the Social Welfare Consolidation Act 2005). Having made an appeal, the appellant was referred for a second medical examination. There was no change in the assessment and the decision was confirmed. In making an appeal against that decision, she requested an oral hearing.

Oral hearing: The appellant reported that she was not fit to return to her previous employment because of problems with her back. In addition, she said she considered that her communication skills were not all they had been and that her memory was not as good as it used to be, especially in the morning. She related no restrictions or problems in relation to her daily routine. She submitted that the VTOS course suited her as she could do things at her own pace, whereas she had found her previous workplace to be very stressful. She referred to a change in work practice which meant that she had been required to work a 10 hour shift and she said that this was too much for her back. She went on to say that she was no longer able for the demands of a busy kitchen and the modern requirements of food preparation and managing staff. She expressed frustration that she had been unable to complete the VTOS course because of the decision to terminate her Illness Benefit claim.

The Appeals Officer outlined details of the Medical Assessor’s reports. The first referred to the diagnosis of stress and noted that the appellant had finished counselling, was not taking any medication and suggested that she might cope well with a return to work. The second report noted that the appellant had a history of epilepsy but had been seizure free for 30 years and that it had been five years since the diagnosis of cervical cancer and she was attending for annual review. In relation to the certified incapacity of stress, it was noted that her mood had improved, that she had reported no restrictions, and the opinion was offered that she was fit for light sedentary duties. The Appeals Officer reviewed the letter from the appellant’s G.P., stating that she was attending a VTOS course and was managing well but felt she was unable to engage in full-time employment, and she concurred with this assessment.

Consideration: The Appeals Officer noted that her G.P. had indicated that the appellant’s diagnosis of stress had affected her mental health to a mild to moderate degree and had advised that she had not been prescribed medication and was not attending any support services. He noted that the medical evidence indicated no other significant impact across the range of other abilities. Having regard to all the medical evidence and to her own account at oral hearing, he concluded that the appellant was capable of work within the meaning of social welfare legislation.

Outcome: Appeal disallowed.