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Case Study: Man was wrongly refused Carers’ Allowance when medical report was ‘missed’ by appeals office
Published on
Last updated on
Published on
Last updated on
John complained to the Ombudsman when the Department of Social Protection said he was not entitled to Carer’s Allowance for his father. His father suffered from chronic heart disease, hypertension and diabetes. However, the Department said that he was not eligible as his father did not meet the scheme’s criterion of being “so invalided or disabled as to require fulltime care and attention”.
While the Ombudsman was investigating his complaint John re-applied and was awarded Carer’s Allowance. However, the Department said that John was not entitled to the allowance from the date of his initial application nine months previously.
John appealed the decision to the Social Welfare Appeals Office (SWAO) and provided additional medical evidence in support of his appeal. The additional medical evidence described his father’s chronic heart disease, hypertension, diabetes and his coronary artery bypass graft. However, the SWAO refused his appeal to backdate the payment on the same grounds as the Department.
The Ombudsman examined the Department’s file on John’s case. He saw that the SWAO had sent the file to the Department’s Medical Referee Assessment (MRA) section for an opinion on the additional medical evidence that John had supplied. Although the MRA Section had subsequently provided a report saying that John’s father was considered medically eligible for Carer’s Allowance, it appeared that the report had not been considered by the SWAO. The Appeals Officer had made no mention of the MRA report in the background note explaining the reasoning behind the decision to refuse the appeal. As a result, the Ombudsman asked the SWAO to look at the case again.
After reviewing the case, the SWAO changed its decision and backdated the payment of Carer’s Allowance to John to the date of his initial application. John was awarded nine months’ arrears totalling €6,078.