MJW-v-Department for Social Development (ESA) [2011] NICom 174
Decision No: C4/10-11(ESA)
Appeal to a Social Security Commissioner
on a question of law from a Tribunal's decision
dated 17 May 2010
DECISION OF THE SOCIAL SECURITY COMMISSIONER
Background
(i) grounds existed to supersede an earlier decision of the Department, dated 22 July 2009, and which had awarded an entitlement to incapacity benefit (IB), from and including 4 June 2009; and
(ii) the appellant did not have limited capability for work and was, therefore, not entitled to ESA from and including 22 January 2010.
'Whether the Statement of Reasons is adequate, given that it does not explicitly refer to supersession.'
Proceedings before the Social Security Commissioner
Errors of law
"(i) making perverse or irrational findings on a matter or matters that were material to the outcome ('material matters');
(ii) failing to give reasons or any adequate reasons for findings on material matters;
(iii) failing to take into account and/or resolve conflicts of fact or opinion on material matters;
(iv) giving weight to immaterial matters;
(v) making a material misdirection of law on any material matter;
(vi) committing or permitting a procedural or other irregularity capable of making a material difference to the outcome or the fairness of proceedings; …
Each of these grounds for detecting any error of law contains the word 'material' (or 'immaterial'). Errors of law of which it can be said that they would have made no difference to the outcome do not matter."
Was the decision of the appeal tribunal in the instant case in error of law?
The supersession issue
(i) grounds existed to supersede an earlier decision of the Department, dated 22 July 2009, and which had awarded an entitlement to IB, from and including 4 June 2009; and
(ii) the appellant did not have limited capability for work and was, therefore, not entitled to ESA from and including 22 January 2010.
'The law says that the Department may supersede a decision awarding Employment and Support Allowance on receipt of medical evidence following an examination by a healthcare professional of the Department. In this case a report was received following an examination on 05/01/2010 and the Department, on consideration of all evidence, determined that (the claimant) does not have Limited Capability for Work in accordance with the Work Capability Assessment.˛ As such the decision dated 22/07/2009 awarding Employment and Support Allowance was superseded on 22/01/2010 disallowing Employment and Support Allowance from and including 22/01/2010.'
'Article 11(1), (5) of the Social Security (Northern Ireland) Order 1998, The Social Security and Child Support (Decisions and Appeals) Regulations (Northern Ireland) 1999, regulation 6(1), 6(2)(a)(i) and 6(2)(q).'
'… is an employment and support allowance decision where, since the decision was made, the Department has received medical evidence from a health care professional approved by the Department for the purposes of regulation 23 or 38 of the Employment and Support Allowance Regulations'
'… is an incapacity benefit decision where there has been an incapacity determination (whether before or after the decision) and where, since the decision was made, the Department has received medical evidence following an examination in accordance with regulation 8 of the Incapacity for Work Regulations from a health care professional referred to in paragraph (1) of that regulation'
31. In C12/08-09(DLA), at paragraphs 33 to 36, I set out the duties of the appeal tribunal with respect to the decision-making process:
33. Accordingly, the first task of the appeal tribunal was to determine whether the decision-maker, on 24 March 2007, had grounds to supersede the earlier decision of the Department, dated 29 November 1996.
34. If the appeal tribunal determined that the decision-maker, on 24 March 2007, did not have grounds to supersede the decision dated 29 November 1996, then that latter decision would continue to have effect.
35. If the appeal tribunal determined that the decision-maker, on 24 March 2007, did have grounds to supersede the decision dated 29 November 1996, then the appeal tribunal could have gone on to consider entitlement to benefit, in light of the substantive rules for entitlement to DLA.
36. Finally, the appeal tribunal was under a duty to determine the effective date from which any supersession decision should take effect.'
32. The approach taken by the appeal tribunal in C12/08-09(DLA) was in error in the following way. Neither the decision notice prepared by the LQPM of the appeal tribunal, nor the statement of reasons for the appeal tribunal's decision, dealt with the issue of supersession to any degree of sufficient detail. As I noted at paragraphs 44 to 45:
44. What the decision notice and statement of reasons does tell the appellant is that the appeal tribunal has determined and agrees that the appellant should not have an entitlement to either component of DLA from a specific date, and then something of the evidential basis for its conclusions on that issue.
45. What the decision notice and statement of reasons does not inform the appellant is:
(i) that the appeal tribunal has addressed the issue of whether the Department had a legal and evidential basis for reconsidering and changing its earlier decision; and
(ii) the effective date from which any new decision should take effect.'
33. In their written observations on the appeal in C12/08-09(DLA), DMS had submitted that while the appeal tribunal did not specifically refer to the grounds for supersession in the conclusion to its statement of reasons, and while it may have been preferable for it to have done so, in concluding that no award of DLA was appropriate it was implicit that the appeal tribunal considered that grounds for supersession existed to remove the award, namely a relevant change of circumstances.
34. I rejected that submission from DMS, and concluded, at paragraph 48:
'The appeal tribunal was under a specific duty to determine whether the decision under appeal was correct. As that decision was a supersession decision the duty was to determine whether there were grounds to supersede under regulation 6 of the Social Security and Child Support (Decisions and Appeals) Regulations (Northern Ireland) 1999, as amended.'
35. Finally I stated, at paragraph 52 that:
'The appeal tribunal's duty is not only to consider the supersession issue, including grounds, entitlement and effective date, but to make clear that it has done so. It is not sufficient for it to be, as DMS suggests, implicit from the appeal tribunal's documentation that the supersession issue was addressed. That consideration must be explicit from the decision notice, the statement of reasons or a combination of both. In the present case, I am of the view that it is not even implicit that consideration was given to the supersession issue.
36. It was in the context of the submission made by DMS, and my rejection of the argument that it could be implied from the appeal tribunal's reasoning, that my comments at paragraph 52 were derived.'
'It is arguable that in IB cases, the regulation 6(2)(g) ground is intrinsic to the benefit decision itself and that, subject to the necessary and sufficient fact-finding, a confirmation of the benefit decision by the appeal tribunal will be sufficient to confirm that the decision-maker had grounds, under regulation 6(2)(g), to supersede the earlier entitlement decision. All will depend on the circumstances of each individual case, however.'
The appellant's grounds for appealing
'I think the tribunal was wrong, as I've stated before my mental and physical health were not looked at correctly. I've been on tablets daily for a long time to cope with high anxiety and depression, which have also over time had a huge effect to my physical health and wellbeing. At present I could not work in a strange or crowded workplace but have been looking at other ways to get back to work. I would like if possible to meet to talk about this.'
'8(1) For the purposes of this Part, whether a person's capability for work is limited by his physical or mental condition and, if it is, whether the limitation is such that it is not reasonable to require him to work shall be determined in accordance with regulations.'
'19(1) For the purposes of Part 1 of the Act, whether a claimant's capability for work is limited by the claimant's physical or mental condition and, if it is, whether the limitation is such that it is not reasonable to require the claimant to work is to be determined on the basis of a limited capability for work assessment of the claimant in accordance with this Part.
(2) The limited capability for work assessment is an assessment of the extent to which a claimant who has some specific disease or bodily or mental disablement is capable of performing the activities prescribed in Schedule 2 or is incapable by reason of such disease or bodily or mental disablement of performing those activities.
(3) Subject to paragraph (6), for the purposes of Part 1 of the Act a claimant has limited capability for work if, by adding the points listed in column (3) of Schedule 2 against any descriptor listed in that Schedule, the claimant obtains a total score of at least—
(a)15 points whether singly or by a combination of descriptors specified in Part 1 of that Schedule;
(b)15 points whether singly or by a combination of descriptors specified in Part 2 of that Schedule; or
(c)15 points by a combination of descriptors specified in Parts 1 and 2 of that Schedule.'
Disposal
(Signed): K Mullan
Commissioner
23 May 2011