R(DLA) 1/03
(Wood v. Secretary of State for Work and Pensions [2003] EWCA Civ 53)
CA (Rix, Arden and Dyson LJJ) CDLA/3912/2001
31.1.03
Supersession satisfaction of grounds removal of existing award of benefit
The claimant who suffered from cerebral palsy and was partially deaf had a life-time award of mobility allowance which became an award of mobility component of disability living allowance in 1992. In December 2000 he applied for supersession on the basis that he had care needs. A doctor from his GP practice completed a standard questionnaire about his mobility and care needs. His GP also wrote a letter saying his condition was permanent.
The Secretary of State made a decision on supersession that the clamant was not entitled to the care component and was no longer entitled to the mobility component. In relation to mobility he gave as his reason that the claimant could manage to walk 400-1000 meters on a good day and was not virtually unable to walk. A tribunal confirmed the Secretary of State's decision. The Commissioner allowed the claimant's appeal but not on grounds relating to supersession of the life-time award. The claimant appealed. It was agreed by both parties that there was no evidence of a change in the claimant's ability to walk.
Held, allowing the appeal, that:
- a decision awarding benefit could not be superseded under section 10 of the Social Security Act 1998 unless one of the grounds for supersession set out in regulation 6 of the Social Security and Child Support (Decisions and Appeals) Regulations 1999 was satisfied. There had been no finding of a relevant change of circumstances in this case and the Secretary of State was not entitled to supersede the claimant's award of mobility component;
- (per curiam) section 12(9) of the Social Security Act 1998 must be construed so as to give a right of appeal from a rejection by the Secretary of State of a properly constituted application for a supersession under section 10 of the 1998 Act.
DECISION OF THE COURT OF APPEAL
Mr. Richard Drabble QC and Mr. Ben Jaffey (instructed by Messrs Leigh, Day & Co) appeared for the Appellant.
Ms. Nathalie Lieven (instructed by the Office of the Solicitor to the Department for Work and Pensions) appeared for the Respondent
Judgment (reserved)
LORD JUSTICE RIX:
"C of C [Change of Circumstances] care needs claimed.
Mr. Wood can walk 400-1000m on a good day. He has occasional loss of balance but he is not VUTW [virtually unable to walk]. He can be left safely alone outdoors.
Mr. Wood can manage his own personal care. He can be safely left alone by day and night. He does have 1-2 falls per month but overall this is not enough. He can do all tasks to cook a main meal."
"1.1 The decision of the Harlow appeal tribunal, held on 8th June 2001, is erroneous in point of law.
- 2 I set it aside and remit the case to a differently constituted appeal tribunal.
- 3 I direct that appeal tribunal to conduct a complete rehearing of the issues that arise for decision.
The tribunal must follow the analysis of the supersession procedure laid down by the Tribunal of Commissioners in CDLA/3466/2000 and CI3700/2000
The tribunal must accept that the threshold criterion in regulation 6(2)(a)(i) of the Social Security and Child Support (Decisions and Appeals) Regulations 1999 is satisfied.
The burden is on the claimant to show entitlement to the care component, but on the Secretary of State to justify the termination of the award of the mobility component "
"If the Secretary of State finds that there has been no change of circumstances, the supersession decision will contain the same award."
She also observes that Mr. Commissioner Jacobs was a member of the Tribunal of Commissioners in the 6/02 decision.
"The mistake made by the appeal tribunal was to concentrate on the distance that the claimant could walk without taking account of the manner of his walking."
"The key word in head (ii) is 'or'. It contains 4 factors which have to [be] taken into account distance, speed, time, manner. It is sufficient for the claimant to be virtually unable to walk having regard to any one of them. The tribunal must take that approach at the rehearing."
"there are no legislative outcome criteria. The Secretary of State had to decide whether or not the conditions of entitlement for an award were satisfied."
"there are circumstances in which different decision-makers could apply the same law to those facts and reach opposite but legitimate conclusions."
"The proper approach is to consider whether there has in fact been a change in circumstances (such as a change in an underlying medical condition), not merely that the claimant has applied for supersession or the Secretary of State has initiated a reconsideration process of his own motion."
"(1) Subject to the following provisions of this regulation, for the purposes of section 10, the cases and circumstances in which a decision may be superseded under that section are set out in paragraphs (2) to (4).
(2) A decision under section 10 may be made on the Secretary of State's or the Board's own initiative or on an application made for the purpose on the basis that the decision to be superseded
(a) is one in respect of which
(i) there has been a relevant change of circumstances since the decision was made "
"(g) is an incapacity benefit where there has been an incapacity determination (whether before or after the decision) and where, since the decision was made, the Secretary of State has received medical evidence following an examination in accordance with regulation 8 of the Social Security (Incapacity for Work) (General) Regulations 1995 from a doctor referred to in paragraph (1) of that regulation."
"An alternative construction requires there to be read in after "superseding" the words "or refusing to supersede" on the basis that the purpose of the subsection is merely to emphasise that any decision under s. 10 may be the subject of an appeal and not just the first such decision."
"(1) Subject to the provisions of this Chapter, it shall be for the Secretary of State
(a) to decide any claim for a relevant benefit "
"(1) Subject to subsection (3) and section 36(3) below, the following, namely
(a) any decision of the Secretary of State under section 8 above or this section, whether as originally made or as revised under section 9 above; and
(b) any decision under this Chapter of an appeal tribunal or a Commissioner,
may be superseded by a decision made by the Secretary of State, either on application made for the purpose or on his own initiative.
(2) In making a decision under subsection (1) above, the Secretary of State need not consider any issue that is not raised by the application or, as the case may be, did not cause him to act on his own initiative.
(3) Regulations may prescribe the cases and circumstances in which, and the procedure by which, a decision may be made under this section
(5) Subject to subsection (6) and section 27 below, a decision under this section shall take effect as from the date on which it is made or, where applicable, the date on which the application was made.
(6) Regulations may provide that, in prescribed cases or circumstances, a decision under this section shall take effect as from such other date as may be prescribed."
"(1) Subject to the following provisions of this regulation, for the purposes of section 10, the cases and circumstances in which a decision may be superseded under that section are set out in paragraphs (2) to (4).
(2) A decision under section 10 may be made on the Secretary of State's or the Board's own initiative or on an application made for the purpose on the basis that the decision to be superseded
(a) is one in respect of which
(i) there has been a relevant change of circumstances since the decision was made; or
(ii) it is anticipated that a relevant change of circumstances will occur "
and then there are set out other criteria for supersession (b) to (h), such as error of law or mistake of fact provided the application or the decision to act on the Secretary of State's own initiative was made more than one month after the date of notification of the decision which is to be superseded.
"(1) This section applies to any decision of the Secretary of State under section 8 or 10 above (whether as originally made or as revised under section 9 above) which
(a) is made on a claim for, or an award of, a relevant benefit, and does not fall within Schedule 2 to this Act; or
(b) is made otherwise than on such a claim or award, and falls within Schedule 3 to this Act.
(2) In the case of a decision to which this section applies, the claimant and such other person as may be prescribed shall have a right of appeal to an appeal tribunal
(6) A person with a right of appeal under this section shall be given such notice of a decision to which this section applies and of that right as may be prescribed.
(9) The reference in subsection (1) above to a decision under section 10 above is a reference to a decision superseding any such decision as is mentioned in paragraph (a) or (b) of subsection (1) of that section."
"35. We broadly accept Ms. Lieven's analysis of sections 8, 10 and 12 of the Act. Section 10 authorises the supersession of decisions. Supersede means replace. It refers to a process. There is no implication that the decision superseded must be wrong in fact or law, out of date, or deficient in any other respect. That leaves no scope for a refusal to supersede It also follows that section 12(9) merely makes clear what was the case anyway.
- This analysis does not result in a violation of Article 6(1) of the European Convention on Human Rights and Fundamental Freedoms. The reason is found in the Regulations and in the availability of judicial review.
- Regulation 6 prescribes threshold criteria, not outcome criteria. By that we mean this. It prescribes cases and circumstances in which an application is brought within the scope of section 10. That is in accordance with the interpretation of supersession as a process that is neutral on the correctness of the decision that has been superseded. It does not prescribe criteria that determine whether a new outcome is appropriate. That is not governed by regulation 6. It is left to be determined, without prescription, by reference to the facts of the case and the conditions of entitlement.
- The first question for the Secretary of State when a letter is received from a claimant who has an award is: is this an application for a supersession? The Secretary of State is entitled to treat a letter that contains no more than abuse or irrelevance as not amounting to or containing an application. This covers two categories of letter. The first category consists of cases where the letter contains nothing that is relevant to the benefit that the claimant has been awarded. An example is the claimant who asks for an increase in income support because the price of cat food has gone up. The second category consists of cases where the claimant already has the maximum award of benefit. An example is the letter asking for an award of disability living allowance for a period earlier than the date of claim. Those two categories are linked by this common thread, that no further investigation of fact or law could possibly produce a different award from the one that has been made. The Secretary of State is entitled to keep those cases out of the adjudication scheme. Judicial review provides an adequate procedure for challenging this limited class of case in which the claimant has no possibility of success. There is no violation of Article 6(1) in this regard.
- If there is no application, the Secretary of State is not required to give a decision on it and need do no more than explain to the claimant why that will not be done.
- In all other cases there will be an application. It will contain an assertion, for example that there has been a change of circumstances. That is sufficient to satisfy a threshold criterion for entry into the supersession procedures. Once within those procedures, the Secretary of State has to investigate and determine the facts. The Secretary of State then supersedes the earlier decision. The decision given will depend on the facts found.
- If the Secretary of State finds that there has been no change of circumstances, the supersession decision will contain the same award. The Secretary of State must identify an effective date for the supersession decision
- If the Secretary of State finds that there has been a change of circumstances, the supersession decision will contain a different award. A new effective date has to be determined
- We have explained our analysis in terms of supersession on an application that confirms or increases an award. However, it applies also to supersession decisions that reduce or terminate an award and to supersessions on the Secretary of State's own initiative."
"12 I would therefore suggest that, when considering a case on his own initiative, the Secretary of State must find that one of the threshold criteria is actually satisfied before he can supersede a decision. Alternatively, if for the sake of consistency the Secretary of State's mere assertion that there has been a change of circumstances is to be regarded as sufficient to justify a supersession, I would hold that, although regulation does not prescribe outcome criteria, the threshold criteria must be satisfied if the outcome is to be different from the decision under consideration. Indeed, that seems to me to be the case whether the supersession is on the Secretary of State's initiative or on an application by a claimant. Otherwise the obvious purpose of section 10(3) (ie that a decision should be altered on supersession only in prescribed circumstances) would be entirely defeated
- This case illustrates the value of the threshold criteria. Once a judgment inevitably, to some extent, a value judgment is made that a person is virtually unable to walk, it stands until it is shown to be flawed by error or no longer to be valid because circumstances have changed. This is important. Claimants need a degree of certainty about their entitlement to benefits and this is particularly so where the higher rate of the mobility component of disability living allowance is concerned."
"In bringing forward this technical amendment we are seeking to clarify which applications made under Clause 11 will attract a right of appeal under Clause 13. As noble Lords will be aware, under our new proposals decisions of the Secretary of State will either be revised or superseded depending generally upon the timing of the application. Where an application is made to revise the Secretary of State's decision within one month after that decision is made, it will be revised under Clause 10 [now, section 9]. Once that period has ended, cases will be superseded under Clause 11 only where the application is made for specified reasons such as ignorance of or a mistake as to a material fact, an error of law on the original decision or where there has been a relevant change of circumstances.
Where an application for supersession has no prospect of success that is, where it is clear that there has been no relevant change in the claimant's circumstances the Secretary of State will not act on the application. The decision not to act will not be a decision under Clause 11. Therefore, it will not fall within Clause 13(1) and will not attract appeal rights. Of course, if the Secretary of State gets it wrong in refusing to entertain the application, there would be a remedy by way of judicial review.
That approach should be seen in the context of creating a modernised social security system which will allow customers to exercise their rights more effectively. If the Secretary of State has to deal with nugatory applications this must affect her ability to operate processes effectively. Moreover, if we were to offer appeal rights on applications which could not succeed, then more nugatory work would be created for the new appeal service, causing delays to claimants who had a justifiable case.
I have explained when appeal rights will not be offered. I will now briefly explain when they will be offered under Clause 11. Appeal rights will be granted where the Secretary of State acts on an application. This will include those circumstances when the amount of the award is not changed; in other words, by acting, the Secretary of State decides that there should be no change. It may seem odd to describe a decision as superseded where there is no change. However, that will be the case. A decision will be superseded every time that the Secretary of State issues a benefit decision in response to an application. That will be a new outcome decision which will attract appeal rights and a period of one month in which to appeal."
"Lords amendment No 16 is technical and puts beyond doubt the circumstances that will attract a right of appeal under Clause 11 Appeal rights will be granted where the Secretary of State acts on an application for a decision to be superseded, even if ultimately the amount of the award is not changed "
LADY JUSTICE ARDEN:
i) To "be superseded" for the purposes of section 10(1) means "to be replaced". Accordingly, a decision to award benefits can be "superseded" by a new decision to maintain the benefit at the existing level.
ii) Regulation 6(2) sets out threshold criteria but not outcome criteria. Applications which do not meet these criteria do not have to be actioned under section 10 and give rise to no right of appeal.
iii) Section 12(9) bears its literal meaning. It encompasses both decisions to award benefits at the same rate as before and decisions to award benefits at a higher rate. There is no need to take the extreme step of applying section 3(1) of the Human Rights Act 1998 to section 12(9).
"(1) Subject to subsection (3) and section 36(3) below, the following, namely:
(a) any decision of the Secretary of State under section 8 above or this section, whether as originally made or as revised under section 9 above; and
(b) any decision under this Chapter of an appeal tribunal or a Commissioner,
may be superseded by a decision made by the Secretary of State, either on an application made for the purpose or on his own initiative.
(2) In making a decision under subsection (1) above, the Secretary of State need not consider any issue that is not raised by the application or, as the case may be, did not cause him to act on his own initiative.
(3) Regulations may prescribe the cases and circumstances in which, and the procedure by which, a decision may be made under this section.
(5) Subject to subsection (6) and section 27 below, a decision under this section shall take effect as from the date on which it is made or, where applicable, the date on which the application was made.
(6) Regulations may provide that, in prescribed cases or circumstances, a decision under this section shall take effect as from such other date as may be prescribed."
"(1) Subject to the following provisions of this regulation, for the purposes of section 10, the cases and circumstances in which a decision may be superseded under that section are set out in paragraphs (2) to (4).
(2) A decision under section 10 may be made on the Secretary of State's or the Board's own initiative or on an application made for the purpose on the basis that the decision to be superseded:
(a) is one in respect of which:
(i) there has been a relevant change of circumstances since the decision was made: or
(ii) it is anticipated that a relevant change of circumstances will occur;
(g) 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 Secretary of State has received medical evidence following an examination in accordance with regulation 8 of the Social Security (Incapacity for Work) (General) Regulations 1995 from a doctor "
"(1) This section applies to any decision of the Secretary of State under section 8 or 10 above (whether as originally made or as revised under section 9 above) which:
(a) is made on a claim for, or on an award of, a relevant benefit, and does not fall within Schedule 2 to this Act; or
(b) is made otherwise than on such a claim or award, and falls within Schedule 3 to this Act;
(2) In the case of a decision to which this section applies, the claimant and such other person as may be prescribed shall have a right of appeal to an appeal tribunal, but nothing in this subsection shall confer a right of appeal in relation to a prescribed decision, or a prescribed determination embodied in or necessary to a decision.
(9) The reference in subsection (1) above to a decision under section 10 above is a reference to a decision superseding any such decision as is mentioned in paragraph (a) or (b) of subsection (1) of that section."
"6. verb trans. Take the place of; succeed and supplant in some respect; in pass., be replaced by something regarded as superior. M17 [date of first recorded use: 1630 1669]
- verb trans. Adopt or appoint a person or thing in place of (also foll. by by, with); promote another over the head of; in pass., be removed from a position or office to make way for another. E18. [date of first recorded use: 1700 1729]."
"The provisions mentioned in subsection (5) below (which this section supersedes so far as they apply to the High Court and county courts) shall cease to have effect in relation to those courts."
"Paragraph 7 applies where the relevant authority is proposing to
(a) release any undertaking under section 73 or 82 or paragraph 3 or 9 of Schedule 7 (other than in connection with accepting an undertaking under the enactment concerned which varies or supersedes an undertaking under that enactment); or
(b) revoke any order under section 75, 83 or 84 or paragraph 5, 10 or 11 of Schedule 7 (other than in connection with making an order under the enactment concerned which varies or supersedes an order under that enactment)."
"Supersede means replace. It refers to a process. There is no implication that the decision superseded must be wrong in fact or law, out of date or deficient in any other respect. That leaves no scope for a refusal to supersede."
LORD JUSTICE DYSON:
Order:
(Order does not form part of the approved judgment)