DECISION OF THE SOCIAL SECURITY COMMISSIONER
(a) the decisions of the adjudication officer, dated 6 May 1997, and of the Secretary of State, dated 18 April 2000, as to payability of the care component of disability living allowance are revised on the ground that they arose from an official error (Social Security and Child Support (Decisions and Appeals) Regulations 1999, regulation 3(5)(a)); and
(b) the decisions as revised, with effect from 6 May 1997 and 4 April 2000 respectively, are that the care component of disability living allowance is payable to the claimant for the days on which she was not at her residential school, that is for all the dates within the period from 10 July 1998 to 21 May 2001 specifically identified (although with the wrong conclusion as to payability attached) in the decision of 8 August 2002 and on the boarder record card on page 78 of the papers.
The background
"DLA care component is not payable for any day from and including 4/4/00 because the claimant is in certain accommodation."
The decision maker had had a choice of using those printed boxes or the boxes further on in that part of the form, which allowed only a decision that a component was or was not payable from and including a specified date, rather than for any day from and including a specified date. The part of the form for reasons for decision included the statement "Customer still residing at a residential school receiving LA funding".
"We cannot pay you Disability Living Allowance for help with personal care for any day that you are in residential accommodation from and including 4.4.00."
The rest of the letter gives information about asking for the decision to be looked at again and appealing and about where to ask for help or advice about the contents, but says nothing about the procedure for payment of the care component. What is evident is that no payments of care component were made following the decision, although payments of mobility component were made into Maria's mother's bank account.
"Re: DLA claim for Maria ...
I have completed the dates for when Maria was not at Residential school and was staying at home with her family.
Unfortunately, I have not claimed the allowance for which Maria was entitled because I was not aware I could. Previously, you asked me to return the allowance for a period and I did not know how to claim for the days she was at home. I have obtained help and advice for claiming in the past but this has not been available to me for sometime. My son, who is aged fourteen years, has completed the dates for me.
Since late November 2001, Maria has been attending a local school for one day a week, she arrives home on a Thursday."
A list of school holiday dates and weekends at home during term covering the whole period from December 1995 to April 2002 was attached.
The decision under appeal
"(1) Subject to paragraph (2A), the right to payment of any sum by way of benefit shall be extinguished where payment of that sum is not obtained within the period of 12 months from the date on which the right is to be treated as having arisen; and for the purposes of this regulation the right shall be treated as having arisen--
(a) [deals with cases where an instrument of payment has been issued;]
(aa) [deals with cases where an instrument of payment has been issued;]
(b) [deals with cases where notice that a sum is ready for collection has been sent;]
(c) in relation to any sum to which none of (a), (aa) or (b) apply, on such date as the Secretary of State determines ... .
(2A) Where a question arises whether the right to payment of any sum by way of benefit has been extinguished by the operation of this regulation and the Secretary of State is satisfied that--
(a) he first received ... written notice requesting payment of that sum after the expiration of 12 months; and
(b) from a day within that period of 12 months and continuing until the day the written notice was given, there was good cause for not giving the notice; and
(c) either--
(i) no instrument of payment has been given or sent to the person to whom it is payable and no payment has been made under the provisions of regulation 21 (automated credit transfer); or
(ii) that such instrument has been produced to the Secretary of State and no further instrument has been issued as a replacement,
the period of 12 months shall be extended to the date on which the Secretary of State decides that question, and this regulation shall accordingly apply as though the right to payment had arisen on that date."
The appeal to the appeal tribunal
"Whilst the decision dated the 18th of April 2000 does not refer to a set sum of money for the care component, it clearly indicates that it is to be paid at the highest rate. We therefore consider that contrary to Mr Dyson's representation, a decision had been made as to the amount of benefit payable and when it was payable from.
...
Consequently, when [Maria's mother] finally got round to providing the necessary information, a decision for the period of entitlement was made on the 8th of August 2002 pursuant to Regulation 38(1)(c). On that date, the Secretary of State determined the dates for which benefit was payable pursuant to the decision of entitlement to benefit dated the 18th of April 2000. Until [Maria's mother] provided that information, such a decision could not be made."
The appeal to the Commissioner
The nature of the payability decision of 18 April 2000
"(i) The system of paying claimants [DLA] for days when not in Local Authority funded accommodation used in this case has been in operation at the DWP's Disability Benefit Unit for many years.
(ii) The payability decision is framed in such a way as to make benefit payable for any day when the claimant is not at the LA-funded residential school. The decision at page 50 states: `DLA care component is not payable for any day from and including 4.4.00 because the claimant was in certain accommodation' (underlining added). This accommodation is then specified at page 53. The words `for any day' are significant because they relate to the provisions under reg 25 of the Claims and Payments Regs 1987 for making daily rate payments of DLA. Reg 25(1) provides that DLA payable under that regulation shall be paid weekly or as the Secretary of State may direct in any case.
(iii) By having ticked `for any day' the DWP decision-maker has indicated that the daily rate of DLA under reg 25 is not payable for any day in which the claimant is in an LA-funded residential school. The decision therefore also intimates that benefit is potentially available to the claimant for any days of non-residence at the school: all that is required of the claimant is that she notify the Secretary of State of these days. The wording of the decision does in effect qualify the payability restriction imposed to the extent of `except when the claimant is at home' referred to by the Legal Officer in his Direction. In these circumstances supersession of the awarding decision is not necessary."
How does regulation 38 of the Claims and Payments Regulations apply?
How can the decision of 18 April 2000 be altered?
Is Adams applicable?
"Nor is there anything in either the substantive or the procedural law which entitles the Secretary of State to refuse payment of benefit due to a claimant for a past period merely because the Secretary of State himself has failed to notice that an adjustment wrongly still being applied under the regulations should have ceased ... ."
The Commissioner therefore decided that the claimant was legally entitled to payment of ICA from 12 May 2000.
"it is not impossible to regard it as a decision to pay which superseded the decision not to pay. But it is more in conformity with the legislative scheme to regard it simply as a decision on a claim for a relevant benefit, or as a decision falling to be made under the enactments which had so far created an entitlement but inhibited payment. The decision to restore payments after May 2000 was predetermined by the decision notified in February 1996."
An alternative method of altering the decision of 18 April 2000
Was revision of the decision of 18 April 2000 within the powers of the appeal tribunal of 6 May 2003?
The dates in the period from 6 May 1997 to 3 April 2000
Conclusion
The Commissioner's decision on the appeal against the decision of 8 August 2002
(Signed) J Mesher
Commissioner
Date: 26 June 2006