[2007] UKSSCSC CIB_1146_2005 (24 May 2007)
R(IB) 4/07
(Hooper v Secretary of State for Work and Pensions [2007] EWCA Civ 495)
CA (Ward, Dyson and Thomas LJJ)
24 May 2007
CIB/1146/2005
Supersession date of effect of supersession decision transitional award of incapacity benefit whether decision being superseded "incapacity benefit decision"
Recovery of overpayment failure to disclose requirement to notify Secretary of State of change of circumstances statement by Secretary of State that claimant "should" disclose whether amounted to requirement
The claimant had been in receipt of invalidity benefit, which took effect as an award of incapacity benefit under the Social Security (Incapacity for Work) (Transitional) Regulations 1995. In March 2002 he received a factsheet explaining the new rules for exempt work that a claimant would be permitted to do without loss of entitlement to incapacity benefit, following amendments to regulation 17 of the Incapacity for Work (General) Regulations 1995. The factsheet stated that he "should" tell the office dealing with his benefit before starting work. In September 2002 he started work that would comply with the new rules apart from the specific notice requirement in regulation 17(1)(a) that he inform the Secretary of State within 42 days of starting work. He continued working until April 2004 without informing the Secretary of State. In August 2004 the Secretary of State made a supersession decision to the effect that the claimant was not entitled to incapacity benefit for the period he was working, He appealed and the tribunal upheld both decisions. On the claimant's further appeal, the Commissioner held that the statement in the factsheet that the claimant should disclose his having started work amounted to a requirement to disclose a change of circumstances within the meaning of regulation 32(1) of the Social Security (Claims and Payments) Regulations 1987, and that there had therefore been a failure to disclose in breach of section 71(1) of the Social Security Administration Act 1992. The Commissioner followed B v Secretary of State for Work and Pensions [2005] EWCA Civ 929, reported at R(IS) 9/06, in disregarding the claimant's mental state and memory difficulties.
The claimant appealed to the Court of Appeal. Before the Court of Appeal it was argued that the tribunal had erred in failing to consider as a matter "raised by the appeal" whether the decision superseded by the Secretary of State was an "incapacity decision" as defined in regulation 7(2)(c) of the Social Security and Child Support (Decisions and Appeals) Regulations 1999, and so could be superseded only from the date that the claimant knew or could reasonably have been expected to know that the change of circumstances should have been notified, Mongan v Department of Social Development [2005] NICA 16, reported as R 3/05 (DLA), being cited as authority that an issue need not be explicitly raised by a party to be raised "by the appeal" under section 12(8) of the Social Security Act 1998, provided it is clearly apparent from the evidence.
Held, dismissing the supersession appeal, but allowing the overpayment appeal, that:
Note: the notice requirement in regulation 17 of the Incapacity for Work (General) Regulations 1995 was abolished with effect from 10 April 2006 by SI 2006/757.
DECISION OF THE COURT OF APPEAL
Mr Simon Cox (instructed by Messrs Will Rolt) appeared for the appellant.
Mr Martin Chamberlain (instructed by Solicitor, Department for Work and Pensions) appeared for the respondent.
Judgment (reserved)
LORD JUSTICE DYSON:
Introduction
The facts
"You will no longer need to get a doctor to agree that the work will help your medical condition, but you should tell the office that deals with your benefit before you start work. You should fill in an application form before you do any permitted work."
The statutory framework
"(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."
"7. (1) This regulation
(b) contains exceptions to the provisions of section 10(5) as to the date from which a decision under section 10 which supersedes an earlier decision is to take effect.
(2) Where a decision under section 10 is made on the ground that there has been a relevant change of circumstances since the decision had effect or, in the case of an advance award, since the decision was made, the decision under section 10 shall take effect
(c) where the decision is not advantageous to the claimant
(ii) in the case of a disability benefit decision, or an incapacity benefit decision where there has been an incapacity determination (whether before of after the decision), where the Secretary of State is satisfied that in relation to a disability determination embodied in or necessary to the disability benefit decision, or the incapacity determination, the claimant or payee failed to notify an appropriate office of a change of circumstances which regulations under the Administration Act required him to notify, and the claimant or payee, as the case may be, knew or could reasonably have been expected to know that the change of circumstances should have been notified,
(aa) from the date on which the claimant or payee, as the case may be, ought to have notified the change of circumstances, or
(bb) if more than one change has taken place between the date from which the decision to be superseded took effect and the date of the superseding decision, from the date on which the first change ought to have been notified, or
(iii) in any other case, except in the case of a decision which supersedes a disability benefit decision, or an incapacity benefit decision where there has been an incapacity determination (whether before or after the decision), from the date of the change."
"7A. (1) For the purposes of regulations 7(2)(c) and (5)
'incapacity benefit decision' means a decision to award a relevant benefit or relevant credit embodied in or necessary to which is a determination that a person is or is to be treated as incapable of work under Part XIIA of the Contributions and Benefits Act,
'incapacity determination' means a determination whether a person is incapable of work by applying the personal capability assessment in regulation 24 of the Social Security (Incapacity for Work) (General) Regulations 1995 or whether a person is to be treated as incapable of work in accordance with regulation 10 (certain persons with a severe condition to be treated as incapable of work) or 27 (exceptional circumstances) of those Regulations,
"
"(1) Where it is determined that, whether fraudulently or otherwise, any person has misrepresented, or failed to disclose, any material fact and in consequence of the misrepresentation or failure
(a) a payment has been made in respect of a benefit to which this section applies; or
(b) any sum recoverable by or on behalf of the Secretary of State in connection with any such payment has not been recovered,
the Secretary of State shall be entitled to recover the amount of any payment which he would not have made or any sum which he would have received but for the misrepresentation or failure to disclose."
"(1) every beneficiary and every person by whom or on whose behalf sums payable by way of benefit are receivable shall furnish in such manner and at such times as the Secretary of State may determine such certificates and other documents and such information or facts affecting the right to benefit or to its receipt as the Secretary of State may require (either as a condition on which any sum or sums shall be receivable or otherwise), and in particular shall notify the Secretary of State of any change of circumstances which he might reasonably be expected to know might affect the right to benefit, or to its receipt, as soon as reasonably practicable after its occurrence, by giving notice in writing (unless the Secretary of State determine in any particular case to accept notice given otherwise than in writing) of any such change to the appropriate office."
The decisions below
"I read that passage as containing an instruction to the claimant to report that he was going to start work. The word "should" in both places is not the most mandatory term that could have been used, but it is commonly used as a polite way of wording an instruction and that is how I read it. The Secretary of State was authorised to give instructions to claimants to provide information under regulation 32 of the Social Security (Claims and Payments) Regulations 1987. Accordingly, the claimant was under a duty to report the fact that he was going to start work".
The issues
The first issue: should this court deal with the regulation 7(2)(c) issue?
"[14] The terms of article 13(8)(a) of the 1998 Order make it clear that issues not raised by an appeal need not be considered by an appeal tribunal. The use of the phrase "raised by the appeal" should be noted. The use of these words would tend to suggest that the tribunal would not be absolved of the duty to consider relevant issues simply because they have been neglected by the appellant or her legal representatives and that it has a role to identify what issues are at stake on the appeal even if they have not been clearly or expressly articulated by the appellant. Such an approach would chime well with the inquisitorial nature of the proceedings before the tribunal.
[15] It is now well established that appeal tribunal proceedings are inquisitorial in nature see, for example the recent Decision of a Tribunal of Social Security Commissioners CIB/4751/2002, CDLA 4753/2002, CDLA 4939/2002 and CDLA 514/2002 [reported as R(IB) 2/04]. Mr McAlister relied on this decision, however, to support his contention that the tribunal was not required to consider matters that had not been raised by the parties to the proceedings. In that case it was held that 'raised by the appeal' should be interpreted to mean 'actually raised at or before the hearing by one of the parties'. In so far as the decision suggests that an appeal tribunal would not be competent to inquire into a matter that arose on an appeal simply because it was not expressly argued by one of the parties to the appeal, we could not agree with it. It appears to us that the plain meaning of the words of the statute, taken together with the inquisitorial nature of the appeal hearing, demand a more proactive approach. If, for instance, it appeared to the tribunal from the evidence presented to it that an appellant might be entitled to a lower level of benefit than that claimed, its inquisitorial role would require a proper investigation of that possible entitlement.
[16] Mr McAlister suggested that even if the tribunal had a duty to consider issues not explicitly raised, this was a limited responsibility and he referred to an unreported decision C5/03-04(IB) in which Commissioner Brown held that the tribunal was not required "to exhaustively trawl the evidence to see if there is any remote possibility of an issue being raised by it". We accept that there must be limits to the tribunal's responsibility to identify and examine issues that have not been expressly raised and we agree with the observation of Commissioner Brown. But as she said in a later passage in the same case, issues "clearly apparent from the evidence" must be considered.
[17] Whether an issue is sufficiently apparent from the evidence will depend on the particular circumstances of each case. Likewise, the question of how far the tribunal must go in exploring such an issue will depend on the specific facts of the case. The more obviously relevant an issue, the greater will be the need to investigate it. An extensive inquiry into the issue will not invariably be required. Indeed, a perfunctory examination of the issue may often suffice. It appears to us, however, that where a higher rate of benefit is claimed and the facts presented to the tribunal suggest that an appellant might well be entitled to a lower rate, it will normally be necessary to examine that issue, whether or not it has been raised by the appellant or her legal representatives.
[18] In carrying out their inquisitorial function, the tribunal should have regard to whether the party has the benefit of legal representation. It need hardly be said that close attention should be paid to the possibility that relevant issues might be overlooked where the appellant does not have legal representation. Where an appellant is legally represented the tribunal is entitled to look to the legal representatives for elucidation of the issues that arise. But this does not relieve it of the obligation to enquire into potentially relevant matters. A poorly represented party should not be placed at any greater disadvantage than an unrepresented party."
"a decision to award a relevant benefit embodied in or necessary to which is a determination that a person is or is to be treated as incapable of work under Part XIIA of the Contributions and Benefits Act."
"17. (1) Where a person is entitled to invalidity benefit immediately before the appointed day, that award of invalidity benefit shall have effect on or after the appointed day as if it were an award of long-term incapacity benefit; and such an award shall be referred to in these Regulations as a transitional award of long-term incapacity benefit.
(2) Subject to the provisions in Part VI, a person's entitlement to a transitional award of long-term incapacity benefit shall be subject to him being incapable of work as determined in accordance with Part XIIA of the 1992 Act (Incapacity for Work)."
"8. I agree that 'shall have effect' in Regulation 17(1) of the Transitional Regulations means that the award falls to be treated "as if it were an award of long-term incapacity benefit". However, it is only to 'have effect' as, but it is not to 'become', incapacity benefit. I also consider that the provision in Regulation 17(2) is important in that it provides that 'a person's entitlement to a transitional award shall be subject to him being incapable of work'. If the award is subject to the claimant continuing to be incapable of work, then the decision must be capable of being changed (to use a neutral word) if the claimant becomes capable of work under Part XIIA of the 1992 Act. The question is whether this change can be effected under Regulation 6(2)(g).
9. The Transitional Regulations calls the award "a transitional award of long-term incapacity benefit" and provides that it shall be referred to as such in those Regulations. It does not specify how they are to be referred to in other Regulations. Regulation 6 of the 1999 Regulations refers to an 'incapacity benefit decision', a term which is defined in Regulation 7A.
10. The critical point in this case is the definition of 'incapacity benefit decision', because Regulation 6(2)(g) relates only to such a decision. The definition relates to 'a decision to award a relevant benefit' and one which is 'embodied in or necessary to which is a determination that a person is or is to be treated as incapable of work under Part XIIA'. I agree with the submission of the claimant, that the decision to award, what is now called 'a transitional award of long-term incapacity benefit' to the claimant in 1990 cannot be 'a decision to award a relevant benefit which is a determination under Part XIIA'. Any determination in 1990 could not have been a determination under Part XIIA which came into effect in April 1995. I also consider that the 'take effect' does not convert the 1990 decision into an incapacity decision, because it relates only to the continuing effect and not to a change into the new benefit."
"20. If conversion under regulation 17 of the transitional regulations makes an invalidity benefit decision count as an incapacity benefit decision for all purposes, then regulation 17(2) is otiose in so far as it provides that:
' a person's entitlement to a transitional award of long-term incapacity benefit shall be subject to him being incapable of work as determined in accordance with Part XIIA of the 1992 Act (Incapacity for Work)'
If it is so converted by operation of law, from one benefit to another benefit, then the tests applying to the latter automatically apply to the former invalidity benefit award. Moreover, calling it 'a transitional award of long-term incapacity benefit' underscores that it is not identical to a regular award of the same. Regulation 29 of the same regulations is also rendered redundant to a degree.
22. The award is treated as one of long-term incapacity benefit but the decision leading to that award, which decision when made was a decision to award invalidity benefit, was in no sense a decision critical to which was a determination of incapacity under the new scheme: ex hypothesi at the relevant date the test underpinning the basis of the award was the one germane to sickness or invalidity benefit under section 57(1) of the Social Security Contributions and Benefits Act 1992. On their present wording, nothing in regulation 17 of the transitional regulations, nor in the definition of 'incapacity benefit decision' under regulation 7A(1)(c) of the decisions regulations, turns an invalidity benefit decision into one which used anything other that the then invalidity benefit test when it was made; that the effect of an award resulting from such decision is changed for some purposes by legislative fiat from 13 April 1995 is a different matter entirely."
" It is quite probable that on a technical issue of understanding and applying the complex legislation the Social Security Commissioner will have got it right. The Commissioners will know how that particular issue fits into the broader picture of social security principles as a whole. They will be less likely to introduce distortion into those principles. They may be better placed, where it is appropriate, to apply those principles in purposive construction of the legislation in question. They will also know the realities of tribunal life. All of this should be taken into account by an appellate court when considering whether an appeal will have a real prospect of success."
The second issue:
The third issue: was there an error of law in relation to the overpayment issue?
"Telling the incapacity benefit office before starting work was not set out in the factsheet as one of the conditions on which work was permitted. The conditions stated were merely in terms of hours and earnings, and the length of time for which the permission would continue. The very use of the term 'permitted work', in the context of rules which were said to be making it easier for people to try paid work without affecting benefit, created an impression that work would be permitted, and not affect benefit, on those conditions alone. Then the instruction about telling the office was put at the end of the section on how benefit was affected, as the second part of a sentence beginning with the issue of doctors' advice about working, in terms of what 'should' be done. The sentence about filling in an application form before doing permitted work did not say that work would not be permitted work if an application form or information was not submitted at the right time. In those circumstances, I conclude that a person reading the factsheet with the degree of care to be expected of ordinary people, rather than lawyers or benefit experts, could think, without going outside the boundaries of reasonableness, that it was not necessary to inform the incapacity benefit authorities of work within the hours and earnings limits for permitted work. It could reasonably have been thought that giving such information was desirable, but no more, as it could have been thought that the giving of the information was irrelevant to the question of whether or not the work would affect entitlement to benefit. It could also reasonably have been thought that the new information superseded whatever was printed in the order book."
"14. In fact the leaflet, which started by explaining that from 8 April 2002 there were new more flexible rules for people who wanted to try paid work while getting incapacity benefit, and that it would now be much easier to do this without it affecting benefit entitlement, made no mention of any notification condition when setting out the requirements for the 'permitted work' claimants were told they were now allowed to do. In the section of the leaflet describing what qualified as 'permitted work' it referred to the various conditions as to hours of work, earnings and so forth, but at no point there or elsewhere in the leaflet did it set out anything that reflected the actual condition as to notification or the 42-day time limit for it under regulation 17. Instead all the leaflet contained was a passage in a separate section, after the one that described what work was 'permitted' and after the express assurance that 'Permitted work will not affect your incapacity benefit', saying:
'You will no longer need to get a doctor to agree that the work will help your medical condition, but you should tell the office that deals with your benefit before you start work. You should fill in an application form before you do any permitted work.'
15. I agree with the decision already cited and with Mr Newton's argument that this language is not apt on a fair construction to convey a mandatory requirement or condition of reporting in order for the work to count as permitted work at all. It follows that on the basis of what the claimant was told in the letter, which was the only evidence relied on by the Department, the chairman was not justified in his conclusion that there had been a failure on the claimant's part to make the disclosure reasonably to be expected of him in all the circumstances, applying the established test in R(SB) 21/82. I further accept Mr Newton's submission that if any more stringent test omitting the element of reasonableness is the one to apply in this context as suggested in a recent Tribunal of Commissioners' decision in CIS/4348/2003 [the decision upheld by the Court of Appeal in B, now reported as R(IS) 9/06], the evidence was still insufficient to establish a 'failure' on the claimant's part in view of the lack of clarity in the leaflet about whether notification was actually required, as distinct from being advisable. Paragraphs 33 and 34 of that decision make clear that what is there said about failure to provide information required by the Secretary of State applies only if the form of the requirement or request is 'unambiguous', and the leaflet here was very far from that. In addition, the chairman's reference to the claimant's parents being able to make enquiries introduces what as it stands is an irrelevant consideration since the question is what the claimant himself ought or ought not to have done, there being no suggestion that he was unable to manage his own affairs or that anyone else was appointed to act for him."
LORD JUSTICE THOMAS:
LORD JUSTICE WARD:
Order: appeal allowed. Decision of Commissioner set aside. Decision of appeal tribunal set aside and decision substituted confirming decision of Secretary of State issued 7 August 2004 and setting aside decision of Secretary of State issued 13 August 2004. Respondent to pay appellant's costs subject to assessment.
(Order does not form part of the approved judgment)