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Press Release - Social Welfare/Health Boards Case Summaries (Annual Report 1995)

Press Release - Social Welfare/Health Boards Case Summaries (Annual Report 1995)

Social Welfare/Health Boards - Notes

• Arrears of benefit refused because of failure to apply in time.

Every year, the Ombudsman receives complaints from people who belatedly discover that they have been entitled to a contributory social welfare payment for some time but who, when they apply, are not paid arrears from the date on which they would have been first eligible. These complainants feel that, because their entitlement is based on social insurance contributions, they should be fully entitled to whatever arrears arise.

The Ombudsman received 12 such complaints in 1995. In many of these cases, very substantial arrears - up to eight years and €40,000 in one case - are at issue. These complainants did not apply for the pension at the prescribed time either because they were simply unaware of their entitlement or because they say that they were given wrong information regarding entitlements. The Department says that arrears can only be paid for a maximum of six months prior to the actual date of claim and that their position is governed by the regulations relating to late claims. The Ombudsman feels that this provision is essentially unfair and that it is not in line with the principle of proportionality i.e. that the penalty (loss of arrears) should be in proportion to the "fault" (failure to apply in time). He remains concerned that pension entitlements, based on social insurance contributions, can be lost simply because there was a failure to apply in time without due regard to the reason for the failure to apply. In his view, the penalty imposed by the regulations is, in many cases, too severe. Some of these complainants say that they were unaware of their entitlements. The Ombudsman points out that it seems that the social welfare system has now become so complex that it may no longer be sufficient for the Department to put the onus on ordinary citizens to be aware of their rights and entitlements.

He has started a formal investigation of three of these complaints.

• Social Welfare Insurance Anomaly affecting the Self-Employed

A complaint received during 1995 illustrates an anomaly in the social welfare system affecting people who become self-employed following a long period of paid employment with full PRSI.

A complainant was refused Invalidity Pension by the Department of Social Welfare. He had been in employment for 26 years, paying full-rate PRSI, before being made redundant in 1984. He claimed Unemployment Benefit for the maximum period and then went into self-employment until forced to stop at the end of 1992 because he developed serious health problems. He considered that he was entitled to a social welfare disability payment because of his full PRSI record from the time he was in employment. However, to bring this record into effect for Disability Benefit purposes he would have had to resume work and pay full-rate PRSI for 13 weeks, with a further 26 weeks of credits. For Invalidity Pension, he would have needed at least 48 credits, which can only follow paid contributions. Had he remained unemployed rather than taking up self-employment, in all probability he would have qualified for Invalidity Pension on the basis of social insurance credits.

This case demonstrates the unfortunate implications for people who become self-employed following a substantial period of paid employment carrying full PRSI and who subsequently become ill.

• Pension arrears of €17,000 paid.

An old age pensioner who qualified for a Non-Contributory Old Age Pension in 1973 was unaware that he should have been claiming for his wife as an adult dependent since the introduction of an adult dependent allowance by the Department of Social Welfare in 1974. It was only in 1993, when a Department official called to him on separate business that he discovered that he should have been claiming for his wife since 1974. Initially the Department refused to pay arrears but, following an examination by the Ombudsman, and because of several factors unique to this particular case, the Department eventually agreed to pay the full arrears which amounted to €17,000.

• Health Boards - Communication Failure

Over the years, the Ombudsman has received numerous complaints about the administration of the Domiciliary Care Allowance (DCA) and Disabled Persons Maintenance Allowance (DPMA) Schemes by the various Health Boards. Details of some of these are outlined in the Annual Report. Two cases concern failures by the Eastern Health Board and the Southern Health Board to provide adequate information to parents with children who would have qualified for DCA but who were not advised by the Health Boards to apply. When they eventually found out about the allowance, the Boards refused to backdate the allowance to the date when their children would have been eligible. Following the intervention of the Ombudsman, the Boards agreed to pay arrears to the date of qualification (€7,546 in the case of the Eastern Health Board, €9,672 in the case of the Southern). However in order to address the recurring problems which have arisen with the Health Boards in the administration of these schemes, the Ombudsman met with the Chief Executive Officers of the Health Boards. He has since issued a memorandum, which they have circulated to their staff, setting out what he considers to be relevant factors in relation to the award of DCA and DPMA.