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Annual Report of the Ombudsman 2008 (text version)

6.2.5 Selected Cases - Carer for aunt and uncle gets full allowance (€322.10) weekly following Department review

This case demonstrates the value of my powers to access the files of public bodies. A woman applied for carer's benefit in respect of her claim that she was providing full-time care and attention to her aunt and uncle (carees). She was awarded payment with effect from 3 May 2007 by the department in respect of her uncle, who was involved in a serious road accident and had broken his neck.  However, she was refused payment in respect of her aunt, who was certified by her GP as having medical problems from birth. This refusal of benefit followed the examination of medical evidence provided by the woman and submitted by the department's deciding officer to its medical adviser. He determined, based on the medical evidence provided, that the caree was "not approved" under the terms and conditions of the scheme.

The woman appealed the disallowance of carer's benefit to the independent Social Welfare Appeals Office in September 2007.  An oral hearing of the appeal was convened and the woman was afforded the opportunity to provide additional information in relation to her aunt's situation. Having heard all the evidence the appeals officer determined that in his opinion the caree's circumstances did not require continual supervision and frequent assistance with personal needs. The appeal was therefore disallowed.

The woman complained to my Office and I examined both the department's and the Social Welfare Appeals Office’s files.  Following that examination, it emerged that there was additional medical evidence submitted to the department by the woman which had not been referred by the deciding officer to the department's medical adviser.  Additionally, it was not referred to by the deciding officer, when preparing a submission on the case to the Social Welfare Appeals Office.

The evidence suggested that the caree's condition was more severe than the original medical evidence used to determine the caree's eligibility under the carer's benefit scheme. I asked the department to carry out a review of its decision to take account of the additional medical evidence and it was referred to the medical adviser. He subsequently concluded that this evidence was sufficient to approve the caree as suitable under the terms and conditions of the carer's benefit scheme. Payment of carer's benefit was then approved and the woman was awarded payment for the second caree.  This resulted in her entitlement being increased from €214.70 per week (one caree) to €322.10 (for two carees). Her claim was backdated to the date of application and she received arrears totalling nearly €12,000, which included payment of a respite care grant for 2007 and 2008.

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