Citizens Advice Bureau

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LOCAL INFORMATION

9.20.4
Social Security Appeal System

Extent:Jersey
Updated 01 November 2013
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Assistance with appeals

There are various appeal procedures in place to enable the public to have decisions of the Social Security Department adjudicated by independent tribunals. The procedures differ according to the benefit in questions, and assistance is available to the public from members of staff at the Department or the Registrar of Appeals. Also see the Social Security booklet "If you think our decision is wrong" available from the Social Security Department or Citizens Advice Jersey.

Contact for the Adjudication Section or Registrar of Appeals- telephone 445505

Basic procedure

Client receives decision on benefit/pension, and finds it unsatisfactory,
or Social Security Department wants to have decision reviewed:
 
An application to appeal must be lodged in the form of a written letter within the
prescribed time (normally 28 days). Statements as evidence to support the
appeal must be submitted.
 
The case is reviewed by Determining Officer first. If the client is still dissatisfied
the case is passed to the Registrar of Appeals for action.
 
Case is adjudicated by appropriate tribunal:
     
Medical Tribunal - Social
Security
Tribunal
-  
 
If client feels a 'point of law' is in dispute there is recourse to:
 
Inferior Number of the Royal Court
(The Determining Officer could also seek an opinion on a point of law)



WHAT TYPE OF BENEFIT IS IN QUESTION

CONTRIBUTORY BENEFITS

Contributions

Where the benefit in question is dependent upon a contribution record, eg old age pension, decisions are based on the client's contributions paid over a period of time. For some benefits, eg Maternity Benefit, there is a relevant period of time specified during which a sufficient level of contributions must have been made. The record of such contributions is a matter of fact for which there is no right of appeal. Although the recording of payments may extend back over a long time, and payments may have been made during work in another country eg the UK, it is up to the Social Security Department with the assistance of the claimant to research such records and assess whether contribution conditions have been satisfied.

Reasons for possible appeal

Benefits must be claimed within prescribed times set out in law for claims to be accepted outside these times good cause must be demonstrated for late application, however application made more than six months after the start of the prescribed time cannot be considered by the Determining Officer. An appeal could be lodged regarding the Determining Officer's decision relating to good cause not being present.

There may be medical reasons for a benefit being refused or limited. Benefits such as Long Term Incapacity Allowance are decided on evidence assessed by a Medical Board of two medical practitioners or medical specialists. If a client is unhappy with the benefit offered, or if benefit is refused, a client should contact the Department immediately for advice because there is no appeal available in the case of some awards of Long Term Incapacity Allowance.

In some cases where the percentage of incapacity is disputed, a Medical Tribunal can be convened to hear medical evidence provided by the applicant's GP or specialist. The Medical Tribunal consists of the Chairman (an advocate) and two medical practitioners. The rules governing Long Term Incapacity Allowance appeals are complex and therefore people wishing to question an award should contact the Department for guidance.

NON-CONTRIBUTORY BENEFITS

Medical disputes

Where the benefit being applied for is based on medical circumstances, eg Personal Care Component of Income Support, any dispute would be considered by a Medical Tribunal but in these cases the Board consists of three medical practitioners.

Other disputes

Legal aspects of a decision on a non-contributory benefit may be looked into by the Social Security Tribunal, and ultimately, by the Inferior Number of the Royal Court.

The Operation of Tribunals

Applicants would normally appear before the tribunal, and may be represented and supported by a lawyer, possibly on legal aid, a friend or a treating doctor.

Oaths are administered to those giving evidence to tribunals, and the Chairman has the discretion to admit written evidence where appropriate.

The tribunal hears evidence from the Determining Officer, for the Social Security Department, and also from the appellant and her/his representatives. The Tribunal has the right to request additional information if necessary to help it reach a decision.

The tribunal members must then make a value judgement on the case, which is binding on both parties, subject to review by the Inferior Number of the Royal Court.

When there is no right of appeal

  • There is no appeal available on the award of death grant.
  • There is no appeal in cases where the Department must assess which of two or more persons satisfy entitlement to a benefit, eg in cases where a man has a wife, and also a common law' wife.
  • There is also no appeal where the Department must assess which of two or more person's contribution record should be used in evaluating a claim, eg for a woman with a husband, and common law' husband.
  • There is no appeal against some awards of Long Term Incapacity Allowance. As This is a complex area clients should contact the Social Security Department as soon as possible for advice.