Long term incapacity allowance and return to work by recipients

1240/5(2355)

WRITTEN QUESTION TO THE PRESIDENT OF THE EMPLOYMENT AND SOCIAL SECURITY COMMITTEE BY DEPUTY G.P. SOUTHERN OF ST. HELIER

ANSWER TO BE TABLED ON TUESDAY 15th MARCH 2005

Question

The President has stated that the reason for the application of an incapacity percentage rule to all long term incapacity allowance (LTIA) recipients is to encourage a return to work. Would the President inform members –

(a ) h ow many any of the 125 LTIA recipients in the last quarter of 2004 have managed to return to

work?

( b )  whether any recipients of LTIA have been refused Health Insurance Exception benefit (HIE),

despite meeting the income criteria, on the grounds that they are less than 100% incapacitated, and, if so, would he confirm whether this is the Committee's policy?

(c ) w hether any difficulties exist concerning the ability of the medical board to fairly assign a degree of

incapacity to applicants for LTIA showing a wide range of illnesses, and, if so, has this lead to an increase in the rate of appeals made? and,

(d ) w hether the Committee will review the appeals procedure by which a period of two years applies to

failed appeals, given the possibility that an applicant's condition may change during this time?

Answer

1. It i s impossible to answer this question in the time available as it would divert a disproportionateamount of resourcefor a manualsearchand survey. This is because contribution returns for the first quarter of 2005 have not been submittedbyemployersyetand are not due for processing untilApril2005.When contribution returns are completelyprocessedit will bepossibleto see if claimants onLTIA are working and paying contributions through a computer search. I can say that several claimants are being helped by the Department'sWorkwiseTeam.As Deputy Southern isaware from ananswer to a previous question, the Committee will undertake a full review at the end of the first year when a clearer pattern mayhave emerged.
2. T h ereareseveralnon-financial criteria for the awardof HIE which can include the circumstancesofother membersof the household.Thereisno criterion that states that a person mustbe 100% incapacitated. However, there is a criterion that a personofworking age who is notworking can qualify if it is likely that he or she wouldbeunlikely ever to workagainduetoincapacity.In the past this was authenticated by a letter from the claimant's general practitioner. Thenew incapacity pensionisbasedon the same criteria and can be used as a passport to HIEifother criteria are metincluding the income test. The Committee is alsoconsideringifsuch an automaticprovisioncould be extendedto claimants with high rates of LTIA withoutbreachingthecashlimit set by the States as the HIEscheme is partially funded from general revenues.
3. T h e Committeeis not aware of difficulties in assessmentonce all the relevant information on the claimant is made available. Themedical board system works well, with decisions subject to appeal, but despite the volumeofassessments very few actually go to appeal. A factor in this maybe the constitution of the medical boardwhichconsistsof two doctors rather than one. Ingeneral, the system isgenerallyperceived to be fair and reasonable.However,members will know of particular caseswheremedical opinions differ and the SocialSecurityLawwas changed in 2001 to allow the use of external experts to determine any particular case should the need arise. I should also mention that every assessment by the board is preceded by the Department writing totherelevantgeneral practitioner for information.

4. If a claimant's condition deteriorates substantially a review ofthe decision can bemadeand similarly if the Department believes a person's condition has improved a referral for review can alsobe made. The two year period has been used to stop persistent frivolous appeals.