Social Security Administration (Northern Ireland) Act 1992 (c. 8)

(The document as of February, 2008)

-- Back --

Page 3

Pages: P.1 | P.2 | P.3 | P.4 | P.5 | P.6 | P.7 | P.8 | P.9 | P.10 | P.11

(a) by the person himself; or

(b) by any other person purporting to act on his behalf, whether or not that other person is acting with his knowledge or authority;

and a decision may be so reviewed on such an application, notwithstanding that no claim under section 66(1), 72(5) or 73(12) of that Act has been made.

(6) Where a decision is reviewed under section 28 above on the ground that it is anticipated that a change of circumstances will occur, the decision given on review--

(a) shall take effect on the day prescribed for that purpose by reference to the date on which the change of circumstances is expected to occur; and

(b) shall be reviewed again if the change of circumstances either does not occur or occurs otherwise than on that date.

(7) Where a claimant has appealed against a decision of an adjudication officer under section 31 below and the decision is reviewed again under section 28(2), (4) or (5) above by an adjudication officer, then--

(a) if the adjudication officer considers that the decision which he has made on the review is the same as the decision that would have been made on the appeal had every ground of the appeal succeeded, then the appeal shall lapse; but

(b) in any other case, the review shall be of no effect and the appeal shall proceed accordingly.

(8) Regulations may make provision restricting the payment of any benefit, or any increase of benefit, to which a person would, but for this subsection, be entitled by reason of a review in respect of any period before or after the review (whether that period falls wholly or partly before or after the making of the regulations).

(9) Where an adjudication officer has determined that any amount paid by way of an attendance allowance, a disability living allowance or a disability working allowance is recoverable under or by virtue of section 69 below, any person from whom he has determined that it is recoverable shall have the same right of review under section 28 above as a claimant.

(10) This Act and the Contributions and Benefits Act shall have effect in relation to a review by virtue of subsection (9) above as if any reference to the claimant were a reference to the person from whom the adjudication officer has determined that the amount in question is recoverable.

31 Appeals following reviews

(1) Where an adjudication officer has given a decision on a review under section 28(1) above, the claimant or such other person as may be prescribed may appeal--

(a) in prescribed cases, to a disability appeal tribunal; and

(b) in any other case, to a social security appeal tribunal.

(2) Regulations may make provision as to the manner in which, and the time within which, appeals are to be brought.

(3) An award on an appeal under this section replaces any award which was the subject of the appeal.

(4) Where a person who has been awarded a disability living allowance consisting of one component alleges on an appeal that he is also entitled to the other component, the tribunal need not consider the question of his entitlement to the component which he has already been awarded or the rate of that component.

(5) Where a person who has been awarded a disability living allowance consisting of both components alleges on an appeal that he is entitled to one component at a rate higher than that at which it has been awarded, the tribunal need not consider the question of his entitlement to the other component or the rate of that component.

(6) The tribunal shall not consider--

(a) a person's entitlement to a component which has been awarded for life;

(b) the rate of a component so awarded; or

unless--

(i) the appeal expressly raises that question; or

(ii) information is available to the tribunal which gives it reasonable grounds for believing that entitlement to the component, or entitlement to it at the rate awarded or for that period, ought not to continue.

32 Appeal from social security appeal tribunals or disability appeal tribunals to Commissioners and appeals from Commissioners

(1) Subject to the provisions of this section, an appeal lies to a Commissioner from any decision of a social security appeal tribunal or disability appeal tribunal under section 31 above on the ground that the decision of the tribunal was erroneous in point of law.

(2) An appeal lies under this section at the instance of any of the following--

(a) an adjudication officer;

(b) the claimant;

(i) where the claimant is a member of the union at the time of the appeal and was so immediately before the question at issue arose;

(ii) where that question in any way relates to a deceased person who was a member of the union at the time of his death; and

(d) a person from whom it is determined that any amount is recoverable under section 69 below.

(3) Subsection (2) above, as it applies to a trade union, applies also to any other association which exists to promote the interests and welfare of its members.

(4) Subsections (7) to (10) of section 21 above have effect for the purposes of this section as they have effect for the purposes of that section.

(5) Section 22 above applies to a decision of a Commissioner under this section as it applies to a decision of a Commissioner under section 21 above.

33 Reviews of decisions on appeal

(1) Any decision under this Act of a social security appeal tribunal, a disability appeal tribunal or a Commissioner which relates to an attendance allowance or a disability living allowance may be reviewed at any time by an adjudication officer if--

(a) he is satisfied that the decision was given in ignorance of, or was based on a mistake as to, some material fact;

(b) there has been any relevant change of circumstances since the decision was given;

(d) the decision was that a person is or was at any time terminally ill for the purposes of section 66(1), 72(5) or 73(12) of the Contributions and Benefits Act and there has been a change of medical opinion with respect to his condition or his reasonable expectation of life; or

(e) the decision was to make an award for a period wholly or partly after the date on which the claim was made or treated as made but subject to a condition being fulfilled and that condition has not been fulfilled,

but regulations may provide that a decision may not be reviewed on the ground mentioned in paragraph (a) above unless the officer is satisfied as mentioned in that paragraph by fresh evidence.

(2) Regulations may prescribe what are, or are not, relevant changes of circumstances for the purposes of subsection (1)(b) and (c) above.

(3) Any decision under this Act of a social security appeal tribunal, a disability appeal tribunal or a Commissioner which relates to a disability working allowance may be reviewed at any time by an adjudication officer if--

(a) he is satisfied that the decision was given in ignorance of, or was based on a mistake as to, some material fact;

(b) subject to section 128(6) of the Contributions and Benefits Act, there has been any prescribed change of circumstances since the decision was given; or

(c) the decision was to make an award for a period wholly or partly after the date on which the claim was made or treated as made but subject to a condition being fulfilled and that condition has not been fulfilled,

but regulations may provide that a decision may not be reviewed on the ground mentioned in paragraph (a) above unless the officer is satisfied as mentioned in that paragraph by fresh evidence.

(4) A question may be raised with a view to a review under this section by means of an application made in writing to an adjudication officer, stating the grounds of the application and supplying such information and evidence as may be prescribed.

(5) Regulations may provide for enabling or requiring, in prescribed circumstances, a review under this section notwithstanding that no application for a review has been made under subsection (4) above.

(6) Reviews under this section shall be carried out by adjudication officers.

(7) Except in prescribed circumstances, where a claim for a disability living allowance in respect of a person already awarded such an allowance on an appeal is made or treated as made during the period for which he has been awarded the allowance, it shall be treated as an application for a review under this section.

(8) Subsections (1), (2), (4) and (5) of section 28 above shall apply--

(a) to a decision on a review under this section; and

(b) to a refusal to review a decision such as is mentioned in subsection (1) above,

as they apply to a decision of an adjudication officer under section 19 above.

(9) The person whose claim was the subject of the appeal the decision on which has been reviewed under this section shall be given such notification as may be prescribed--

(a) of the decision on the review; and

(b) of his right to a further review under section 28(1) above.

(10) Regulations may make provision restricting the payment of any benefit, or any increase of benefit, to what a person would, but for this subsection, be entitled by reason of a review in respect of any period before or after the review (whether that period falls wholly or partly before or after the making of the regulations).

(11) Where a decision is reviewed on the ground mentioned in subsection (1)(c) above, the decision given on the review--

(a) shall take effect on the day prescribed for that purpose by reference to the date on which the relevant change of circumstances is expected to occur; and

(b) shall be reviewed again if the relevant change of circumstances either does not occur or occurs otherwise than on that date.

(12) Sections 28(10) and 30(1) to (5) above shall apply in relation to a review under this section as they apply to a review under section 28 above.

Questions first arising on appeal

34 Questions first arising on appeal

(1) Where a question which but for this section would fall to be determined by an adjudication officer first arises in the course of an appeal to a social security appeal tribunal, a disability appeal tribunal or a Commissioner, the tribunal, subject to subsection (2) below, or the Commissioner may, if they or he think fit, proceed to determine the question notwithstanding that it has not been considered by an adjudication officer.

(2) A social security appeal tribunal may not determine a question by virtue of subsection (1) above if an appeal in relation to such a question would have lain to a disability appeal tribunal.

Reference of special questions

35 Reference of special questions

(1) Subject to subsection (2) below--

(a) if on consideration of any claim or question an adjudication officer is of opinion that there arises any question which under or by virtue of this Act falls to be determined otherwise than by an adjudication officer, he shall refer the question for such determination; and

(b) if on consideration of any claim or question a social security appeal tribunal or Commissioner is of opinion that any such question arises, the tribunal or Commissioner shall direct it to be referred by an adjudication officer for such determination.

(2) The person or tribunal making or directing the reference shall then deal with any other question as if the referred question had not arisen.

(3) The adjudication officer, tribunal or Commissioner may--

(a) postpone the reference of, or dealing with, any question until other questions have been determined;

(b) in cases where the determination of any question disposes of a claim or any part of it, make an award or decide that an award cannot be made, as to the claim or that part of it, without referring or dealing with, or before the determination of, any other question.

Adjudication officers and the Chief Adjudication Officer

36 Adjudication officers

(1) Adjudication officers shall be appointed by the Department, subject to the consent of the Department of Finance and Personnel as to number, and may include officers of the Department of Social Security appointed with the concurrence of the Secretary of State.

(2) An adjudication officer may be appointed to perform all the functions of adjudication officers under any enactment or such functions of such officers as may be specified in his instrument of appointment.

37 The Chief Adjudication Officer

(1) The Department shall appoint for Northern Ireland a Chief Adjudication Officer.

(2) It shall be the duty of the Chief Adjudication Officer to advise adjudication officers on the performance of their functions under this or any other enactment.

(3) The Chief Adjudication Officer shall keep under review the operation of the system of adjudication by adjudication officers and matters connected with the operation of that system.

(4) The Chief Adjudication Officer shall report annually in writing to the Department on the standards of adjudication and the Department shall publish his report.

Social security appeal tribunals

38 Panels for appointment to social security appeal tribunals

(1) The President shall constitute for the whole of Northern Ireland to act for such areas as he thinks fit and to be composed of such persons as he thinks fit to appoint, panels of persons to act as members of social security appeal tribunals.

(2) The panel for an area shall be composed of persons appearing to the President to have knowledge or experience of conditions in the area and to be representative of persons living or working in the area.

(3) Before appointing members of a panel, the President shall take into consideration any recommendations from such organisations or persons as he considers appropriate.

(4) The members of the panels shall hold office for such period as the President may direct, but the President may at any time terminate the appointment of any member of a panel.

39 Constitution of social security appeal tribunals

(1) A social security appeal tribunal shall consist of a chairman and two other persons.

(2) The members other than the chairman shall be drawn from the appropriate panel constituted under section 38 above.

(3) The President shall nominate the chairman.

(4) The President may nominate as chairman--

(a) himself;

(b) one of the full-time chairmen appointed under section 49(1)(b) below; or

(5) If practicable, at least one of the members of the appeal tribunal hearing a case shall be of the same sex as the claimant.

(6) Schedule 2 to this Act shall have effect for supplementing this section.

Disability appeal tribunals

40 Panels for appointment to disability appeal tribunals

(1) The President shall constitute for the whole of Northern Ireland, to act for such areas as he thinks fit and be composed of such persons as he thinks fit to appoint, panels of persons to act as members of disability appeal tribunals.

(2) There shall be two panels for each area.

(3) One panel shall be composed of medical practitioners.

(4) The other shall be composed of persons who are experienced in dealing with the needs of disabled persons--

(a) in a professional or voluntary capacity; or

(b) because they are themselves disabled,

but may not include medical practitioners.

(5) In considering the appointment of members of the panels the President shall have regard to the desirability of appointing disabled persons.

(6) Before appointing members of a panel, the President shall take into consideration any recommendations from such organisations or persons as he considers appropriate.

(7) The members of the panels shall hold office for such periods as the President may direct, but the President may at any time terminate the appointment of any member of a panel.

41 Constitution of disability appeal tribunals

(1) A disability appeal tribunal shall consist of a chairman and two other persons.

(2) Of the members of a tribunal other than the chairman, one shall be drawn from the panel mentioned in subsection (3) of section 40 above.

(3) The other shall be drawn from the panel mentioned in subsection (4) of that section.

(4) The President shall nominate the chairman.

(5) The President may nominate as chairman--

(a) himself;

(b) one of the full-time chairmen appointed under section 49(1)(b) below; or

(6) In summoning members of a panel to serve on a tribunal, the clerk to the tribunal shall have regard to the desirability of at least one of the members of the tribunal being a disabled person.

(7) If practicable, at least one of the members of the tribunal shall be of the same sex as the claimant.

(8) Schedule 2 to this Act shall have effect for supplementing this section.

Adjudication in relation to industrial injuries and disablement benefit

42 Declaration that accident is an industrial accident

(1) Where, in connection with any claim for industrial injuries benefit, it is determined that the relevant accident was or was not an industrial accident, an express declaration of that fact shall be made and recorded and (subject to subsection (3) below) a claimant shall be entitled to have the question whether the relevant accident was an industrial accident determined notwithstanding that his claim is disallowed on other grounds.

(2) Subject to subsection (3) below and to section 58 below, any person suffering personal injury by accident shall be entitled, if he claims the accident was an industrial accident, to have that question determined, and a declaration made and recorded accordingly, notwithstanding that no claim for benefit has been made in connection with which the question arises; and this Part of this Act applies for that purpose as if the question had arisen in connection with a claim for benefit.

(3) The adjudication officer, social security appeal tribunal or Commissioner (as the case may be) may refuse to determine the question whether an accident was an industrial accident if satisfied that it is unlikely to be necessary to determine the question for the purposes of any claim for benefit; but any such refusal of an adjudication officer or social security appeal tribunal shall be subject to appeal to a social security appeal tribunal or Commissioner, as the case may be.

(4) Subject to the provisions of this Part of this Act as to appeal and review, any declaration under this section that an accident was or was not an industrial accident shall be conclusive for the purposes of any claim for industrial injuries benefit in respect of that accident.

(5) Where subsection (4) above applies--

(a) in relation to a death occurring before 11th April 1988; or

(b) for the purposes of section 60(2) of the Contributions and Benefits Act,

it shall have effect as if at the end there were added the words "whether or not the claimant is the person at whose instance the declaration was made".

(6) For the purposes of this section (but subject to section 58(3) below), an accident whereby a person suffers personal injury shall be deemed, in relation to him, to be an industrial accident if--

(a) it arises out of and in the course of his employment;

(b) that employment is employed earner's employment for the purposes of Part V of the Contributions and Benefits Act;

(c) payment of benefit is not under section 94(5) of that Act precluded because the accident happened while he was outside Northern Ireland.

(7) A decision under this section shall be final except that sections 23 to 27 above apply to a decision under this section that an accident was or was not an industrial accident as they apply to a decision under sections 19 to 21 above if, but only if, the adjudication officer or social security appeal tribunal, as the case may be, is satisfied that the decision under this section was given in consequence of any wilful non-disclosure or misrepresentation of a material fact.

43 Disablement questions

(1) In relation to industrial injuries benefit and severe disablement allowance, the "disablement questions" are the questions--

(a) in relation to industrial injuries benefit, whether the relevant accident has resulted in a loss of faculty;

(b) in relation to both benefits, at what degree the extent of disablement resulting from a loss of faculty is to be assessed, and what period is to be taken into account by the assessment;

but questions relating to the aggregation of percentages of disablement resulting from different accidents are not disablement questions (and accordingly fall to be determined by an adjudication officer).

(2) Subject to and in accordance with regulations, the disablement questions shall be referred to and determined--

(a) by an adjudicating medical practitioner;

(b) by two or more adjudicating medical practitioners;

(d) in such cases relating to severe disablement allowance as may be prescribed, by an adjudication officer.

(3) Where--

(a) the case of a claimant for disablement benefit has been referred by the adjudication officer to one or more adjudicating medical practitioners for determination of the disablement questions; and

(b) on that or any subsequent reference, the extent of the disablement is provisionally assessed,

the case shall again be referred under this section, to one or more adjudicating medical practitioners as regulations may provide for the purposes of such subsequent references, not later than the end of the period taken into account by the provisional assessment.

(4) Where, in the case of a claimant for disablement benefit, the extent of any disablement of his resulting from an aggregable accident (that is to say, an accident other than the one which is the basis of the claim in question) has been assessed in accordance with paragraph 6(3) of Schedule 6 to the Contributions and Benefits Act at less than 14 per cent., then--

(a) the adjudication officer may refer the disablement questions relating to the aggregable accident to one or more adjudicating medical practitioners for fresh determination; and

(b) on any such reference--

(i) those questions shall be determined as at the first day of the common period; and

(ii) the period to be taken into account shall be the period beginning with that day.

(5) In subsection (4) above "the first day of the common period" means whichever is the later of--

(a) the first day of the period taken into account by the assessment of the extent of the claimant's disablement resulting from the accident which is the basis of the claim in question;

(b) the first day of the period taken into account by the assessment of the extent of his disablement resulting from the aggregable accident.

(6) In the following provisions of this Act "adjudicating medical practitioner" means, in relation to any case, one such practitioner, unless regulations applicable to cases of that description provide for references to more than one.

44 Medical appeals and references

(1) This section has effect where the case of a claimant for disablement benefit or severe disablement allowance has been referred by the adjudication officer to an adjudicating medical practitioner for determination of the disablement questions.

(2) Subject to subsection (3) below, if the claimant is dissatisfied with the decision of the adjudicating medical practitioner, he may appeal in the prescribed manner and within the prescribed time, and the case shall be referred to a medical appeal tribunal.

(3) If--

(a) the Department notifies the adjudication officer within the prescribed time that it is of the opinion that any decision of the adjudicating medical practitioner ought to be considered by a medical appeal tribunal; or

(b) the adjudication officer is of the opinion that any such decision ought to be so considered,

the adjudication officer shall refer the case to a medical appeal tribunal for their consideration, and the tribunal may confirm, reverse or vary the decision in whole or in part as on an appeal.

45 Review of medical decisions

(1) Any decision under this Act of an adjudicating medical practitioner or a medical appeal tribunal may be reviewed at any time by an adjudicating medical practitioner if satisfied that the decision was given in ignorance of a material fact or was based on a mistake as to a material fact.

(2) Any decision under this Act of an adjudicating medical practitioner may be reviewed at any time by such a practitioner if he is satisfied that the decision was erroneous in point of law.

(3) Regulations may provide that a decision may not be reviewed under subsection (1) above unless the adjudicating medical practitioner is satisfied as mentioned in that subsection by fresh evidence.

(4) Any assessment of the extent of the disablement resulting from the relevant loss of faculty may also be reviewed by an adjudicating medical practitioner if he is satisfied that since the making of the assessment there has been an unforeseen aggravation of the results of the relevant injury.

(5) Where in connection with a claim for disablement benefit made after 20th October 1953 it is decided that the relevant accident has not resulted in a loss of faculty, the decision--

(a) may be reviewed under subsection (4) above as if it were an assessment of the extent of disablement resulting from a relevant loss of faculty; but

(b) subject to any further decision on appeal or review, shall be treated as deciding the question whether the relevant accident had so resulted both for the time about which the decision was given and for any subsequent time.

(6) For the purposes of subsection (5) above, a final assessment of the extent of the disablement resulting from a loss of faculty made for a period limited by reference to a definite date shall be treated as deciding that at that date the relevant accident had not resulted in a loss of faculty.

(7) An assessment made, confirmed or varied by a medical appeal tribunal shall not be reviewed under subsection (4) above without the leave of a medical appeal tribunal, and (notwithstanding the provisions of Part V of the Contributions and Benefits Act) on a review under that subsection the period to be taken into account by any revised assessment shall only include a period before the date of the application for the review if and in so far as regulations so provide.

(8) Subject to the foregoing provisions of this section, an adjudicating medical practitioner may deal with a case on a review in any manner in which he could deal with it on an original reference to him, and in particular may in any case relating to disablement benefit make a provisional assessment notwithstanding that the assessment under review was final.

(9) Section 44 above applies to an application for a review under this section and to a decision of an adjudicating medical practitioner in connection with such an application as it applies to an original claim for disablement benefit or severe disablement allowance, as the case may be, and to a decision of an adjudicating medical practitioner in connection with such a claim.

(10) In subsection (6) above the reference to a final assessment does not include an assessment made for the purpose of section 12(1)(a) or (b) of the [1946 c. 21 (N.I.).] National Insurance (Industrial Injuries) Act (Northern Ireland) 1946 as originally enacted and having the effect that benefit is not payable.

46 Appeal etc. on question of law to Commissioner

(1) Subject to this section, an appeal lies to a Commissioner from any decision of a medical appeal tribunal (if given after 6th April 1987) on the ground that the decision is erroneous in point of law, at the instance of--

(a) an adjudication officer;

(b) the claimant;

(c) a trade union of which the claimant was a member at the time of the relevant accident or, in a case relating to severe disablement allowance, at the prescribed time; or

(d) the Department.

(2) Subsection (1) above, as it applies to a trade union, applies also to any other association which exists to promote the interests and welfare of its members.

(3) No appeal lies under subsection (1) above without the leave--

(a) of the person who was the chairman of the medical appeal tribunal when the decision was given or, in a prescribed case, the leave of some other chairman of a medical appeal tribunal; or

(b) subject to and in accordance with regulations, of a Commissioner,

and regulations may make provision as to the manner in which, and the time within which, appeals are to be brought and applications made for leave to appeal.

(4) On any such appeal, the question of law arising for the decision of the Commissioner and the facts on which it arises shall be submitted for his consideration in the prescribed manner.

(5) Where the Commissioner holds that the decision was erroneous in point of law he shall set it aside and refer the case to a medical appeal tribunal with directions for its determination.

(6) Subject to any direction of the Commissioner, the tribunal on a reference under subsection (5) above shall consist of persons who were not members of the tribunal which gave the erroneous decision.

Adjudicating medical practitioners and medical appeal tribunals

47 Adjudicating medical practitioners

(1) Adjudicating medical practitioners shall be appointed by the Department.

(2) The Department may make arrangements whereby any adjudicating medical practitioners for the purposes of the Great Britain Administration Act shall be adjudicating medical practitioners for the purposes of this Act.

(3) Subject to subsections (1) and (2) above, the appointment of adjudicating medical practitioners shall be determined by regulations.

48 Constitution of medical appeal tribunals

(1) A medical appeal tribunal shall consist of a chairman and two other persons.

(2) The members other than the chairman shall be medical practitioners appointed by the President after consultation with such academic medical bodies as appear to him to be appropriate.

(3) The President shall nominate the chairman.

(4) The President may nominate as chairman--

(a) himself;

(b) one of the full-time chairmen appointed under section 49(1)(b) below; or

(5) The Department may make arrangements whereby a medical appeal tribunal for the purposes of the Great Britain Administration Act shall be a medical appeal tribunal for the purposes of this Act.

(6) Subject to subsections (1) to (4) above, the constitution of medical appeal tribunals shall be determined by regulations.

(7) Schedule 2 to this Act shall have effect for supplementing this section.

The President and chairmen of tribunals

49 The President of social security appeal tribunals, medical appeal tribunals and disability appeal tribunals and chairmen

(1) The Lord Chancellor may appoint for Northern Ireland--

(a) a President of social security appeal tribunals, medical appeal tribunals and disability appeal tribunals;

(b) full-time chairmen of such tribunals; and

(2) A person is qualified to be appointed President if he is a barrister or solicitor of at least 10 years' standing.

(3) A person is qualified to be appointed a full-time chairman if he is a barrister or solicitor of at least 7 years' standing.

(4) A person is qualified to be appointed to the panel referred to in subsection (1)(c) above if he is a barrister or solicitor of at least 5 years' standing.

(5) Schedule 2 to this Act shall have effect for supplementing this section.

Social Security Commissioners

50 Appointment of Commissioners

(1) Her Majesty may from time to time appoint for Northern Ireland, from among persons who are barristers or solicitors of at least 10 years' standing--

(a) a Chief Social Security Commissioner; and

(b) such number of other Social Security Commissioners,

as Her Majesty thinks fit.

(2) If the Lord Chancellor considers that, in order to facilitate the disposal of the business of Social Security Commissioners, he should make an appointment in pursuance of this subsection, he may appoint--

(a) a member of the bar of Northern Ireland or solicitor of the Supreme Court of Northern Ireland of at least 10 years' standing;

(b) a person who has a 10 year general qualification within the meaning of section 71 of the [1990 c. 41.] Courts and Legal Services Act 1990; or

to be a Social Security Commissioner (but to be known as a deputy Commissioner) for such period or on such occasions as the Lord Chancellor thinks fit.

(3) Schedule 2 to this Act shall have effect for supplementing this section.

Pages: P.1 | P.2 | P.3 | P.4 | P.5 | P.6 | P.7 | P.8 | P.9 | P.10 | P.11

-- Back --

Stat