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

(The document as of February, 2008)

-- Back --

Page 4

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

References to medical practitioners, the Disability Living Allowance Advisory Board etc.

51 Power of adjudicating authorities to refer matters to experts

(1) An authority to which this section applies may refer any question of special difficulty arising for decision by the authority to one or more experts for examination and report.

(2) The authorities to which this section applies are--

(a) an adjudication officer;

(b) an adjudicating medical practitioner, or two or more such practitioners acting together;

(c) a specially qualified adjudicating medical practitioner appointed by virtue of section 60 below, or two or more such practitioners acting together;

(d) a social security appeal tribunal;

(e) a disability appeal tribunal;

(f) a medical appeal tribunal;

(g) a Commissioner;

(h) the Department.

(3) Regulations may prescribe cases in which a Commissioner shall not exercise the power conferred by subsection (1) above.

(4) In this section "expert" means a person appearing to the authority to have knowledge or experience which would be relevant in determining the question of special difficulty.

52 Claims relating to attendance allowance, disability living allowance and disability working allowance

(1) Before a claim for an attendance allowance, a disability living allowance or a disability working allowance or any question relating to such an allowance is submitted to an adjudication officer under section 18 above the Department may refer the person in respect of whom the claim is made or the question is raised to a medical practitioner for such examination and report as appears to the Department to be necessary--

(a) for the purpose of providing the adjudication officer with information for use in determining the claim or question; or

(b) for the purpose of general monitoring of claims for attendance allowances, disability living allowances and disability working allowances.

(2) An adjudication officer may refer--

(a) a person in respect of whom such a claim is made or such a question is raised;

(b) a person who has applied or is treated as having applied for a review under section 28 or 33 above,

to a medical practitioner for such examination and report as appears to the adjudication officer to be needed to enable him to reach a decision on the claim or question or the matter under review.

(3) The Department may direct adjudication officers to refer for advice to a medical practitioner who is an officer of the Department any case falling within a specified class of cases relating to attendance allowance or disability living allowance, and an adjudication officer may refer for advice any case relating to attendance allowance or disability living allowance to such a medical practitioner without such a direction.

(4) An adjudication officer may refer for advice any case relating to disability working allowance to such a medical practitioner.

(5) A medical practitioner who is an officer of the Department and to whom a case or question relating to an attendance allowance or a disability living allowance is referred under section 51 above or subsection (3) above may refer the case or question to the Disability Living Allowance Advisory Board for advice.

(6) Such a medical practitioner may obtain information about such a case or question from another medical practitioner.

(7) A medical practitioner who is an officer of the Department and to whom a question relating to disability working allowance is referred under section 51 above may obtain information about it from another medical practitioner.

(8) Where--

(a) the Department has exercised the power conferred on it by subsection (1) above or an adjudication officer has exercised the power conferred on him by subsection (2) above; and

(b) the medical practitioner requests the person referred to him to attend for or submit himself to medical examination; but

the adjudication officer shall decide the claim or question or matter under review against him.

53 Medical examination etc. in relation to appeals to disability appeal tribunals

(1) Where an appeal has been brought under section 31 above, a person who may be nominated as chairman of a disability appeal tribunal may, if prescribed conditions are satisfied, refer the claimant to a medical practitioner for such examination and report as appears to him to be necessary for the purpose of providing a disability appeal tribunal with information for use in determining the appeal.

(2) At a hearing before a disability appeal tribunal, except in prescribed circumstances, the tribunal --

(a) may not carry out a physical examination of the claimant; and

(b) may not require the claimant to undergo any physical test for the purpose of determining whether he satisfies the condition mentioned in section 73(1)(a) of the Contributions and Benefits Act.

Determination of questions of special difficulty

54 Assessors

(1) Where it appears to an authority to which this section applies that a matter before the authority involves a question of fact of special difficulty, then, unless regulations otherwise provide, the authority may direct that in dealing with that matter they shall have the assistance of one or more assessors.

(2) The authorities to which this section applies are--

(a) two or more adjudicating medical practitioners acting together;

(b) two or more specially qualified adjudicating medical practitioners, appointed by virtue of section 60 below, acting together;

(d) a disability appeal tribunal;

(e) a medical appeal tribunal;

(f) a Commissioner;

(g) the Department.

55 Tribunal of 2 or 3 Commissioners

(1) If it appears to the Chief Social Security Commissioner (or, in the case of his inability to act, to such other of the Commissioners as he may have nominated to act for the purpose) that an appeal falling to be heard by one of the Commissioners involves a question of law of special difficulty, he may direct that the appeal be dealt with, not by that Commissioner alone, but by a Tribunal consisting of any 2 or 3 of the Commissioners.

(2) If the decision of the Tribunal is not unanimous, the decision of the majority, or, in the case of a Tribunal consisting of 2 Commissioners, the decision of the presiding member, shall be the decision of the Tribunal.

Regulations

56 Regulations as to determination of questions and matters arising out of, or pending, reviews and appeals

(1) Subject to the provisions of this Act, provision may be made by regulations for the determination--

(a) by the Department; or

(b) by a person or tribunal appointed or constituted in accordance with the regulations,

of any question arising under or in connection with the Contributions and Benefits Act or the former legislation, including a claim for benefit.

(2) In this section "the former legislation" means the National Insurance Acts (Northern Ireland) 1965 to 1974 and the National Insurance (Industrial Injuries) Acts (Northern Ireland) 1965 to 1974 and the 1975 Act and Part III of the 1986 Order.

(3) Regulations under subsection (1) above may modify, add to or exclude any provisions of this Part of this Act, so far as relating to any questions to which the regulations relate.

(4) It is hereby declared for the avoidance of doubt that the power to make regulations under subsection (1) above includes power to make regulations for the determination of any question arising as to the total or partial recoupment of unemployment benefit in pursuance of regulations under Article 72(1) of the [S.I. 1976/1043 (N.I. 16).] Industrial Relations (Northern Ireland) Order 1976 (including any decision as to the amount of benefit).

(5) Regulations under subsection (1) above may provide for the review by the Department of decisions on questions determined by it.

(6) The Lord Chancellor may by regulations provide--

(a) for officers authorised by him to determine any question which is determinable by a Commissioner and which does not involve the determination of any appeal, application for leave to appeal or reference;

(b) for the procedure to be followed by any such officer in determining any such question;

(7) A determination which would have the effect of preventing an appeal, application for leave to appeal or reference being determined by a Commissioner is not a determination of the appeal, application or reference for the purposes of subsection (6) above.

(8) Regulations under subsection (1) above may provide--

(a) for the reference to the Court of Appeal for decision of any question of law arising in connection with the determination of a question by the Department; and

(b) for appeals to that court from the decision of the Department on any such question of law;

and subsections (5) and (6) of section 16 above shall apply to a reference or appeal under this subsection as they apply to a reference or appeal under subsections (1) to (3) of that section.

57 Procedure

(1) Regulations (in this section referred to as "procedure regulations") may make any such provision as is specified in Schedule 3 to this Act.

(2) Procedure regulations may deal differently with claims and questions relating to--

(a) benefit under Parts II to IV of the Contributions and Benefits Act;

(b) industrial injuries benefit;

(3) At any inquiry held by virtue of procedure regulations the witnesses shall, if the person holding the inquiry thinks fit, be examined on oath; and the person holding the inquiry shall have power to administer oaths for that purpose.

(4) In proceedings for the determination of a question mentioned in section 15(1)(c) above (including proceedings on an inquiry), there shall be available to a witness (other than the person who is liable, or alleged to be liable, to pay the Class 1A contribution in question) any privilege against self-incrimination or incrimination of a spouse which is available to a witness in legal proceedings.

(5) It is hereby declared--

(a) that the power to prescribe procedure includes power to make provision as to the representation of one person, at any hearing of a case, by another person whether having professional qualifications or not; and

(b) that the power to provide for the manner in which questions arising for determination by the Department are to be raised includes power to make provision with respect to the formulation of any such questions, whether arising on a reference under section 111 below or otherwise.

(6) Except so far as it may be applied by procedure regulations, the [1937 c. 8 (N.I.).] Arbitration Act (Northern Ireland) 1937 shall not apply to any proceedings under this Part of this Act.

58 Finality of decisions

(1) Subject to the provisions of this Part of this Act, the decision of any claim or question in accordance with the foregoing provisions of this Part of this Act shall be final; and subject to the provisions of any regulations under section 56 above, the decision of any claim or question in accordance with those regulations shall be final.

(2) Subsection (1) above shall not make any finding of fact or other determination embodied in or necessary to a decision, or on which it is based, conclusive for the purpose of any further decision.

(3) A decision (given under subsection (2) of section 42 above or otherwise) that an accident was an industrial accident is to be taken as determining only that paragraphs (a), (b) and (c) of subsection (5) of that section are satisfied in relation to the accident, and neither any such decision nor the reference to an adjudicating medical practitioner or a medical appeal tribunal under section 43 above of the disablement questions in connection with any claim to or award of disablement benefit is to be taken as importing a decision as to the origin of any injury or disability suffered by the claimant, whether or not there is an event identifiable as an accident apart from any injury that may have been received; but--

(a) a decision that on a particular occasion when there was no such event a person had an industrial accident by reason of an injury shall be treated as a decision that, if the injury was suffered by accident on that occasion, the accident was an industrial accident; and

(b) a decision that an accident was an industrial accident may be given, and a declaration to that effect be made and recorded in accordance with section 42 above, without its having been found that personal injury resulted from the accident (saving always the discretion under subsection (3) of that section to refuse to determine the question if it is unlikely to be necessary for the purposes of a claim for benefit).

(4) Notwithstanding anything in subsection (2) or (3) above (but subject to the provisions of this Part of this Act as to appeal and review), where for purposes of disablement pension or disablement gratuity in respect of an accident it has been found by an adjudicating medical practitioner or a medical appeal tribunal, on the determination or last determination of the disablement questions, that an injury resulted in whole or in part from the accident, then for purposes of industrial death benefit in respect of that accident the finding shall be conclusive that the injury did so result.

(5) Subsections (2) to (4) above shall apply as regards the effect to be given in any proceedings to any decision, or to a reference under section 43 above, whether the decision was given or reference made or the proceedings were commenced before or after the passing of the [1972 c. 57.] National Insurance Act 1972 (section 5 of which originally contained the provisions contained in this section), except that it shall not affect the determination of any appeal under section 46 above from a decision of a medical appeal tribunal given before the passing of that Act, nor affect any proceedings consequent on such an appeal from a decision so given; and accordingly--

(a) any decision given before the passing of that Act that a claimant was not entitled to industrial death benefit may be reviewed in accordance with this Part of this Act to give effect to subsection (4) above; and

(b) the references in subsections (2) and (3) above to provisions of this Act, and the reference in this subsection to section 43 above shall (so far as necessary) include the corresponding provisions of previous Acts.

59 Regulations about supplementary matters relating to determinations

(1) Regulations may make provision as respects matters arising--

(a) pending the determination under this Act (whether in the first instance or on an appeal or reference, and whether originally or on review)--

(i) of any claim for benefit to which this section applies;

(ii) of any question affecting any person's right to such benefit or its receipt; or

(iii) of any person's liability for contributions under Part I of the Contributions and Benefits Act; or

(b) out of the revision on appeal or review of any decision under this Act on any such claim or question.

(2) Without prejudice to the generality of subsection (1) above, regulations under that subsection may include provision as to the date from which any decision on a review is to have effect or to be deemed to have had effect.

(3) Regulations under subsection (1) above as it applies to child benefit may include provision as to the date from which child benefit is to be payable to a person in respect of a child in a case where, before the benefit was awarded to that person, child benefit in respect of the child was awarded to another person.

(4) This section applies to the following benefits--

(a) benefit as defined in section 121 of the Contributions and Benefits Act;

(b) child benefit;

(d) statutory maternity pay;

(e) income support;

(f) family credit;

(g) disability working allowance; and

(h) any social fund payments such as are mentioned in section 134(1)(a) or (2) of the Contributions and Benefits Act.

Industrial diseases

60 Adjudication as to industrial diseases

(1) Regulations shall provide for applying, in relation--

(a) to claims for benefit under sections 108 to 110 of the Contributions and Benefits Act; and

(b) to questions arising in connection with such claims or with awards of such benefit,

the provisions of this Part of this Act subject to any prescribed additions or modifications.

(2) Regulations for those purposes may in particular provide--

(a) for the appointment of specially qualified adjudicating medical practitioners and the appointment of medical officers for the purposes of the regulations (which shall be taken to include, in the case of specially qualified adjudicating medical practitioners, the purposes for which adjudicating medical practitioners are appointed and medical appeal tribunals are established); and

(b) for the payment by the prescribed persons of fees of the prescribed amount in connection with any medical examination by specially qualified adjudicating medical practitioners or any such officer and their return in any prescribed cases, and (so far as not required to be returned) their payment into the National Insurance Fund and recovery as sums due to that Fund.

Housing benefit

61 Adjudication

(1) Regulations shall require a person who has claimed housing benefit to be notified of the determination of the claim.

(2) Any such notification shall be given in such form as may be prescribed.

(3) Regulations shall make provision for reviews of determinations relating to housing benefit.

Social fund officers and inspectors and the social fund Commissioner

62 Social fund officers

(1) The Department shall appoint officers, to be known as "social fund officers", for the purpose of performing functions in relation to payments out of the social fund such as are mentioned in section 134(1)(b) of the Contributions and Benefits Act.

(2) A social fund officer may be appointed to perform all the functions of social fund officers or such functions of such officers as may be specified in his instrument of appointment.

(3) The Department may nominate for an area a social fund officer who shall issue general guidance to the other social fund officers in the area about such matters relating to the social fund as the Department may specify.

63 The social fund Commissioner and inspectors

(1) There shall continue to be an officer known as "the social fund Commissioner" (in this section referred to as "the Commissioner").

(2) The Commissioner shall be appointed by the Department.

(3) The Commissioner--

(a) shall appoint such social fund inspectors; and

(b) may appoint such officers and staff for himself and for social fund inspectors,

as he thinks fit, but with the consent of the Department and the Department of Finance and Personnel as to numbers.

(4) Appointments under subsection (3) above shall be made from persons made available to the Commissioner by the Department.

(5) It shall be the duty of the Commissioner--

(a) to monitor the quality of decisions of social fund inspectors and give them such advice and assistance as he thinks fit to improve the standard of their decisions;

(b) to arrange such training of social fund inspectors as he considers appropriate; and

(c) to carry out such other functions in connection with the work of social fund inspectors as the Department may direct.

(6) The Commissioner shall report annually in writing to the Department on the standards of reviews by social fund inspectors and the Department shall publish his report.

64 Reviews

(1) A social fund officer--

(a) shall review a determination made under the Contributions and Benefits Act by himself or some other social fund officer, if an application for a review is made within such time and in such form and manner as may be prescribed by or on behalf of the person who applied for the payment to which the determination relates; and

(b) may review such a determination in such other circumstances as he thinks fit;

and may exercise on a review any power exercisable by an officer under Part VIII of the Contributions and Benefits Act.

(2) The power to review a determination conferred on a social fund officer by subsection (1) above includes power to review a determination made by a social fund officer on a previous review.

(3) On an application made by or on behalf of the person to whom a determination relates within such time and in such form and manner as may be prescribed a determination of a social fund officer which has been reviewed shall be further reviewed by a social fund inspector.

(4) On a review a social fund inspector shall have the following powers--

(a) power to confirm the determination made by the social fund officer;

(b) power to make any determination which a social fund officer could have made;

(5) A social fund inspector may review a determination under subsection (3) above made by himself or some other social fund inspector.

(6) In determining a question on a review a social fund officer or social fund inspector shall have regard, subject to subsection (7) below, to all the circumstances of the case and, in particular, to the matters specified in section 136(1)(a) to (e) of the Contributions and Benefits Act.

(7) An officer or inspector shall determine any question on a review in accordance with any general directions issued by the Department under section 136(2) of the Contributions and Benefits Act and any general directions issued by the Department with regard to reviews and in determining any such question shall take account of any general guidance issued by the Department under that subsection or with regard to reviews.

(8) Directions under this section may specify--

(a) the circumstances in which a determination is to be reviewed; and

(b) the manner in which a review is to be conducted.

(9) In reviewing a question under this section a social fund officer shall take account (subject to any directions or guidance issued by the Department under this section) of any guidance issued by the social fund officer nominated for his area under section 62(3) above.

(10) A social fund inspector reviewing a determination shall be under the same duties in relation to such guidance as the social fund officer or inspector who made the determination.

Christmas bonus

65 Determination of questions

(1) A determination by the competent authority that a person is entitled or not entitled to payment of a qualifying benefit in respect of a period which includes a day in the relevant week shall be conclusive for the purposes of section 144 of the Contributions and Benefits Act; and in this subsection "competent authority" means, in relation to a payment of any description of a qualifying benefit, an authority that ordinarily determines whether a person is entitled to such a payment.

(2) Any question arising under that section other than one determined or falling to be determined under subsection (1) above shall be determined by the Department whose decision shall, except as provided by subsection (3) below, be final.

(3) The Department may reverse a decision under subsection (2) above on new facts being brought to its notice or if it is satisfied that the decision was given in ignorance of, or was based on a mistake as to, some material fact.

(4) Expressions used in this section to which a meaning is assigned by section 146 of the Contributions and Benefits Act have that meaning in this section.

Restrictions on entitlement to benefit following erroneous decision

66 Restrictions on entitlement to benefit in certain cases of error

(1) This section applies where--

(a) on the determination, whenever made, of a Commissioner or the court (the "relevant determination"), a decision made by an adjudicating authority is or was found to have been erroneous in point of law; and

(b) after both--

(i) 14th August 1990 (the date of the coming into operation of section 154D of the 1975 Act, the provision of that Act corresponding to this section); and

(ii) the date of the relevant determination,

a claim which falls, or which would apart from this section fall, to be decided in accordance with the relevant determination is made or treated under section 5(1)(i) above as made by any person for any benefit.

(2) Where this section applies, any question which arises on, or on the review of a decision which is referable to, the claim mentioned in subsection (1)(b) above and which relates to the entitlement of the claimant or any other person to any benefit--

(a) in respect of a period before the relevant date; or

(b) in the case of a widow's payment, in respect of a death occurring before that date,

shall be determined as if the decision referred to in subsection (1)(a) above had been found by the Commissioner or court in question not to have been erroneous in point of law.

(3) In determining whether a person is entitled to benefit in a case where--

(a) his entitlement depends on his having been entitled to the same or some other benefit before attaining a particular age; and

(b) he attained that age--

(i) before both the date of the relevant determination and the date of the claim referred in subsection (1)(b) above, but

(ii) not before the earliest day in respect of which benefit could, apart from this section, have been awarded on that claim,

subsection (2) above shall be disregarded for the purpose only of determining the question whether he was entitled as mentioned in paragraph (a) above.

(4) In this section--

"adjudicating authority" means--

(a) an adjudication officer or, where the original decision was given on a reference under section 19(2) or 23(1) above, a social security appeal tribunal, a disability appeal tribunal or a medical appeal tribunal;

(b) any of the following former bodies or officers, that is to say, the National Assistance Board for Northern Ireland, the Supplementary Benefits Commission for Northern Ireland, the Attendance Allowance Board for Northern Ireland, a benefit officer, an insurance officer or a supplement officer; or

(c) any of the officers who, or tribunals or other bodies which, in Great Britain correspond to those mentioned in paragraph (a) or (b) above;

"benefit" means--

(a) benefit as defined in section 121 of the Contributions and Benefits Act;

(b) any income-related benefit;

"the court" means the High Court, the Court of Appeal, the Court of Session, the High Court or Court of Appeal in England and Wales, the House of Lords or the Court of Justice of the European Community;
"the relevant date" means whichever is the latest of--

(a) the date of the relevant determination;

(b) the date which falls 12 months before the date on which the claim referred to in subsection (1)(b) above is made or treated under section 5(1)(i) above as made; and

(c) the earliest date in respect of which the claimant would, apart from this section, be entitled on that claim to the benefit in question.

(5) For the purposes of this section--

(a) any reference in this section to entitlement to benefit includes a reference to entitlement--

(i) to any increase in the rate of a benefit; or

(ii) to a benefit, or increase of benefit, at a particular rate; and

(b) any reference to a decision which is "referable to" a claim is a reference to--

(i) a decision on the claim,

(ii) a decision on a review of the decision on the claim, or

(iii) a decision on a subsequent review of the decision on the review,

and so on.

(6) The date of the relevant determination shall, in prescribed cases, be determined for the purposes of this section in accordance with any regulations made for that purpose.

67 Determination of questions on review following erroneous decisions

(1) Subsection (2) below applies in any case where--

(b) in consequence of that determination, any other decision--

(i) which was made before the date of that determination; and

(ii) which is referable to a claim made or treated as made by any person for any benefit,

falls (or would, apart from subsection (2) below, fall) to be revised on a review carried out under section 23(5) above after 14th August 1990 (the date of the coming into force of section 104(7) to (10) of the 1975 Act, the provision of that Act corresponding to this section) or on a review under section 28 above on the ground that the decision under review was erroneous in point of law.

(2) Where this subsection applies, any question arising on the review referred to in subsection (1)(b) above, or on any subsequent review of a decision which is referable to the same claim, as to any person's entitlement to, or right to payment of, any benefit--

(a) in respect of any period before the date of the relevant determination; or

(b) in the case of a widow's payment, in respect of a death occurring before that date,

shall be determined as if the decision referred to in subsection (1)(a) above had been found by the Commissioner or court in question not to have been erroneous in point of law.

(3) In determining whether a person is entitled to benefit in a case where his entitlement depends on his having been entitled to the same or some other benefit before attaining a particular age, subsection (2) above shall be disregarded for the purpose only of determining the question whether he was so entitled before attaining that age.

(4) For the purposes of this section--

(a) "adjudicating authority" and "the court" have the same meaning as they have in section 66 above;

(b) any reference to--

(i) a person's entitlement to benefit; or

(ii) a decision which is referable to a claim,

shall be construed in accordance with subsection (5) of that section; and

(c) the date of the relevant determination shall, in prescribed cases, be determined in accordance with any regulations made under subsection (6) of that section.

Correction of errors

68 Regulations as to correction of errors

(1) Regulations may make provision with respect to--

(a) the correction of accidental errors in any decision or record of a decision given with respect to a claim or question arising under or in connection with any relevant enactment by a body or person authorised to decide the claim or question; and

(b) the setting aside of any such decision in a case where it appears just to set the decision aside on the ground that--

(i) a document relating to the proceedings in which the decision was given was not sent to, or was not received at an appropriate time by, a party to the proceedings or a party's representative or was not received at an appropriate time by the body or person who gave the decision; or

(ii) a party to the proceedings or a party's representative was not present at a hearing related to the proceedings.

(2) Nothing in subsection (1) above shall be construed as derogating from any power to correct errors or set aside decisions which is exercisable apart from regulations made by virtue of that subsection.

(3) In this section "relevant enactment" means any enactment contained in--

(a) the National Insurance Measures (Northern Ireland) 1966 to 1974;

(b) the National Insurance (Industrial Injuries) Measures (Northern Ireland) 1966 to 1974;

(d) the [1973 c. 38.] Social Security Act 1973;

(e) the Social Security (Northern Ireland) Acts 1975 to 1991;

(f) the Old Cases Act;

(g) the [S.I. 1975/1504 (N.I. 16).] Child Benefit (Northern Ireland) Order 1975;

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