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UK Social Security and Child Support Commissioners' Decisions |
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You are here: BAILII >> Databases >> UK Social Security and Child Support Commissioners' Decisions >> [2005] UKSSCSC CIS_1657_2004 (15 February 2005) URL: http://www.bailii.org/uk/cases/UKSSCSC/2005/CIS_1657_2004.html Cite as: [2005] UKSSCSC CIS_1657_2004 |
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THE SOCIAL SECURITY COMMISSIONERS
Commissioner's Case No. : CIS/1657/2004
APPEAL FROM A DECISION OF AN APPEAL TRIBUNAL ON A QUESTION OF LAW
DECISION OF THE SOCIAL SECURITY COMMISSIONER
MR DEPUTY COMMISSIONER POYNTER
(a) that the claimant was not entitled to income support, for various specified periods between 11 October 2000 and 16 September 2002; and
(b) that she had been overpaid—and was liable to repay—£4,912.25 as income support for those periods; and
(c) that the claimant was entitled to income support at a reduced rate for other specified periods between 5 May 2001 and 7 June 2002; and
(d) that she had been overpaid—and was liable to repay—£566.38 as income support for those periods.
The facts
(e) The appellant has been claiming income support since 1993. At the beginning of her claim, she established entitlement to that benefit on the basis that she was the lone parent of two sons.
(f) Subsequently the appellant claimed incapacity benefit. The papers are silent as to the illness or disability that formed the basis of that claim and equivocal as to the date on which it was made, but it is not in dispute that the Secretary of State accepted her as being incapable of work. The appellant had not paid sufficient national insurance contributions to be entitled to incapacity benefit but the acceptance of her incapacity for work provided her with an additional basis for her entitlement to income support and had the practical consequence that, after a year, income support was paid at a higher rate because of the inclusion in her applicable amount of the disability premium (see paragraphs 11(a) and 12 of Schedule 2 to the Income Support (General) Regulations 1987 ("the Income Support Regulations")).
(g) In August 1998, the appellant's younger son reached the age of 16 and was therefore no longer a "child" for income support purposes. This in turn meant that the appellant ceased to be a "lone parent". However, income support continued to be paid to her on the basis that she was incapable of work.
(h) On 21 September 2000, the appellant began work. The tribunal found the nature of the work to be as follows:
"She worked on a self-employed basis for B. S. Limited, a company which produces and sells Christmas crackers. The company recruits people on low incomes, provides them with the wherewithal to make crackers and pays on a "piece work" basis. The system is attractive to benefit claimants because they can do the work in their own homes and at their own pace. The rate paid for the job is so poor that the work is unlikely to attract anyone who does not have an income from another source."
(i) The tribunal also found as a fact that the appellant was working 25 hours per week on average. That had been disputed by the Secretary of State on the basis that the appellant had said in a formal written statement that she "was working on average about 60 hours a week". In the appeal to the Commissioner, the appellant maintains that in many weeks she worked for fewer than 16 hours.
(j) There is no suggestion in the papers that the appellant's work for B. S. Limited was undertaken on the advice of a doctor. Further, the appellant neither obtained the approval of the Department before she started work nor notified it of that change of circumstances after it had occurred. In particular, on 26 March 2001, she completed and signed an A2 review form on which she did not declare either the work that she was doing or the wages that she received for that work.
(k) Evidence of the amounts paid to the appellant was obtained from B. S. Limited and appears in the papers. The first payment was made on 17 October 2000 and the final payment on 16 September 2002. It appears that the appellant did no further work for B. S. Limited after the latter date.
(l) The appellant was subsequently prosecuted for criminal offences arising out of the work she did and her failure to report that work. She pleaded guilty to those charges at Blackpool Magistrates Court on 2 June 2003 and was sentenced to a community punishment.
The Secretary of State's decisions and the appeals against them
(a) for any week commencing on or after 5 May 2001 in which the appellant was entitled to income support at all, she was so entitled at reduced rate; and
(b) for those weeks there had been a further overpayment of income support, which was recoverable from the appellant.
The tribunal's decision and the appeal to the Commissioner
The prescribed categories
(c) whether the appellant remained a lone parent;
(d) whether the appellant was a "person appealing against a decision which embodies a determination that they are not incapable of work" within paragraph 24 of Schedule 1B; and
(e) whether the appellant was a "disabled worker" within paragraph 8 of the Schedule
"Disabled workers
8. A person to whom regulation 6(4)(a) (persons not treated as engaged in remunerative work) applies."
Regulation 6(4)(a) provides as follows:
"(4) The following persons shall not be treated as engaged in remunerative work—
(a) a person who is mentally or physically disabled and by reason of that disability—
(i) his earnings are reduced to 75 per cent, or less of what a person without that disability and working the same number of hours would reasonably be expected to earn in that employment or in comparable employment in the area; or
(ii) his number of hours of work are 75 per cent. or less of what a person without that disability would reasonably be expected to undertake in that employment or in comparable employment in the area;"
'61. Ever since the decision of the Divisional Court in R v Medical Appeal Tribunal (North Midland Region), Ex p Hubble [1958] 2 QB 228, it has been accepted that the process of benefits adjudication is inquisitorial rather than adversarial. Diplock J as he then was said this of an industrial injury benefit claim at p 240:
"A claim by an insured person to benefit under the Act is not truly analogous to a lis inter partes. A claim to benefit is a claim to receive money out of the insurance funds . . . Any such claim requires investigation to determine whether any, and if so, what amount of benefit is payable out of the fund. In such an investigation, the minister or the insurance officer is not a party adverse to the claimant. If analogy be sought in the other branches of the law, it is to be found in an inquest rather than in an action."
62. What emerges from all this is a co-operative process of investigation in which both the claimant and the department play their part. The department is the one which knows what questions it needs to ask and what information it needs to have in order to determine whether the conditions of entitlement have been met. The claimant is the one who generally speaking can and must supply that information. But where the information is available to the department rather than the claimant, then the department must take the necessary steps to enable it to be traced.
The missing incapacity decision
"has been reversed or varied on an appeal or has been revised under section 9 or superseded under section 10 of the Social Security Act 1998"
(see section 71(5A) of the Social Security Administration Act 1992 ("the Administration Act")). The requirements of that section have recently been considered by Mr Commissioner Bano in CIS/3228/2003 and Mr Commissioner Williams in CIS/170/2003 and the new tribunal will want to have regard to what is said there about the general principles to be applied.
(a) the "week" during which the claimant is treated as capable of work is not the same as the "week" which is used for the purposes of income support. The former period is fixed and runs from Sunday to Saturday. The latter is a "benefit week" which is determined in accordance with paragraph 4 of Schedule 7 to the Social Security (Claims and Payments) Regulations 1987. In the particular circumstances of this appeal, the two "weeks" should be the same (because before she started work, the appellant would have been entitled to incapacity benefit if she had paid sufficient contributions). But it is not clear that the rule has been correctly applied. In particular, 11 October 2000 (which is said to be the first day of the first period of non-entitlement) was a Wednesday, not a Sunday. I cannot immediately see how that can be correct.
(b) if, for some reason, the appellant's income support benefit week did not run from Sunday to Saturday, there is the additional problem for the Secretary of State that under regulation 4ZA(4) of the Income Support Regulations, if the appellant was incapable of work for even one day in a benefit week she is treated as falling within that prescribed category for the whole of the week.
Was the appellant a "disabled worker"?
(c) Regulation 6(4)(a) only applies to the appellant in respect of weeks during which she was actually in employment. Mr Commissioner Rice so decided in CIS/15/1997. That appeal concerned the predecessor to the current regulation 6(4)(a) but the wording is the same. Mr Rice's decision was recently followed by Mr Commissioner Henty in CIS/1997/2002. The commentary to paragraph 8 of Schedule 1B in Social Security Legislation 2004 (Bonner et al. Vol. II, pp. 505-506) which suggests that regulation 6(4)(a) may apply in some circumstances in which the claimant's earnings, or hours worked, are nil, appears to have been written without reference to those decisions. The regulation requires a comparison between what a claimant actually earns (or the number of hours she actually works) and what a person without a disability would be expected to earn (or the hours that person might be expected to work) "in that employment or in comparable employment in the area". The basis for that comparison only exists if the claimant is in employment.
(d) There is no definition of what might amount to a mental or physical disability for the purposes of regulation 6(4)(a), so whether or not the appellant is "mentally or physically disabled" is a question of fact for the new tribunal to decide, having regard to what I say at paragraph 22 above.
(e) If the new tribunal decides that the appellant is "mentally or physically disabled", then it will also need to make findings on
(i) What was the nature of that disability?
(ii) How many hours did the appellant work?
(iii) How many hours would a person without that disability reasonably be expected to work in that employment or in comparable employment in the area?
(iv) How much did the appellant earn?
(v) How much would a person without that disability and working the same number of hours reasonably be expected to earn in that employment or in comparable employment in the area?
(f) If the appellant does come within regulation 6(4)(a), then she is treated as not being in remunerative work even if she in fact works for more than 16 hours a week.
Earnings
Conclusion
(Signed on the original)
Richard Poynter