Determining officer guidance for Long Term Incapacity Benefit (FOI)

​Request

A.

Complete Procedures that SSD have, the DOG, that govern the processes that SSD must follow, in carrying out these task, for a person that’s trying to obtain STIB.

B.

Complete Procedures that SSD have, the DOG, that govern the processes that SSD must follow, in carrying out these task, for a person that’s trying to obtain LTIB.

C.

Complete procedures that SSD have that govern the process a person is asked to carry out, the DOG, in obtaining a Medical Board, this to include normal, reassessments and early requests.

D.

A complete list of all Medical Board doctors that I have been subjected to, with their qualifications that they need for being a Social Security doctor, their qualifications they have and their authorisation of.

E.

The Tribunal and other persons, their complete procedures, in what they do and carryout to action this Tribunal process.

F.

The Tribunal doctors and other persons, in particular details of their specific authorisations to sit on Medical Board Tribunals, again their qualifications required, the qualifications they have and their authorisations to carry this out.

Response

This response has been answered by the Social Security Department and Judicial Greffe. By STIB and LTIB we have taken this acronym to mean the benefits Short Term Incapacity Allowance (STIA) and Long Term Incapacity Allowance (LTIA). These benefits are administrated by the Social Security Department. The Judicial Greffe is responsible for the organising and holding hearings of the Social Security Tribunal which hears appeals on matters of STIA and the Social Security Medical Appeal Tribunal which hears appeals on matters of LTIA.

A.

The Social Security Department does not have a written Determining Officer Guide (DOG) for STIA. STIA claims are automatically process through the Social Security computer system unless there is conflicting information held regarding a STIA claim.

“LTIA Procedures” describes the conditions for an individual to be moved from an STIA to LTIA claim.

“Disallowance of STIA and INV” is related to the provision of STIA claims. Additional
supporting material is available if required.

The “Social Security (Jersey) law 1974” has reference to Incapacity disallowance (see Article 18).

Download LTIA procedure (size 584kb)

Social Security (Jersey) Law 1974

Download incapacity benefit leaflet (size 1.26mb)

B.

“LTIA DOG’s” is an export of the Determining Officer Guide (LTIA DOG) for LTIA. Additional supporting materials are provided to which the LTIA DOG refers to:

Download LITA DOG document (size 1.79mb)

Download depression assessment report (size 17.3kb)

Download FTIA and incapacity pension medical report (size 22.3kb)

Download LTIA alcohol depedency flowchart (size 101kb)

Download LTIA back examination report (size 10.4kb)
C.

The LTIA DOG includes the Social Security Department guidance in conducting a Medical Board.
The “Social Security (Jersey) law 1974” has reference to early reviews for LTIA (Article 34D).

D.

The Social Security Department can confirm that it holds information relating to the Medical Board doctors that have been involved in reviewing the applicants claim. The names of medical board doctors is exempt under Article 25 (Personal Information) of the Freedom of Information (Jersey) Law 2011. Additionally public disclosure of Medical Board doctor details would likely jeopardise the department’s ability to recruit medical practitioners for their services and is exempt under Article 33 (Commercial Interests) of the Freedom of Information (Jersey) Law 2011.

However the Social Security department can confirm a medical practitioner is defined in the Social Security (Jersey) law 1974 as;

“(a)  a  “registered  medical  practitioner”   as  defined  in  Article 1(1)  of  the  Medical Practitioners (Registration) (Jersey) Law 1960; or
(b) a “fully registered person” as defined in section 55 of the Medical Act 1983 of the United Kingdom;”

E.

The Social Security Department and Judicial Greffe do not hold specific procedures on conducting Social Security Tribunals which hear appeals on matters of STIA and Social Security Medical Appeal Tribunals which hear appeals on matters of LTIA as the requirements and process for holding these are outlined in the legislation referred to below. The following answer has been provided by the Judicial Greffe.

Tribunal appeals concerning Long Term Incapacity Allowance arise under Articles 34 and 34A to 34E of the Social Security (Jersey) Law 1974: the constitution and procedures of the Tribunal are defined by Articles 6 to 8 of the Social Security (Determination of Disablement Questions) (Jersey) Order 1974.

Appeals concerning Short Term Incapacity Allowance arise under Articles 33 and 33A of the Social Security (Jersey) Law 1974: the constitution and procedures of the Tribunal are defined by Articles 3 to 14 of the Social Security (Determination of Claims and Questions) (Jersey) Order 1974.

The Orders referred to have both been updated this year by the Social Security, Health Insurance and Income Support (Miscellaneous Provisions) (Jersey) Order 2015 which means that the Revised versions of the Orders on the Jersey Law website are not completely up to date because all revisions after 1 January 2015 have not been applied yet.

To assist in reading the law versions of both Orders up to date on 27 August 2015 are provided below. These versions are for information purposes only as stated in the watermark and the notice on the header of each page. A booklet from the Social Security Department entitled “If you think our decision is wrong” includes information on the Appeal Process: this booklet is available under “Related Links” at the bottom of this web page:

If you think a Social Security decision is wrong

Download Social Security (Determination of Disablement Questions) (Jersey) Order 1974 (size 292kb)

Download Social Security (Determination of Claims) (Jersey) Order 1974 (size 410kb)

The Tribunal has developed additional working procedures as allowed under the law to ensure compliance with the necessary Orders. These procedures are explicitly communicated to appellants using letters based on standard templates. The following additional working procedures have been developed:

Procedure for determining whether a hearing is in private or public
1. The initial letter sent to the applicant includes highlighted text “All hearings are held in public, unless the Tribunal considers it necessary to sit in private.”

2. The letter notifying the applicant of the date of hearing includes highlighted text “All hearings are held in public, unless the Tribunal considers it necessary to sit in private.” and the paragraph:

“The Law states that all Social Security Tribunal hearings are open to the public and we do make lists of forthcoming hearings available to the general public on a weekly basis. If you wish to apply for your hearing to be held in private you must write to the Chairman of the Tribunal as early as possible prior to the date of the hearing giving full reasons why you believe it should be held in private. The Chairman will consider the matter and inform you of his/her decision before the hearing takes place. Please forward your application to the Registrar.”

F.

The constitution of the Social Security Medical Appeal Tribunal, which hears appeals on matters of LTIA is stated in Article 34 of the Social Security (Jersey) Law 1974 and the role of the Tribunal and qualifications of the members in Article 6 of the Social Security (Determination of Disablement Questions) (Jersey) Order 1974 as amended by the Social Security, Health Insurance and Income Support (Miscellaneous Provisions) Order 2015 (see part 5 for fuller explanation of Law changes). A medical practitioner is further defined in the Social Security (Jersey) Law 1974 as

“medical practitioner” means:
(a) a “registered medical practitioner” as defined in Article 1(1) of the Medical Practitioners (Registration) (Jersey) Law 1960; or
(b) a “fully registered person” as defined in section 55 of the Medical Act 1983 of the United Kingdom;

The Constitution of the Social Security Tribunal which hears appeals on matters of STIA is stated in Article 33A of the Social Security (Jersey) Law 1974 and Article 8 of the Social Security (Determination of Claims and Questions) (Jersey) Order 1974.
The recruitment of Tribunal members is overseen by the Appointments Commission and appointments are made by the States of Jersey on the recommendation of the Minister for
Social Security following that recruitment process. The recruitment process includes confirmation of any specific qualifications required, for example a qualification in Law or being a
qualified medical practitioner.

Exemption(s)

FOI exemption(s) applied:

Article 25 Personal Information

(2) Information is absolutely exempt information if
(a) it constitutes personal data of which the applicant is not the data subject as defined in the Data Protection (Jersey) Law 2005; and
(b) its supply to a member of the public would contravene any of the data protection principles, as defined in that Law.

Article 33 Commercial interests

Information is qualified exempt information if

(a) it constitutes a trade secret; or

(b) its disclosure would, or would be likely to, prejudice the commercial interests of a person (including the scheduled public authority holding the information).

Justification for exemptions

Article 25 has been engaged in three instances:
• Redaction of documentation authors/named individuals to protect Social Security staff members right to a private life.

• In redaction of examples from procedure documentation and the LITA DOGs export as these may be based on real cases as experience is gained and may often be the only example.  As such, there is concern that individuals may be identified, or identity assumed. Therefore, to protect the privacy of those who have claimed Long Term Incapacity Allowance and any possible breach of the Data Protection (Jersey) Law 2005, the specific examples have been redacted from the guideline extract provided in response to the FOI request.

• Redaction of Medical Board doctors names and details to protect their right to a private life.

Article 33 has been engaged to protect the Social Security departments commercial interests in being able to recruit medical practitioners.