The Social Security (Adjudication) Regulations (Northern Ireland) 1995

• (a) the date declared by the adjudicating authority making the review to be the date on which that change took place;

• (b) where more than one change has taken place between the date from which the original decision took effect and the date of the application for review, the date declared by the adjudicating authority making the review to be the date on which the most recent change took place; or

• (c) the date three months before the date of the application for review, whichever is the later.

• (6) Paragraph (5) applies only to a relevant change of circumstances which relates to a deterioration in a person’s physical or mental condition.

• (7) Where a claim for attendance allowance or disability living allowance has been refused and either—

• (a) an application for review of the decision is made under section 28(1) of the Administration Act; or

• (b) a further claim is made within the period prescribed under section 28(1) and is treated as an application for review in accordance with section 28(13) of that Act,

then, if that review results in an award of attendance allowance or disability living allowance, the decision on review shall have effect from the date specified in paragraph (8).

• (8) The date referred to in paragraph (7) is such date as may be specified in the decision on review being a date not later than—

• (a) in the case of attendance allowance, six months; and

• (b) in the case of disability living allowance, three months,

after the date on which the application for review or the further claim is made, whichever is appropriate.

• (9) For the purposes of this regulation, where a decision is reviewed at the instance of an adjudication officer under section 23(1) or (2) of the Administration Act, the date on which the adjudication officer decided to make that review shall be deemed to be the date of the application for the review.

• (10) In any case to which paragraph (1) applies, the decision on review shall not in any event have effect for any period before the date on which the original decision took effect or would have taken effect if any award had been made.

Review of decisions involving payment or increase of industrial injuries benefit

60

• (1) Except in a case to which regulation 57(2), (3) or (4) or regulation 58 applies, where on a review a decision of an adjudication officer, an appeal tribunal or a Commissioner is revised so as to make industrial injuries benefit payable or to increase the rate of such benefit, the decision given on review shall, subject to paragraph (2) have effect as from the date of the application for the review or from such earlier date as appears to the person or tribunal determining the review to be reasonable in the circumstances.

• (2) Paragraph (1)—

• (a) shall not permit benefit to become payable from a date earlier than the earliest date from which it could have been payable had it been awarded in the decision being reviewed; or

• (b) in the case of a review made by virtue of section 58(5)(a) of the Administration Act (which permits the review of a decision given before the passing of the National Insurance Act 1972[^f00020] that a claimant was not entitled to industrial death benefit), shall not permit benefit to become payable for any period earlier than 9th August 1972.

• (3) Where a decision is reviewed at the instance of an adjudication officer under section 23(1) or (2) of the Administration Act, the date on which it was first decided by the adjudication officer that the decision should be reviewed shall be treated for the purposes of this regulation as the date of the application for review.

Review of medical decisions on grounds of ignorance of, or mistake as to, a material fact

61

A decision of an adjudicating medical authority or a medical appeal tribunal may not be reviewed under section 45(1) of the Administration Act unless the adjudicating medical authority is satisfied as mentioned in that subsection by fresh evidence.

Period to be taken into account by assessments revised on ground of unforeseen aggravation

62

On a review of any assessment under section 45(4) of the Administration Act the period to be taken into account by any revised assessment may include any period not exceeding three months before—

• (a) where the review is in consequence of an application by the claimant, or a person acting on his behalf, the date of that application; or

• (b) where the review is in consequence of a decision on a recrudescence question, within the meaning of regulation 43(3)(b), given under regulation 7(4) of the Prescribed Diseases Regulations, the date of the claim on which that decision was given,

if the medical board is satisfied that throughout that period there has been unforeseen aggravation of the results of the relevant injury since the making of the assessment under review.

Review in income support cases

63

• (1) Except in a case to which regulation 57(2), (3) or (4) or regulation 58 applies, a determination on a claim or question relating to income support shall not be revised on review under section 23 of the Administration Act so as to make income support payable or to increase the amount of income support payable in respect of—

• (a) any period which falls more than 12 months before the date on which the review was requested or, where no request is made, the date of the review; or

• (b) any past period which falls within the period of 12 months mentioned in sub-paragraph (a) and has been followed by termination or interruption of entitlement to income support and—

• (i) the total amount of the increase would be &5 or less, or

• (ii) the grounds for review are a material fact or relevant change of circumstances of which the claimant was aware but of which he previously failed to furnish information to the Department.

• (2) Section 139 of the Administration Act shall not apply to any award of income support in force in favour of a person where there is applicable to that person—

• (a) any amount determined in accordance with regulation 17(2) to (7) of the Income Support Regulations[^f00021];

• (b) any protected sum determined in accordance with Schedule 3A[^f00022] or 3B[^f00023] to those regulations; or

• (c) any transitional addition, personal expenses addition or special transitional addition applicable under Part III of the Income Support (Transitional) Regulations[^f00024].

• (3) Where section 139 of the Administration Act does not apply to an award of income support by virtue of paragraph (2), that award may be reviewed by an adjudication officer or, on a reference by him, by an appeal tribunal for the sole purpose of giving effect to any change made by an order under section 132 of that Act.

• (4) A determination relating to income support made by an adjudicating authority or a Commissioner shall be reviewed by an adjudication officer or, on a reference by him, by an appeal tribunal where this is necessary to give effect to—

• (a) regulation 22 of the Income Support Regulations (reductions in applicable amounts in certain cases of actual or notional unemployment benefit disqualification);

• (b) a determination given on a question to which regulation 56 (income support and social fund questions not immediately determinable) applies; or

• (c) a change of circumstances to which regulations 14 (reduction and termination of transitional and personal expenses addition) and 15 (special transitional addition) of the Income Support (Transitional) Regulations apply.

• (5) Where a claimant in receipt of income support, other than a claimant to whom Part II of Schedule 4 to the Income Support Regulations[^f00025] applies, lives in a nursing home or residential care home and is absent from the home for a period of less than one week, that absence shall not be treated as a relevant change of circumstances for the purposes of section 23(1)(b) and (c) of the Administration Act.

• (6) In paragraph (5) “nursing home” and “residential care home” have the same meanings as they have in regulation 19 of the Income Support Regulations[^f00026].

Repayment of student loan not a change of circumstances

64

The repayment of a loan to which regulation 66A of the Income Support Regulations[^f00027] or regulation 42A of the Family Credit (General) Regulations (Northern Ireland) 1987[^f00028] (treatment of student loans) applies shall not be treated as a relevant change of circumstances for the purposes of section 23(1)(b) and (c) of the Administration Act.

Review in family credit cases

65

Where a review under section 23(1)(a) of the Administration Act of a decision relating to family credit arises from a disclosure of a material fact of which the person who claimed family credit was, or could reasonably have been expected to be, aware but of which he previously failed to furnish information to the Department, then where that review would result in either a new award of family credit or an increase in the amount of family credit payable, such new award or increase shall not be payable in respect of any period earlier than 12 months before the date on which that person first furnished that information.

Review in disability working allowance cases

66

• (1) Where a claim for disability working allowance has been refused and either—

• (a) an application for review of the decision is made under section 28(1) of the Administration Act; or

• (b) a further claim is made within the period prescribed under section 28(1) and is treated as an application for review in accordance with section 28(13) of that Act,

then, if that review results in an award of disability working allowance, the decision on review shall have effect from the date on which the application for review or the further claim is made, whichever is appropriate.

• (2) Where a review under section 28(1) or (5)(u) or section 33(3)(u) of the Administration Act of a decision relating to disability working allowance arises from a disclosure of a material fact of which the person who claimed disability working allowance was, or could reasonably have been expected to be, aware but of which he previously failed to furnish information to the Department, then if that review would result in either a new award of disability working allowance or an increase in the amount of disability working allowance payable, the decision on review shall not have effect in respect of any period earlier than 12 months before the date on which that person first furnished that information.

Review in social fund maternity, funeral or heating expenses cases

67

Except in a case to which regulation 57(2), (3) or (4) or regulation 58 applies, a determination on a claim or question relating to maternity or funeral expenses or expenses for heating, which appear to the Department to have been or to be likely to be incurred in cold weather, out of the social fund under Part VIII of the Contributions and Benefits Act and section 64 of the Administration Act shall not be revised on review under sections 23 to 27 and 67 of the Administration Act so as to make such expenses payable or to increase the amount of such expenses payable in respect of a determination of a claim for such expenses made more than 12 months before the date on which the review was requested or, where no request is made, the date of review.

PART V — TRANSITIONAL PROVISIONS AND REVOCATIONS

Transitional provisions

68

• (1) The Social Security (Adjudication) Regulations (Northern Ireland) 1987[^f00029] as originally made, shall continue to apply to the adjudication of any claim or question under the National Assistance Act (Northern Ireland) 1948[^f00030] or the Supplementary Benefits &c. Act (Northern Ireland) 1966[^f00031] as they apply to a corresponding claim or question under the Supplementary Benefits (Northern Ireland) Order 1977[^f00032] and to the adjudication of any claim or question under that Order as if these Regulations had not been made.

• (2) Anything done, begun or deemed to be done or begun under the Social Security (Adjudication) Regulations (Northern Ireland) 1987 shall be deemed to have been done or continued under the corresponding provisions of these Regulations.

• (3) So much of any document as refers expressly or by implication to any regulation revoked by these Regulations shall, if and so far as the context permits, for the purposes of these Regulations be treated as referring to the corresponding provision of these Regulations.

Revocations

69

The regulations set out in column (1) of Schedule 4 are revoked to the extent mentioned in column (3) of that Schedule.

SCHEDULE 1 — Provisions Conferring Powers Exercised in Making these Regulations

SCHEDULE 2 — Time Limits for >Making Applications, Appeals or References

1

Appeal to an or reference medical authority from an adjudication officer’s determination of a diagnosis or recrudescence question (regulation 48).

2

Appeal to a medical appeal tribunal from a decision of an adjudicating medical authority, as defined in regulation 34 (;section 44(2) of the Administration Act).

3

Reference by the Department notifying the adjudication officer that a decision of an adjudicating medical practitioner ought to he considered by a medical appeal tribunal (section 44f3) of the Administration Act).

4

Appeal to an appeal tribunal from a decision of an adjudication officer (section 2W 1) (of the Administration Act).

5

Appeal to a disability appeal tribunal from a decision (on review of an adjudication officer under section 28(1) of the Administration Act.

6

Appeal to an appeal tribunal from a decision (on review of an adjudication officer under section 28(1) of the Administration Act.

7

Application to the chairman for leave to appeal to a Commissioner from the decision o an appeal tribunal (regulation 24(1)).

8

Application to the chairman for leave to appeal to ;I Commissioner from the decision (1 a medical appeal tribunal (regulation 39(1)).

9

Application to the chairman for leave to appeal to a Commissioner from the decision of a disability appeal tribunal (regulation 32(1)).

10

Application to the Department with a view to a review under section 17(1) of the Administration Act of a decision under section 15(1) of that Act (regulation 16(1)).

11

Application to an adjudicating authority to set aside its decision (regulation 10(2)).

SCHEDULE 3 — Modification of Part II of the Administration Act in its Application to Benefit and Claims and Questions to which Part IV of these Regulations Applies

1

Section 58(4) of the Administration Act shall have effect as if for “an accident” there were substituted “a prescribed disease”; as if for “an injury resulted in whole or in part from the accident” there were substituted “a person suffered from a prescribed disease”; as if for “that accident” there were substituted “that disease”; and as if for “the injury did so result” there were substituted “the person did so suffer”.

2

There shall be included in the questions to be determined under the Administration Act any question—

• (a) whether a person is suffering or has suffered from a prescribed disease or injury; and

• (b) whether a prescribed disease or injury, suffered by a person who has previously been awarded benefit under the National Insurance (Industrial Injuries) Act (Northern Ireland) 1946[^f00034], under the National Insurance (Industrial Injuries) Act (Northern Ireland) 1966[^f00035], under the Social Security (Northern Ireland) Act 1975[^f00036] or under the Acts or who is or has been in receipt of compensation under the Workmen’s Compensation Acts (Northern Ireland) 1927 to 1943 or under any contracting-out scheme duly certified thereunder in respect of the same disease or injury, has been contracted or received afresh (if and in so far as regulations made under section 108,109 or 110 of the Contributions and Benefits Act or section 60(1) of the Administration Act necessitate the determination of that question),

which shall, where the question arises in connection with a claim for, or award of, sickness benefit made by virtue of section 102 of the Contributions and Benefits Act which or disablement benefit, be determined as provided by regulations, by an adjudication officer in the light of medical advice or by a medical board or a medical appeal tribunal, so however that no appeal shall lie under the provisions of section 20 or 21 of the Administration Act from a decision of an adjudication officer on any such question.

SCHEDULE 4 — Regulations Revoked

Signed

Sealed with the Official Seal of the Department of Health and Social Services for Northern Ireland on

W. G. Purdy — Assistant Secretary — 21st July 1995.

Explanatory note

(This note is not part of the Regulations.)

These Regulations are made for the purpose only of consolidating the regulations hereby revoked (set out in Schedule 4) and accordingly, by virtue of section 149(3) of, and paragraph 9 of Schedule 5 to, the Social Security Administration (Northern Ireland) Act 1992 (c. 8), (“the Administration Act”), are not subject to the requirement of section 149(2) of that Act for prior reference to the Social Security Advisory Committee.

The Regulations relate to the determination of claims and questions under the Social Security Contributions and Benefits (Northern Ireland) Act 1992 (c. 7) and the Administration Act.

Part I contains provisions about the citation, commencement and interpretation of the Regulations.

Part II and Schedule 2 contain provisions common to the proceedings of all the adjudicating authorities, both medical and non-medical.

Part III makes provision for each of the various adjudicating authorities — Section A for the Department of Health and Social Services; Section B for adjudication officers; Section C for social security appeal tribunals; Section D for disability adjudication; and Section E for medical adjudication.

Part IV contains provisions relating to particular benefits or procedures — Section A (with Schedule 3) relates to prescribed industrial diseases; Section B to income support; and Section C to the review of decisions.

Part V contains transitional provisions and revocations.

Footnotes

[^f00001]: 1992 c. 7

[^f00002]: 1992 c. 8

[^f00003]: S.R. 1987 No. 459

[^f00004]: S.R. 1987 No. 460

[^f00005]: S.R. 1986 No. 179

[^f00006]: 1954 c. 33 (N.I.)

[^f00007]: 1993 c. 49

[^f00008]: S.R. 1976 No. 227; relevant amending regulations are S.R. 1976 No. 329

[^f00009]: Section 128(1) was amended by Article 12(2) of the Social Security (Incapacity for Work) (Northern Ireland) Order 1994 (S.I. 1994/1898 (N.I. 12))

[^f00010]: Relevant amending regulations are S.R. 1986 No. 270, S.R. 1987 No. 116, S.R. 1991 No. 414 and S.R. 1993 Nos. 148 and 350

[^f00011]: Relevant amending regulations are S.R. 1989 No. 319 and S.R. 1993 Nos. 148 and 350

[^f00012]: Sections 23(1) and 25(2) were amended by paragraphs 46 and 47 respectively of Schedule 1 to the Social Security (Incapacity for Work) Order (Northern Ireland) 1994 (S.I. 1994/1898 (N.I. 12))

[^f00013]: Relevant amending provisions are S.R. 1988 Nos. 146, 193, 274, 318 and 431, S.R. 1989 Nos. 139, 249 and 395, S.R. 1990 Nos. 131, 346 and 387, S.R. 1991 No. 474, S.R. 1992 Nos. 6, 85, 147 and 403, S.R. 1993 Nos. 28, 120, 149, 195, 218, 233, 311, 373 and 479, S.R. 1994 Nos.77 and 138 and S.R. 1995 Nos. 71, 86, 101 and 162

[^f00014]: Regulation 10(1)(d) was amended by regulation 5(a) of S.R. 1989 No. 365

[^f00015]: Regulation 10A was inserted by regulation 6 of S.R. 1989 No. 365 and amended by regulation 2 of S.R. 1992 No. 471

[^f00016]: Relevant amending regulations are S.R. 1990 No. 131, S.R. 1992 No. 403 and S.R. 1993 No. 373

[^f00017]: Paragraph 13 of Schedule 2 was amended by regulation 30(d) of S.R. 1988 No. 146, regulation 6(f) of S.R. 1989 No. 395, regulation 10(4)(c) of S.R. 1992 No. 6, regulation 3(2) of S.R. 1993 No. 218 and regulation 2(9)(b) of S.R. 1994 No. 327

[^f00018]: Relevant amending regulations are S.R. 1988 No. 146, S.R. 1989 Nos. 139, 249 and 365, S.R. 1990 No. 131, S.R. 1991 No. 46 and S.R. 1993 No. 149

[^f00019]: 1992 c. 5

[^f00020]: 1972 c. 57

[^f00022]: Schedule 3A was inserted by paragraph 16 of Schedule 1 to S.R. 1988 No. 318 and amended by regulation 17 of S.R. 1988 No. 431, regulation 7 of, and paragraph 11 of Schedule 1 to, S.R. 1989 No. 139, regulation 8 of S.R. 1989 No. 395, regulation 17(b) of S.R. 1990 No. 131, regulation 14(b) of S.R. 1991 No. 338 and regulation 3(3) of S.R. 1992 No. 284

[^f00023]: Schedule 3B was inserted by regulation 10 of, and paragraph 18 of Schedule 1 to, S.R. 1989 No. 139 and amended by regulation 9 of S.R. 1989 No. 395, regulation 18 of S.R. 1990 No. 131, regulation 15(b) of S.R. 1991 No. 338 and regulation 3(4) of S.R. 1992 No. 284

[^f00024]: Relevant amending regulations are S.R. 1988 Nos. 132 and 153, S.R. 1989 Nos. 371 and 485, S.R. 1991 No. 341 and S.R. 1992 No. 284

[^f00025]: Relevant amending regulations are S.R. 1988 No. 146 and S.R. 1993 No. 149

[^f00026]: Relevant amending regulations are S.R. 1993 Nos. 149 and 373 and S.R. 1994 No. 65

[^f00027]: Regulation 66A was inserted by regulation 4(7) of S.R. 1990 No. 297 and amended by regulation 8 of S.R. 1991 No. 46 and regulation 10 of S.R. 1991 No. 338

[^f00028]: S.R. 1987 No. 463; regulation 42A was inserted by regulation 2(5) of S.R. 1990 No. 297 and amended by regulation 8 of S.R. 1991 No. 326

[^f00029]: S.R. 1987 No. 82

[^f00030]: 1948 c. 13 (N.I.)

[^f00031]: 1966 c. 28(N.I.)

[^f00032]: S.I. 1977/2156(N.I. 27)

[^f00033]: 1992 c. 8

[^f00034]: 1946 c. 21 (N.I.)

[^f00035]: 1966 c. 9 (N.I.)

[^f00036]: 1975 c. 15