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Illness Benefit Case 1

Question At Issue:

Whether the appellant had sufficient social insurance contributions to qualify for Disability Benefit which had been in payment since 1980. The key issue related to the appellant’s social insurance record during the years 1976 to 1980.


The appellant made a claim for Invalidity Pension, having been in receipt of Disability Benefit for twenty-three years. Her social insurance record was examined and a Deciding Officer determined that she did not have sufficient social insurance contributions, paid or credited, to satisfy the governing contribution conditions for the original Disability Benefit claim. The Deciding Officer concluded that payment had been made in error. In addition, she decided that the appellant was not entitled to those credited contributions (‘credits’) which had been awarded for the duration of her Disability Benefit claim. Payment of Disability Benefit was stopped. The appellant was advised, however, that no attempt would be made to recover the amount deemed to have been overpaid as it was due to an error by the Department of Social and Family Affairs.

Oral Hearing:

The appellant was accompanied by her husband. The Deciding Officer attended at the request of the Appeals Officer, as did the two Social Welfare Inspectors who had been involved in investigating the case. The Appeals Officer outlined the question at issue in detail and read the Deciding Officer’s decision.

The Deciding Officer outlined the background to her decision, referring to the facts and contentions on which she had relied.

The Social Welfare Inspectors outlined the details of their investigations. They described the actions that had been taken in 1980 in relation to the non-payment of social insurance contributions during the years 1976 to 1980. This matter had come to light in the context of a claim for Unemployment Benefit in 1980. Following investigation, arrears of social insurance contributions were collected and Unemployment Benefit was paid. In the course of the current investigation, however, it was discovered that the collection of arrears had led to only 19 contributions being added to the appellant’s social insurance record; this was insufficient for purposes of qualifying for Disability Benefit.

The appellant argued that she was not satisfied with the Deciding Officer’s decision on grounds that her employment during the years 1976 to 1980 had been fully investigated in 1980, in connection with her Unemployment Benefit claim. She pointed out that her claim had initially been rejected but was allowed, following the investigation; she had also received a lump sum payment to cover the period of her initial disallowance. In terms of the details that were requested in the context of the more recent investigation, she argued that it was unreasonable to expect that she would remember specific details relating to her employment after some twenty-five years. She contended that she had co-operated fully with the investigation in 1980.

The Appeals Officer advised the appellant that Social Welfare Inspectors would usually look for full compliance when dealing with an employer who had failed to pay social insurance contributions for an employee. He suggested that the fact that only 19 contributions had been collected appeared to indicate that this was the full extent of the arrears of contributions due, in contrast to her assertion that she had been employed for four years during the period at issue. He drew attention to the fact that Inspectors may, subject to certain conditions, award replacement contributions so as to preserve entitlement to benefits but that they had not done so in her case. He referred to extensive searches which had been undertaken in an effort to trace any relevant papers, as reported on the appellant’s file, and indicated that it had been submitted by the Department of Social and Family Affairs that all papers had been destroyed.

On the question of the replacement of contributions, one of the Social Welfare Inspectors stated that the appellant had been unable to recall her employer’s name. On this basis, he was unwilling to recommended the award of replacement contributions. He argued that, in 1980, non-compliance action had been taken only in respect of a nineteen-week period and he suggested that this was indicative of the total duration involved.

In response, the appellant reported that she had worked as a sewing machinist in the years at issue and that, at the time, such work had been carried out in tenement houses along a particular street, with small rooms being used as factories. She argued that these premises hardly ever had signs outside identifying the employer.

Consideration of the Appeals Officer:

The Appeals Officer noted the appellant’s contention that she was employed continuously from 1976 to 1980 as a sewing machinist in a small factory and her assertion that she could not recall the name of the employer. He noted also that she was adamant that the investigation in 1980 had resulted in non-compliance action being taken against her former employer; as a result of which, contributions were collected which gave her an entitlement to benefit. He took account also of her contention that she had been advised to continue signing on at her local Social Welfare Office while the investigation was carried out and that she was eventually awarded a lump sum by way of arrears of Unemployment Benefit.

In the context of the more recent investigation undertaken by Social Welfare Inspectors into non-compliance during the 1976-80 period, the Appeals Officer noted that replacement contributions had not been awarded. While he accepted that there was a possibility of the Unemployment Benefit claim having been put into payment in error, he found it less plausible that the Disability Benefit claim had been dealt with in a similarly erroneous fashion. He noted that the papers relating to the appellant’s claim in 1980 had been destroyed. In the circumstances, he considered it possible that the papers relating to the investigation had been filed with the appellant’s claim, without having been noted on her social insurance record. On the basis of his experience, he was satisfied that some employers in the clothing industry at the time were noted for the non-payment of social insurance contributions. Having examined the evidence available, including that adduced at the oral hearing, he concluded that the appellant must be given the benefit of the doubt in this case. He considered that it would be most unreasonable to terminate her claim to Disability Benefit after twenty three years, given that the Department of Social and Family Affairs had had ample opportunity during that time to review her entitlement but had failed to do so. In the circumstances, he concluded that the appellant was insurably employed during the period in question and, accordingly, was satisfied that her appeal should succeed.


Appeal allowed.

End of Document

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