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Case Studies » Sickness » Illness Benefit - Case from 2015 Annual Report (ref: 2015/08)

Background: The appellant, a woman in her 40s, was suffering from Ligament Injury in her left knee which had started late in 2013.  She was employed as a packing operator in a local factory.  In connection with a review of her Illness Benefit claim, her G.P. provided a report at the request of the Department of Social Protection and advised that the condition was likely to last for 6 to 12 months.  He also completed an ability/disability profile, assessing the appellant as being affected to a severe degree in the categories of bending, sitting, standing, climbing and walking.  The appellant attended a Medical Assessor for the Department and a report of that examination was made available to the Deciding Officer.  Ultimately, it was determined that the appellant was not incapable of work, in line with the qualifying criteria for receipt of Illness Benefit.

Oral hearing: The appellant attended alone.  She advised that she had been in receipt of Jobseeker’s Benefit following the disallowance of her Illness Benefit claim.  She reported that she had recently started a six-month training course in computer applications with a view to retraining.  She advised that she was still submitting medical certificates to the Department. 

The appellant outlined the background to the injury she had sustained, describing how she had tripped over some cable in the workplace and suffered an injury to her left leg.  She was referred to the company doctor and had an MRI scan.  This showed a tear in the ligament and she was advised that she could not return to work until she was fit.  She reported that she attends her G.P. and had been referred for a steroid injection in her knee some twelve months earlier.  She advised that she had attended a Physiotherapist and that she continues to do the recommended exercises at home.  She takes pain relief medication as required.

The appellant reported that she is aware of her left knee, that she feels the bones grinding and that the knee dislocates quite often so that she has to bend her leg to get it back to where it should be.  She said that the Orthopaedic Consultant had advised that she was too young for a knee operation but that it was likely that surgery would be required in the future. 

In terms of progress, the appellant reported that it had become easier to manage than when she sustained the injury originally.  However, she had concluded that she would not be returning to her previous employment and that she saw her future in retraining for office/administrative work.  In conclusion, she advised that she had made a claim for compensation in connection with the injury.

Consideration: The Appeals Officer noted that while the appellant continued to have difficulties associated with her knee injury, she was keen to embark on a new career and was currently retraining in an area that would better accommodate her needs.  Having considered carefully all of the evidence, including that adduced at oral hearing and the medical evidence available, she concluded that it had not been established that the appellant was incapable of work, in line with the qualifying conditions for receipt of Illness Benefit. 

Outcome: Appeal disallowed.