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Case Studies » Sickness » Disablement Benefit (OIB) - Case from 2016 Annual Report (ref: 2016/14)

2016/14 (OIB) Disablement Benefit

Oral hearing

Question at issue: Causal association between accident and injury

Background: The appellant, in his early 60s, had been at work on a specified date in 2013. He was carrying a tray down a flight of stairs when he missed a step and fell. He was diagnosed initially with lumbar pain but developed an infection and was diagnosed ultimately with spinal cord injury secondary to epidural abscess. He is in receipt of Invalidity Pension and his wife receives Carer’s Allowance in respect of the care she provides for him. He made a claim for Disablement Benefit under the Occupational Injuries Benefit scheme and, in line with the provisions of the scheme, loss of faculty was assessed in percentage terms. It was held that all of the loss of faculty sustained was not attributable to the occupational accident and an assessment of 10% was made. As this is less than the 15% threshold provided for in the governing legislation, he did not qualify for Disablement Benefit. An appeal was made on his behalf by the local Citizens Information Centre (CIC).

Oral hearing: The appellant attended with a personal assistant and was accompanied by his wife and a member of staff from his local CIC. The Deciding Officer and Social Welfare Inspector attended at the request of the Appeals Officer.

The Social Welfare Inspector reported that he had interviewed the manager at the appellant’s former workplace and she stated that she was satisfied than an accident had occurred. She advised that she had not witnessed the incident but had spoken with the appellant afterwards and advised him to go home. The Inspector stated that he had also interviewed the appellant, who advised that on the day in question he had continued working until he finished his shift, some three hours later. He attended the Accident and Emergency department of his local hospital, was prescribed pain relief and went home, with his G.P. having attended him at home on the following day. He outlined the sequence of events over the following days and weeks, where he developed an infection (epidural abscess) which caused pain and led, ultimately, to paralysis.

The Deciding Officer acknowledged the severity of the appellant’s injury but indicated that he had regard to the opinion of the Medical Assessor who had accepted a temporal association between the occupational injury and the appellant’s diagnosis but considered that a causal association had not been established. He referred to medical evidence which indicated a history of back issues, with the appellant having had spinal surgery, a hip replacement and deep vein thrombosis. He pointed out that the claim form completed by the appellant and certified by his G.P. had referred to lumbar pain.

On behalf of the appellant, the CIC representative submitted that before his accident the appellant was well, holding down a full-time job, active and healthy; that, subsequently, he suffered 100% disablement with no causal effect from his previous medical history. She

referred to medical evidence which outlined the details of his admission to hospital, diagnosis, treatment and referral to rehabilitation services. She submitted that the appellant suffered spinal cord injury leading to paralysis as a direct result of injuries sustained following an accident at his place of work in 2013. She contended that it was a serious error to conclude that he had sustained a 10% loss of faculty when the medical evidence pointed to 100%.

Consideration: The Appeals Officer had regard to the details outlined in relation to the accident and to the appellant’s diagnosis of spinal cord injury secondary to epidural abscess, as well as the assessments made on admission to hospital and at discharge which were undertaken with reference to the American Spinal Injury Association (ASIA) classification system. He noted that it was not disputed that an occupational accident had occurred and that the appellant was incapacitated such that he required the support of a personal assistant for daily living. He considered that the question to be determined was the assessment of disablement (in percentage terms as provided for in legislation) and the extent to which that disablement might be attributed to the accident sustained in 2013.

The Appeals Officer considered that in the absence of any evidence of another accident between the time of the fall and his ultimate diagnosis, or any other event in the interim period that might have had such effect, the extent of the appellant’s injuries must be held to have arisen from the accident at work. He concluded that the medical evidence confirmed that the appellant had been compromised by his previous history of back injuries and medical interventions and that it was appropriate to take this into account in determining the assessment which should be deemed to apply. He considered it reasonable to think in terms of 100% loss of faculty, given the nature of the appellant’s circumstances, with a reduction of 33% to reflect earlier injuries. He concluded, therefore, that the appropriate assessment was 67%. As assessments above the rate of 20% are rounded to the nearest 10%, the award in this case was rounded upwards to 70%.

Outcome: Appeal allowed.