Social Security (Recovery of Benefits) Act 1997

Reviews and appeals

10 Review of certificates of recoverable benefits

(1) The Secretary of State may review any certificate of recoverable benefits if he is satisfied—

(a) that it was issued in ignorance of, or was based on a mistake as to, a material fact, or

(b) that a mistake (whether in computation or otherwise) has occurred in its preparation.

(2) On a review under this section the Secretary of State may either—

(a) confirm the certificate, or

(b) (subject to subsection (3)) issue a fresh certificate containing such variations as he considers appropriate.

(3) The Secretary of State may not vary the certificate so as to increase the total amount of the recoverable benefits unless it appears to him that the variation is required as a result of the person who applied for the certificate supplying him with incorrect or insufficient information.

11 Appeals against certificates of recoverable benefits

(1) An appeal against a certificate of recoverable benefits may be made on the ground—

(a) that any amount, rate or period specified in the certificate is incorrect, or

(b) that listed benefits which have been, or are likely to be, paid otherwise than in respect of the accident, injury or disease in question have been brought into account.

(2) An appeal under this section may be made by—

(a) the person who applied for the certificate of recoverable benefits, or

(b) (in a case where the amount of the compensation payment has been calculated under section 8) the injured person or other person to whom the payment is made.

(3) No appeal may be made under this section until—

(a) the claim giving rise to the compensation payment has been finally disposed of, and

(b) the liability under section 6 has been discharged.

(4) For the purposes of subsection (3)(a), if an award of damages in respect of a claim has been made under or by virtue of—

(a) section 32A(2)(a) of the [1981 c. 54.] Supreme Court Act 1981,

(b) section 12(2)(a) of the [1982 c. 53.] Administration of Justice Act 1982, or

(c) section 51(2)(a) of the [1984 c. 28.] County Courts Act 1984,

(orders for provisional damages in personal injury cases), the claim is to be treated as having been finally disposed of.

(5) Regulations may make provision—

(a) as to the manner in which, and the time within which, appeals under this section may be made,

(b) as to the procedure to be followed where such an appeal is made, and

(c) for the purpose of enabling any such appeal to be treated as an application for review under section 10.

(6) Regulations under subsection (5)(c) may (among other things) provide that the circumstances in which a review may be carried out are not to be restricted to those specified in section 10(1).

12 Reference of questions to medical appeal tribunal

(1) The Secretary of State must refer to a medical appeal tribunal any question mentioned in subsection (2) arising for determination on an appeal under section 11.

(2) The questions are any concerning—

(a) any amount, rate or period specified in the certificate of recoverable benefits, or

(b) whether listed benefits which have been, or are likely to be, paid otherwise than in respect of the accident, injury or disease in question have been brought into account.

(3) In determining any question referred to it under subsection (1), the tribunal must take into account any decision of a court relating to the same, or any similar, issue arising in connection with the accident, injury or disease in question.

(4) On a reference under subsection (1) a medical appeal tribunal may either—

(a) confirm the amounts, rates and periods specified in the certificate of recoverable benefits, or

(b) specify any variations which are to be made on the issue of a fresh certificate under subsection (5).

(5) When the Secretary of State has received the decisions of the tribunal on the questions referred to it under subsection (1), he must in accordance with those decisions either—

(a) confirm the certificate against which the appeal was brought, or

(b) issue a fresh certificate.

(6) Regulations may make provision—

(a) as to the manner in which, and the time within which, a reference under subsection (1) is to be made, and

(b) as to the procedure to be followed where such a reference is made.

(7) Regulations under subsection (6)(b) may (among other things) provide for the non-disclosure of medical advice or medical evidence given or submitted following a reference under subsection (1).

(8) In this section “medical appeal tribunal” means a medical appeal tribunal constituted under section 50 of the [1992 c. 5.] Social Security Administration Act 1992.

13 Appeal to Social Security Commissioner

(1) An appeal may be made to a Commissioner against any decision of a medical appeal tribunal under section 12 on the ground that the decision was erroneous in point of law.

(2) An appeal under this section may be made by—

(a) the Secretary of State,

(b) the person who applied for the certificate of recoverable benefits, or

(c) (in a case where the amount of the compensation payment has been calculated in accordance with section 8) the injured person or other person to whom the payment is made.

(3) Subsections (7) to (10) of section 23 of the Social Security Administration Act 1992 apply to appeals under this section as they apply to appeals under that section.

(4) In this section “Commissioner” has the same meaning as in the Social Security Administration Act 1992 (see section 191).

14 Reviews and appeals: supplementary

(1) This section applies in cases where a fresh certificate of recoverable benefits is issued as a result of a review under section 10 or an appeal under section 11.

(2) If—

(a) a person has made one or more payments to the Secretary of State under section 6, and

(b) in consequence of the review or appeal, it appears that the total amount paid is more than the amount that ought to have been paid,

regulations may provide for the Secretary of State to pay the difference to that person, or to the person to whom the compensation payment is made, or partly to one and partly to the other.

(3) If—

(a) a person has made one or more payments to the Secretary of State under section 6, and

(b) in consequence of the review or appeal, it appears that the total amount paid is less than the amount that ought to have been paid,

regulations may provide for that person to pay the difference to the Secretary of State.

(4) Regulations under this section may provide—

(a) for the re-calculation in accordance with section 8 of the amount of any compensation payment,

(b) for giving credit for amounts already paid, and

(c) for the payment by any person of any balance or the recovery from any person of any excess,

and may provide for any matter by modifying this Act.