The Social Security (Adjudication) (Amendment) Regulations 1999

Amendment of the principal Regulations

2.  The principal Regulations shall be amended by the insertion after regulation 59 of the following–

“Review of decisions involving incapacity for work or cessation or reduction of certain benefits

59A.— (1) For the purposes of this regulation–

(a) “original decision” means a decision–

(i) relating to an attendance allowance provided for in section 64 of the Contributions and Benefits Act, or the care component or the mobility component of a disability living allowance provided for in sections 72 and 73 respectively of that Act, or

(ii) as to whether a person is incapable of work applying the all work test in Part III of the Social Security (Incapacity for Work) (General) Regulations 1995(1) or is to be treated as incapable of work made in accordance with regulation 10 (certain persons with a severe condition to be treated as incapable of work) or 27 (exceptional circumstances) of those Regulations and

(b) “payee” means the person to whom a benefit referred to in head (i) of paragraph (a), or a benefit a condition of entitlement to which is incapacity for work determined under Part XIIA of the Contributions and Benefits Act, is payable.

(2) This regulation applies where a decision on review revises an original decision–

(a) in the case of a decision in relation to a benefit referred to in head (i) of paragraph (1)(a) so as to make that benefit cease to be payable or to reduce the rate of that benefit and the decision on review is based on–

(i) in the case of an attendance allowance, the person not satisfying any of the conditions in section 64 of the Contributions and Benefits Act,

(ii) in the case of the care component of a disability living allowance, the person not satisfying any of the conditions in section 72(1) of the Contributions and Benefits Act; or

(iii) in the case of the mobility component of a disability living allowance, the person not satisfying any of the conditions in section 73(1) to (3) of the Contributions and Benefits Act; or

(b) in the case of a decision as to whether a person is or is to be treated as incapable of work, so that a person is not incapable of work applying the all work test referred to in head (ii) of paragraph (1)(a) or is not treated as incapable of work in accordance with the regulations referred to in head (ii) of paragraph (1)(a).

(3) A decision on review to which this regulation applies shall take effect from the date of the decision, except that–

(a) where the review is on a ground set out in section 25(1)(a), 30(2)(a) or 35(1)(a), as the case may be, (the adjudicating authority is satisfied that the original decision was given in ignorance of, or was based on a mistake as to, some material fact) of the Administration Act and the adjudicating authority is satisfied that the claimant or payee knew, or could reasonably have been expected to know, of the fact in question and that it was relevant to the original decision, the decision on review shall take effect from the date that the claimant or the payee, as the case may be, had, or could reasonably be expected to have had, such knowledge or from the date of the original decision whichever is the later; or

(b) where the review is on a ground set out in section 25(1)(b), 30(2)(b) or 35(1)(b), as the case may be, (there has been a relevant change of circumstances since the original decision was given) of the Administration Act and the adjudicating authority is satisfied that the claimant or payee failed to notify a change of circumstances which regulations under the Administration Act require him to notify, and the claimant or payee knew, or could reasonably have been expected to know, that the change of circumstances should have been notified, the decision on review shall take effect–

(i) from the date on which the claimant or payee ought to have notified the change of circumstances, or

(ii) if more than one change has taken place between the date from which the original decision took effect and the date of the review, from the date on which the first change ought to have been notified.

(4) Where a person’s receipt of or entitlement to a benefit (“the first benefit”) is a condition of his receiving or being entitled to any other benefit, allowance or advantage (“the second benefit”) and a decision is made to which this regulation applies the effect of which is that the first benefit ceases to be payable, or becomes payable at a lower rate than was in payment following the original decision, the consequent change in his receipt of or entitlement to the second benefit shall take effect from the date referred to in paragraph (3).”.

(1)

S.I. 1995/311; relevant amending instruments are S.I. 1995/987, 1996/3207 and 1997/1009.