Period of Analysis: SWAO Annual Reports 2009-2020
Keywords: Backdating; entitlements; late claims
Casebase No. Case G0114
Summary of the relevant law:
The primary legislative provisions governing claims and late claims are set out in Sections 241, 342 and 342A of the Social Welfare Consolidation Act 2005, as amended. See also Part 9, Chapter 1 of Social Welfare Consolidation Act 2005 (as amended).
The main regulatory provisions with regard to claims are contained in Chapter 1 of Part 7 of the Social Welfare (Consolidated Claims, Payments and Control) Regulations (S.I. No. 142 of 2007) as amended – Articles 179 to 191 and SI 102 of 2007 (for the purposes of the Occupational Injury scheme).
Certain provisions override or reduce the period of disqualification for a late claim. All decisions with regard to entitlement under these provisions are made by deciding officers, and can therefore be appealed to the Social Welfare Appeals Office (SWAO).
Helpful guidance is contained in the Department of Social Protection Operational Guidelines on Claims and Late Claims and in the separate departmental guidelines dealing with the individual schemes.
Generally social welfare legislation provides for backdating of claims (for up to 6 months) where it is accepted that there was good cause for the delay and where entitlement throughout the period in question is established (Section 241(3) of the 2005 Act as amended). The deciding officer may consider backdating the claim where there is a good cause for the delay in making the application. What constitutes “good cause” is not clearly set out; however being ill or delay in establishing that the applicant qualifies for the relevant scheme may be considered good cause. Generally, not knowing that you were entitled to a payment is not considered to be good cause for not making your claim on time.
The circumstances in which a claim may be backdated further are more onerous to establish and are specified in legislation as an incapacity to make a claim and where incorrect information was given by the Department.
Normally payments will be made from the date of the application.
Key grounds of appeals by appellants:
Key grounds for appeal included:
- applicants not being aware of the entitlement;
- applicant having difficulties in completing the application on time due to personal circumstances;
- the date of qualification for the relevant scheme being in doubt;
Observations on appeal outcomes:
The appeals were generally successful in backdating the claim by six months where the deciding officer was satisfied that the applicant had a good cause for the delay, these included personal circumstances, not being informed of entitlements by the department and delay in establishing that the applicant qualified for the relevant scheme.
Where the applicant applied for the wrong scheme but this should have alerted the department of entitlement for another scheme, the date of initial application for the wrong scheme can be used for backdating.
While generally, not knowing that you were entitled to a payment is not considered to be a good reason for not making your claim on time, the cases are to be considered on a case by case basis and in specific circumstances it may constitute a good cause.