Title of Payment: Partial Capacity Benefit
Date of Final Decision: SWAO Annual Reports 2009-2020
Keywords: Partial Capacity Benefit, Disability, Incapacity to Work
Casebase no: G0121
Summary of the relevant law:
The legislative basis for the Partial Capacity Benefit (the “Benefit”) is provided by Sections 46A-46D of the Social Welfare Consolidation Act 2005 (the “Act”) and the sections inserted into Social Welfare (Consolidated Claims, Payments and Control) Regulations 2007 (S.I. 142/2007) by the Social Welfare (Consolidated Claims, Payments and Control) (Amendment) (No. 2) (Partial Capacity Benefit) Regulations 2012 (S.I. 43/2012) (the “Regulations”).
Under the Act, a person is entitled to receive the Benefit where:
a) they have applied for it;
b) they have a profound restriction on their capacity for work in relation to the capacity for work of a person of the same age who has no restriction;
c) on the day immediately before the day the Benefit was claimed, they were in receipt either of Illness Benefits (for at least 26 weeks) or Invalidity Pension; and
d) they are under pensionable age.
Degree of restriction on capacity to work
The Regulations provide for assessment of the degree of restriction based on the opinion of a medical assessor, taking into account: (a) medical evidence; (b) the claimant’s own assessment of their capacity for work; (c) certain medical protocols specified in the Regulations; and/or (d) any other relevant material evidence.
A claimant is regarded as having a profound restriction where they have a residual capacity for work which is not more than a quarter the norm in relation to the capacity for work of a person of the same age who has no restriction on his or her capacity for work. The restriction is considered severe if it is not more than a half the norm; moderate if it is not more than a four-fifths the norm; and mild if the restriction is not materially different to the capacity for work of a person of the same age who has no restriction on his or her capacity for work.
Rate of Payment
Under the Act, claimants with a profound restriction are entitled to 100% of the weekly rate of Illness Benefit / Invalidity Pension being paid to them on the day immediately before the day for which the Benefit is awarded. Under the Act and the Regulations, claimants with lesser degrees of restriction are entitled to a percentage of their Illness Benefit/Invalidity Pension as follows: for severe restriction, 75%; for moderate restriction, 50%; and, for mild restriction, no benefit is paid.
Under the Act, the Benefit shall be paid for a maximum of 156 weeks. If Partial Capacity Benefit was received on foot of Invalidity Pension, you can apply for Partial Capacity Benefit again. You will be reassessed to find out if you qualify.
However, where the claimant was receiving Illness Benefit, they are paid for whichever is the shorter of 156 weeks or the period they would have been entitled to keep receiving Illness Benefit (albeit that if, on expiry of entitlement to Illness Benefit, they become entitled to receive Invalidity Pension, they may continue to receive the Benefit for up to 156 weeks).
The Regulations provide for disqualification for a period for failing without good cause to attend medical examination, comply with medical advice etc. An exception from disqualification may apply where a course of training is being undertaken.
Key grounds of appeals by appellants:
All but one of the appeals to date concern the assessment of the degree of restriction on the claimant’s capacity for work. These appeals were allowed. All claimants were reassessed at the level of restriction they claimed, save for one case in which the claimant, having claimed severe, was moved up from mild to moderate.
The other appeal concerned one of the conditions that claimants must meet to receive the Benefit. The claimant had been on Illness Benefit and then Invalidity Pension. The Invalidity Pension was stopped when she returned to work and her application for the Benefit was not granted on the ground that she had not been in receipt of Illness Benefit (for at least 26 weeks) or Invalidity Pension on the day before she applied for the Benefit. Her appeal was allowed on the basis that, while DSD decided she was not in receipt of Invalidity Pension on the day before she made the claim, there was no valid written decision disallowing the Invalidity Pension. The factual circumstances around her return to work were also taken into account.
Observations on appeal outcomes:
The focus so far is on assessment of degree of restriction. The Appeal Officer has considered medical evidence available at the time of application for the Benefit including medical history, as well as medical evidence of ongoing symptoms and required treatment. Reports were from both GPs and other specialists.
There are also indications of the Appeal Officer having considered the medical evidence in the context of the specific duties that the claimant would be required to perform in their work.
All appeal decisions so far have been made by the Appeal Officer.