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If you think our decision is wrong

Offering... Support, Opportunity and Service

SSD 42

Offering... Support, Opportunity and Service 1

ContentsPart One Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Part Two What benefit or claim decisions can we reconsider? . . . . . . . . . . . . . . . . . . . . 3Social Security and Health Benefits, Food Costs Bonus and Cold Weather Bonus Income Support and Special PaymentsLong-Term CarePart Three Asking us to reconsider a decision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Part Four Time limit for requesting us to reconsider a decision . . . . . . . . . . . . . . . . . . . . 5Social Security and Health Benefits Income Support and Special Payments Food Costs Bonus and Cold Weather BonusLong-Term CarePart Five What happens next? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Long Term Incapacity Allowance Long-Term Care - Care Assessments All other decisions of the DepartmentPart Six Changing the decision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8If the decision can be changed If the decision can’t be changedPart Seven Appeals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Appealing through an independent tribunal Decisions that cannot be appealed against Time limit for submitting an appeal Late appealsPart Eight What happens during the appeal process? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Oral hearing Paper hearing Costs Groundless appeals The tribunal outcomePart Nine If you disagree with the tribunal’s decision? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15What can you appeal to the Royal Court about? Who can appeal to the Royal Court? How can you appeal to the Royal Court?Part Ten Where can I find out more? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Advice centres Lawyer Trade unions Voluntary organisations

Part One

IntroductionIf you have applied for or are getting a benefit, you may need to know what you can do if you think we have made the wrong decision about your claim or if you don’t understand our decision.

If you receive a decision from us in writing, it’s usually because you have:

• claimed a benefit

• had a change of circumstanceswhich affects your benefit, or

• been told to pay a benefit back.

If you think our decision is wrong, or you don’t understand it, you can:

• ask us for an explanation

• ask us to look at our decision again(this is known as reconsidered), or

• if you have already had thedecision reconsidered, appealagainst our decision.

If you have received a letter about a decision, and you would like more information, please contact the officer of the Department that sent you the decision letter straight away.

For certain decisions, you may be able to appeal to an independent tribunal who can change our decision if they agree that it’s wrong. You can find more information on tribunals in this leaflet.

However for most decisions you cannot appeal unless you have first had it reconsidered .

Therefore for those decisions if you submit an application to appeal before you have asked for it to be reconsidered it will be treated as a request to reconsider the decision and not an application to appeal. This does not affect your right to appeal against the reconsidered (second) decision if you still think that is wrong.

There are time limits for asking us to reconsider a decision and appeals. We tell you about these and which decisions they affect in this leaflet.

Offering... Support, Opportunity and Service2

Social Security and Health Benefits, Food Costs Bonus and Cold Weather Bonus If you receive a decision in writing about your Social Security and Health benefits, Food Cost’s Bonus or Cold Weather Bonus and you disagree with the decision, you can ask us to reconsider it. If we do not change our decision, in some cases you may be able to appeal to an independent tribunal. The letter telling you about our decision will tell you if you can appeal.

Income Support and Special PaymentsIf you receive a decision in writing about your Income Support or Income Support Special Payment claim and you disagree with the decision, you or any other relevant adult member of your household can ask us to reconsider it.

If we do not change our decision, in some cases you or any other relevant adult member of your household may be able to appeal to an independent tribunal. For this reason where we refer to you in this leaflet it also includes any other relevant adult member of your household. The letter telling you about our decision will also tell you if you can appeal.

Long-Term CareIf you receive a decision in writing about your Long-Term Care claim and you disagree with the assessment of your care level you can ask for it to be reassessed. For all other decisions you and your partner (if you have one) can ask us to reconsider it.If we do not change our decision, you and where applicable your partner may be able to appeal to an independent tribunal. For this reason where we refer to you in this leaflet it may also include your partner. The letter telling you about our decision will also tell you if you or anyone else can appeal.

Part Two

What benefit or claim decisions can we reconsider?


If you’re claiming on behalf of someone elseThere are special rules if you are claiming on behalf of someone who is not able to claim for themselves. You should ask the Social Security Department for more information.If you’re an appointeeAn appointee is someone the Social Security Department has chosen to act for a person who cannot act for themselves. If you are an appointee for another person, you can ask us to look again at a decision about their benefit and you may be able to appeal for them. The letter telling you about the decision will tell you if you can appeal on their behalf.

Part Three


Asking us to reconsider a decision• If you have received a letter telling

you about a decision and you aredissatisfied with it, or you havereceived an explanation aboutthe decision and you still think it iswrong, you can ask us to reconsiderit. This may be done in writing, byphone, e-mail or in person and it willhelp if you tell us why you want usto reconsider the decision

• If you want us to reconsider adecision, you must let us knowwithin the relevant time periodfrom the date you received thefirst letter advising you of thedecision. The time period for thisdepends on the benefit or decisionyou are dissatisfied with. Theseare explained separately in thisleaflet and will also be stated in thedecision letter

• You may also send us anyadditional evidence you wish to useto support your case or requesta meeting with an officer of thedepartment to discuss the matterfurther

• If you ask for a decision to bereconsidered after the relevant timeperiod has passed, we may still beable to look at the decision again.But if it changes we will usually onlybe able to do this from the date youcontacted us and not the date theoriginal decision was effective from.

Part Four


The time limit for requesting us to reconsider a decision is stated in legislation and depends on the decision you are dissatisfied with.

Social Security and Health BenefitsLong Term Incapacity Allowance If your claim is for Long Term Incapacity Allowance and you disagree with the decision of the Social Security medical board concerning your assessment or the period of that assessment you can ask the medical board to reconsider it or you can appeal against it.

The time limit for submitting an appeal is 14 days from the date you received the first letter advising you of the decision and therefore this time limit also applies to your requesting us to reconsider it. However you do not have to request the medical board to reconsider the decision before submitting an appeal.

75+ Television Licence BenefitIf your claim is for a 75+ Television Licence Benefit and you disagree with the decision you can ask us to reconsider it.

The time limit for requesting this is 14 days from the date you received the first letter advising you of the decision.

All other Social Security and Health Benefit decisionsFor all other Social Security and Health benefit decisions the time limit for requesting us to reconsider the decision is 21 days from the date you received the first letter advising you of the decision.

Time limit for requesting us to reconsider a decision


Income Support and Special PaymentsJobseeking and giving up workIf the decision concerned whether an adult member of your household;

1 . is required to work and the numberof hours work they have to do

2 . satisfies the requirements tobe actively seeking full timeremunerative work

3 . has been issued with a warningnotice

4 . is in breach of a warning notice or

5 . has given up remunerative workwithout good cause

and you disagree with the decision you and any other relevant adult in your household can ask us to look at it again.


All other Income Support and Special Payment decisionsFor all other Income Support and Special Payment decisions the time limit for requesting us to reconsider the decision is 21 days from the date you received the first letter advising you of the decision.

Food Costs Bonus and Cold Weather BonusIf your claim is for Food Costs Bonus or Cold Weather Bonus and you disagree with the decision you can ask us to look at it again.


Long-Term CareIf your claim is for Long-Term Care and you disagree with the decision you can ask us to look at it again. The time limit for requesting this is 21 days from the date you received the first letter advising you of the decision.

Part Four


Long Term Incapacity AllowanceIf your claim is for Long Term Incapacity Allowance and you disagree with the decision of the medical board and ask for the decision to be reconsidered;

• You will be contacted by anofficer of the department whowill explain the reason for thedecision

• You will then be asked if youstill wish to have the decisionreconsidered

• If you do, an appointmentwill be made for you to see amedical board doctor who wasnot involved in the decision youare disagreeing with.

Long-Term Care – Care AssessmentsIf your claim is for Long-Term Care and you disagree with the assessment of your care level and ask for it to be reassessed this will be referred to the Heath & Social Services Department who will undertake the reassessment and may contact you as part of this process.

All other decisions of the Department• If you ask for the decision to

be reconsidered, we will checkwhether we have made the rightdecision

• You will be contacted by an officerof the department who will explainthe reason for the decision

• You will then be asked if youstill wish to have the decisionreconsidered

- If you do, an officer at theDepartment who was not involved with the original decision will do this

- If you do not, then your decision not to have this reconsidered will be confirmed to you in writing. This will also give you 7 days in which to change your mind. If you change your mind after this period has passed you will not be able to ask us again to reconsider the decision

• This second officer will look at anyevidence you send to support whyyou think the decision is wrong

• If they decide that the originaldecision was wrong, they willchange it.

What happens next?

Part Five

Part Six

Part Seven


Changing the decision

AppealsAppealing through an independent tribunalAn independent tribunal will decide your appeal at a tribunal hearing. The tribunal can only look at the evidence, the law, and your circumstances at the time the officer of the Department made the decision you are appealing against.

The tribunal can’t consider any changes to your circumstances that happened after the officer made the decision you are appealing against.

• An independent tribunal is made upof 3 members. Tribunal membersare appointed by the States ofJersey and act independently of theSocial Security Department

• All tribunals have a legally qualifiedChairman to help apply the law toyour appeal

• Tribunals could also includesomeone with medical qualifications,someone with financial qualificationsor someone with experience orknowledge of disability issues.

If the decision can be changed• If you asked us to look at the

decision again within the relevanttime period anything you havebeen awarded as a result of thenew decision will be changed fromthe date of the original decision

• If you do not agree with the newdecision, you may be able toappeal against it.

If the decision can’t be changed• If the decision can’t be changed you

will be sent a letter telling you thisand the reasons why. The letter willconfirm the original decision

• The letter will tell you if you canappeal to an independent tribunal.

Part Seven


If the circumstances which may affect your claim to benefits change, you should report it to the Department straight away . Don’t wait for the appeal hearing . Contact the officer who sent you the reconsidered (second) decision letter .

Decisions that cannot be appealed againstSocial Security benefit and contribution decisionsYou cannot appeal to an independent tribunal against decisions made on the following;

• whether the contribution conditionsfor any claim to benefit aresatisfied, or any other decisionrelating to your contributions

• entitlement to a death grant

• which person should receive anincrease of benefit where two ormore people satisfy the conditionsfor the increase and the legislationdoes not allow more than oneperson to receive it; or

• which class of contributions you arerequired to pay.

Income Support exceptional circumstance Special PaymentsYou cannot appeal to an independent tribunal against decisions made by the Minister for Social Security concerning the payment of an income support exceptional circumstance special payment.

Time limit for submitting an appealThe time limits for submitting an appeal are stated in legislation and depend on the decision you are dissatisfied with.

Long Term Incapacity Allowance If your claim is for Long Term Incapacity Allowance and you disagree with the decision of the Social Security medical board concerning your assessment or the period of that assessment you can appeal against it.

The time limit for submitting this is 14 days from the date you received the first letter notifying you of the decision or, if you have asked for this to be reconsidered, the date of the reconsidered (second) decision letter.

Part Seven


All other decisions of the DepartmentFor all other decisions that can be appealed against, the time limit for submitting an appeal is 14 days from the date you received the reconsidered (second) decision letter.

To appeal you must fill out the form at the back of this leaflet and send it to the Registrar of Appeals and NOT this Department

If you decide to appeal to an independent tribunal, and the tribunal finds you have been getting too much money, your benefit will be reduced

You can appeal on someone else’s behalf if that person has said in writing that you can . You do not have to be legally qualified to do this . You could be a family member or anyone else that person has asked to represent them .

Late appealsThe Chair or Deputy Chair of the tribunal may not accept your appeal if it is received by the Registrar of Appeals after the relevant time period;

• 14 days for a decision of the SocialSecurity medical board regardinga claim to Long Term IncapacityAllowance. However the Chair orDeputy Chair of the tribunal can onlyaccept a late appeal if there are

special circumstances and the appeal is received by the Registrar of Appeals within 28 days of the date you received the first letter notifying you of the decision or, if you have asked for this to be reconsidered, the date of the reconsidered (second) decision letter.

• 14 days for all other decisions of theSocial Security Department. Howeverthe Chair or Deputy Chair of thetribunal can only accept a late appealif there are special circumstancesand the appeal is received by theRegistrar of Appeals within 28days of the date you received thereconsidered (second) decision letter.

You should explain why you couldn’t appeal within the relevant time period when filling in the form at the back of this leaflet.Certain conditions have to be met for a late appeal to be accepted. The Chair of the independent tribunal will look at the reasons you give to see:• whether there were special

circumstances for the delay• the length of time that has passed

since you received the reconsidered(second) decision letter

• whether it would be fair for the tribunalto accept your late appeal, or

• whether your appeal is likely to besuccessful.

Only a Chair or Deputy Chair of the tribunal can decide whether a late appeal can be accepted .


Part Eight

What happens during the appeal process?After you submit the form at the back of this leaflet telling the Registrar of Appeals that you want to appeal to an independent tribunal, the Registrar will notify the Social Security Department and forward to the Department a copy of the form and of any documents you may have submitted in support of your appeal.

The officer of the Department who completed the reconsidered (second) decision will look at their decision again, even if they have already done so, if you have submitted any new information to the Registrar of Appeals.

• If they agree that the reconsidered(second) decision is wrong and anew decision is to your advantage (forexample, this gives you more money),they will send you a new decision

• If they agree that the originaldecision is wrong, but the newdecision is not to your advantage(for example, this shortens theperiod you can receive benefits),they will send you a new decision.

In either case you may be able to continue with your appeal or withdraw it . However you must notify the Registrar of Appeals in writing of your decision within 14 days .

If they do not change the decision, we will send an explanation of the law and facts used to make the decision you are appealing against to the Registrar of Appeals. This will also include any other relevant papers.

The Registrar of Appeals will then send you or your representative (if you have one) a copy of the Departments appeal papers.

Read the appeal papers very carefully. If you don’t understand something, contact the Registrar of Appeals. You can also contact an advice centre, like Citizens Advice or a lawyer for help.

Oral hearing• This is an appeal hearing which

you go to in person

• The tribunal may ask you questions

• You can take someone with you torepresent you

• You can call witnesses to giveevidence to the tribunal

• A representative from theDepartment will be at the hearing.They may ask you questions andcall witnesses


Part Eight

Oral hearing (continued)• If after receiving notification of

the date for the hearing you findyou can’t go to it, you must letthe Registrar of Appeals knowstraight away. You must have agood reason why you can’t go tothe hearing, such as illness. Youmay be able to arrange anotherdate. If you don’t let the Registrar ofAppeals know that you can’t go tothe hearing, the tribunal may dealwith the appeal without you

• If your appeal is about LongTerm Incapacity Allowance or theImpairment Component of IncomeSupport, you may be asked tohave a medical examination at thehearing. This will be carried out inprivate by a medical professional

• Oral hearings are open to the publicbut the tribunal can stop membersof the public from attending ahearing in certain circumstances

• If you live abroad and want toattend the hearing, let the Registrarof Appeals know you want to goto the hearing or want to sendsomeone to represent you.

Paper hearingA paper hearing can only be held if both you and the Social Security Department agree to this and the tribunal thinks that the case can properly be determined on the information supplied by you and the Department without an oral hearing.

• Unlike the oral hearing, this is anappeal hearing which you do notattend

• You should send any otherinformation which you think will helpyour case to the Registrar of Appeals

• Don’t delay sending information asyou won’t be told when the paperhearing will take place

• The appeal will be dealt with andthe Registrar of Appeals will sendyou the decision

• If the Social Security Departmentdoes not agree with your requestfor a paper hearing an oral hearingwill be held

• If the members of the tribunal thinkthat they need you to go to an oralhearing, they can turn down yourdecision to have a paper hearing.

If you choose a paper hearing but change your mind, you can choose to have an oral hearing provided that this is before the paper hearing is held. Write to the Registrar of Appeals straight away.


Part Eight

Costs• If you engage a lawyer to assist

you with your appeal be awarethat you cannot use the legal aidscheme to cover any costs youincur

• The independent tribunal is notable to award costs and no costsare payable by the Social SecurityDepartment or the States of Jersey.You are therefore responsible forany cost you incur as a result of theappeal, for instance if you engagea lawyer to represent you

• If you live abroad, you will have topay your own fares to and fromJersey and any accommodationcosts whilst the tribunal is ongoing.

Groundless appeals All tribunals have to ensure that their decisions are made in accordance with the legislation. Therefore if in the opinion of the Department your appeal is made on grounds that mean the appeal is bound to fail we may, within 14 days of receiving the copy of your application from the Registrar of Appeals, forward to the Registrar the grounds on which we have reached this opinion and ask the Registrar to refer this to the Chair or Deputy Chair of the tribunal for a decision.

Situations where your appeal may be considered as bound to fail include:

• If you are appealing because youdisagree with the legislation orStates policy

• Where a decision in your favourcould only be reached if the tribunaldid not comply with the legislation.

If the Chair or Deputy Chair disagrees that on the basis of the facts presented your appeal is bound to fail they will instruct the Registrar to allow your appeal to proceed to a tribunal hearing.

If the Chair or Deputy Chair agrees that on the basis of the facts presented your appeal is bound to fail they will instruct the Registrar to write to you advising that:

• The Chair or Deputy Chair hasconsidered your appeal applicationand is of the opinion that theappeal is bound to fail; and

• That unless you renew yourapplication to appeal to the tribunal,by confirming this in writing to theRegistrar of Appeals, within 14 daysof receiving the letter from theRegistrar your appeal will stop .

If you do renew your appeal application within the 14 day period your appeal will then continue to a tribunal hearing.


Part Eight

The tribunal outcome If you have an oral or a paper hearing, the following will apply.

• The tribunal will give its decision atthe end of the hearing

• The tribunal will also ask theRegistrar of Appeals to send youa decision notice. This explainsthe tribunal’s decision, includingthe facts and the law they used tomake their decision. The Registrarwill also send a copy to the SocialSecurity Department as soon aspossible after your appeal hearing

• The Registrar of Appeals keeps arecord of the appeal proceedingsfor at least 6 months after thedate of the hearing. You mayapply for a copy of this recordinghowever these are released veryrarely and only under exceptionalcircumstances

• If your appeal is successful, wewill usually carry out the tribunal’sdecision as soon as we receivea copy of the decision notice.However, if as a result of thetribunal’s decision we decide torefer a point of law to the RoyalCourt for a decision, we will nottake any action until the RoyalCourt has made their decision.


Part Nine

If you disagree with the tribunal’s decision?• the decision of the tribunal on the

facts is final

• if however you feel the tribunalhave made an error on a point ofLaw, you may be able to appeal tothe Royal Court.

What can you appeal to the Royal Court about?You can only appeal to the Royal Court if you think the tribunal has not applied the law correctly in dealing with your appeal. You can’t appeal to the Royal Court about:

• facts they have used, or

• their medical findings orconclusions.

You cannot appeal to the Royal Court against a decision of the Social Security Medical Appeal Tribunal concerning an award of Long Term Incapacity Allowance.

Who can appeal to the Royal Court?• Appeals can be made by anyone

who has already appealed thedecision to a tribunal

• The Chairman of the tribunal or anofficer of the Department can alsorefer any point of law to the RoyalCourt for the Court to give a rulingon the point.

How can you appeal to the Royal Court?Appeals to the Royal Court can only be made with the agreement of the Tribunal or if that is refused the Royal Court and applications for appeal must be made within 4 weeks from the date of the written decision of the Tribunal. Further information on how to appeal to the Royal Court can be obtained from the Registrar of Appeals.


Part Ten

Where can I find out more?Advice centresAdvice centres such as Jersey Citizens Advice can give you help and support. They can also help you to fill in forms or to write a letter.

LawyerIf you decide to use a lawyer to help you at an appeal tribunal be aware that the legal aid scheme cannot be used to cover the cost of a lawyer to help you at an appeal tribunal. Also you cannot get any money for lawyer’s fees from the Social Security Department, the States of Jersey or the Registrar of Appeals.

If you live abroad, you can ask someone in Jersey to act for you. They may be able to get help from a lawyer on your behalf.

Trade unionsTrade unions may also give you free advice, or may speak on your behalf at an appeal tribunal.

Voluntary organisationsMany voluntary organisations have people who can give help and support. They may also be able to help you to fill in forms or to write a letter, and may also go with you to an appeal tribunal.

You can find addresses for these centres and organisations in the telephone directory, or at the library.

You can get further information on any of the issues raised in this leaflet, or copies of any other leaflets, from the Social Security Department.

If you want more information on the law, go on-line to;

www.gov.je/Government/Departments/SocialSecurity/Pages/index.aspx

Please remember that this leaflet is a guide only. It is not meant to say exactly what your legal rights are. While we have tried to make sure that the information in this leaflet is correct at the date shown on the cover, it is possible that there may be incorrect information or some items may be oversimplified. Also, please remember that the information in this leaflet is likely to become less accurate over time, for example because of changes to the law.

Go to www.gov.je for the latest and widest range of public service information.

Where to find us


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Hill Street

La Colomberie

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La Motte Street

Queen Street

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Don Road

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Hilgrove Street

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Department

Map Reference

Disabled Parking

States of Jersey Social Security Department, PO Box 55Philip Le Feuvre House, La Motte Street, St. Helier JE4 8PE

Tel: 01534 445505 Fax: 01534 445525 www.gov.je/socialsecurity www.jobsinjersey.gov.je

Opening hours: Monday to Friday 8.30am to 5.00pm

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