Reasons for Decisions


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1.     Introduction
2.     Regulations
3.     DAO Remarks on Regulations
4.     Guiding principles for communications
5.     Applying the principles and legal provisions
6.     Recording the decision
7.     Distinguish between Grounds and Reasons
8.     Comprehensive notification of the decision
9.     Limitations on release of personal data

Appendix 1:        Framework Letter of Notification
Appendix 2    Supplementary information

 

 


1 Introduction

The purpose of this guideline is to clarify the level of detail that must be provided to a customer where the decision is not in his or her favour.

The High Court has found that the ‘short and general reasons’ given in some decisions are inadequate. The Court has set a standard of reasoning expected to be reflected in a Deciding Officer’s decision.

This guideline sets out the principles that should be followed in giving reasons for decisions and gives guidance on how they should be applied in practice.

2 Regulations

 Article 191 of the Social Welfare (Consolidated Claims, Payments and Control) Regulations 2007  (as amended) [S.I. No. 142 of 2007] provides that decisions on social welfare claims must be set out in writing and, where the decision is unfavourable, the reasons for the decision must also be recorded and included in the notification to the person concerned.

The following is the relevant extract from the Regulations:

Decision of deciding officer

  • The decision of a deciding officer shall be in writing and signed by him or her.
  • Where the decision of the deciding officer is not in favour of the person, the deciding officer shall set out in writing the reasons for the said decision.
  • Subject to sub article (4), the Minister shall, as soon as may be after the decision is made, cause a memorandum of
          • the decision, and
          • where it is not in favour of the person, the reasons for the said decision to issue to the person.
  • In the case of a decision arising under section 300(2)(a), other than decisions arising under sub-paragraphs (i), (ii) and (iii) of that section, the Minister shall, as soon as may be after the decision is made, cause a memorandum of -

            (a) the decision, and  (b) the reasons for the said decision, to issue to the parties who are subject to the decision.


3 DAO remarks on regulations

Note that the regulations distinguish between the decision itself (which must be signed) and the “memorandum” of the decision which issues to the person; the “memorandum” - that is, the communication that issues to the customer - does not necessarily have to be signed by the Deciding officer (DO). But the DO must sign the decision on file (either electronic or paper).

Sub-article 1:
The Deciding officer must sign his/her name in full on the decision. The signature can be written or electronic. Use of an electronic signature as a signature for a record or a decision is permitted under legislation including The Interpretation Act 2005. (1)

Sub-article 2:
This requires the Deciding officer to set out his/her reasons for the decision as part of that decision. The DO is only required to give reasons where the decision is not in favour of the customer, but if it is an unusual case it would be good practice for the DO to give reasons even in a situation where the decision is in favour of the customer.

Sub-articles 3 4:
The notification that issues with the decision and reasons combined therein is sufficient “memorandum” for this purpose i.e. a separate page with the reasons is not required, unless it is standard operational procedure in the relevant business area.

Sub-article 4:
The other sub-paragraphs refer to decisions on insurability i.e. Scope decisions where both the employee and employer may be subject to the decision.

 (1) Part 1 of the Schedule to the Interpretation Act 2005 defines “writing” as including
“…other modes of representing or reproducing words in visible form and any information kept in a non-legible form whether stored electronically or otherwise, which is capable by any means of being produced in a legible form”;

4 Guiding principles for communications

Communications regarding disallowances should be guided by the following principles:

  • Consistency
    • Reflect consistent format and style in all communications of disallow outcomes
    • Use the recommended structure as set out in the framework letter of notification in Appendix 1.
  • Make a clear distinction between the legislative grounds for the decision and your reasons for that decision
  • Check that all references to legislation are correct and complete
  • Explain the legislative requirements (grounds) in Plain English
    • State ‘ground(s)’ for disallowance i.e. criteria not fulfilled

…..If more than one ground disallowed….

    • clarify which is the principal consideration and explain that the other grounds remain open for determination should circumstances change.
  • Reasons must be clear
  • State the main reasons in body of letter
  • Add cross references to attachments that will elaborate on rationale
  • Give at least one reason for each ground decided, more if possible.

 

  • Must show engagement with the facts
        • Facts/evidence must be clearly set out
        • Demonstrate that the claim has been evaluated
        • Outline the conflicts in the evidence or the disputes in relation to those facts – Test: look for consistency, credibility and consensus between different sets of evidence
        • Distinguish the facts from supporting evidence. Fully explain why certain facts are accepted and other related evidence rejected
        • Outline the reasons why the facts advanced by one party are preferred. Describe how you have come to an interpretation based on those facts, and the weights accorded to same i.e. decision maker’s logic and judgment
  • Objective and material evidence to back-up a conclusion.

The Guideline on Decision Making and Natural Justice, Section 3 has further advice on this. See Appendix 2.

  • On a first reading, the communication must reflect that that the decision is objective, well-founded, and there’s a clear rationale for the outcome.
  • Reflect principles of natural justice
      • Show you heard the other side
      • Give reasons for the outcome
      • Tell what was considered relevant
      • Give an opportunity to contest.
  • DO decision on file should outline the process applied to establish the facts considered relevant at that point in time - in case of later review.  
  • Be informative and constructive
  • On what to do next (rights to a review and appeal)
  • On where to get more information
  • On right to reapply if circumstances change.

5 Applying the principles and legal provisions

The deciding officer is required to:

  • Keep a written, signed record of the decision
  • Record the reasons if the decision is unfavourable.

The Department is required to notify the person in writing of the decision and, if unfavourable, give the reasons why.  As noted above, the DO does not have to be the person who signs or issues this.

6 Recording the decision

Where the decision is unfavourable, the Deciding Officer's record should show:

  • The ground(s) of disallowance or disqualification, or for the reduction in payment
  • If there is more than one ground disallowed / disqualified, the reason for each one must be recorded.

The reason(s) for the decision on each ground must be clearly stated and identify:

      • the evidence relied on to establish the relevant facts
      • links between the facts and the relevant ground(s)
      • balance in the testing and weighting of evidence.
      • a structured, logical, objective approach.
  • The record must be dated and signed n (in either written or electronic format).

7 Distinguish between ‘grounds’ and ‘reasons

A distinction needs to be made between these two terms. The 'grounds' for a decision consist of the relevant condition in the legislation that is not satisfied. The 'reason(s)' for the decision explain why that condition is not satisfied.

Note: this distinction is also reflected in the structure and content of the framework letter of notification. The ‘grounds’ are expressed in precise, legislative terms extracted from the Regulations. This is the minimum requirement. However, best practice is to include an explanation of the conditions being assessed by the DO, in layman’s terms.

The ‘reason(s)’ logically will follow immediately after the grounds statement(s). The reason statement, while clear and concise, must also comprehensively explain the failed condition.

The following three examples reflect an adequately reasoned decision to disallow specific grounds by drawing on the facts available to validate the conclusion. The level of detail given in the explanation for a given reason will vary according to the complexity and number of grounds being decided.

Remember that you must give reasons in full, and show that you have engaged with the facts of the individual case.

Example 1
The person concerned is not entitled to Jobseeker's Benefit on the grounds that she is not available for employment. The reason for this decision is that she is placing unreasonable restrictions on the nature of the employment she is prepared to accept. While this person has considerable management experience in retail in various locations, she has limited her consideration of jobs to those within a five-mile radius of her home.

Example 2
The person concerned is not entitled to Illness Benefit on the grounds that he does not satisfy the contribution condition which requires him to have a minimum of 39 paid or credited contributions in the relevant tax year (also known as the Governing Contribution Year) 2017. The reason for this decision is that, according to the Department's records, he had a total of 27 contributions (paid and credited) in 2017.  Furthermore, the person concerned does not satisfy any of the alternative tests. See the Guidelines on Illness Benefit for more information about alternative tax years that can be used to accumulate contributions.

Example 3
The person concerned is not entitled to Carer's Allowance on the grounds that she does not satisfy the means test. The reason for this decision is that the means derived from her spouse's earnings are in excess of EUR X which is the means limit appropriate in her case.

8 Comprehensive notification of the decision

The letter or form used in notifying a person of an adverse decision should include sufficient information to enable him/her to understand:

  • The relevant grounds/conditions considered
  • The reason(s) for the decision reached
  • What is the main question(s) the DO has to decide?
  • What are the indicators of the condition(s) being assessed?
  • What evidence was considered relevant and substantive?
  • What relative weights applied to conflicting evidence?
  • The direct links between the facts established and the grounds, pointing to remaining information gaps.
  • That the process of analyses was comprehensive, structured, objective and fair overall.
  • The next steps to take if not satisfied with the decision. All communications to customers to notify the outcome of a decision review must clarify the respective rights of appeal and further review arising.

The Principles-based framework letter in Appendix 1 sets out the various elements that must be included in the notification of the decision (the “memorandum”). Note: Sample letters of notification are available in all scheme areas.

9 Limitations on release of personal data

Data Protection legislation places some limitation on the release of personal data. When notifying a person of a decision, you should be conscious of the need not to release data relevant to a third party, unless it is clear that they are aware of this and agree to it.

It may be relatively rare for it to arise that you are making your decision based on information from a third party that has not provided this information to the customer, but here are some examples.

Example 1: Joe (aged 19) applies for Jobseekers Allowance. On the application form he states that both his parents (with whom he lives) are employed, but he doesn’t have their earnings. However, his parents are prepared to give this data directly to the Department on the understanding that the details are not given to Joe. The DO decides that Joe does not satisfy the means test due to assessment of the Benefit & Privilege of living in the family home. Releasing the full details of the means assessment in this case would be in conflict with Data Protection legislation. Joe may be advised the he does not satisfy the means test, but the details of his parents’ earnings may not be released.

Example 2: Brian and Mary are married. Brian applies for Jobseekers Allowance. On the form, he says that he does not have information regarding Mary’s bank accounts, as they had always kept part of their finances separate. Mary agrees to send the details to the Department for the purposes of assessing Brian’s claim, on condition that the details of her savings are not released to Brian. The DO decides that Brian qualifies for a reduced rate of JA due to the money in Mary’s accounts. In notifying the decision to Brian, the DO can indicate that the reduced rate is due to the means test, but the DO cannot give information regarding the amount of money held by Mary.

See Appendix 2 for more information.

Appendix 1:  Framework letter of notification

The framework below shows the various elements that should be included when you are notifying a person about an unfavourable decision. (Note: grey italic type used to reflect advice on drafting).

(Letter headed paper if available)
Address of Section (Include if not pre-printed)

Person's name, Address,                                                                                 PPSN No        

Quote Reference Number if relevant                                                          Telephone No

Date

Dear Mr/Mrs/Ms (Use surname only)

[Statement of outcome]: In relation to your claim to...... made on ......, it has been decided by a Deciding officer that you are not entitled to…... [with effect from …...to….... ] on the grounds that you.....(See section 7 on Grounds and Reasons)

Governing legislation:
This decision is based on…… [incorporate the complete, relevant legislative extracts from the Social Welfare Consolidation Act 2005 and Social Welfare (Consolidated Claims, Payments and Control Provisions) Regulations 2007 (i.e. sections, articles and subparts), or other as relevant].

 The reason[s] why you do not qualify is that you
 

Remember Principles: (c) Reasons must be clear (d) Show engagement with the facts!

  • State the main reasons associated with each ground tested
  • Give at least one reason for each ground, more if possible

Principles: (e) Objectivity (f) Natural Justice (d) Balanced analysis!

  • Give fact-based explanation of rationale.
  • Show testing, balance and weighting of different views
  • Cross-refer to any attachment that elaborates on reason for decision.

In reaching this decision, the points made by you in your letter of ......were taken into account. (Include this paragraph only if a person has put forward a case.)
(Medical/care claims only: In reaching this decision, the Department’s Medical Assessor’s opinion was taken into account. The reasons are in the attached sheet [cross-refer to Tab})

(Reflect the analysis and testing of evidence, the evaluation to establish the facts, then your conclusions drawn from the process e.g.
I note XXX has…..(short time/ temporary duration)….(and has in the past/recently)…therefore, likely that…..‘
This report says, whereas that report states, but on balance…….etc.
I am persuaded by….because….
However, the evidence provided does not substantiate that you…...
I consider evidence A more determinative of facts / current situation than evidence B”).

If you consider this decision is incorrect, there are a number of options available to you:

  • You have a right to request a review of the decision by a Deciding Officer by contacting this office with any further documentary evidence you think is relevant to your case [note: individual sections may wish to add/customise details here re who to address it to etc]
  • You also have a right to appeal this decision directly to the independent Chief Appeals Officer at: Social Welfare Appeals Office, FREEPOST, D'Olier House, D'Olier Street, Dublin 2, DO2 XY31 or by email to: swappeals@welfare.ie.

More information on how to do this is available at: https://www.socialwelfareappeals.ie/your_appeal/how_to_make_appeal/

  • OR you can pursue both a review and an appeal of the Decision separately.

IMPORTANT: The statutory time-limit for submitting an Appeal is within 21 days of the date of this Decision (i.e. this letter). Failure to submit an appeal in a timely manner may result in the appeal being rejected. If you wish to seek a review before you appeal, it is important that you do so as soon as possible.

Further information on the scheme/payment conditions is available on http:/www.welfare.ie/en/Pages/….

If you require further clarification regarding this decision, please contact this section at the above address. Remember to quote your PPS number (found at the top of this letter) in any ‘phone or written contact with this Office.

If you are in financial need you may qualify for Supplementary Welfare Allowance. You can get full details of this allowance from your Designated Person (formerly known as Community Welfare Officer) based at your local Social Welfare Office/Intreo Office.

Yours sincerely,

 

First-name Surname
<Print Full-name>
Deciding Officer


Appendix 2  Supplementary information

Legislation:

Guidelines:

  1. Decision Making and Natural Justice
  2. Revised Decisions and their Date of Effect

 


     
Last modified:07/08/2019
 

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