Terms & Conditions

[jmembery]

We are having a subsidy claim audit at the moment.
They are looking at a case where backdating was granted.

Claimant’s partner had Heart attack on 9th June. Claimant completed form and handed it in on 17th June. Backdating requested for 4 days only to 13th June. Backdating Granted

Auditor’s Comment
“I cannot see any evidence of a backdate application demonstrating good cause. I note that she declared that her husband had suffered a heart attack but this in itself does not constitute good cause. Please provide the evidence of good cause”

[Kevin D]

Presumably, the Auditor hasn’t experienced one of those. A heart, that is.

[Anonymous]

Whether or not the claimant has demonstrated good cause is none of the auditor’s business – they are not decision makers. Their job is to ensure that there is:

a) a request for backdating
b) a [i:34dfa66cfc]recording[/i:34dfa66cfc] of a finding of good cause
c) to ensure the calculation is correct

Other than that, keep your opinions to yourself, pal.

[Anonymous]

When I hear the words external auditor I (semi-automatically) reach for my gun! 😉

[Anonymous]

[size=9:79ca35d69f]Mind you, I think most of the assessors here would have refused it, too[/size:79ca35d69f]

[gerryg]

9th June 2005 was a Thursday, she handed the form in the following Friday.

I would have probably given it. But then I don’t work in an LA anymore and have probably gone soft!

*Edited in light of Jeffs comment below*

[jmembery]

This is the 2005/06 subsidy Audit, the Heart Attack was a Thursday and she handed the form in the following Friday.

[seanosul]

I agree with Andrew on this one and I have made it absolutely clear that the audit is not to second guess a decision maker but to ensure that the amounts are correct.

[jmembery]

I tried arguing that last year. The auditors just pointed to their audit instructions.

a sample of backdated awards in cells 078 and 079 should be examined to [b:301654cdf5]confirm compliance with the backdating provisions [/b:301654cdf5]and that the amounts are fairly stated and been analysed and also included in the appropriate cells in each section of the form.

[Julian Hobson]

What are the backdating provisions ? And how does an LA comply with them ?

1. Is there a claim for backdating ?
2. Is there Good Cause for failing to make a claim earlier ?

and from the GM:

2.128 To establish if a claimant has shown good cause for not claiming earlier, you must be satisfied the reason for not claiming earlier is such that any reasonable person of that age, health and experience would probably not have claimed earlier in the same way as the claimant. The burden of proving good cause rests on the claimant but you must examine all the relevant facts in each case.

The first question for the decision maker (and the auditor) is whether the husband having a heart attack is capable of constituting Good Cause. If the answer to that is yes the second question is whether that potential Good Cause is continuous.

In the example you have given, [i:0b01e927c0]anyone [/i:0b01e927c0] with a close relative who is seriously ill might do things or not do things that they wouldn’t otherwise do. I don’t think you need to be a Doctor to realise that the effect of the Heart Attack on the claimant is likely to be that she was under great Pressure/Stress at the time. It is also important that the delay in claiming was so small as to demonstrate that she acted as soon as she could and that the Good Cause was continuous.

There is absolutely no need in this case for the appellant to demonstrate by way of medical evidence how her husbands heart attack affected her ability to deal with their affairs. The fact that she has made the request and stated her husbands heart attack as being the cause of the delay is sufficient.

I’m assuming that had the delay been 3 months you would have been less inclined to accept that the good cause persisted throughout the period but you would have accepted that it it might have existed at the beginning.

I would ask the auditor whether he would have accepted a days delay (would he want the claim to be made on the day of the heart attack), 2 days, 3 days etc and at what point he believes the continuous nature of the good cause to have expired.

Having said all that I agree that it isn’t for the auditor to question the decision maker’s decision, would he do the same if the decision had been made by a tribunal, and if not why not ?

[Anonymous]

I haven’t seen your case file, so I don’t know how lilely this is, but is it possible that the auditor just picking up on a procedural omission?

Anyone looking at that sequence of events would probably think good cause is self-evident, but the Council still needs to go through the formality of saying:-

– aha, here is a claim for backdating
– the claimant’s husband had a heart attack, that seems like a good enough reason to me

and leaving a note on the case record to show that the two steps had been followed – claim for backdating exists, council accepts good cause.

If such a decision record does exist, and the auditor is questioning the merits of the decision, he really should not teach his grandmother to suck eggs.

[jmembery]

Hi Peter
No, he had accepted that we have a written request for backdating and that the decision notice (not computer generated) states the facts that the backdating has been granted, the reason being good cause has been shown due to the partner’s heart attack and the amount of the backdating period has been correctly calculated.

He just didn’t think it was good cause. However, following an “animated” discussion late on Friday PM he has reluctantly agreed not to fail the case.

Jeff

[Anonymous]

Good cause is not defined anywhere in the legislation and you might have liked to have quoted para 7 of R(G)2/74 to your auditor

“…Whether a person has good cause for a late claim depends on the facts and circumstances of the particular case and an a priori approach to the question – an approach which avoids considering the facts and circumstances but seeks to apply some fixed and automatic principle – can in many cases lead to injustice”

What is more, Commissioners regularly point out that they can not interfere in decisions merely on the basis that they would have come to a different judgement or conclusion thatn the Tribunal would have done. They can only intefere if there was an error of law, and the test is the adequacy of the Tribunals reasons. If a Tribunal, correctly instucted as to the law could reasonably have made the decision in question, then it must stand. It is not enough that a Commissioner or another Tribunal might have come to a different conclusion.

The same princple must apply to decision makers and their auditors.

I am glad to see that your auditor has backed down anyway

[Anonymous]

The husband having a heart attack is not good cause in itself.

What is good cause is the demands on the claimant’s time and multitasking capacity (the latter reduced by anxiety) that resulted from the husband’s condition. The claim for backdating ought to say whether he was hospitalised etc.

What’s been missed from the procedure is the connection between this and her benefit claim: the assessor hasn’t actually said “For the first few days the claimant gave her husband priority over her benefit claim and we think that was reasonable”.

To avoid audit stress in future years you could review the design of your backdate decision record form: if you have separate spaces for a description of the claimant’s circs, and for the reason they kept her from claiming, the logic behind the decisions is clearer.

[Anonymous]

The test is not whether or not it was possible for the claimant to make the claim on time, but whether or not it is resonable to expect the claimant to have done so in the circumstances, or as Mr Commissioner Rowland wrote at par 9 of R(I)3/96:

“9. Happily, it is not necessary for me to go more deeply into the question whether the tribunal ought to have granted an adjournment in the particular circumstances of the present case because Mr. Varley advanced a separate, but in my view not wholly unrelated, ground for holding that the tribunal’s decision was erroneous in point of law. He submitted that the tribunal had applied the wrong test when considering whether or not the claimant had good cause for his delay in claiming, because they had asked themselves whether the claimant could have claimed earlier rather than asking whether it was “reasonable” for him “not” to have claimed earlier. I accept that submission. The tribunal themselves referred indirectly to the classic description of “good cause” contained in CS/371/1949 to which the local adjudication officer had referred in his or her written submission:

“Good cause means, in my opinion, some fact which, having regard to all the circumstances (including the claimant’s state of health and the information which he had received and that which he might have obtained) would probably have caused a reasonable person of his age and experience to act (or fail to act) as the claimant did.”

In R(S) 3/79, the Commissioner said at paragraph 9:

“….the claimant was plainly not a fit man at the time that the documents were sent. He had very recently left hospital where he had been in intensive care on account of a myocardial infarction and he could not have been expected either to attend to the documents at the time or to set them aside methodically for prompt attention when he was better. Documents of this kind sent out to claimants may have an impact at the time of their receipt, but if the claimant is then unfit to deal with them he may be excused for failing to attend to them when at a later stage he is better and has a backlog of matters to attend to.”

In the present case, the tribunal appear to have concerned themselves only with what was within the claimant’s capacity during the relevant period. That was the wrong test.”

I dont think it is necessary to go into every minute detail of the circumstances surrounding the case in order to justify a decision in the claimants favour. Just a few points as to why it was found that it was reasonable for the claimant not to have claimed earlier will be sufficient

[Author]

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