Docstoc

Chapter 66 - Industrial Accidents

Document Sample
Chapter 66 - Industrial Accidents Powered By Docstoc
					                           Decision Makers Guide
                                     Volume 11
                           Amendment 11 January 2010

1.   Amendments to the Decision Makers Guide are issued at regular intervals, all
     amendments have already been incorporated in to the intranet version of the DMG.
     PDF amendment packages are available with the amended pages being
     reproduced in full.

2.   On printing the PDF amendment package the amendment number is displayed at
     the bottom of each replacement page. Significant changes are sidelined for ease of
     identification.
     Note : When printing PDF packages set the print properties to double-sided.

3.   Amendment 11 affects Chapters 66, 67 and 69. The changes

         make minor amendments to Chapter 66

         incorporate DMG Memo Vol 11/16 and make minor changes to Chapter 67

         make minor amendments to Chapter 69.

4.   The last two amendment packages amending Volume 11 were:

         Amendment 10 [August 2009]

         Amendment 9 [April 2009]

5.   Please note that Decision Making Services no longer arrange for hard copies of
     DMG amendment packages to be distributed to Department for Social Development
     customers (see SAO letter 18/06). If using a PDF amendment package remove the
     sheets in the left hand column and insert new sheets in the right hand column.
     When revised sheets have been inserted, note the record of amendments at the
     back of the Volume.

6.   The DMG can be accessed on the DSD Intranet. Click on the link below to access
     the index page for the amendment packages or Decision Makers Guide (DMG)
     http://dsdintranet/index/guidance/decision_making-pg/dms_decision_making-pg.htm
Remove                      Insert

Chapter 66
Contents (3 pages)          Contents (3 pages)
66001 - 66070 (4 pages)     66001 - 66070 (4 pages)

66565 - 66577 (1 page)      66565 - 66577 (1 page)


Chapter 67
Contents (5 pages)          Contents (5 pages)
67001 - 67020 (1 page)      67001 - 67020 (1 page)
67081 - 67100 (2 pages)     67081 - 67100 (2 pages)
67331 - 67349 (2 pages)     67331 - 67349 (2 pages)
67420 - 67447 (3 pages)     67420 - 67447 (3 pages)
67456 - 67500 (2 pages)     67456 - 67500 (2 pages)
67521 - 67533 (1 page)      67521 - 67533 (2 pages)
67979 - 67990 (1 page)      67979 - 67990 (1 page)
Appendix 1                  Appendix 1

A12 (cont) - A13 (1 page)   A12 (cont) - A14 (1 page)


Chapter 69

Contents (2 pages)          Contents (2 pages)
Statutory Rules (1 page)    Statutory Rules (1 page)
69009 - 69019 (1 page)      69009 - 69019 (2 pages)
69225 - 69228 (1 page)      69225 - 69228 (1 page)
Decision Makers Guide                                                                                                   Contents



         Chapter 66 - Industrial Accidents
         Contents
         Industrial accidents
         General ......................................................................................................... 66001
         Provision of National Insurance number ...................................................... 66007
         Industrial accident declaration ...................................................................... 66008

         Refusal to give an industrial accident declaration ........................................ 66011
         Extension of “arising out of and in the course of” ......................................... 66030
         Notice of accident and obligations of the employer ..................................... 66036

         Unreported or unwitnessed accident ............................................................ 66045
         Claim made long after the date of incident................................................... 66047

         Prescribed diseases caused by industrial accident ..................................... 66055
         Employed earner’s employment ................................................................... 66061

         Accidents outside Northern Ireland ......................................................... 66071

         Accidents in Northern Ireland ................................................................... 66072

         General ......................................................................................................... 66076
         Whether accidental....................................................................................... 66078
         Vaccination or injection ................................................................................ 66079

         Self-inflicted injury or suicide ........................................................................ 66081
         Shock or fright .............................................................................................. 66083
         Accident as distinguished from process ....................................................... 66084
         Stress-related incidents
             Introduction.............................................................................................. 66095
             General principles ................................................................................... 66097

         Cases requiring special consideration

         No untoward event or condition of constitutional origin ............................... 66111
         Seeking medical advice................................................................................ 66116

         Format of reference for medical advice ........................................................ 66120
         Heart (cardiovascular) conditions
             General.................................................................................................... 66121
             Atherosclerosis, atheroma, arteriosclerosis ............................................ 66124
             Ischaemic heart disease (coronary artery disease) ................................ 66125




Volume 11 Amendment 11                                                                                              January 2010
Decision Makers Guide                                                                                                   Contents



             Angina of effort, angina pectoris, angina ................................................ 66128

             Coronary, coronary thrombosis, coronary occlusion,
             myocardial infarction ............................................................................... 66130
         Strokes, cerebrovascular accidents ............................................................. 66135
         Exposure to sensitizing agents

             General.................................................................................................... 66137
             Deciding claims ....................................................................................... 66145
             Favourable accident decision ................................................................. 66148
         Back conditions, including prolapsed intervertebral disc
             General.................................................................................................... 66150

             Back problems ........................................................................................ 66151
             Prolapsed intervertebral disc................................................................... 66157

             Further enquiries required ....................................................................... 66159
         Hernias ......................................................................................................... 66163

             Inguinal hernia ......................................................................................... 66164
             Femoral hernia ........................................................................................ 66168
             Umbilical hernia ....................................................................................... 66170
             Hiatus hernia ........................................................................................... 66171
             Epigastric hernia ..................................................................................... 66172

             Claims as a result of a hernia.................................................................. 66173

         Tennis elbow ............................................................................................... 66175

         Disease

         General ......................................................................................................... 66181
         Infectious disease carriers or contacts ......................................................... 66183
         Epidermophytosis (athlete’s foot, ringworm of the feet tinea
         pedis, dermatophyte infection) ..................................................................... 66191
         Tuberculosis by infection .............................................................................. 66201
         Brucellosis by accident (indulant, Malta, Mediterranean or
         Gibraltar fever) ............................................................................................. 66205

         Date of accident .......................................................................................... 66221

         Period of incubation...................................................................................... 66230
         Changing the accepted date of accident ...................................................... 66231

         Arising out of and in the course of the employment
         Introduction ................................................................................................... 66301



Volume 11 Amendment 11                                                                                              January 2010
Decision Makers Guide                                                                                                   Contents



         General principles ...................................................................................... 66321

         Limits of employment in time and place .................................................. 66326

         Duties not started ......................................................................................... 66327
         Time of arrival or departure .......................................................................... 66328
         Access to and exit from place of work .......................................................... 66331

             Shared or public access .......................................................................... 66336
             Evidence of public use ............................................................................ 66337
             Docks, wharves and railways .................................................................. 66338

             Construction sites .................................................................................... 66341
         Resumption of work or return to premises ................................................... 66345

         Police and fire services ................................................................................ 66346
         Split duties .................................................................................................... 66351

         No fixed hours of work.................................................................................. 66356
         Continuous employment .............................................................................. 66361
         Living accommodation provided or arranged by employer .......................... 66371
         Attendance at school or other training establishment .................................. 66375
             Activities outside the syllabus ................................................................. 66376

             Attendance outside normal working hours .............................................. 66377
             Journey to or from school or college ....................................................... 66378

         Acting in an emergency ................................................................................ 66381

         Travelling accidents
         Introduction ................................................................................................... 66401
         General principle .......................................................................................... 66405
         General propositions .................................................................................... 66407
         Consideration of factors - question of payment ........................................... 66415
         Assessment of factual picture ...................................................................... 66418
         Travelling as passenger in employer’s transport ......................................... 66420

         Acts incidental to and acts interrupting employment

         General ......................................................................................................... 66425

         Incidental to .................................................................................................. 66431
         Welfare and related amenities ..................................................................... 66432
         Attending meetings....................................................................................... 66436
         Social and recreational amenities ................................................................ 66441
         Extra activities .............................................................................................. 66451



Volume 11 Amendment 11                                                                                              January 2010
Decision Makers Guide                                                                                                  Contents



         Trade union activities ................................................................................... 66455

         Acting under orders from a superior ............................................................. 66461
         Breach of rules or orders, or acting without instructions .............................. 66465
         Negligence or foolhardiness ......................................................................... 66471
         Evacuation of premises ................................................................................ 66473

         Voluntary assistance to others ..................................................................... 66475
         Acts for personal purposes .......................................................................... 66481
             Retrieval of personal property ................................................................. 66483
             Smoking .................................................................................................. 66485
             Heating and ventilation ............................................................................ 66488

             Sleeping .................................................................................................. 66491
             Breaking away from work or taking advantage of a lull .......................... 66495
             Wandering on premises or tampering with machinery ............................ 66498
         Breaks for meals or refreshment .................................................................. 66501
             Ownership and place of canteen ............................................................ 66505

             Journey to canteen or to obtain food ...................................................... 66506
             Visit to canteen before or after work ....................................................... 66508

             Break spent away from employer’s premises ......................................... 66510
             Recreation during break .......................................................................... 66515
             Acts and risks outside employment ........................................................ 66521

         “Deeming” provisions ............................................................................... 66551

         Presumption of “arising out of” ..................................................................... 66552

         Breach of rules or orders or acting without instructions ............................... 66556
             Regulations or orders .............................................................................. 66559
             Application of the deeming provision ...................................................... 66561
         Travelling in employer’s transport ................................................................ 66571
         Accident while travelling as a passenger ..................................................... 66573
             Vehicle..................................................................................................... 66575
             Travelling as a passenger ....................................................................... 66577

             Employer’s permission ............................................................................ 66583
             Ownership and operation of vehicle ........................................................ 66584
             Not in public transport service ................................................................. 66591
             Otherwise arising out of .......................................................................... 66595
         Accidents happening while meeting an emergency ..................................... 66611




Volume 11 Amendment 11                                                                                             January 2010
Decision Makers Guide                                                                                                 Contents



             Premises, etc .......................................................................................... 66615

             Emergency .............................................................................................. 66621
             Rescuing or protecting persons or preventing damage to property ........ 66625
             Civil defence services ............................................................................. 66626
         Risks which might not be attributable to employment .................................. 66631

             Skylarking ................................................................................................ 66634
             Assault or dispute .................................................................................... 66645
             Negligence .............................................................................................. 66651
             Animals and insects ................................................................................ 66655
             Forces of nature ...................................................................................... 66659

         Common risks ............................................................................................ 66671

         General principles ........................................................................................ 66675

         Antecedent and proximate causes ............................................................... 66681
         Pre-existing disability or disease .................................................................. 66685
         Specific aspects of common risks ................................................................ 66691
             Forces of nature ...................................................................................... 66693
             Animals, insects and infections ............................................................... 66695

             Poisoning or injury from refreshment ...................................................... 66699
             Vaccination or injection ........................................................................... 66701

             Foreign body in eye ................................................................................. 66703
             Street risks .............................................................................................. 66704
             Locality risks ............................................................................................ 66709

             Events involving shock or fright............................................................... 66713

         Further conditions for benefit ................................................................... 66750

         On or after 5.7.48 ......................................................................................... 66751
         Personal injury.............................................................................................. 66755

         Appendix 1 – Medical advice required on the accident question
         Appendix 2 – Physiological change/pathological change




Volume 11 Amendment 11                                                                                             January 2010
Decision Makers Guide                                                                   Industrial accidents




         Industrial accidents
         General

                                                 1
66001    An accident is an industrial accident if

         1.     the claimant has been involved in

                1.1     an event describable as an accident or

                1.2     an event in which there was no identifiable accident apart from the
                        injury suffered and

         2.     the accident arises out of and in the course of the claimant’s employment,
                (DMG 66301 et seq) and

         3.     the employment is employed earner’s employment (DMG 66065 et seq) and

         4.     payment of benefit is not prevented because the accident happened whilst
                                                                                             2
                the claimant was outside Northern Ireland (DMG 66071 et seq) .

                                              1 SS (NI) Order 98, art 29(6) & 30; 2 SS C&B (NI) Act 92, sec 94(5)

66002    If the criteria of DMG 66001 2., 3. and 4. are satisfied the decision maker should
         give a favourable accident decision that

         1.     describes the incident and

         2.     identifies the part or parts of the body affected.

         At this stage the decision maker does not need to consider whether personal injury
                                       1
         resulted from the accident .      This will only be necessary if the decision maker
                                                                       2
         receives a claim to benefit as a result of the accident .

                                                                             1 SS (NI) Order 98, art 29; 2 art 30

         66003 – 66006


         Provision of National Insurance number

                                                                                                        1
66007    For the purpose of an accident declaration there is a specific requirement for a
         claimant to provide sufficient information or evidence to establish their National
         Insurance number. See DMG 02172 et seq for full guidance.

                                                                             1 SS A Act (NI) 92, sec 1(1A) & (1B)




Volume 11 Amendment 11                                                                           January 2010
Decision Makers Guide                                                           Industrial accidents




         Industrial accident declaration

66008    The decision maker must make and record a declaration that an accident was or
                                                                                  1
         was not an industrial accident when a claim to benefit is made . The accident
         declaration should still be given if

         1.     a claim fails on grounds other than the industrial accident question, for
                example, the accident did not arise in the course of employed earners
                employment or
                                                                                                 2
         2.     at the request of the claimant, even if no claim to benefit has been made .

                                                               1 SS (NI) Order 98, art 29(1); 2 art 29(2)

66009    If an application for an industrial accident declaration is made the decision maker
         should note the following

         1.     when a decision has been given it is binding for the purposes of any benefit
                claim for that accident and

         2.     the decision maker cannot give a second industrial accident decision for any
                subsequent claim for the same accident except on revision or supersession.

66010    Any decision that there was, or was not, an industrial accident is final. The decision
                                                    1
         can only be changed on appeal or revision (see DMG Chapter 3).

                                                                           1 SS (NI) Order 98, sec 29(7)


         Refusal to give an industrial accident declaration

66011    The decision maker may refuse to give an industrial accident declaration if satisfied
         that it is unlikely to be needed for any claim for benefit. There is a right of appeal
                                1
         against such a refusal .

                                                                      1 SS (NI) Order 98, art 29(3) & (7)

66012    Refusals to decide the accident questions should be rare. The decision maker
         should not refuse to decide the question just because there is doubt about what
         decision to give. The question should be decided on the balance of probabilities.
         However, if the decision maker refuses to decide the question, all the relevant
         information should be annotated and retained in the same way as if the accident
         question had been decided.

         66013 – 66029




Volume 11 Amendment 11                                                                   January 2010
Decision Makers Guide                                                                    Industrial accidents




         Extension of “arising out of and in the course of”

66030    In certain situations accidents may be treated as “arising out of and in the course of
         employed earner’s employment”. Guidance on these provisions is at

         1.     DMG 66556 – 66564 for accidents happening while acting in breach of
                                                         1
                regulations or absence of instructions

         2.     DMG 66571 – 66595 for accidents happening while travelling in employer’s
                            2
                transport
                                                                                                          3
         3.     DMG 66611 – 66628 for accidents happening while meeting an emergency

         4.     DMG 66631 – 66659 for accidents caused by

                4.1     other persons’ misconduct or

                4.2     animals or
                                                                  4
                4.3     being struck by an object or lightening .

                                                 1 SS C&B (NI) Act 92, sec 98; 2 sec 99; 3 sec 100; 4 sec 101

         66031 – 66035


         Notice of accident and obligations of the employer

66036    An employed earner who suffers personal injury by accident for which benefit may
         be payable must by law report the accident by giving notice to

         1.     the employer or

         2.     a person supervising the injured person’s work at the time of the accident or
                                                                                     1
         3.     a person authorised by the employer to accept such notice .

         Note: Notice may be given orally or in writing and may be given by somebody
                                                 2
         acting on the injured person’s behalf .

                                                         1 SS (C&P) Regs (NI) 77, reg 24(3); 2 reg 24(1) & (2)

66037    Notice should be given

         1.     at the time of the accident or

         2.     as soon afterwards as it is practicable to do so.

         An entry made by or on behalf of the injured person and kept in the manner
                                                          1
         prescribed is sufficient notice of the accident .

                                                                         1 SS (C&P) Regs (NI), reg 24(3) & (5)

66038    The record of the notice of accident should include



Volume 11 Amendment 11                                                                          January 2010
Decision Makers Guide                                                          Industrial accidents



         1.     full name, address and occupation of the injured person

         2.     date and time of the accident

         3.     place where the accident happened

         4.     cause and nature of the injury

         5.     name, address and occupation of the person giving the notice, if not the
                                1
                injured person .

                                                                            1 SS (C&P) Regs (NI), Sch 4

66039    The employer must by law

         1.     investigate every reported accident and

         2.     record any discrepancies between the notice given and the results of the
                investigations and

         3.     if 10 or more people are normally employed at the same time on or about the
                premises in connection with a trade or business

                3.1     keep a record of the details of each accident in a form approved by the
                        Department (whether in a book or by electronic means) and

                3.2     retain each record for a period of at least 3 years from the date of entry
                        and

         4.     give an officer of the Department any information about an alleged accident
                                                                      1
                which may be required to decide a claim for benefit .

                                                                           1 SS (C&P) Regs (NI), reg 25

         66040 – 66044


         Unreported or unwitnessed accident

66045    When considering an unreported or unwitnessed accident the decision maker
         should note the following.

         1.     If notice of an accident is given and recorded by the employer soon after it
                happened this is usually enough to prove a claim that there was an accident.

         2.     The absence of a record does not mean that the claim cannot succeed. But
                any long delay in reporting an accident may throw doubt on the claim and
                should be carefully investigated.

         3.     Corroboration by witnesses is helpful in cases where there is doubt over
                whether an accident occurred.

66046    The decision maker should also consider the following.




Volume 11 Amendment 11                                                                  January 2010
Decision Makers Guide                                                           Industrial accidents



         1.     Whether there is a reasonable explanation for the absence of

                1.1     witnesses or

                1.2     a notice of accident or

                1.3     a record in the accident book?

         2.     Whether the claimant’s account of the accident is consistent and credible.
                Enquiries should be made of the employer to clarify any points. If a visit to
                the employer is necessary to obtain the information, the decision maker
                should ask the visiting officer to include with the report a sketch of the area
                where the accident took place.

         3.     The medical evidence to decide whether the alleged accident resulted in the
                diagnosed injury and whether any injury was suffered.

         4.     The interviewing officer’s opinion of the claimant’s honesty.

         Note 1 : For the purposes of 1. it may be established that the claimant was working
         alone at the time of the alleged accident and thought the accident was trivial. If
         there is evidence that the claimant was not working alone, or if it cannot be
         confirmed that the claimant was working at the relevant time, the decision maker
         may doubt the reliability of the claimant’s story.

         Note 2 : For the purposes of 2. enquiries should be made of the employer to clarify
         any points. If a visit to the employer is necessary to obtain the information, the
         decision maker should ask the visiting officer to include with the report a sketch of
         the area where the accident took place.


         Claim made long after the date of incident

66047    When a claim or application for an industrial accident declaration is made a long
         time after the date of alleged incident the decision maker should consider the case
         very carefully. The evidence may indicate that

         1.     the claimant thought the incident was too trivial to report at the time or

         2.     there were no immediate signs of any material injury.

66048    Evidence of this kind casts doubt on the occurrence and nature of the incident. The
         question arises whether a claimant’s condition is

         1.     the result of injury or

         2.     due to constitutional or other causes and the claimant has just looked for an
                event to which it may be attributed.




Volume 11 Amendment 11                                                                 January 2010
Decision Makers Guide                                                           Industrial accidents



         The claimant may be genuinely convinced that the incident is responsible for the
         condition. In such cases the causation question may be difficult to decide and the
         decision maker may need to seek medical advice (DMG 66111 et seq).

66049    The degree of proof is the same for all accident cases regardless of the length of
         time involved.      The claimant must show on the balance of probabilities that an
         accident occurred. However, because of factors such as

         1.     destruction of records and

         2.     problems of tracing witnesses

         the more remote in time the claim or application is from the date of the alleged
         accident the more likely it is that the claimant will have difficulty in providing the
         necessary evidence to prove the claim.

66050    The decision maker may give a favourable accident decision despite the period of
         delay involved if

         1.     a clear cut incident (such as one involving obvious injury) was reported and
                recorded at the time, or if reported late the decision maker is satisfied after
                further enquiry that an incident as described took place and

         2.     a satisfactory explanation has been given or it is clear for other reasons why
                a claim or an application for an accident declaration was not made at the
                time.

         66051 - 66054


         Prescribed diseases caused by industrial accident

66055    Benefit can be paid for

         1.     injuries and
                                                                                                     1
         2.     diseases which are prescribed for employed earners in certain occupations .

         A claimant may contract a disease because of an industrial accident in prescribed
         circumstances. The claimant may be entitled to benefit for the prescribed disease
         and the industrial accident. But benefit can only be awarded under one heading.

                                                                   1 SS C&B (NI) Act 92, sec 108(1)(a)(b)

66056    Benefit must be based on the prescribed disease if at the time of the accident

         1.     a disease is prescribed for a claimant and
                                                                                             1
         2.     the injury resulting from the accident is the contraction of the disease .

         It does not matter that the claim was made on the basis of an industrial accident.

                                                                        1 SS C&B (NI) Act 92, sec 108(6)



Volume 11 Amendment 11                                                                   January 2010
Decision Makers Guide                                                                       Industrial accidents



         Example

         A man employed in an occupation involving the use of carbon tetrachloride is
         poisoned by fumes when a container is accidentally broken and suffers liver toxicity
         as a result. Liver toxicity is a disease prescribed for him (prescribed disease C26).
         Although he has had an industrial accident, benefit is dealt with under the
         prescribed disease provisions because he has suffered no other injury.

66057    Benefit should be based on injury by industrial accident if

         1.     an industrial accident causes injury and

         2.     the prescribed disease results from that injury even if the injury is slight and
                the disease develops soon after the accident.

         Example

         A miner suffers a blow on the knee by industrial accident causing bruising and
         abrasions. Subcutaneous cellulitis of the knee (prescribed disease A6) develops.
         Whilst the disease clearly stems from the effects of the physical injury, it is not the
         injury itself. Benefit should be based on injury by industrial accident.

66058    If, after an industrial accident, a disease develops that is

         1.     not on the list of prescribed diseases or
                                                                           1
         2.     prescribed but not for the claimant’s occupation
                                                                                            2
         payment of benefit should be based on injury by industrial accident .

                                                  1 SS (II) (PD) Regs (NI), Sch 1; 2 SS C&B (NI) Act 92, sec 108(6)

         66059 – 66060


         Employed earner’s employment

66061    To qualify as an industrial accident an accident must arise out of and in the course
                                                    1
         of employed earner’s employment .

                                                                                    1 SS (NI) Order 98, art 29(6)(b)

66062    An employed earner is a person who is gainfully employed in Northern Ireland

         1.     under a contract of service or
                                                                                                1
         2.     in an office (including an elective office) with general earnings .

                          1 SS C&B (NI) Act 92, sec 2(1)(a); Income Tax (Earnings and Pensions) Act 2003, sec 57(3)

66063    People who are
                                                                                        1
         1.     members of Her Majesty’s Forces, whether serving or not or




Volume 11 Amendment 11                                                                              January 2010
Decision Makers Guide                                                               Industrial accidents



         2.     prisoners working (whether paid at the commercial rate or not) during periods
                of legal custody

         are not covered by the Industrial Injuries provisions.

                                                                            1 SS C&B (NI) Act 92, sec 115(2)

66064    People on employment and training schemes that are funded out of public funds are
         employees or trainees. Employees get a wage from their employer. Trainees get a
         training allowance with no income tax or social security contributions deducted and
         are not in employed earner’s employment. If there is a doubt as to whether a
         person is a trainee or an employee, advice should be sought from the local Jobs
         and Benefits Office.

66065    The decision maker should give an informal opinion on employed earner’s
         employment. If the decision maker

         1.     accepts that it is employed earner’s employment, no further question on the
                employment status arises or

         2.     does not accept that the claimant was in employed earner's employment,
                then the claim or application may be disallowed for that reason.

66066    Where the claimant disputes the disallowance, the case should be referred to Her
         Majesty’s Revenue and Customs for a formal decision an employed earner's
         employment.

66067    If Her Majesty’s Revenue and Custom’s formal decision is that the claimant was
         employed in employed earner’s employment, the appeal must then be forwarded to
         the tribunal as the circumstances in which an accident decision can be reconsidered
                         1
         are very limited .

                                                                                1 SS (NI) Order 98, art 29(7)

66068    Where, exceptionally, an appeal tribunal or Commissioner considers that the
         question of employment status arises in a case where the decision maker has
         accepted that the claimant was not employed in employed earner’s employment,
         they will direct the decision maker to refer the question for a formal decision to Her
                                           1
         Majesty’s Revenue and Customs .

                                            1 CI/401/50 (KL); R(I) 2/75; SS & CS (D&A) Regs (NI), reg 38A(1)

         66069 – 66070




Volume 11 Amendment 11                                                                       January 2010
Decision Makers Guide                                                       “Deeming” provisions



         66565 - 66570


         Travelling in employer’s transport

66571    While travelling to or from their usual place of work employees are normally outside
         the course of their employment.       Their contractual obligations to their employer
         normally

         1.     do not begin until they reach their place of work and

         2.     end on leaving their place of work.

         But the course of employment may be extended in some cases if employees travel
         to work in vehicles operated by or on behalf of their employers.

66572    The decision maker should note the following about travelling in employer’s
         transport.

         1.     The journey is in the course of the employee’s employment

                1.1     where the use of the transport in DMG 66571 is compulsory and

                1.2     unless the employee interrupts the course of the employment by their
                        own actions, for example by larking about.

         2.     Where the use of the employer’s transport is not compulsory, the journey is
                not normally in the course of the employees’ employment unless they are
                carrying out some task for the employer while travelling.


         Accident while travelling as a passenger

66573    Accidents may happen to employees travelling by their own choice to or from their
         place of work as a passenger in any vehicle operated by or on behalf of the
         employer. In these cases the accident is deemed, subject to certain conditions, to
                                                            1
         arise out of and in the course of the employment . The following conditions, which
         are covered in subsequent paragraphs, must be satisfied

         1.     employees must be travelling as passengers to or from their place of work
                (DMG 66577 - 66579) and

         2.     they must have their employer’s permission to travel in the vehicle (DMG
                66583) and

         3.     at the time of the accident the vehicle must have been

                3.1     operated by or on behalf of the employer or

                3.2     provided by some other person as arranged by the employer (DMG
                        66584 - 66586) and



Volume 11 Amendment 11                                                              January 2010
Decision Makers Guide                                                                             “Deeming” provisions



         4.      the vehicle must be one which, at the time of the accident, is not being
                 operated as a public transport service (DMG 66591 - 66592) and

         5.      the accident must be one which would have been accepted as arising out of
                 and in the course of the employment had the employees been obliged to
                 travel by the vehicle (DMG 66595).

                                                                             1 SS C&B (NI) Act 92, sec 99(1)(a)(b)(i) & (ii)

         66574


         Vehicle
66575    The word “vehicle” should be given a broad meaning and not necessarily confined
                                                                                                                      1
         to those means of transport specifically designed for the carriage of passengers . It
         includes

         1.      a ship

         2.      a vessel

         3.      a hovercraft
                                2
         4.      an aircraft
                                      3
         5.      a motor-cycle

         6.      a train and
                            4
         7.      a tractor .

                                                 1 R(I) 42/56; 2 SS C&B (NI) Act 92, sec 99(2); 3 R(I) 8/51; 4 R(I) 42/56

         66576


         Travelling as a passenger
66577    In connection with DMG 66573 the following should be noted.

         1.      The term “passenger” does not apply to
                                                           1
                 1.1      the driver of a vehicle or
                                                       2                 3
                 1.2      the rider of a bicycle or motorcycle or
                                                   4
                 1.3      the driver of a car .

         2.      A pillion passenger on a motor cycle has been held to be a passenger 5.

         3.      Employees may be travelling as passengers even if they travel in or on some
                                                                                              6
                 part of the vehicle not designed for carrying passengers .

                                    1 CI 49/49(KL); 2 CI 33/50(KL); 3 R(I) 9/51; 4 R(I) 51/51; 5 R(I) 8/51; 6 R(I) 42/56




Volume 11 Amendment 11                                                                                      January 2010
Decision Makers Guide                                                                                                   Contents



         Chapter 67 - Prescribed diseases
         Contents
         Introduction
         General ......................................................................................................... 67001
         Provision of National Insurance number ...................................................... 67014

         Adaptation of Acts and Regulations

         General ......................................................................................................... 67021
         Burden of Proof ............................................................................................ 67025
         Benefits ........................................................................................................ 67031
         Relevant disease .......................................................................................... 67041
             Disease contracted outside Northern Ireland .......................................... 67044

             Claims and payments .............................................................................. 67051
             Prescribed disease contracted by industrial accident ............................. 67061

             Conditions resulting from prescribed diseases (sequelae) ..................... 67065

         Questions arising on a prescribed disease claim .................................. 67071

         Prescription

         Disease not prescribed in the regulations .................................................... 67081
             Prescribed occupations ........................................................................... 67091

         Prescription of diseases involving poisoning etc .......................................... 67098

         Diagnosis

         General ......................................................................................................... 67101
         Determination of diagnosis question ............................................................ 67104
         References for medical advice
             Non-respiratory diseases ....................................................................... 67111
             Respiratory diseases ............................................................................... 67113
             Power to dispense with reference for medical advice ............................. 67115
             Raising the diagnosis question afresh .................................................... 67155




Volume 11 Amendment 11                                                                                              January 2010
Decision Makers Guide                                                                                                  Contents



         Due to the nature of the employed earner’s employment...................... 67181

         Presumption ................................................................................................. 67191
         Employment outside Northern Ireland ......................................................... 67201
             European Economic Area countries ....................................................... 67202
         Evidence ....................................................................................................... 67211

         Date of onset, recrudescence and fresh contraction ............................. 67215
         Determination of recrudescence question.................................................... 67241

         Date of onset where Workmen’s Compensation received for the
         same disease ............................................................................................... 67265

         Notes on individual diseases – general ................................................... 67301

         Prescribed diseases A1, A2, A4 and A7

         Prescribed disease A1 ................................................................................. 67311
         Transitional provisions.................................................................................. 67312
         Prescribed disease A2 ................................................................................. 67313
         Prescribed disease A4 ................................................................................. 67317
             Effect on Reduced Earnings Allowance .................................................. 67320
         Prescribed disease A7 ................................................................................. 67321
             Effect on Reduced Earnings Allowance .................................................. 67326

         Prescribed disease A10 (occupational deafness) .................................. 67331
         Time limits for claiming ................................................................................. 67334

         Date of onset ................................................................................................ 67340
         Prescription
             General.................................................................................................... 67345

             Effect of current legislation ...................................................................... 67347
             Obtaining and considering evidence ....................................................... 67349

             Application of regulations ........................................................................ 67352
             Degree of usage... ................................................................................... 67358
             Pneumatic ............................................................................................... 67359

             Percussive ............................................................................................... 67360
             Tools and machines ................................................................................ 67361
             “Wholly or mainly” ................................................................................... 67365
             “Of the use of” ......................................................................................... 67370
             “Whilst they are being so used” .............................................................. 67371




Volume 11 Amendment 11                                                                                              January 2010
Decision Makers Guide                                                                                                 Contents



            Immediate vicinity of ................................................................................ 67373

            Immediate vicinity - equipment/claimant subject to movement............... 67377
         Sub para (a)
         Foundry, metal work and associated industries
            Powered grinding tools on metal ............................................................. 67381

            Cleaning, dressing and finishing ............................................................. 67384
            On metal .................................................................................................. 67385
            Air arc gouging ........................................................................................ 67388
            Skid transfer bank ................................................................................... 67389
            Knock out and shake out grids ................................................................ 67390

            Machine (other than a power press machine) to forge metal ................. 67394
            Forging .................................................................................................... 67395
            Close-die forging ..................................................................................... 67396
            Open-die forging ..................................................................................... 67398
            Power press plant ................................................................................... 67400

            Machine to cut, shape or clean metal nails ............................................. 67402
            Plasma spray gun to spray molten metal ................................................ 67403

         Sub para (b)
            Mining, Quarrying and Tunnelling ........................................................... 67408
            Underground ........................................................................................... 67409

            Mining coal .............................................................................................. 67410
         Sub para (c)
            Concrete products ................................................................................... 67413
         Sub para (d)

            The textile industry .................................................................................. 67414
            Weaving .................................................................................................. 67415
            High speed false twisting ........................................................................ 67416
            The mechanical cleaning of bobbins ....................................................... 67420
         Sub para (e)

            Woodworking and associated industries ................................................. 67425
         Sub para (f)
            Water jetting and jet channelling ............................................................. 67427
         Sub para (g)
            Engines in ships and aircraft ................................................................... 67429
         Sub paras (h), (i) and (j)


Volume 11 Amendment 11                                                                                            January 2010
Decision Makers Guide                                                                                                  Contents



             The glassmaking and associated industries ........................................... 67433

         Sub para (k)
             Police firearms training officers ............................................................... 67434
         Sub para (l)
             Shot blasting ........................................................................................... 67435

         Diagnosis ...................................................................................................... 67436
         Assessment .................................................................................................. 67438
         Re-assessment at less than 50 decibels...................................................... 67443
         Change of circumstances ............................................................................. 67444
         Due to the nature of employed earner’s employment .................................. 67447

         Prescribed disease A11 ............................................................................. 67448

         Prescription .................................................................................................. 67449

         Diagnosis before 1.10.07 ............................................................................. 67461
         Diagnosis from 1.10.07 ................................................................................ 67463
         Effect on Reduced Earnings Allowance entitlement .................................... 67496
         Transitional provisions.................................................................................. 67497
         Injury by accident ......................................................................................... 67498

         Prescribed diseases A12 and A13 ............................................................ 67501
         Prescription .................................................................................................. 67502

             Hand-held ................................................................................................ 67511
             Vibrating .................................................................................................. 67512
             Effect on Reduced Earnings Allowance entitlement ............................... 67521
         Transitional provisions.................................................................................. 67523
         Presumption ................................................................................................. 67526
         Prescribed disease A13 ............................................................................... 67527

         Prescribed disease A14

         Introduction ................................................................................................... 67528
         Prescription .................................................................................................. 67529
         Non-mechanised coal face ........................................................................... 67531

         Effect on REA entitlement ............................................................................ 67532

         Prescribed diseases B1, B3 and B4

         Prescribed disease B1 ................................................................................. 67534
         Prescribed disease B3 ................................................................................. 67535




Volume 11 Amendment 11                                                                                              January 2010
Decision Makers Guide                                                                                                Contents



         Prescribed disease B4 ................................................................................. 67537

         Prescribed disease B5 (tuberculosis) ...................................................... 67541

             Definition of tuberculosis ......................................................................... 67544
             Sources of tuberculous infection ............................................................. 67546
         Due to the nature of the employed earner’s employment ............................ 67548

         Presumption ................................................................................................. 67549
         Previous history of tuberculosis ................................................................... 67553

         Prescribed diseases B6, B7, B8A, B8B and B9

         Prescribed disease B6 ................................................................................. 67556
             Prescription test not satisfied .................................................................. 67559

             Effect on Reduced Earnings Allowance .................................................. 67560
         Prescribed disease B7 ................................................................................. 67561

         Prescribed disease B8A and B8B ................................................................ 67566
         Prescribed disease B9 ................................................................................. 67571

         Prescribed diseases B10(a), B10(b), B11, B12, B13, B14 and B15

         Prescribed disease B10(a) and B10(b) ........................................................ 67581
         Prescribed disease B11 ............................................................................... 67586
         Prescribed disease B12 ............................................................................... 67588
         Prescribed disease B13 ............................................................................... 67589

         Prescribed disease B14 ............................................................................... 67590
         Prescribed disease B15 ............................................................................... 67591

         Prescribed diseases due to chemical agents
         General guidance on C diseases
             Prescription ............................................................................................. 67631
             Causation ................................................................................................ 67635
             Accident provisions ................................................................................. 67639
         Most commonly claimed diseases ............................................................... 67640
         Prescribed diseases C4

             Background ............................................................................................. 67641
             Relevant occupations .............................................................................. 67642
             Causation ................................................................................................ 67645
         Prescribed disease C7
             Background ............................................................................................. 67651




Volume 11 Amendment 11                                                                                            January 2010
Decision Makers Guide                                                                                                  Contents



             Relevant occupations .............................................................................. 67653

             Causation ................................................................................................ 67655
         Prescribed disease C18 ............................................................................... 67681
         Prescribed disease C19
             Background ............................................................................................. 67685

             Relevant occupations .............................................................................. 67686
             Causation ................................................................................................ 67688
         Prescribed disease C23
             Background ............................................................................................. 67706
             Relevant occupations .............................................................................. 67708

             Effects and causation .............................................................................. 67712
         Prescribed disease C24 and C24A
             Background ............................................................................................. 67714
             Relevant occupations .............................................................................. 67717
             Causation ................................................................................................ 67720

             Transitional provisions ............................................................................ 67721
         Prescribed disease C25 ............................................................................... 67722

         Prescribed disease C26-C27 ....................................................................... 67731
         Prescribed disease C29 ............................................................................... 67741
         Prescribed disease C30

             Background ............................................................................................. 67743
             Relevant occupations .............................................................................. 67746
             Causation ................................................................................................ 67748
         Transitional provisions.................................................................................. 67749

         Effect on Reduced Earnings Allowance entitlement .................................... 67752

         Prescribed disease D1 (pneumoconiosis) ............................................... 67801

         Prescription .................................................................................................. 67806
         Notes on scheduled occupations ................................................................. 67808
             Para 1 – Silica rock, dry quartzose sand, dry deposit or
             residue of silica and dry admixture containing such materials ................ 67813
             Silica rock ................................................................................................ 67816

             Free and combined silica ........................................................................ 67817
             Dried quartzose sand .............................................................................. 67819
             Deposit, residue and admixture .............................................................. 67821




Volume 11 Amendment 11                                                                                             January 2010
Decision Makers Guide                                                                                                    Contents



             Working ................................................................................................... 67823

             Arc welding .............................................................................................. 67824
             Building workers using sand and cement ............................................... 67827
             Bricklayers engaged in building, demolishing or repairing furnaces,
             retorts etc ................................................................................................ 67828

             Clay ......................................................................................................... 67830
             Para 2 – Breaking, crushing or grinding of flint ....................................... 67831
             Para 4 – Foundry workers ....................................................................... 67832
             Para 5 – China or earthenware ............................................................... 67835
             Para 6 – Mineral graphite ........................................................................ 67837

             Para 8 – Grindstones .............................................................................. 67838
             Para 9 – Asbestos ................................................................................... 67840

             Para 10 – Mining and slate ..................................................................... 67845
             Para 10(a) – Underground work in a mine .............................................. 67846

             Para 10(b) – Surface work at a coal or tin mine...................................... 67847
             Para 10(c) – Coal trimming ..................................................................... 67852
             Para 10(d) – Slate ................................................................................... 67854
             Para 11 – Carbon electrodes .................................................................. 67856
             Para 12 – Boiler scalers .......................................................................... 67857

         Unscheduled occupations involving exposure to dust ................................. 67858
             Diagnosis................................................................................................. 67866
         Due to the nature of the employed earner’s employment
             Presumption ............................................................................................ 67871
         Recrudescence and fresh contraction .......................................................... 67872
         Re-employment of Pneumoconiosis ............................................................ 67876

         Prescribed disease D2 (byssinosis)

         Rate of pension ............................................................................................ 67891
         Prescription .................................................................................................. 67892

         Due to the nature of the employed earner’s employment
             Presumption ............................................................................................ 67896
         Recrudescence and fresh contraction .......................................................... 67897

         Asbestos – related diseases

         Prescribed disease D3 ................................................................................. 67901
             Asbestos – related diseases ................................................................... 67902



Volume 11 Amendment 11                                                                                               January 2010
Decision Makers Guide                                                                                                   Contents



             Asbestos – its nature and its uses .......................................................... 67903

             Prescription ............................................................................................. 67906
             Effect on Reduced Earnings Allowance entitlement ............................... 67912
             Special action – prescribed disease D3 .................................................. 67915
             Benefit ..................................................................................................... 67917

         Prescribed diseases D4 to D10
         Prescribed disease D4 ................................................................................. 67920
         Due to the nature of the employed earner’s employment

             Presumption ............................................................................................ 67923
             Effect of Reduced Earnings Allowance entitlement ................................ 67924

         Prescribed disease D5 (dermatitis)
             Prescription ............................................................................................. 67925

         Diagnosis – sensitisation .............................................................................. 67929
         Due to the nature of the employed earner’s employment
             Presumption ............................................................................................ 67930
         Effect of Reduced Earnings Allowance entitlement ..................................... 67931
         Prescribed disease D6

             Prescription ............................................................................................. 67932
         Due to the nature of the employed earner’s employment ............................ 67933

         Similarities with prescribed disease D13 ...................................................... 67934
         Prescribed disease D7 (occupational asthma)
             Prescription ............................................................................................. 67936

         Ten year rule ................................................................................................ 67938
         Date of onset and recrudescence ................................................................ 67940
             Relevant date .......................................................................................... 67941
         Prescribed diseases D8, D8A and D9.......................................................... 67946
             Date of onset and recrudescence ........................................................... 67953
             Qualifying period ..................................................................................... 67955
             Transitional provisions ............................................................................ 67956

             Effect of Reduced Earnings Allowance entitlement ................................ 67957
         Prescribed disease D10
             Prescription ............................................................................................. 67958
             Diagnosis................................................................................................. 67963
             Recrudescence ....................................................................................... 67964




Volume 11 Amendment 11                                                                                              January 2010
Decision Makers Guide                                                                                                 Contents



         Prescribed disease D11

         Prescription .................................................................................................. 67965
         Diagnosis and recrudescence ...................................................................... 67967
         Relevant date ............................................................................................... 67968

         Prescribed disease D12

         Prescription .................................................................................................. 67970
             Definitions................................................................................................ 67975
         Medical tests ................................................................................................ 67976

         Change of circumstances ............................................................................. 67979
         Previous compensation for prescribed disease D1 ...................................... 67982

         Recrudescence and presumption ................................................................ 67983
         Relevant date ............................................................................................... 67984

         Effect on Reduced Earnings Allowance entitlement .................................... 67985

         Prescribed disease D13

         Prescription .................................................................................................. 67991
         Similarities with prescribed disease D6 ........................................................ 67993
         Effect on Reduced Earnings Allowance entitlement .................................... 67995


         Appendix 1 – Prescribed diseases added and changes made to the Schedule of
                                diseases since 5 July 1948 (see DMG 67301)
         Appendix 2 – Changes since 5 July 1948 amending the regulations affecting
                                claims for prescribed diseases Nos D1, D2 and D3
         Appendix 3 – List of occupations for prescribed disease D3 mesothelioma
         Appendix 4 – Diagnosis for prescribed disease D1




Volume 11 Amendment 11                                                                                             January 2010
Decision Makers Guide                                                                              Introduction



         Chapter 67 - Prescribed diseases
         Introduction
         General

67001    Industrial Injury benefits are payable for

         1.     prescribed diseases and

         2.     prescribed personal injuries
                                                   1
         caused by the work a person does . A disease or injury is prescribed when the
         Department is satisfied that it is a risk arising from a person’s occupation and not a
                                      2
         risk common to everybody .

                                                                   1 SS C&B (NI) Act 92, sec 108(1); 2 sec 108(2)

67002    The diseases and injuries for which benefits are payable and the occupations for
                                                                                1
         which they are prescribed are laid down in regulations .                    In this part the term
                                                                        2
         prescribed disease also includes prescribed injuries .

                                                                        1 SS (II) (PD) Regs (NI), Sch 1; 2 reg 1(2)

67003    The provisions only apply to
                                                       1
         1.     employed earner’s employment and

         2.     diseases due to the nature of a person’s employment which in certain
                circumstances can be presumed to be satisfied without needing to be
                                                                    2
                established by evidence (see DMG 67191) .

         Note: If a prescribed disease is contracted while a person is self-employed there is
         no entitlement to benefit.

                             1 SS C&B (NI) Act 92, sec 108(1)(a) & (b); 2 sec 109(3); SS (II) (PD) Regs (NI), reg 4

67004    If there is no entitlement to benefit because

         1.     a disease is not prescribed or

         2.     an occupation is not listed

         there may be entitlement to benefit under the industrial accident provisions if it is as
         a result of an accident.

67005    The date of onset      or development of a prescribed disease, which may have
                                                                                                                 1
         resulted in incapacity, loss of faculty or death, must be on or after 5.7.48 .
         However, benefit can be paid from the National Insurance fund for certain diseases
         resulting from employment before 5.7.47 (see DMG Chapter 64).

                                          1 SS C&B (NI) Act 92, sec 108(1); 2 sec 111 & Sch 8; WC (S) Regs (NI)



Volume 11 Amendment 11                                                                             January 2010
Decision Makers Guide                                                                    Introduction



67006    The decision maker will need to obtain medical advice to establish
         1.     whether a person is suffering or has suffered from a prescribed disease (the
                “diagnosis” question) or

         2.     whether a second or subsequent attack of a prescribed disease is a fresh
                attack or a recrudescence (the “recrudescence” question).

         67007 – 67010
                                                                       1
67011    Diseases and occupations are added to the Schedule                from time to time by
         amending regulations. These may be retrospective but cannot take effect before
         5.7.48.

                                                                       1 SS C&B (NI) Act 92, sec 108(3)

67012    Prescribed disease are grouped according to their causes. There are four groups.

         1.     Group A - due to physical agents.

         2.     Group B - due to biological agents.

         3.     Group C - due to chemical agents.

         4.     Group D – miscellaneous diseases.

         Prescribed diseases are numbered within each group. To avoid confusion they
         should always be referred to by their group letter and number, for example A2, B2,
         C2 and D2.
                                                                           1
67013    The grouping of prescribed diseases was introduced in 1983 . Previously there had
         been only numbering. A conversion table for prescribed diseases prescribed before
         3.10.83 is at Appendix 1 to this Chapter.

                                                           1 SS (II) (PD) Amdt (No 2) Regs (NI) 83, reg 3


         Provision of National Insurance number

                                                                                    1
67014    For a claim for a Prescribed Disease there is a specific requirement for a claimant
         to provide sufficient information or evidence to establish their National Insurance
         number. See DMG 02172 et seq for full guidance.

                                                                    1 SS A (NI) Act 92, sec 1(1A) & (1B)

         67015 – 67020




Volume 11 Amendment 11                                                                   January 2010
Decision Makers Guide                                                                     Prescription




         Prescription
         Disease not prescribed in the regulations

67081    Benefit cannot be paid under the prescribed disease provisions for a disease which
         is not prescribed in the regulations unless it has itself resulted from a prescribed
         disease (DMG 67065). But as difficulties can arise in this type of situation, the
                                                                                      1
         decision maker should be entirely sure that disallowance is appropriate .

                                                                                   1 R(I) 3/74; R(I) 4/80

67082    Decision makers should note that

         1.      if a claimant cannot identify a relevant disease, the decision maker should
                 ensure full enquiries have been made to check if the condition could have
                 resulted from a prescribed disease

         2.      if they consider that the claimant may be suffering from a particular
                 prescribed disease or from a sequela (even though the claimant has not
                 identified it) they should not disallow as in DMG 67081 but should seek
                 medical advice on the appropriate diagnosis question.

67083    Where DMG 67082 2. applies, further action in these cases depends upon the
         medical advice provided on the diagnosis question.

         67084 – 67090


         Prescribed occupations
67091    Each prescribed disease is prescribed only for employed earners who have been
         employed on or after 5.7.48 in employed earner’s employment in one or more
                                                 1
         occupations prescribed for that disease .

                                                               1 SS (II) (PD) Regs (NI), reg 2; R(I) 7/61

67092    The prescription test

         1.      is not restricted to employment in which the person has worked after the date
                 on which the disease was added to the schedule or the terms of prescription
                 were modified and

         2.      may be satisfied by any period of employed earner's employment which the
                 person has had in the relevant occupation since 5.7.48.

         Note:    Benefit cannot be paid for disablement before the date of introduction/
         modification of the disease.




Volume 11 Amendment 11                                                                    January 2010
Decision Makers Guide                                                                             Prescription



67093    The prescribed diseases and their prescribed occupations are listed at Appendix 1
         to this Chapter. Matters of particular interest concerning some of the prescribed
                                                           1
         diseases are discussed in DMG 67301 et seq .

                                                                            1 SS (II) (PD) Regs (NI), Sch 1, Part 1

67094    Whether the claimant has been employed in a prescribed occupation is a question
         of fact to be determined by the decision maker. Employed in an occupation means
         actually working in an occupation that is exposed to the risk of the disease. It does
         not mean merely legally bound by a contract of employment to work, though not in
                        1
         fact working . However, when calculating periods of actual work the decision maker
                                        2
         should include normal breaks . Examples of normal breaks are

         1.     weekends

         2.     holidays

         3.     short term absences for sickness or absenteeism

         4.     short term interruptions due to industrial troubles.

         A continuous break of 3 months or more should not normally be included when
         calculating periods of actual work.

                                                                      1 CI 59/49(KL); CI 60/49(KL); 2 R(I) 2/79

67095    The prescribed occupations are those involving the activities, contacts and
         exposures listed. "Involve" is not restricted to the duties persons have to perform
         under their contract of service. If, as well as those duties, they voluntarily perform
         other work which it is reasonable to accept as part of their duties, their occupation
                                                               1
         might be held to involve the additional work .               If the work which involves the
         prescribed activity etc - whether voluntary or a contractual requirement - is
         performed very infrequently, or for a very short time, it might be disregarded as
                                                    2
         being too trivial to be taken into account .

                                                                   1 R(I) 4/53; 2 R(I) 4/53; R(I) 61/53; R(I) 8/57

67096    Any doubt about whether the employment in the prescribed occupation was
         employed earner's employment should be referred to Her Majesty’s Revenue and
         Customs (see DMG Chapter 66).

67097    If it is clear that the claimant has not been employed in a prescribed occupation on
         or after 5.7.48, the decision maker can disallow the claim without determining
                                                                                                         1
         whether the claimant is suffering from the disease for which benefit is claimed . Any
         decision on the prescription question is subject to appeal and if the decision is
         reversed on appeal the diagnosis question has then to be raised and determined.

                                            1 SS & CS (D&A) Regs (NI), reg 12(1)(b)(c); SS (NI) Order 98, art 9




Volume 11 Amendment 11                                                                            January 2010
Decision Makers Guide                                                            Prescription




         Prescription of diseases involving poisoning etc

67098    The decision maker may have difficulty deciding prescription on claims for
         prescribed diseases involving poisoning or exposure to chemical or other agents (for
         example those in Group C and also prescribed disease D7) because employers (as
         well as claimants) cannot give sufficient details of the precise nature of the
         substances or agents involved. The decision maker may need to consult Decision
         Making Services in these cases about the need for expert opinion.

67099    Before a reference is made every effort should be made to obtain as much
         information as possible from persons with relevant knowledge of the claimant’s
         work. In doubtful cases enquiries should be made about the chemical constituents
         of a proprietary product and the name and address of the manufacturer obtained.
         Only where the doubt is not resolved should the Decision Making Services be
         consulted.

         67100




Volume 11 Amendment 11                                                           January 2010
Decision Makers Guide                                        Prescribed disease A10 (occupational deafness)




         Prescribed disease A10 (occupational
         deafness)
67331    This disease was prescribed as prescribed disease 48 from 28.10.74 although
                                                         1
         benefit was not payable until 3.2.75 . Changes were made to the description of the
                                                     2                                    3
         disease from 3.9.79 and 3.10.83 and again from 16.10.89 . From that date the
         description is:

         “Sensorineural hearing loss amounting to at least 50dB in each ear, being the
         average of hearing losses at 1,2 and 3kHz frequencies and being due in the case of
         at least one ear to occupational noise (occupational deafness).”

         Details of the legislative changes and their effects are in Appendix 1.

                    1 NI (II) (PD) Amdt Regs (NI) 74, reg 2 & Sch; 2 SS (II) (PD) Amdt (No 4) Regs (NI) 79, reg 2 & Sch;

                         SS (II) (PD) Amdt (No 2) Regs (NI) 83, reg 3(d) & Sch 1; 3 SS (II) (PD) Amdt Regs (NI) 89, reg 4

67332    Claims to benefit for occupational deafness are subject to numerous special
         provisions and restrictions. Guidance is arranged as follows

         Time limits for claiming                (DMG 67334)

         Date of onset                           (DMG 67340)

         Prescription                            (DMG 67345)

         Diagnosis                               (DMG 67434)

         Assessment                              (DMG 67436)

         Due to the nature                       (DMG 67447)

         67333


         Time limits for claiming

                                                                 1
67334    The normal time limits for claiming benefit do not apply to occupational deafness.
         A claim for occupational deafness must be made within five years of the date a
                                                                          2
         person last worked in a prescribed occupation (whether in employed earner's
         employment or self-employment). Disablement Benefit cannot be paid for any day
         before the date of claim.

                                1 SS (C&P) Regs (NI), reg 6, 19 and Sch 4; SS (II) (PD) Regs (NI), reg 23(1); 2 reg 23(2)

67335    The five year time limit runs from the time a person actually last works in a
         prescribed occupation and not from the date a contract of employment expires (if
               1
         later) .

                                                                                                             1 R(I) 2/79



Volume 11 Amendment 11                                                                                   January 2010
Decision Makers Guide                                Prescribed disease A10 (occupational deafness)



67336    If a claim has been disallowed on the five year rule (DMG 67334) a further claim to
         benefit may be accepted as soon as a person starts work in a prescribed
         occupation. But the prescription test and diagnosis test must be satisfied for benefit
         to be payable.

67337    If a claim has been disallowed on diagnosis a further claim to benefit can only be
                              1
         allowed if the claim is made more than three years after the date

         1.       on which the earlier claim was made or

         2.       of a re-assessment of less than 20 per cent by a decision maker or tribunal.

                                                                  1 SS (II) (PD) Regs (NI), reg 25(1)(a) & (b)

67338    A claimant may find that by delaying a claim until after the dates in DMG 67337 1. or
         2. the five year time limit is not satisfied. In these cases the three year waiting
         period can be waived and one further claim allowed provided it is made within five
                                                         1
         years of working in a prescribed occupation .

         Note: See DMG 67334 for guidance on the five year time limit.

                                                                              1 SS (II) (PD) Regs (NI), reg 25(1)

         Example

         4.3.90                   17.6.92                    3.3.95                            16.6.95

         Last worked in           Date of previous           Expiry of                         Expiry of
         prescribed               claim disallowed           five year                         three year
         occupation               on diagnosis               time limit                        waiting
         period

         By delaying a claim until after 16.6.95 the five year time limit will not be satisfied. A
         further claim can therefore be accepted provided it is made before 3.3.95.

67339    The decision maker, the tribunal or Commissioner may disallow a claim made under
         DMG 67338 without referring for a medical opinion where the medical evidence
         satisfies the decision maker, tribunal or Commissioner that the claimant does not
                                        1
         have occupational deafness .

                                                                              1 SS (II) (PD) Regs (NI), reg 25(2)


         Date of onset

                                                                          1
67340    In a claim for occupational deafness the date of onset is the day on which the
         claimant first had the relevant loss of faculty on or after 3.2.75, or, if later

         1.       3.9.79 in the case of a claim made before that date which results in the
                  payment of benefit commencing on that date or




Volume 11 Amendment 11                                                                           January 2010
Decision Makers Guide                                   Prescribed disease A10 (occupational deafness)



         2.     in any other case, the date on which a successful claim to benefit is made.

         For practical purposes, the date of onset is always the date of the successful claim.

                                           1 SS (II) (PD) Regs (NI), reg 6(2)(c); SS (NI) Order 90, Sch 6, para 2(3)

         67341 – 67344


         Prescription

         General
67345    Since the introduction of this prescribed disease there have been four major
         amendments to the list of prescribed occupations

         1.     3.9.79 - which added a number of occupations and brought in those assisting
                in and supervising the use of prescribed tools in addition to persons actually
                             1
                using them

         2.     3.10.83 - which amended supervision and assistance to work in the
                                                                                                       2
                immediate vicinity and added further occupations to those prescribed

         3.     4.1.88 - which amended the definitions of the occupations in sub-paras (a) to
                                                                                    3
                (e) to clarify legislation in areas of doubt and ambiguity

         4.     10.10.94 - which added further occupations to the prescribed list and
                                                    4
                amended sub-paras (a) and (c)

         5.     22.9.03 – which added two new occupations to the list, amended two others
                                                5
                and regrouped the entire list .

         Details of the changes are in Appendix 1 to this Chapter.

         The effect of the changes in 2. was not only to extend the occupations covered but
         also to reduce the twenty year qualifying period to ten years and to extend the time
         within which claims were to be made to five years.

         The changes from 4.1.88 clarified and consolidated the existing categories of
         occupation.

         The changes from 22.9.03 regrouped the list of occupations and revoked provisions
         dealing with provisional assessments, supersession, revision and appeal of
         assessments for occupational deafness.

                                 1 SS (II) (PD) (Amdt No 4) Regs (NI) 79; 2 SS (II) (PD) (Amdt No 2) Regs (NI) 83;

                                      3 SS (II) (PD) (Amdt No 2) Regs (NI) 87; 4 SS (II) (PD) (Amdt) Regs (NI) 94;

                                                                           5 SS (II) (PD) (Amdt No 2) Regs (NI) 03

67346    The guidance in DMG 67347-67447 is based on the definitions of the occupations
         prescribed from 10.10.94. It also refers to the terms of prescription in force before



Volume 11 Amendment 11                                                                              January 2010
Decision Makers Guide                             Prescribed disease A10 (occupational deafness)



         10.10.94. The decision maker will need this guidance in deciding claims which were
         made and questions which arose before that date.


         Effect of current legislation
67347    The conditions of entitlement are that the claimant must have been employed in
         employed earner’s employment

         1.     at any time on or after 5.7.48 and

         2.     for a period (or periods totalling) not less than ten years (whether before or
                                                          1
                after 5.7.48) in a prescribed occupation .

         If a person has been employed at the same time in more than one of the
         occupations described in sub-paras (a), (b), (d), (e), (f), (g) and (h), those
         occupations are treated as one in deciding whether a person has been employed
                                                                              2
         wholly or mainly in the work described in those paragraphs .

                                                              1 SS (II) (PD) Regs (NI), Sch 1, Part 1; 2 reg 2(c)

                                                                                                          1
67348    Employment means work actually done, not the contractual obligation to do it . In
         calculating the ten year period short-term absences from work can be ignored but a
         person should not normally be accepted as working if an absence exceeds three
         months. The total of ten years employment does not have to have been continuous
         and may include periods before and after 5.7.48.                   If an employment is not
         prescribed there is no entitlement to benefit even if the claimant has been in a
                            2
         noisier occupation .

                                                                                        1 R(I) 2/79; 2 R(I) 8/76


         Obtaining and considering evidence
67349    The claim form normally shows which prescribed occupation the claim is based on.
         If it does not, such information should be obtained from the claimant before an
         enquiry is sent to the employer.

         It may also be clear from factors such as

         1.     the nature of the claimant’s occupation

         2.     the type of industry

         3.     local knowledge

         4.     replies from the employer

         that the ten year test is satisfied and in such cases the decision maker may accept
         prescription without further enquiry.




Volume 11 Amendment 11                                                                           January 2010
Decision Makers Guide                              Prescribed disease A10 (occupational deafness)



         4.     edge crimping and

         5.     knit-de-knit texturing.


         The mechanical cleaning of bobbins
67420    Mechanical bobbin cleaning entails the removal of fibres from bobbins by means of
         a machine consisting of a line driven parallel rollers and is used in the textile
         industry.

         67421 – 67424


         Sub para (e)

         Woodworking and associated industries
67425    This category covers specific woodworking machinery. The rather detailed nature of
         this category is necessary, as the various machines in this industry cannot readily
         be classified under any general heading such as “high-speed” etc.

67426    As from 22.9.03 the use of the chainsaw is no longer restricted to use in forestry.
         The new prescription requires only the use of a chainsaw on wood.


         Sub para (f)

         Water jetting and jet channelling
67427    As from 22.9.03 the prescription for water jetting requires only that a jet of water (or
         water and an abrasive material) is delivered at a pressure above 680 bar (9862.2
         p.s.i). In the event that conversion to or from p.s.i. (pounds per square inch) is
         required 1 bar = 14.50326 p.s.i. and 1 p.s.i. = 0.06895 bar. Examples where water
         jetting is used include:

         1.     cleaning drains, oil rig legs, ships hulls, boilers and walls of buildings

         2.     cutting through reinforced concrete (for example to study the state of repair of
                roads).

67428    The process of jet channelling involves the burning of natural stone in quarries.




Volume 11 Amendment 11                                                                 January 2010
Decision Makers Guide                            Prescribed disease A10 (occupational deafness)




         Sub para (g)

         Engines in ships and aircraft
67429    Work in a ship’s engine room may be carried out on a wide variety of vessels from
         tugs towing barges on the Thames to luxury ocean-going liners. It will usually be
         carried out by engineering staff.

67430    The acceptance testing of civil aeroplanes is not covered by the prescription.


         Sub paras (h), (i) and (j)

         The glassmaking and associated industries
67431    Hollow ware includes vases, glasses and ornaments but not flat glass.


         Sub para (k)

         Police firearms training officers
67432    Police firearms training officers means those giving instruction, not those being
         instructed. Persons working wholly or mainly in the immediate vicinity of the training
         officers, for example armourers or others working on or close to the firing range are
         also covered. Those undertaking training who suffer damage to their hearing can
         claim under the industrial accident provisions.


         Sub para (l)

         Shot blasting
67433    Shot blasting involves the use of high pressure air and an abrasive material in a
         directed jet to remove coating from a surface. This will include the processes known
         as shot blasting, bead blasting and sand blasting. Common applications are the
         cleaning of metal in the motor refinishing industry, for example steel or allow wheels
         and of metal in the metal fabrication industry, for example large fabricated structures
         prior to painting and in the building renovation industry, for example old beams,
         walls and ceilings.


         Diagnosis

67434    Diagnosis questions are determined in basically the same manner as other
         prescribed diseases apart from respiratory diseases. This means that




Volume 11 Amendment 11                                                             January 2010
Decision Makers Guide                              Prescribed disease A10 (occupational deafness)



         1.     an audiometric test is carried out to establish whether the claimant’s hearing
                loss due to noise at work has reached the minimum 50dB level

         2.     if 1. is not satisfied the Disablement Benefit claim is for disallowance by the
                decision maker with the normal right of appeal

         3.     if the test shows that the hearing loss has reached the 50dB level the
                claimant is referred to a medical adviser for determination of the diagnosis
                                           1
                and disablement questions .

                                                             1 SS & CS (D&A) Regs (NI), reg 12(1)(b) & (c)

67435    With prescribed disease A10 occupational deafness, (as with prescribed diseases,
         D1, D2, D3, D7, D8, D8A, D9 and D12) no question of recrudescence or fresh
         contraction arises since a person cannot recover and then suffer a fresh
                    1
         contraction .

                                                                          1 SS (II) (PD) Regs (NI), reg 7(1)


         Assessment

67436    Assessment of the level of disablement due to the relevant loss of faculty is by
                                                       1
         means of a formula laid down in regulations . The formula measures the dB hearing
         loss in each ear and also the binaural disablement.

                                                                   1 SS (II) (PD) Regs (NI), Sch 3, parts 1-3

67437    The table in Part I is for use in claims made before 3.9.79 which result in payment of
                                               1
         benefit for a period before that date . This table provides for disablement to be
         assessed as 100% when hearing loss reaches 88dB.
                                                                                                          2
         In all other cases the degree of disablement is assessed using the table in Part II .
         A degree of disablement of 100% only arises where hearing loss is 106 dB or more.

                                                            1 SS (II) (PD) Regs (NI), reg 32(1); 2 reg 32(2)




Volume 11 Amendment 11                                                                      January 2010
Decision Makers Guide                                      Prescribed disease A10 (occupational deafness)


                                                     1
67438    An effect of amending regulations was that claimants could be reassessed at a
         lower level despite there having been no improvement in their hearing. Also from
         3.10.83, a medical board could give a reduced assessment of disablement where
                                                                                                  2
         there had been an apparent improvement in the claimant’s condition .

                              1 SS (II) (PD) (Amdt No 4) Regs (NI), reg 6; 2 SS (II) (PD) (Amdt No 2) Regs (NI), reg 14

                                   1
67439    There are provisions which apply to claimants who were assessed under the pre
         3.9.79 provisions which in some cases enable Disablement Benefit to be paid on a
         mark-time basis and in others “cushion” the claimant against the effect of the
         legislative changes. Any case in which the claimant was entitled to benefit prior to
         3.9.79 must therefore be considered in accordance with DMG 67442 - 67444.

                                                                                 1 SS (II) (PD) Regs (NI), reg 32(7)-(9)

67440    If the renewal is before 3.10.83 the decision maker can award the

         3.        1.      normal rate taking into account the medical advice on the renewal
                               1
                   assessment or

         4.        2.      rate in payment immediately before renewal if that is higher (awarded
                                           2
                   on a mark-time basis) .

                                                            1 SS (II) (PD) Regs (NI), reg 32(7)(b)(i); 2 reg 32(7)(b)(ii)

67441    If the renewal is on or after 3.10.83 the decision maker should award the normal
         rate taking account of the medical advice on the renewal unless

         5.        1.      the claimant is already in receipt of a mark-time rate as the result of
                                       1
                   an earlier renewal or
                                                                                  2
         6.        2.      this is the first re-assessment since 3.9.79 .

                                                                 1 SS (II) (PD) Regs (NI), reg 32(8)(a); 2 reg 32(8)(b)

67442    If either DMG 67441 1. or 2. applies the decision maker may still award the normal
         rate taking into account the opinion of the medical advisor on the renewal but only if
         it is the same as or more than the rate in payment immediately before renewal takes
               1
         effect . Otherwise the decision maker should consider awarding the rate

         7.        1.      payable if disablement had been renewal according to the pre 3.9.79
                                           2
                   scales of assessment (the renewal board will provide the notional degree) or
                                                                                                 3
         8.        2.      in payment immediately before renewals takes effect

         whichever is lower, on a mark-time basis.

                                           1 SS (II) (PD) Regs (NI), reg 32(9)(a); 2 reg 32(9)(b)(i); 3 reg 32(9)(b)(ii)




Volume 11 Amendment 11                                                                                  January 2010
Decision Makers Guide                                    Prescribed disease A10 (occupational deafness)




         Re-assessment at less than 50 decibels
                                                                                                                  1
67443    The word permanent was removed from the description of the disease in 1983 .
         The regulations now provide that if on renewal the hearing loss is

         1.     found not to be 50dB or more in each ear or

         2.     found to be 50dB but not due in at least one ear to occupational noise

         the extent of disablement shall be assessed at less than 20% and disablement
                                       2
         benefit shall not be payable . Any assessment of less than 20% is final. However,
         the claimant may ask for his claim to be reconsidered or may appeal to an appeal
         tribunal or make a fresh claim. But see DMG 67337-67338 for restrictions on further
         claims.

                                 1 SS (II) (PD) (Amdt No 2) Regs (NI) 83; 2 SS (II) (PD) Regs (NI), reg 32(5) & (6)


         Change of circumstances
67444    Where a claimant maintains that there has been a worsening in their condition the
         case should be referred to Medical Services on the grounds that there has been a
         change of circumstances. In Prescribed Disease A10 cases a further audiometric
         test will be required. When advising on the results of the audiometric test the
         medical adviser needs to consider both the figures of average hearing loss and
         whether the behaviour of the claimant suggests adequate co-operation.

67445    If the audiometric test is not satisfied the medical adviser should give an opinion that
         the disease is not diagnosed. When giving that opinion the medical adviser should
         also re-consider the original audiometric test and give fully justified advice on why it
         is considered that the latest test represents the full extent of the claimant’s hearing
         loss. If this advice is not received the case should be returned to Medical Services.

67446    If the decision maker is satisfied that the current test most accurately reflects the
         claimant’s present hearing loss then supersession of the decision awarding benefit
                                                                                                1
         on the grounds of mistake as to a material fact will be appropriate . The effective
                                                                                            2
         date of the new decision will be the date the decision is given . For advice on
         superseding on the grounds of mistake as to a material fact and the effective date,
         see DMG Chapter 04.

                                           1 SS CS (D&A) Regs (NI), reg 6(2)(b) & (3); 2 SS (NI) Order 98, art 10(5)

         Example

         Bill was diagnosed as suffering from Prescribed Disease A10 and was awarded
         Industrial Injuries Disablement Benefit at 20% from 8.06.06 for life. On 7.09.09 he
         notified a worsening of his condition.              Medical advice was requested.                  At an
         examination on 5.10.09 a further audiometric test was carried out. The test resulted



Volume 11 Amendment 11                                                                              January 2010
Decision Makers Guide                             Prescribed disease A10 (occupational deafness)



         in average hearing loss of less than 50dB in each ear. Subsequently, medical
         advice was that the claimant did not suffer from Prescribed Disease A10 and this
         was accompanied by a full explanation why the original audiometric test was
         incorrect. On 15.10.09 the decision maker accepts the advice and supersedes the
         original decision on the grounds of mistake as to a material fact and disallows on
         diagnosis from and including 15.10.09.


         Due to the nature of employed earner’s employment
67447    The requirement that the claimant’s hearing loss must be due to occupational noise
         is included in the description of the disease and is, thus, considered at the same
         time as the diagnosis question. It is presumed the disease is due to the nature of
                                                                               1
         the employed earner’s employment unless the contrary is proved . It would be rare
         for a claimant who had satisfied all other relevant tests to fail to satisfy the “due to
         the nature of” test.

                                                                       1 SS (II) (PD) Regs (NI), reg 4(5)




Volume 11 Amendment 11                                                                  January 2010
Decision Makers Guide                                                     Prescribed disease A11



         nature as well as the frequency of the activities. Dictionary definitions should be
         used with care but generally it should be considered whether the activities of a
         particular job can fairly be described as “destroying the fabric of”, “knocking down”,
         “levelling”, “reducing to ruin”, “tearing down or breaking up” etc. If they can then
         prescription should be allowed. But an activity that is performed only occasionally or
         only in an incidental way should not be accepted as satisfying the prescription.

         Example

         The claimant is employed as a plumber and on occasions had to demolish walls and
         drill into concrete floors to install pipes. Prescription should not be accepted, as this
         is not demolition as it does not involve the destruction of the whole, or substantial
         part of a building, the work is incidental to the occupation of plumber whose main
         job is to improve, not destroy.

67456    The decision maker should note that

         1.     in the case of a claim based on category (b) where the relevant operation is
                grinding there is no restriction on the type of material being ground, or being
                held while being ground

         2.     where the relevant operation is sanding or polishing the claim succeeds
                only if the object being sanded or polished, or being held while being sanded
                or polished, is metal

         3.     it is essential, therefore, that claimants make absolutely clear which of the
                three operations they were engaged in and, if in sanding or polishing, what
                material they were working on or holding.

67457    There are no limits as to the length of time that a person must have been employed
         in any of the prescribed occupations. But the decision maker must be satisfied that
         the time spent using the relevant tools or holding the relevant material was a regular
         part of the job and was not so trivial a part as to be regarded as negligible.

         67458 – 67460


         Diagnosis before 1.10.07

67461    Before 1.10.07 prescribed disease A11 was defined as episodic blanching of the
         phalanges. These are vascular symptoms. Once a person has been diagnosed as
         suffering from prescribed disease A11 the loss of faculty which causes the
         disablement should be assessed by reference to the medical condition known as
         vibration white finger which includes vascular and neurological symptoms.

         Note: See DMG 67497 for guidance on when transitional provisions apply.




Volume 11 Amendment 11                                                               January 2010
Decision Makers Guide                                                   Prescribed disease A11



67462    When assessing vibration white finger the medical adviser should advise separately
         on the vascular and neurological effects.        Where a neurological component is
         identified it should be listed as fully relevant.    Where it is not clear that both
         conditions have been considered the case should be returned.


         Diagnosis from 1.10.07

67463    The revised prescription for prescribed disease A11 includes both vascular and
         sensorineural symptoms. It does not mention vibration white finger. It allows for
         diagnosis of the disease on either the vascular or the sensorineural elements alone.
         Before 1.10.07 the disablement arising from the effects of sensorineural symptoms
         could only be taken into account when prescribed disease A11 was diagnosed on
         the basis of the extent of the vascular symptoms.

67464    As in the case with prescribed disease A11 before 1.10.07, diagnosis based on the
         revised prescription of the vascular element is unlikely to give rise to significant
         assessments of disablement.         This may also apply to diagnosis based on the
         sensorineural criteria.

67465    A claimant who meets the criteria for diagnosis set out in (a) of the revised
         prescription (i.e. satisfies the vascular symptoms alone) will be given an assessment
         of disablement based on what they can or cannot do. This will include the effects of
         any existing sensorineural symptoms.

         Note: Where prescribed disease A11 can be diagnosed on the vascular criteria,
         there will be no necessity to refer the claimant for thermal aesthesiometry and
         vibrotactile testing.

67466    However, a claimant who does not satisfy the vascular criteria for diagnosis will
         have the sensorineural criteria considered on their own and will be diagnosed as
         suffering from prescribed disease A11 if all the criteria set out in (b) of the revised
         prescription are satisfied.

         Note: Thermal aesthesiometry and vibrotactile tests will only be undertaken for
         those claimants where all the evidence collected by the medical adviser suggests
         that all the criteria in (b) may be satisfied.

67467    Vascular and sensorineural symptoms are not unique to vibration damage. The
         symptoms are common in the general population as many medical conditions cause
         them. Therefore, the decision maker should be satisfied that the medical adviser
         has given careful consideration to probable other causes of the symptoms.

67468    The decision maker must also be satisfied from

         1.     the history obtained by the medical adviser or




Volume 11 Amendment 11                                                             January 2010
Decision Makers Guide                                                                Prescribed disease A11



         2.     other evidence (for example a previous claim or further medical evidence
                supplied by the claimant)

         that there was no blanching or sensorineural symptoms prior to the claimant starting
         employment in a prescribed occupation. In respect of claims for blanching, this only
         applies to claims for periods on or after 1.10.07, not those made or backdated to
         before 1.10.07.     However, see DMG 67497 et seq for guidance on transitional
         provisions.

67469    When sensorineural symptoms are being considered, “demonstrable” means that
         claimants must show signs of reduced sensory perception and manual dexterity, in
         practice this will be by demonstrating them at the examination. However, if there is
         no examination (e.g. because the claimant has died), the medical adviser and the
         decision maker would base their opinion and decision on all available evidence and
         apply the test of balance of probabilities.

         67470 – 67495


         Effect on Reduced Earnings Allowance entitlement

67496    There is no entitlement to Reduced Earnings Allowance where entitlement arises
         from prescribed disease A11 diagnosed and assessed solely on the basis of the
         sensorineural symptoms because this is an extension of prescribed disease A11
                         1
         after 10.10.94 .    However, entitlement to Reduced Earnings Allowance may still
         arise where the date of onset of prescribed disease A11 due to vascular symptoms
                             2
         is before 1.10.90 .     This is because the new vascular symptoms are not an
         extension of prescribed disease A11. Cases of doubt should be referred to Decision
         Making Services.

                                          1 SS C&B (NI) Act 92, Sch 7, para 11(1); SS (II) (PD) Regs (NI), reg 12A;

                                                                           2 SS C&B (NI) Act 92, Sch 7, para 11(1)


         Transitional provisions

67497    The prescription conditions in force before 1.10.07 continue to apply to

         9.     1.       claims in respect of vascular symptoms made
                                      1
               1.1      before 1.10.07 or
                                                                                                        2
               1.2      no later than 31.12.07 where the date of onset is before 1.10.07 or

         10.    2.       recrudescence of a disease where a claim in respect of vascular
                symptoms is made

               2.1      before 1.10.07 or



Volume 11 Amendment 11                                                                             January 2010
Decision Makers Guide                                                                     Prescribed disease A11


                                                                                                              3
               2.2      no later than 31.12.07 where the date of onset is before 1.10.07 or

         11.    3.        a period of assessment following a

               3.1      previous period of assessment or

               3.2      provisional award
                                     4
         where there is no break .

         Note: Recrudescence is unlikely to arise because once prescribed disease A11
         has been diagnosed, it is unusual for the condition to improve or resolve itself.
         Cases of doubt should be referred to Decision Making Services for advice.

                             1 SS (II) (PD) (Amdt No 2) Regs (NI), reg 3(1)(a)(i) & 3(2)(a); 2 reg 3(1)(a)(ii) & 3(2)(a);

                                                                                 3 reg 3(1)(b) & 3(2)(a); 4 reg 3(2)(b)


         Injury by accident

67498    Claims for vibration white finger should always be actioned under the prescribed
         disease provisions, as it is virtually impossible for the condition to be contracted by
         accident.      If, exceptionally, a claimant insists on claiming under the accident
         provisions, the papers should be sent to Decision Making Services with full details of
         the circumstances before any action is taken.

         67499 – 67500




Volume 11 Amendment 11                                                                                  January 2010
Decision Makers Guide                                                   Prescribed diseases A12 and A13




         Effect on Reduced Earning Allowance entitlement
67521    As the change in prescription for prescribed disease A12 from 24.3.96 was not an
         extension, entitlement to Reduced Earnings Allowance can still be established (see
         DMG Chapter 71).

67522    However, there was an extension in the change in prescription for prescribed
         disease A12 with effect from 6.4.07. Therefore, there is no entitlement to Reduced
                                                                                                   1
         Earnings Allowance for people who satisfy this extended prescription . Cases of
         doubt should be referred to Decision Making Services for advice.

                                                                           1 SS C&B (NI) Act 92, Sch 7, para 11(1)


         Transitional provisions

67523    The prescription conditions in force prior to 24.3.96 continue to apply to people

         1.     during any period for which an assessment of disablement which includes
                                               1
                24.3.96 remains continuous or

         2.     during any period for which an assessment of disablement which includes
                24.3.96 remains continuous and

               2.1      the claim was made before 24.3.96 and
                                                                       2
               2.2      a review (reconsideration on any claim) takes place on or after 24.3.96
                        and
                                                                                                   3
               2.3      the review results in an assessment which includes 24.3.96 or

         3.     during any period for which there is a continuous assessment of disablement
                which began no later than 91 days after 24.3.96 (excluding Sundays) and

               3.1      the claim was made before 24.3.96 and
                                                                4
               3.2      the date of onset is before 24.3.96 or

         4.     who had an assessment of disablement which ended before 24.3.96 and
                                                        5
               4.1      who suffer a recrudescence of the same disease (DMG 67232)
                        beginning before 24.3.96 and
                                                                                               6
               4.2      who make a claim in respect of that disease after 24.3.96 .
                                     1 SS (II & D) (Misc Amdt) Regs (NI), reg 7(2)(a); 2 SS (NI) Order 98, Art 10;
                                                     3 SS (II & D) (Misc Amdt) Regs (NI), reg 7(2)(b); 4 reg 7(3);
                                     5 SS (II) (PD) Regs (NI), reg 7; 6 SS (II & D) (Misc Amdt) Regs (NI), reg 7(4)




Volume 11 Amendment 11                                                                                 January 2010
Decision Makers Guide                                            Prescribed diseases A12 and A13



67524    For the purpose of DMG 67523 1., 2. or 3. two or more assessments which are
                                                                     1
         consecutive are treated as one continuous assessment .

                                                         1 SS (II & D) (Misc Amdt) Regs (NI), reg 7(2) & (3)

                                                             1
67525    The prescription conditions in force prior to 6.4.07 continue to apply to

         1.     assessments already in place at 6.4.07

         2.     claims made before 6.4.07 where disablement has not yet been assessed

         3.     claims made no later than 5.7.07 in respect of a period starting before 6.4.07

         4.     renewal assessments following a provisional assessment where there is no
                break

         5.     further assessments following a final assessment where there is no break

         6.     assessments spanning 6.4.07 which are superseded after 6.4.07 where there
                is still an assessment of disablement

         7.     recrudescence of a disease where the assessment for the earlier attack
                began before 6.4.07.

                                                                 1 SS (II) (PD) (Amdt) Regs (NI) 2007, reg 3


         Presumption

67526    The usual presumption that the disease was due to the nature of the employment
                         1                                               2
         does not apply . The recrudescence provisions do apply .

                                                              1 SS (II) (PD) Regs (NI), reg 4(1); 2 reg 7(1)


         Prescribed disease A13

67527    The Industrial Injuries Advisory Council considered all the evidence and concluded
         that this disease should be prescribed only in relation to farmers and farm workers
         and that to qualify the claimant must have worked for a period of, or an aggregated
         period of, at least ten years as a farmer or farm worker.




Volume 11 Amendment 11                                                                      January 2010
Decision Makers Guide                                                                    Prescribed diseases A14




         Prescribed disease A14
         Introduction

67528    Prescribed Disease A14, osteoarthritis of the knee, was added to the list of
                                                     1
         Prescribed Diseases on 13.7.09 .                    There is no entitlement to benefit for this
         Prescribed Disease before this date.

                     1 Social Security (Industrial Injuries) (Prescribed Diseases) Amendment Regulations (NI) 2009, reg 2


         Prescription

67529    To satisfy the prescription test, claimants must have worked underground in a coal
         mine for a period, or aggregate periods, of at least 10 years

         1.     before 1.1.86 as a coal miner or

         2.     on or after 1.1.86 as a

               2.1      face worker working on a non-mechanised coal face or

               2.2      development worker or

               2.3      face-salvage worker or

               2.4      conveyor belt cleaner or
                                                         1
               2.5      conveyor belt attendant .
                                                                                    1     II (PD) Regs (NI), Sch 1, Part 1

         Example

         Malcolm worked underground in a coal mine as a conveyor belt cleaner from
         12.5.80 to 31.8.90.         He makes a claim for Prescribed Disease A14.                             Malcolm
         satisfies the occupation test.

67530    Osteoarthritis of the knee is a common disease in the general population. It can be
         caused by prolonged and frequent heavy lifting, kneeling and squatting. Until the
         mid 1980s all underground coal miners had jobs involving those activities.
         However, from the mid 1980s only certain categories of miner undertook those
         activities. For that reason, for periods from 1.1.86, only those mining jobs at DMG
         67529 2. have been prescribed. Therefore, for periods from 1.1.86 it is necessary
         for decision makers to have evidence of the actual mining jobs undertaken by
         claimants.




Volume 11 Amendment 11                                                                                   January 2010
Decision Makers Guide                                                       Prescribed diseases A14



         Example

         Robert started work as an underground coal miner on 2.7.79. He worked
         underground in a coal mine until 28.9.90. From 1.1.86 he was employed as a face
         worker on a non-mechanised coal face. Robert makes a claim for Prescribed
         Disease A14. He satisfies the occupation test.


         Non-mechanised coal face

67531    For the purposes of DMG 67529 2.1, a non-mechanised coal face is a coal face
         without

         1.      either

                 1.1      powered roof supports or

                 1.2      a power loader machine which simultaneously cuts and loads the coal
                          or
                                   1
         2.      both 1.1 and 1.2 .
                                                                    1   SS II (PD) Regs (NI), Sch 1, Part 1


         Effect on Reduced Earnings Allowance entitlement

67532    There is no entitlement to Reduced Earnings Allowance for Prescribed Disease A14
                                                                1
         because it is a new disease prescribed after 10.10.94 .
                                                                        1    SS II (PD) Regs (NI), reg 12A

         67533




Volume 11 Amendment 11                                                                    January 2010
Decision Makers Guide                                                               Prescribed disease D12




         Change of circumstances

67979    Where a claimant maintains that there has been a worsening in their condition the
         case should be referred to Medical Support Services on the grounds that there has
         been a change of circumstances. In prescribed disease D12 cases a further FEV1
         test will be required. When advising on the results of the FEV1 test Medical Support
         Services needs to consider both the FEV1 figure achieved and whether the
         behaviour of the claimant and the shape of the tracings suggest adequate co-
         operation. Medical Support Services should also take into account whether or not
         the claimant’s lung function might have been enhanced by medication.

67980    If the spirometric criterion is not satisfied Medical Support Services should give an
         opinion that the disease is not diagnosed.                When giving that opinion Medical
         Support Services should also re-consider the original FEV1 and give fully justified
         advice on why it is considered that the latest test represents the full extent of the
         claimant’s breathing capacity. If this advice is not received the case should be
         returned to Medical Support Services.

67981    If the decision maker is satisfied that the current reading most accurately reflects the
         claimant’s breathing capacity then supersession of the decision awarding benefit on
                                                                                      1
         the grounds of mistake as to a material fact will be appropriate . The effect date of
                                                                           2
         the new decision will be the date the decision is given . For advice on superseding
         on the grounds of mistake as to a material fact and the effective date, see DMG
         Chapter 4.

                                       1 SS & CS (D&A) Regs (NI), reg 6(2)(b) & (3); 2 SS (NI) Order 98, sec 10(5)

         Example

         The claimant was assessed as suffering from prescribed disease D12 and was
         awarded Disablement Benefit at 20% from 16.4.98 for life. On 6.8.02 he notified a
         worsening of his condition.

         Medical advice was requested. At examination on 4.9.02 a further FEV1 test was
         carried out. The test resulted in a drop of less than 1 litre. Subsequently, the advice
         was that the claimant did not suffer from prescribed disease D12 and this was
         accompanied by a full explanation why the original FEV1 test was incorrect.

         On 12.9.02 the decision maker accepts the advice and supersedes the original
         decision on the grounds of mistake as to a material fact and disallows on diagnosis
         from and including 12.9.02.




Volume 11 Amendment 11                                                                            January 2010
Decision Makers Guide                                                                 Prescribed disease D12




         Previous compensation for prescribed disease D1

67982    A claimant who had a pneumoconiosis (D1) assessment of at least 50% and who
         was also suffering from bronchitis and emphysema will have had the effects of the
                                                                                                    1
         bronchitis and emphysema added to the D1 assessment (DMG 67804) . Prescribed
                                                                   2
         disease D12 is not prescribed for such people . If the D1 assessment was less
         than 50% any interaction of chronic bronchitis and emphysema will have been taken
         into account. If D12 is prescribed in these cases the decision maker should revise
                                                                                                3
         or supersede the D1 assessment to exclude the effects of interaction .

                                     1 SS (II) (PD) Regs (NI), reg 20; 2 reg 2(d); 3 SS (Gen Ben) Regs (NI), reg 11


         Recrudescence and presumption

67983    Where the claimant satisfies the 20 years test and develops prescribed disease
         D12, the disease is presumed to be due to the employment unless the contrary is
                1                                                        2
         proved . The recrudescence provisions do not apply .

                                                                             1 SS (II) (PD) Regs (NI), reg 4; 2 reg 7


         Relevant date

67984    There is no entitlement to Disablement Benefit for prescribed disease D12 for any
         day earlier than 13.9.93.


         Effect on Reduced Earnings Allowance entitlement

67985    Where the claim is made under the new extended test see DMG 67912. There is
         also no entitlement to Reduced Earnings Allowance where entitlement arises to
         Prescribed Disease D12 under the changes from 21.7.08. This is because the
                                                                                              1
         changes are an extension of Prescribed Disease D12 after 10.10.94 .

                                               1 SS C&B (NI) Act 92, Sch 7, para 11(1); II (PD) Regs (NI), reg 12A

         67986 – 67990




Volume 11 Amendment 11                                                                                  January 2010
      Decision Makers Guide                                                           Appendix 1



Disease     Corresponding Amendments to Description       Amendment to Nature              Authority and
No from     No on old         of the Diseases or Injury   of Occupation                    Effective Date
3.10.83     Schedule

A12 cont                                                  (b) repeated palmar flexion
                                                          and dorsiflexion of the wrist
                                                          for at least 20 hours per
                                                          week for a period or periods
                                                          amounting in aggregate to
                                                          at least 12 months in the 24
                                                          months prior to the onset of
                                                          symptoms, where “repeated”
                                                          means once or more often
                                                          in every 30 seconds.”

A13                           New disease added                                            SR 2005
                                                                                           No 37 14.3.05

A14                           New disease added                                            SR 2009

                                                                                           No 228 13.7.09




      Volume 11 Amendment 11                                                          January 2010
Decision Makers Guide                                                                                                   Contents



         Chapter 69 - Disablement Benefits

         Contents
         Introduction ................................................................................................ 69001
         Meaning of terms.......................................................................................... 69003

         Conditions of entitlement

         Claims made before 19.11.86 ...................................................................... 69009
         Claims made on or after 19.11.86 ................................................................ 69010
         Provision of National Insurance number ...................................................... 69011

         Date from which entitlement to Industrial Injuries
         Disablement Benefit arises

         Claims before 6.4.83 .................................................................................... 69011
         Claims after 6.4.83 ....................................................................................... 69012

         Late claims ................................................................................................... 69015

         Questions arising on claims for Industrial Injuries Disablement Benefit

         General ......................................................................................................... 69020
         Medical questions
             General.................................................................................................... 69030

             Meaning of health care professional ....................................................... 69033
             Referring questions for medical advice ................................................... 69034

             The role of the medical adviser ............................................................... 69037
             Information to be put before the medical adviser .................................... 69050
             Format of medical advice ........................................................................ 69052
             Assessment of disablement .................................................................... 69060
             Further medical evidence received before a decision made .................. 69066
             Reconsiderations involving medical issues ............................................. 69070
             Appeals involving medical questions ...................................................... 69085

         Disablement Pension ................................................................................. 69100




         Disablement Gratuities
         General ......................................................................................................... 69110
         Death of claimant ......................................................................................... 69120



Volume 11 Amendment 11                                                                                              January 2010
Decision Makers Guide                                                                                                   Contents



         Gratuity by instalments ................................................................................. 69130

         Pensions in lieu

         Pensions in lieu when Special Hardship Allowance was payable ............... 69135
         Pensions in lieu when a pension is already in payment ............................... 69145
         Limitations on pensions in lieu for successive accidents ............................. 69155

         Extinguishment or reduction of a gratuity ..................................................... 69170

         Pneumoconiosis and Byssinosis ............................................................. 69180

         Effect of changes from 19.11.86 .................................................................. 69185

         Transitional protection for claims made before 19.11.86

         General ......................................................................................................... 69200
         Delayed claim ............................................................................................... 69202
         Incapable of making an earlier claim ............................................................ 69210

         Application for supersession ........................................................................ 69215
         Pneumoconiosis, Byssinosis and Diffuse Mesothelioma ............................. 69216

         Aggregation of Assessments

         Statutory limitations on rate of benefits ........................................................ 69220

         Role of decision maker
             General.................................................................................................... 69225
             Rounding ................................................................................................. 69230

             Determining whether separate awards are advantageous ..................... 69231
             Assessments under pre 19.11.86 provisions .......................................... 69240
             Adjustment .............................................................................................. 69241
             Assessments where claim is treated as made under pre
             19.11.86 provisions ................................................................................. 69243
             Change of circumstances........................................................................ 69250
         Assessments for prescribed diseases D1 or D2
             Less than 20% ........................................................................................ 69251
             20% or more ............................................................................................ 69252

         Disablement Benefit Offsets

         General ......................................................................................................... 69260
         Limitation of offset ........................................................................................ 69270
             Odd days ................................................................................................. 69275
             Difference between offset amount and that originally paid ..................... 69280




Volume 11 Amendment 11                                                                                              January 2010
Decision Makers Guide                                                                                                  Contents



             Hospital treatment allowance .................................................................. 69285

             Calculation and wording of a decision including an offset ...................... 69286
             Period of original award runs beyond the end of the common period .... 69286
             Cases involving aggregated awards ....................................................... 69300

         Constant Attendance Allowance

         Considering a grant of Constant Attendance Allowance .............................. 69310
         Primary conditions ........................................................................................ 69320

         Interpretation of conditions for granting constant
         Attendance Allowance

         Dependant on attendance ............................................................................ 69322
         The necessities of life ................................................................................... 69327
         A prolonged period ....................................................................................... 69329

         Determining the rate of constant Attendance Allowance ...................... 69340

         Artificial limbs ............................................................................................... 69341

         Visiting officer’s report .................................................................................. 69343
         Part time rate ................................................................................................ 69345

         Normal maximum rate .................................................................................. 69350
         Intermediate rate .......................................................................................... 69360

         Exceptional rate ............................................................................................ 69369

         Distinguishing between constant Attendance Allowance rates ........... 69371
         Special factors .............................................................................................. 69377

         Period of grant ............................................................................................ 69378
         Renewal ....................................................................................................... 69384

         Overpayment ................................................................................................ 69385

         Claimant in hospital ................................................................................... 69390

         Conditional grant for hospital in-patient........................................................ 69393

         Exceptionally Severe Disablement Allowance

         Considering a grant of Exceptionally Severe Disablement Allowance ........ 69500
         Permanent .................................................................................................... 69510
         Deciding entitlement ..................................................................................... 69513
         Claimant in hospital ...................................................................................... 69520
         Conditions for Exceptionally Severe Disablement Allowance
         are satisfied .................................................................................................. 69522



Volume 11 Amendment 11                                                                                              January 2010
Decision Makers Guide                                                                                                 Contents



         Conditions for Exceptionally Severe Disablement Allowance
         are not satisfied ............................................................................................ 69523

         Renewals ...................................................................................................... 69530
         Clear evidence ............................................................................................. 69533
         Exceptionally Severe Disablement Allowance grant is not renewed ........... 69535




Volume 11 Amendment 11                                                                                             January 2010
Decision Makers Guide                                                   Statutory Rules




Statutory Rules commonly referred to in
Chapter 69
 Short description        Full title                        Abbreviation

 Claims and Payments      The Social Security (Claims and   SS (C&P) Regs (NI)
 Regulations              Payments) Regulations
                          (Northern Ireland) 1987 No 465

 General Benefit          The Social Security (General      SS (Gen Ben) Regs
 Regulations              Benefit) Regulations (Northern    (NI)
                          Ireland) 1984 No 92

 Miscellaneous            The Social Security (Industrial   SS (II & D) (Misc
 Provisions Regulations   Injuries and Diseases)            Prov) Regs (NI)
                          (Miscellaneous Provisions)
                          Regulations (Northern Ireland)
                          1986 No 340

 Payments on account      The Social Security (Payments     SS (POR) Regs (NI)
 Overpayments and         on account, Overpayments and
 Recovery Regulations     Recovery) Regulations
                          (Northern Ireland) 1988 No 142

 Prescribed Diseases      The Social Security (Industrial   SS (II) (PD) Regs
 Regulations              Injuries) (Prescribed Diseases)   (NI)
                          Regulations (Northern Ireland)
                          1986 No 179

 Reduced Earnings         The Social Security (Industrial   SS (II) (REA &
 Allowance and            Injuries) (Reduced Earnings       Trans) Regs (NI)
 Transitional             Allowance and Transitional)
 Regulations              Regulations (Northern Ireland)
                          1987 No 142

 Decisions and Appeals    Social Security and Child         SS & CS (D&A)
 Regulations              Support (Decisions and            Regs (NI)
                          Appeals) Regulations (Northern
                          Ireland) 1999 No 162




Volume 11 Amendment 11                                                     January 2010
Decision Makers Guide                                                   Statutory Rules




 Abolition of Injury      Social Security Abolition of      SS (AIB) (Conseq)
 Benefit Regulations      Injury Benefit) (Consequential)   Regs (NI)
                          Regulations (Northern Ireland)
                          1983 No 36

 Work-focused             Social Security (Work-focused     SS (WFI) Regs (NI)
 Interviews Regulations   Interviews) Regulations
                          (Northern Ireland) 2003 No 294




Volume 11 Amendment 11                                                     January 2010
Decision Makers Guide                                                                  Conditions of entitlement




         Conditions of entitlement
         Claims made before 19.11.86

69009    An employed earner was entitled to Disablement Benefit if, as a result of an
         industrial accident, a loss of physical or mental faculty occurred for which the extent
                                                                         1
         of disablement was assessed at not less than 1% . A person with pneumoconiosis
         was treated as having satisfied that condition irrespective of whether there was an
                                 2
         actual loss of faculty .

                                                                      1 SS C&B (NI) Act 92, sec 103(1); 2 sec 110(3)


         Claims made on or after 19.11.86

69010    To become entitled to Disablement Benefit an employed earner must establish that

         8.     as a result of an industrial accident, a loss of physical or mental faculty occurs
                                                                                                         1
                for which the extent of disablement is assessed at not less than 14% or

         9.     as a result of more than one accident, losses of physical or mental faculty
                occur, for each of which the disablement is assessed at less than 14% but
                                                                2
                which in total amount to 14% or more or

         10.    in pneumoconiosis, byssinosis or diffuse mesothelioma cases, disablement is
                                                                                      3
                assessed, or treated as assessed, at not less than 1% or

         11.    in the case of claims for occupational deafness, disablement is assessed at
                                      4
                not less than 20% .
                1    SS C&B (NI) Act 92, sec 103(1); 2 sec 103(2)(a)(b); 3 SS (II) (PD) Regs (NI), reg 18; 4 reg 32(6)


         Provision of National Insurance number

                                                                                                             1
69011    For Industrial Injuries Disablement Benefit there is a specific requirement for a
         claimant to provide sufficient information or evidence to establish their National
         Insurance number. See DMG 02172 et seq for full guidance.

                                                                                  1 SS A (NI) Act 92, sec 1(1A) & (1B)




Volume 11 Amendment 11                                                                                January 2010
Decision Makers Guide                                                                Conditions of entitlement




         Date from which entitlement to Industrial Injuries
         Disablement Benefit arises
         Claims before 6.4.83
69012    For claims based on accidents before 6.4.83, entitlement to Disablement Benefit
         depends on whether incapacity resulted within 156 days, excluding Sundays, from
         the date of accident. If not, entitlement arises from the fourth day following the date
         of accident or, in a prescribed disease case, from the beginning of the assessment.
         If there was a period of incapacity due to the accident entitlement is from the earlier
         of

         12.    the day following the last day of such incapacity or
                                                                                                     1
         13.    the day following the expiry of 156 days from the date of accident .

                                                                                      1 SS (AIB) (Conseq) Regs (NI)


         Claims after 6.4.83

69013    There is no entitlement to Industrial Injuries Disablement Benefit for the 90 days,
         disregarding Sundays, beginning with the date of the accident or date of onset in
                                     1
         prescribed disease claims . However, entitlement arises from the date of onset in
         claims for
                                             2
         14.    occupational deafness (prescribed disease A10) and
                                         3
         15.    diffuse mesothelioma (prescribed disease D3) and

         16.    primary carcinoma of the lung (prescribed disease D8 and prescribed disease
                                 4
                D8A) from 6.4.06 .
                                                                                                 5
         In prescribed disease A10 claims the date of onset is the date of claim .

                                                 1 SS C&B (NI) Act 92, sec 103(6); 2 SS (II) (PD) Regs (NI), reg 26;

                                                                  3 reg 18(3)(a); 4 reg 18B(2)(a); 5 reg 6(2)(c)(ii)

69014    This 90 day period is absolute. It applies regardless of whether or not the accident
         has caused incapacity in the intervening period.

69015    In calculating the period of 90 days Sundays are excluded.                          The period can,
         therefore, never begin or end on a Sunday. Disablement Benefit can, however, be
         awarded from a Sunday and so, where an accident occurs on a Sunday or Monday,
         the 90th day will be a Saturday and Disablement Benefit may be awarded from the
                           1
         next day, Sunday .

                                                                                   1 SS C&B (NI) Act 92, sec 103(6)




Volume 11 Amendment 11                                                                                   January 2010
Decision Makers Guide                                                  Conditions of entitlement


         Late claims

69016    The time limits for claiming Disablement Benefit and disentitlement penalties for late
         claims are dealt with in DMG Volume 1.

         69017 – 69019




Volume 11 Amendment 11                                                              January 2010
Decision Makers Guide                                                           Role of decision maker




         Role of decision maker
         General

         [See DMG Memo Vol 11/12]

69225    Aggregation was introduced on 19.11.86. It is the process whereby two or more
         concurrent assessments are added together to produce one award of benefit. The
                                                              1
         decision maker should aggregate assessments unless it is advantageous to the
                               2
         claimant not to do so . Where aggregation is not appropriate there will be separate
         awards. This applies to assessments arising from both accidents and prescribed
                   3
         diseases .     However, see DMG 69251 for guidance where at least one of the
         assessments is for prescribed disease D1 or D2.

         Note:    See DMG 69231 et seq for guidance on whether separate awards are
         advantageous.

                                                     1 SS (II) (PD) Regs (NI), reg 13A; 2 reg 13A; R(I) 4/03;

                                            3 SS C&B (NI) Act 92, sec 103(1); SS (II) (PD) Regs (NI), reg 13A

69226    Aggregation is the responsibility of the decision maker and must be applied in all
         cases where

         17.     assessments of disablement cover a common period

         18.     a claim to benefit resulting in an assessment of disablement is made after
                 18.11.86 (a claim in this instance includes an application for a unforeseen
                 aggravation review or application for reconsideration on the ground of a
                 change of circumstances where the assessment is increased by at least 1%).

         Example 1

         A claimant has an assessment of 10% for life in respect of an accident on 5.1.69 for
         which a gratuity was paid. Following a claim for a further accident on 10.2.71 he is
         assessed at 7% for life and awarded a further gratuity.

         On 19.8.99 he notifies that his condition for the second accident has worsened.
         Medical opinion is that there has been no change. The decision maker supersedes
         but does not change the previous assessment. As there is no requirement for a
         claim the assessments cannot be aggregated.




Volume 11 Amendment 11                                                                       January 2010
Decision Makers Guide                                                    Role of decision maker



         Example 2

         A claimant has an assessment of 10% for an industrial accident on 1.5.62 and 10%
         for an accident on 10.1.75. He is examined by an Adjudicating Medical Authority on
         a claim for unforeseen aggravation on 15.8.94 and the assessment for the first
         accident is increased to 11%. No award is paid.

         On 7.3.01 the claimant applies for a supersession in light of a Commissioner’s
                 1
         decision which held that assessments for which life gratuities had been paid could
         be aggregated. As the claim on 15.8.94 was after 19.11.86, and the assessment
         was increased, the assessments can be aggregated.              The decision maker
         supersedes the decision made on the claim for error of law and awards benefit from
         24.7.95, the date of the relevant determination, at 20%.

                                                                                       1 R(I) 3/00

69227    Aggregation can only be applied during the period of the claim made on or after
         19.11.86. If that claim ceases then aggregation must also cease.

         Example

         Industrial accident on 6.1.04.   Disablement is assessed at 8% from 21.5.04 to
         20.11.04 final.

         Industrial accident on 15.4.73. Disablement assessed at 14% for life, gratuity paid.

         Industrial accident 7.8.84. Disablement assessed at 5% for life, gratuity paid.

         Aggregation is appropriate and an award of disablement benefit at 30% is made
         from 21.5.04 to 20.11.04 only.

69228    Where the aggregated assessments are 14% or more, a pension is payable. If this
         level is not reached the claim should be disallowed in the normal way.

         Example 1

         1st accident assessed at 10%

         2nd accident assessed at 7%

         Aggregation produces an assessment of 20% and a pension at this rate is payable.

         Example 2

         1st accident assessed at 5%

         2nd accident assessed at 5%

         Aggregation produces an assessment of 10%, therefore the claim would be
         disallowed.




Volume 11 Amendment 11                                                             January 2010

				
DOCUMENT INFO