“Information that is transmitted through the Gateway enters a computer system called the Customer Information System. This holds basic identifying information for all individuals who have a National Insurance number and details of the benefits they have received over the last two or three years. The other benefit computer systems draw information from the Customer Information System. In particular, at the end of every day, the state pension credit computer system identifies all changes in the Customer Information System that relate to persons who are or have been receiving state pension credit. It also detects various discrepancies between the information held on the state pension credit computer system and the information recorded on other benefit systems. Overnight, the state pension credit computer system passes details of the changes and discrepancies it has found to the pension offices that are responsible for the claimants in question. In the first instance, it does this by way of a ‘RIS30715’ report. This is a paper report that is printed out at each pension office every morning. It lists all of the office’s cases that have been picked up by grouping them into six categories. For example, section 1 of the report lists the cases on which a decision is required because of a change to a DLA/AA/PIP award, while section 2 lists the cases on which a decision is required because a DLA/AA/PIP award is reaching its end. In certain instances, new information may also be downloaded into a claimant’s state pension credit records. However, no state pension credit decisions are made automatically by this process. A decision maker is always required to open the claimant’s records and make an outcome decision. Moreover, no information is downloaded into a claimant’s records when an award of AA is terminated. Instead, the RIS30715 report records that the award has been “disallowed”
“Unfortunately, it seems there is no single Departmental information technology expert who knows about the whole of the relevant process, and no single Departmental guide that provides comprehensive information about it. However, having spoken to a number of experts, and consulted several sets of guidance published on the Department’s intranet site, I can offer the following summary. If the Judge considers this insufficient, I should be grateful if he would issue directions as to the evidence he requires.”
“On24 February 2014 the decision maker at the appropriate office that paid state pension credit first became aware of the fact that a change of circumstances had occurred following a telephone call made by him where he confirmed that his Attendance Allowance had ceased.”
“The Presenting Officer said the Pension Service did not know of the change of circumstances despite the interface. She said it worked like this; the Pension Service did random scans, they do not sweep the data every day. She went further and said she did not believe there was a direct exchange of data between the Pension Service and DLA. More generally she said that the two departments were separate offices and one office did not know everything the other office was doing. She relied on Hinchy.”
“12. In this case I heard evidence from the Department about data sweeps. The evidence being that the interface, such as it is, does not mean that the Pension Service will automatically know what it has been sent from DLA “over” the interface. It only knows if a sweep has been made and that information has been picked up. I do not think in those circumstances that (and here I follow Hinchy) a claimant can make assumptions about the existence of infallible channels of communication between one office and another. The duty of the appellant is to comply with the “simple instruction in the leaflet INF4 and report any changes of circumstances.”
“12. The RIS30715 reports from the time when the claimant’s attendance allowance was terminated have not survived. There is also nothing in the claimant’s attendance allowance records that sheds light on whether the attendance allowance computer system actually transmitted details of the termination to the Gateway. It seems reasonable to make a presumption of regularity and assume that what should have happened did in fact happen, and thus proceed on the basis that (starting with BD v SSWP[2016] UKUT 0162 (AAC) CPC/1675/2015 6 the day after the attendance allowance decision was made) the claimant’s pension office received eight consecutive daily RIS30715 reports that included a notification that the claimant’s attendance allowance had been “disallowed.”
“Where it is determined that, whether fraudulently or otherwise, any person has misrepresented, or failed to disclose, any material fact and in consequence of the misrepresentation or failure – (a) a payment has been made in respect of a benefit to which this section applies; or (b) …………………………… the Secretary of State shall be entitled to recover the amount of any payment which he would not have made or any sum which he would not have received but for the misrepresentation of failure to disclose.”
“Benefits, allowances or tax credits Tell us if you or your partner start to get any social security benefits, allowances or tax credits. If you or your partner are already getting any of these, you must tell us if there are any changes to them.
“If you are not sure if you have to tell us about a change, tell us anyway.”
“How to tell us about changes You can tell us about a change of circumstances for you or your partner by phone by filling in a Pension Credit reply slip, if you have one by writing to us Our phone number and address are at the top of the letter that we sent you with this booklet.”
“In my submission, as a matter of common sense, the claimant’s failure to disclose in the case now at hand remained an effective cause of the overpayment throughout the period in issue. The Secretary of State appears to have neglected a series of RIS30715 reports about the termination of the claimant’s attendance allowance. In my submission, the most likely explanation for this was that the pension office that received the reports was at that time unable to cope with the volume of reports being produced by the computer interface. In such circumstances, offices in effect chose to give priority to other notifications, such as those received directly from claimants. For this reason, a notification by the claimant himself would in all probability not have met the same fate as the RIS30715 reports and would have either prevented the overpayment from arising at all or quickly brought it to an end. However, despite clear instructions to contact the office, the claimant failed to do so. In effect, the claimant chose to disregard the clear implications of the simple instructions he had been given in favour of his own understanding of what it was appropriate for him to do and what would happen within the Department. He should not have done so. As Lord Hoffmann said in Hinchy v SSWP: “It is not for the claimant to form views about what may go on behind the scenes in the Social Security or other benefit offices. His duty is to comply with the instruction in the order book.”
“What in my judgment is really meant by breaking the chain of causation applying the common sense required by the authorities referred to be me in GJ v SSWP is that a situation has been reached where intervening factors mean that it would not be right as a matter of common sense, and in all the circumstances, to hold the claimant responsible for overpayments.”