No decision without expert evaluation
The degree of severity of disability, on which both the right to the inclusion allowance and the support level depend, is established by expert evaluation. The Institute for Social Work obtains the findings and opinion of the expert evaluation body and only on that basis decides on the right and the support level.
Who carries out the evaluation
The evaluation is carried out by the Institute for Expert Evaluation, Professional Rehabilitation and Employment of Persons with Disabilities, through its regional offices. In appeal proceedings, findings and an opinion may also be given by that Institute’s Central Office.
How the evaluation is done
As a rule, the evaluation is carried out solely on the basis of the medical and other documentation attached to the application. In most cases, therefore, the person is not called for an examination at all — the panel draws its conclusions about their condition from findings, discharge letters and doctors’ opinions.
Where the documentation is insufficient, a direct examination is also carried out. The summons is served personally, with a warning that attendance is mandatory, and where the person cannot attend because of their health, the examination may be carried out at their home.
Precisely because decisions are usually made on the documentation, its quality is decisive. Anything showing how the person functions in everyday life, not just the diagnosis, is useful: specialists’ findings describing the level of independence, documentation of the need for another person’s assistance, findings over a longer period showing the course of the illness, and documentation of additional diagnoses.
Findings and opinion before the decision
The findings and opinion are not a decision. They are evidence on which the Institute for Social Work still has to decide — and like any evidence, they must be made available to the applicant before the decision is issued, with an opportunity to comment on them.
In the procedure, the applicant must be given the opportunity to state their position on all facts, circumstances and legal issues relevant to the decision. Without first hearing the applicant, the procedure may be concluded only if their application is granted in full or if the decision has no adverse effect on their legal interests.
The applicant has the right to take part in establishing the facts, to present facts and evidence, and to rebut claims that contradict their own. The official must enable them to comment on all circumstances, to propose evidence, to take part in the taking of evidence, and to see the results of the evidence and comment on them.
The Institute must therefore deliver the findings and opinion to the applicant and give them the opportunity to comment before the decision is issued. The comments may set out objections to the findings, attach new medical documentation and propose a supplementary evaluation. A decision issued without this has a serious procedural defect that can be raised on appeal.
If you appeal: findings of the Central Office
Where an appeal challenges the decision in relation to the findings and opinion of the expert evaluation body, the Ministry may obtain the findings and opinion of the Central Office of the Institute for Expert Evaluation before deciding on the appeal. That proposal should be made expressly in the appeal, explaining why the first-instance findings are deficient.
Have you received findings and an opinion for comment, or do you disagree with the findings? Contact us in good time — we will help you prepare your comments and represent you in the further procedure before the Institute, the Ministry and the administrative court.