Correct in appealing Medical Card Application decision?

I

ivorystraws

Registered User
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480
Hi,

I had a traumatic Brain Injury in April 2009. I applied for a medical card on the 14th of April 2011. I thought I had supplied all the relevant documentation when they kept getting back to me asking for things which weren't initially requested such as house valuation etc. So I have provided them with all that, which includes;
  1. Evidence of wages: I don't receive wages but an insurance payout which is processed through my employers Permanent Health Insurance scheme which is less than one sixth of what I was on.
  2. Evidence of Savings and Investments: I do not have any shares or investments.
  3. Evidence of fire and contents insurance premia
  4. Evidence of Mortgage Protection Payments
  5. Evidence of expenses incurred in respect of rent: I currently rent in Dublin as all my treatments are ongoing in Dublin.
  6. Evidence of Mortgage Payments
  7. Evidence of my rental income: I am not in receipt of any rental income whatsoever.
  8. Valuation of second property or land: Provided documentary evidence of the valuation of the property I co-own with my brother
  9. Summary details of management of Traumatic Brain Injury: I have provided them with a detailed summary of the majority of my medical appointments and treatments since my accident happened. This also provides details on the prescribed medicines I am on, the ongoing symptoms I am experiencing and the long-term illness medication I have been prescribed.

Now despite the Medical Card office confirming that they had finally received all required documentation on the 22nd of November 2011 (via me calling them), I only received confirmation via letter that my application was unsuccessful on the 16th of January i.e. almost two months later despite them guaranteeing that applications done online would be processed within 15 days!! Aren't they breaching some obligation there?

I was declined a medical card for financial reasons despite their calculations being totally incorrect i.e.
  • they had a number down for Investment income even though I stated I don't receive any!?
  • The amount they have for my employment (insurance) amount is incorrect as the revenue state I have a 2k+ tax liability since I am in receipt of invalidity pension!?
  • I don't see where they took my home and contents insurance into account? Shouldn't that be included with Mortgage/Rent?
  • My rent/Mortgage calculation is now incorrect
  • They haven't taken into account my loan repayments via MABS!?
  • What is 164 euro "Basic Allowance"?

Why didn't they take my MABS loan repayments into account? Is this correct?

The financial burden of me having to pay for further treatment to aid my Traumatic Brain Injury rehabilitation would certainly cause me undue hardship. Why didn't they take that into account?

I am appealing the decision but I'm awaiting my P60 and newest payslip plus I'd appreciate some feedback from anyone on this forum, thanks.
 
They haven't taken into account my loan repayments via MABS!?
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They are not allowed.
Mortgage and rent is allowed. Other loans no.

164 is the standard allowance for a person. So when everything is taken into account the figure let over must be 164 or below to qualify.
 
Time said:
They are not allowed.
Mortgage and rent is allowed. Other loans no.

164 is the standard allowance for a person. So when everything is taken into account the figure let over must be 164 or below to qualify.
Click to expand...

Thanks for clarifying that.

I think they have taken into account my home and contents insurance via the "Fire and Contents insurance premia" but I don't see where my Mortgage protection payments are taken into account?

Its Euro 184 for a single person living alone and Euro 164 for a single person living with family so the medical card department got that wrong for me also!?

So nearly every single amount they have detailed for my Medical Card application is incorrect and they've taken a ridiculous amount of time to do that. Apparently, apart from appealing, there's nothing else I can do i.e. how/where can I make a formal complaint regarding the whole process?
 
Time said:
They are not allowed.
Mortgage and rent is allowed. Other loans no.
Click to expand...

That's not correct according to "http://www.hse.ie/eng/services/Find_a_Service/entitlements/Medical_Card_GP_Visit_Card_Application_Form.pdf From Part 4, details of outgoings and expenses"

If your income is above the income guidelines, you may still be granted a Medical Card or GP Visit Card if you have exceptional circumstances that cause you undue ? nancial hardship.
Please provide details and evidence of any other issues which you wish to have considered.
Examples would include:
• Health Expenses including
professional fees
• Prescribed Medicines or Appliances
• Hospital Charges
• Travel, Accommodation or
Childcare costs related to
attending clinics or hospitals
• Loans or other money management issue
 
They will consider it but do not have to take it into account. I was told by a CWO that things like car loans and credit cards are not looked on favourably in the decision process.
 
Time said:
They will consider it but do not have to take it into account. I was told by a CWO that things like car loans and credit cards are not looked on favourably in the decision process.
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They do have to consider it when it's detailed as part of their process. I was told a lot of things by a lot of people in the HSE but unless I see it written or stated as part of their process, it doesn't mean much i.e. there's no shortage of contradictory statements and opinions from HSE representatives which is why I now record calls, send everything by registered post and keep an audit trail which I can refer to.

So, my outstanding questions are:

  • I don't see where my Mortgage protection payments are taken into account - should it be?
  • How/where (apart from appeals) can I make a formal complaint regarding the whole medical card application process?
 
Time said:
You need to complain to the Ombudsman.
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Yes, thanks for that. I did forget about that option. I'll still have to go through the Medical Card appeals system first before going to the Ombudsman. The Ombudsman does deal with complaints by people who are dissatisfied with the service of the the Health Service Executive (HSE), specifically disputes about the medical card scheme administered by the Health Service Executive.

In the meantime, if anyone can shed any light on these two outstanding queries as they are directly related to my medical card appeal application:

  1. They had a number down for Investment income even though I stated I don't receive any - is this something to do with the house valuation?
  2. I can see that they have a figure down for "Fire and Contents insurance premia" but I don't see where they took my mortgage protection into account? Shouldn't that be included with Mortgage/Rent?
 
Assuming the process is similar to a means test for social welfare, it sounds like they have assessed your investment income based on the value of your share of the house you part own but are not living in. This might also explain why they are excluding the mortgage protection payments.

If this is the case, a written medical opinion that it is necessary for you to reside in Dublin may be useful during any appeal. Also, do you spend any time living in the property?
 
MugsGame said:
Assuming the process is similar to a means test for social welfare, it sounds like they have assessed your investment income based on the value of your share of the house you part own but are not living in. This might also explain why they are excluding the mortgage protection payments.

If this is the case, a written medical opinion that it is necessary for you to reside in Dublin may be useful during any appeal. Also, do you spend any time living in the property?
Click to expand...

Thanks, that is a very helpful response. I think you could be right and it would answer why they asked for the property valuation. But why would they exclude Mortgage Protection when I paid it?

OK, so medical opinion from my GP may be necessary despite me giving them a list of all the hospitals (public and private) I was admitted to, all my outpatient appointments I attended (and still am attending) although with details of all pending appointments.
I don't spend any time at all in the property but how do I prove that and will that make a difference to this application? Some post addressed to me would still get delivered to that address though but my brother just forwards that onto me.
 
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