Disability Living Allowance (DLA) and Personal ... · Web viewMay 07, 2016 · If...

Greater Manchester Welfare Rights Advisers Group - a group to support benefit advisers promote health, wellbeing and good practice in advice work.

DLA, PIP and Nystagmus

Mike Hughes on behalf of GMWRAG – May 2016.

Please note – this information is only guaranteed as accurate as the 7th of May 2016.

http://gmwrag.wordpress.com

Disability Living Allowance (DLA) and Personal Independence Payment (PIP)

What’s changed?

The existing DLA rules have not changed, with 1 very big exception. Claimants must be aged less than 16. Claimants over 16 must now claim a new benefit - PIP.

The rules for challenging a decision you don’t agree with have also changed. These changes were introduced for PIP on the 8th of April 2013. They were introduced for DLA on the 28th of October 2013.

When did it change?

From October 2013 onwards DLA recipients over 16 in certain areas were invited to claim PIP as follows.

Children turning 16 had to claim PIP when their existing fixed term award is ending (unless awarded DLA under the Special Rules for terminal illness).

People reporting changes of circumstances which might affect their rate of payment, such as an improvement or deterioration in their condition, but not issues like going into a care home or hospital or changing address.

People with a fixed-term DLA award due to expire. Anyone who chooses to make an application for PIP, including people

who have a fixed-term or indefinite award of DLA.

If your DLA award is due to end on or after 23 June 2014 you will receive an invitation to make a claim for PIP rather than renew your claim to DLA.

From October 2015 onwards everyone over 16 and under 65 can only claim PIP and those still getting DLA will be invited to claim PIP. Claimants are selected randomly for the latter although DWP say they will “invite


claims as early as possible from recipients who have turned 65 after 8 April 2013, when PIP was first introduced.”

By October 2017 all existing DLA claimants (aged 16 to 64 on 8 April 2013) will have been invited to claim PIP.

DWP do not expect to complete reassessment of all existing DLA claimants for PIP until March 2018.

Many people report having made tentative enquiries about what might happen to their DLA only to find that they are suddenly invited to claim PIP. You should be very wary of ringing DWP with any tentative queries unless this reason as there’s no way out of the process once it has started.

If you need advice about whether you should speed up your move from DLA to PIP then get advice from Citizens Advice, a local authority welfare rights advice service or your local independent advice centre. Approaching DWP for that advice could prematurely impact your entitlement.


What are the main differences?

The main differences are:

PIP has very different qualifying rules to DLA. You will need too be aged 16 to 64. New claims to DLA will now only be for children.o have needed help with extra costs caused by a health condition or

disability for 3 months or more and be reasonably likely to need help for the next 9 months. For DLA this remains at 3 and 12.

o have spent at least 2 out of the last 3 years in Great Britain (a temporary absence abroad for up to 13 weeks, or up to 26 weeks for treatment, will be allowed).

PIP is assessed on a different set of criteria to DLA – you need to score a certain number of points in relation to 12 everyday activities. 8 points gets you a Standard (lower) rate of a component. 12 points gets you an Enhanced rate.

In most cases you will have a medical assessment to see if you can get PIP. In most cases, the medical assessment will involve a face-to-face consultation. Unlike ESA where Nystagmus is a condition which can only be assessed by a doctor or physiotherapist (no, we have no idea why a Physio. either!) for PIP the assessment you have can be a doctor, nurse, paramedic, occupational therapist, physiotherapist or similar.

The 2 components of PIP have only 2 rates of payment, whereas the care component of DLA has 3.

Unlike DLA, all awards of PIP will be reviewed on a regular basis, even if you are permanently disabled, unless you have been awarded the benefit under the terminal illness rules.

Rules for challenging decisions have changed slightly.

There are still similarities:

PIP is a non-means-tested, non-contributory, non-taxable cash benefit. You can spend it on what you want. You can claim whether in or out of work and regardless of income/capital or N.I. contributions.


PIP still has 2 components but these have slightly different names. Daily Living and Mobility replace Care and Mobility.

PIP is still linked to getting other benefits – almost all of the existing arrangements for DLA (such as the Blue Badge and Carers Allowance) will continue. This is called “passporting”.

There are still special rules for terminally ill people.

PIP - What activities are you assessed against?

These are divided into 10 Daily Living activities and 2 Mobility activities. An inability to perform an activity must be because of impairment not preference.

Daily Living activities

Preparing food (4 possible activity levels. Maximum score 8 points). Taking nutrition (6 levels. Max. 10 pts). Managing therapy or monitoring a health condition (6 levels. Max. 8

pts). Washing and bathing (7 levels. Max. 8 pts). Managing toilet needs or incontinence (6 levels. Max. 8 pts). Dressing and undressing (6 levels. Max. 8 pts). Communicating verbally (5 levels. Max. 12 pts). Reading (5 levels. Max. 8 pts). Mixing with other people (4 levels. Max. 8 pts). Making decisions about money (4 levels. Max. 6 pts).

Mobility activities

Planning and following a journey (6 levels. Max. 12 pts). Moving around (6 levels. Max. 12 pts).

An activity scores points if it cannot be performed at some stage of the day reliably more than 50% of the time in a 12 month period. If more than 1 descriptor within an activity applies for less than 50% of the time it can be added together with others within the same activity.

Reliably means “safely, reliably, repeatedly and in a reasonable time period”.


safely – in a manner unlikely to cause harm to themselves or others, either during or after completion of the activity.

reliably - to an acceptable standard. repeatedly – as often as is reasonably required. in a reasonable time period – no more than twice as long as the

maximum period that a non-disabled person would normally take to complete that activity.


The practicalities of filling in a PIP claim pack

Keep a copy of everything. The DWP often lose critical documents but it’s only you who suffer if they do. Note down phone call details in full every time.

Meet deadlines if you can. Explain and ask for more time if you can’t. The assessment is based on how you are now, not how you might be

after treatment. However, a specific date for treatment may affect whether you pass the 9 months forward test.

The assessment is not based on the condition itself but the consequences of it.

It is the need for help which is assessed, not the availability of help or the medical need for help. The availability of help or aids may be relevant.

Multiple conditions can combine to prevent an activity from being completed.

Claimants who use, or could reasonably be expected to use, aids to carry out an activity will generally receive a higher scoring descriptor than those who can carry out the activity unaided.

If you have aids but they have not been prescribed it is important to explain why not e.g. because there is a waiting list for an OT. Medical professionals are advised to ignore aids which have not been prescribed so you will need to make the case for them.

There is a difference between assertion and evidence. Saying something happens is an assertion. Describing an example of an occasion when it happened is evidence. Claims need evidence. So, say what causes a problem with an activity; describe it in detail; give an example of when it happened and say what would happen if help was not provided.

It may sound obvious but tell the truth. Decision Makers are not experts but they have access to expert advice and will pick holes in inaccurate statements.

Do not make any assertion without an example to back it up. Never just tick the boxes and leave the rest blank.

There is no restriction on where evidence can come from buto make a list of who could provide evidence and contact them as

soon as possible.


o it isn’t for everyone, but it often helps to keep a diary of what issues arise; how often and how they are dealt with.

o focus on activities not diagnosis, unless diagnosis is in dispute. You don’t get PIP for Nystagmus or related conditions but because of the way in which you deal with the consequences of it.

o don’t duplicate evidence. 3 letters from different parties saying the same thing e.g. you have Nystagmus, is forceful re: a disputed diagnosis, but not useful in describing the ability to perform activities.

o evidence repeating what you have told someone is not necessarily strong evidence.

o look for evidence that adds value. That’s not always medical evidence.

o Do not assume Decision Makers know the meaning behind what you say. Confirmation that someone has been “statemented” is fine but what happens in practise is what needs describing.

o List your GP in the claim pack but explain why information from your GP will not usually assist. Most claimants with Nystagmus will not usually see their GP about it. Many GPs won’t even know you have Nystagmus.

o Although claim packs ask for information about specialists/consultants DWP will not usually approach these, even if you ask them to, unless they cannot get a report from your GP. The onus is on you to get those reports (but see previous comments about the value of medical evidence).

o Enclose your prescription to illustrate your visual acuity but reference the recent research showing VA to be a poor measure of Nystagmus.

o When enclosing a prescription from a high street optician always make the point that most only list those medical conditions relating to a product which can be sold in connection with that. So, if you already have spectacles or contact lenses your prescription will contain your VA but may not contain any reference to Nystagmus. It will always be worth reminding Decision Makers why not.

Embrace and describe fluctuations in your health condition(s).


o Do not describe only your “worst days” or your “bad days”. . We have seen a number of people advised to do this. It is not what the form is asking you and it can lead to overpayments and accusations of fraud. It’s the fluctuations and unpredictability that often give rise to a need for help with Daily Living or Mobility

o DWP Decision Makers won’t know about Nystagmus. They may refer to a DWP doctor for an opinion. The doctor won’t know much about Nystagmus but the first thing they will find out is that it varies, so describing your worst day and suggesting the impact of your Nystagmus is like that all the time completely undermines the credibility of your claim pack.

o Do not use phrases like “good days” when describing fluctuations. A “good day” to a Decision Maker is one on which you have no issues because of your condition at all. Think in terms of whatever is accurate for you. “Bad days and less bad days” works for some but not all.

o Always focus on each element of the phrase “safely, reliably, repeatedly and in a reasonable time period” when considering which activity applies and at what level.

o Depending on the activity, if you can do something once but then can’t do it again for the rest of the day, you might not count as being able to do it. The same may apply if you can only do it in pain or if you get worse at it or slower each time you do it.

o Remember PIP makes no distinction between day and night but Nystagmus can vary in different light so it will be important to explain those differences and to think about them when deciding whether an activity is something which can be done or not.

o Make clear the difference time-limits make. Doing stuff slowly might mean you think you should say you can do something but, in practice, your speed may be of no use to someone else e.g. peeling vegetables for a family meal. Doing stuff under pressure often impacts on safety and reliability.

o There is no merit in trying to explain that it’s a fluctuating condition and difficult to describe. All medical conditions have fluctuations. If you want PIP you have to describe the impact of the fluctuations in full. It is your evidence that will usually result in a PIP award rather than medical evidence.


Nystagmus specific stuff to consider

Nystagmus can affect the time it takes to see anything. the ability to continue to focus on something once located. the ability to glance. the ability to see movement and/or judge distance and thus the ability

to react. the ability to read and write. the ability to concentrate and complete tasks. the speed of task completion. the ability to deal with changes in light. the field of vision e.g. restrictions because of a null point. physical mobility. This could mean balance but could also include issues

because of a null point. the ability to deal with clutter or crowding. balance.

Nystagmus can be affected by the effort to do any of the above. tiredness, stress or excitement.

Nystagmus is often accompanied by other eye conditions which might impact upon light. movement. field of vision. ability to see colour. distance.

Nystagmus is often accompanied by other impairments or long term conditions like.

physical disability. learning disability. mental health issues.


other sensory impairments.

Bear in mind each of these things, and especially how they interact, for every single activity. Remember that the impacts of acquired Nystagmus on the above could be very different.

DLA for Children - What criteria are you assessed against?


DLA is 1 benefit with 2 components – Care and Mobility. The Care Component is payable at 1 of 3 rates. Mobility is paid at 1 of 2 rates.

To claim DLA a child must

be under 16. pass at least one of the disability tests. pass the 'backwards and forwards' qualifying period tests (3 months

and 6 months respectively). pass the residence and presence tests, and not be subject to

immigration control.

Lower Rate Care Component

A child must need attention in connection with bodily functions for a significant part of the day, which can be during 1 or more periods.

need - This is help which is reasonably needed, not what is given, nor what is medically essential. This is help to lead as normal a life as possible. This includes help your child needs outside your home. For example they can be given help to take part in "reasonable" social activities.

attention in connection with - This is help of an active nature required to be given in your child's physical presence. This can include help given to wash, dress or to go to the toilet providing it is greater than those of a child of the same age who is in normal physical and mental health. It can also be more indirect help such as signing, reading aloud or prompting and encouragement.

bodily functions - These include hearing, eating, seeing, washing, reading, communicating, walking, drinking, sitting, sleeping, dressing or undressing, using the toilet, shaving, shampooing, help with medication and thinking. It does not include domestic tasks like shopping, ironing and cleaning although washing clothes is less straightforward in some cases.

significant - This is around an hour or more.

Middle Rate Care Component


A child must need one of the following

frequent attention throughout the day in connection with their bodily functions.

continual supervision throughout the day to avoid substantial danger to themselves or others.

prolonged or repeated attention at night in connection with their bodily functions.

another person to be awake at night for a prolonged period or at frequent intervals to watch over them in order to avoid substantial danger to themselves or others.

In addition to the above tests their attention or supervision or watching-over needs must also be greater than those of a child of the same age who is in normal physical and mental health. In practice this makes it much harder for very young children to qualify.

frequent - Means more than twice.

throughout - This means spread over the day.

continual - Means regular checking but not non stop supervision. It is not the same as constant.

supervision - This is watching over, ready to intervene.

substantial danger - The danger must be real, not just remotely possible.

prolonged - Means some little time (at least 20 minutes).

repeated - Means two or more times.

night - This is when the household has closed down for the night. It is generally the time when an adult is in bed but must be more or less within night-time hours - generally between the hours of 11pm and 7 am.

Higher Rate Care Component


For the disability test for the highest rate DLA care component your child must either

have one of the day needs and one of the night needs shown in the middle rate conditions, or,

be terminally ill.

Lower Rate Mobility Component

Your child must

need guidance or supervision with walking on unfamiliar routes because of their mental or physical disablement. He or she must need substantially more guidance or supervision than a child of the same age who is in normal physical or mental health.

be at least 5 years old.

guidance – Can be physical or verbal.

supervision – This is not the same type of supervision as for the care component. That supervision is to prevent things happening whereas this is an enabling supervision.

unfamiliar routes - The test is based on the ability to cope with unfamiliar routes.

Your child may get this rate if they can walk but need someone on hand to guide or supervise them. If they are blind, has learning disabilities or is mentally ill they are likely to qualify for this rate. Partial sight needs to be argued on a case by case basis.

Higher Rate Mobility Component

Your child must

be unable to walk. be virtually unable to walk. the exertion required to walk would constitute a danger to your life or

would be likely to lead to a serious deterioration in your health.


have had both legs amputated (or missing from birth) at or above the ankle.

qualify for the highest rate of DLA care component, be severely mentally impaired and show disruptive behaviour.

have a severe visual impairment. be both blind and deaf and need the assistance of another person to

walk out of doors. be at least 3 years old.

Any artificial aid used, such as limbs or walking frames are taken into account when considering your child's mobility needs except for cases where they are claiming on the grounds that they have had both legs amputated or missing.

virtually unable to walk - This test looks at your child's ability to walk out of doors on a normal flat surfaced pavement or road. The following factors are taken into account:

distance walked. speed of walking. length of time taken. manner of walking.

in the absence of severe discomfort.

When stating how far your child can walk remember that any walking done whilst they are experiencing severe discomfort does not count.

severe mental impairment and disruptive behaviour - Severe mental impairment refers to someone who "has arrested or incomplete physical development of the brain resulting in severe impairment of intelligence and social functioning". Conditions that start later in life, such as recent brain damage do not count.

disruptive behaviour - Must be extreme, require physical restraint to prevent physical injury or damage to property and also require someone to watch over your child whenever they are awake.


severe impairment of intelligence - Determined in many ways. It can be through an IQ test or by assessing someone's "useful intelligence" - the ability to function in a real life context.

severe visual impairment - A child must be certified by a consultant ophthalmologist as severely sight impaired or blind and are severely visually impaired. A child is severely visually impaired if:

they have visual acuity, with appropriate corrective lenses if necessary, of less than 3/60; or

they have visual acuity of 3/60 or more, but less than 6/60, with appropriate corrective lenses if necessary; and a complete loss of peripheral visual field; and a central visual field of no more than 10 degrees in total.

If your child has a CVI or BD8 (BP1 in Scotland) certificate of visual impairment, this may provide enough information to satisfy this test but if not, or if you tell the DWP your child's eyesight has worsened, your child may be referred for a sight test.

It is worth noting this is a more rigorous test than registration itself.

Also, case law has ruled the relevant legislation discriminatory and illegal although DWP have no plans to change it. Caselaw also ruled the test is based solely on Snellen results so cannot take account of a deterioration of VA out of doors. Bear in mind it is also based on combined VA.

blind and deaf - To satisfy this your child must have 100% disablement from loss of sight and 80% disablement from loss of hearing and you they someone with them outdoors. 100% is not the same as completely blind as what’s being measured is loss of faculty or ability.

The practicalities of filling in a DLA claim pack


The issues are very similar to filling in a PIP claim pack but there are some other things to bear in mind.

Keep a copy of everything. The DWP often lose critical documents but it’s only you who suffer if they do. Note down phone call details in full every time.

Meet deadlines if you can. Explain and ask for more time if you can’t. The assessment is based on how you are now, not how you might be

after treatment. However, a specific date for treatment may affect whether you pass the 6 months forward test.

The assessment is not based on the condition itself but the consequences of it.

It is the need for help which is assessed, not the availability of help or the medical need for help. The availability of help or aids may be relevant.

Claimants who use, or could reasonably be expected to use, aids to carry out an activity will generally be treated as having a “simpler method”. Use of aids is held to reduce care needs. This is almost the opposite of PIP. What matters here is whether a child can use them by themselves.

If you have aids but they have not been prescribed it is important to explain why not e.g. because there is a waiting list for an OT. Medical professionals are advised to ignore aids which have not been prescribed so you will need to make the case for them.

There is a difference between assertion and evidence. Saying something happens is an assertion. Describing an example of an occasion when it happened is evidence. Claims need evidence. So, say what causes a problem with an activity; describe it in detail; give an example of when it happened and say what would happen if help was not provided.

It may sound obvious but tell the truth. Decision Makers are not experts but they have access to expert advice and will pick holes in inaccurate statements.

Do not make any assertion without an example to back it up. Never just tick the boxes and leave the rest blank.

For the lower rate mobility component


o many people have no physical disability in connection with their mobility. People tend to walk at the fastest speed of which they are capable so it is worth emphasising that slowing down is not necessarily a way of avoiding stumbles.

o walking with another person can often be problematic as you concentrate more on them than where you are walking.

o supervision for the care component must be to prevent danger but guidance and supervision for lower rate mobility is about enabling someone to get from a to b. This might be monitoring mental state by simply holding a conversation about any topic. It could equally be linking arms. It is not just one thing.

o DWP often assert much guidance or supervision is no more than a person “liking to have someone with them for reassurance”. If reassurance is the only thing you need then you won’t qualify. However, what people often glibly describe as reassurance is often a lot more. “Watch out for...” might be what you think of as reassurance but the person saying that is offering guidance and supervising where you tread. Ditto tugging at your cuff/hand to stop you stepping into traffic.

There is no restriction on where evidence can come from but.o make a list of who could provide evidence and contact them as

soon as possible. o it isn’t for everyone, but it often helps to keep a diary of what

issues arise; how often and how they are dealt with. o focus on activities not diagnosis unless diagnosis is in dispute. You

don’t get DLA for Nystagmus or related conditions but because of the way in which you deal with the consequences of it.

o don’t duplicate evidence. 3 letters from different parties saying the same thing e.g. you have Nystagmus, is forceful re: a disputed diagnosis, but not useful in describing the ability to perform activities.

o evidence repeating what you have told someone is not necessarily strong evidence.

o look for evidence that adds value. That’s not always medical evidence.


o Do not assume Decision Makers know the meaning behind what you say. Confirmation that someone has been “statemented” is fine but what happens in practise is what needs describing.

o List your GP in the claim pack but explain why information from your GP will not usually assist. Most claimants with Nystagmus will not usually see their GP about it. Many GPs won’t even know you have Nystagmus.

o Although claim packs ask you for information about specialists/consultants a Decision Maker will not usually approach these, even if you ask them to, unless they cannot get a report from your GP. The onus is really on you to get those reports (but see previous comments about the value of medical evidence).

o By all means enclose your prescription to illustrate your visual acuity but reference the recent research showing VA to be a poor measure of Nystagmus.

o If you are enclosing a prescription from a high street optician always make the point that most only list those medical conditions which relate to a product which can be sold in connection with that. So, if you already have spectacles or contact lenses your prescription will contain your VA but may not contain any reference to Nystagmus. It will always be worth reminding Decision Makers why not.

Embrace and describe fluctuations in your health condition(s). o Do not describe only your “worst days” or your “bad days”. . We

have seen a number of people advised to do this. It is not what the form is asking you and it can lead to overpayments and accusations of fraud. It’s the fluctuations and unpredictability that often give rise to a need for help with Care or Mobility

o DWP Decision Makers won’t know about Nystagmus. They may refer to a DWP doctor for an opinion. The doctor won’t know much about Nystagmus but the first thing they will find out is that it varies, so describing your worst day and suggesting the impact of your Nystagmus is like that all the time completely undermines the credibility of your claim pack.

o Do not use phrases like “good days” when describing fluctuations. A “good day” to a Decision Maker is one on which you have no issues because of your condition at all. Think in terms of whatever


is accurate for you. “Bad days and less bad days” works for some but not all.

o Always focus on whether something is a problem most of the time when looking at attention needs. In a week this means 4 days in 7. It could also be 16 days in 31 and so on.

o Depending on the activity, if you can do something once but then can’t do it again for the rest of the day then you might not count as being able to do it. The same may apply if you can only do it in pain or if you get worse at it or slower each time you do it.

o Remember DLA makes a distinction between day and night. Nystagmus can vary in different light so it will be important to explain those differences and to think about them when deciding whether something which can be done in the day cannot be done at night and vice verse.

o Make clear the difference time-limits make to how you perform different activities. Doing stuff slowly might mean you think you should say you can do something but, in practice, your speed may be of no use to someone else e.g. peeling vegetables for a family meal. Doing stuff under pressure often impacts on safety and reliability but will often be different from activity to activity. You need to detail how and why.

o There is no merit in trying to explain that it’s a fluctuating condition and difficult to describe. All medical conditions have fluctuations. If you want PIP you have to describe the impact of the fluctuations in full. It is your evidence that will usually result in a PIP award rather than medical evidence.

For both DLA and PIP a claim is not affected by

o a person not considering themselves to be disabled.o living alone and not having a carer.o not wanting a carer.o medical professionals telling you that you are not entitled. o having been turned down previously, although there are

exceptions to this.


Dealing with medicals/consultations

DLA claims may result in a medical, which will usually take place in your own home. This means you can have someone present. The Examining Medical Practitioner (EMP) may ask them to leave the room if there is any physical examination.

Most PIP claims involving Nystagmus will result in a consultation with a Health Care Professional (HCP). This will not usually be in your own home. They will not necessarily be a doctor or a specialist in any medical condition let alone yours. Most are nurses, physios, occupational therapists or paramedics. Although they receive training, there is no requirement they have any expertise or even basic knowledge of your medical condition(s) or their consequences. You can take someone with you to the consultation and they can come in with you and also talk.

You may only want a medical person to look at one component of DLA or PIP. They will almost always look at both.

The appointments can vary hugely in length. You will rarely get to cover everything you want to. For DLA a statement will be recorded on your behalf. Insist on reading it back and do not sign it if you are not happy with it. Amend it if needed. If you can’t see it insist a large print version.

For PIP the HCP is working with multiple choice software. They will rarely have digested your claim pack in full and rarely take on board any medical evidence you bring with you. They will choose the nearest answer to what you say. It won’t necessarily be the right answer unless you focus on ensuring it is.

The software does not correspond to the legislation so where you score points under 2 activities the HCP can only record one. You will need to check this with them.

If it is difficult for the claimant to attend a HCP consultation argue for a home-visit. ATOS seem reluctant to do these. Capita say they will although this isn’t evidenced as yet. Alternatively, bear in mind that many claimants will be defined as disabled under the Equality Act 2010 and will be entitled to ‘reasonable adjustments’ as part of the claim


process. However, you have to ask and need to do so well in advance to give a fair opportunity for any adjustments to be put in place.

Based on the experience of ESA claimants, you will be observed as you approach the consultation venue, even when this isn’t mentioned during the appointment. Recent caselaw has said this is acceptable within limits. Explain clearly how you got to the venue (from planning through to arrival) and the problems it posed. It will be assumed you were simply okay to travel unless you explain otherwise in detail. If you do things in the appointment that your claim says you cannot do then you will need to explain this.


PIP and DLA decisions

There have been numerous issues with the contracts for the HCP appointments. This matters because DWP currently advise that it is taking 14 weeks to get a PIP consultation! We have heard of some decisions being made inside 2 weeks but not where a claim involves a face to face assessment. Most claims involving Nystagmus will ordinarily have a face to face assessment.


Challenging PIP and DLA decisions

For PIP and DLA there is now a mandatory reconsideration before you are allowed to appeal to an independent tribunal. You cannot go straight to appeal. You must first ask DWP to look at the decision again within one month of the original decision. There is no time limit in which DWP must make the reconsideration decision, which can be a problem.

If you are outside the 1 month but want to challenge your decision for any reason you can ask for a late mandatory reconsideration but these are discretionary and often refused with no right of appeal.

If you have a change of circumstances you can challenge your decision via a supersession at any time. You can also do this if you think a decision was based on a mistake or on ignorance of a relevant fact.

The difference between the 2 is that a mandatory reconsideration decision is effective from the date of award. A supersession is only effective from the date you asked for it. For all these reasons we recommend acting immediately if you can.

Appeals must usually be made on form SSCS1 within 1 month of the mandatory reconsideration decision. This form is not freely available in paper form. It can be downloaded from http://www.justice.gov.uk/downloads/forms/tribunals/sscs/sscs1.pdf.

When you appeal decisions a decision maker must reconsider the decision again anyway before allowing it to go to an appeal.

Each benefit has an absolute time limit of 13 months for appeals. Appeals can be made outside of the 1 month time limit but 13 months is the absolute limit.

Always get advice on challenging decisions before taking action where there is an existing award. Benefit awards can go down as well as up so the risk needs to be weighed by a professional adviser.

If a person is already in receipt of DLA then a challenge or even a notification of something like registration may result in the ending of


http://www.justice.gov.uk/downloads/forms/tribunals/sscs/sscs1.pdf

their entitlement and an invitation to claim PIP, which may result in a different award. Always get advice before acting.

Consider getting advice on challenging a decision to not award on a new claim. Look for a representative.

It can take a long time to get an appeal to an appeal hearing. Use the time well to get early advice and gather or improve evidence.

Early advice can reduce the need to appeal, and for representation, but statistics consistently show that representation produces better results at the appeal stage.

Some organisations offer “representation” but really mean they will produce a written submission for you to take along alone on the day of the appeal hearing. This does not produce better results.

You should not have to pay for either advice or representation. There is no evidence we are aware of that payment produces a better outcome. See the “Face To Face Advice” section for more information.


Useful Resources

Online Resources

We believe pretty much all the advice you need to make a successful claim for DLA or PIP is in this booklet, however, there’s plenty of good stuff online if you would like to read further.

The “Disability Rights Handbook 41st Edition April 2016 to April 2017” is available for pre-order from https://crm.disabilityrightsuk.org/benefits-information/disability-rights-handbook-edition-41-2016-17. There is a concessionary price of £18 for anyone in receipt of any benefits but please remember it is published annually and will be out of date almost as soon as it’s published.

Some of these are long documents. We recommend you read before you press print to decide whether each one is what you’re looking for.

The Disability Rights UK “Personal Independence Payment – A Guide To Making A Claim” can be downloaded from http://disabilityrightsuk.org/personal-independence-payment-pip

The DWP PIP toolkit at www.gov.uk/government/publications/the-personal-independence-payment-toolkit-for-partners/the-personal-independence-payment-pip-toolkit-for-partners. This is aimed at advisers but contains lots of useful basic information for everyone.

The DWP “PIP Assessment Guide” (updated on the 28th of July 2015) can be downloaded from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/449043/pip-assessment-guide.pdf

The “Benefits And Work” website contains lots of useful PIP and DLA resources at www.benefitsandwork.co.uk/personal-independence-payment-pip

The AdviceNow “Turned Down For DLA, AA and PIP? Or think you’re not getting enough?” Action Guide can be downloaded from


http://www.benefitsandwork.co.uk/personal-independence-payment-pip

http://www.benefitsandwork.co.uk/personal-independence-payment-pip

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/449043/pip-assessment-guide.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/449043/pip-assessment-guide.pdf

http://www.gov.uk/government/publications/the-personal-independence-payment-toolkit-for-partners/the-personal-independence-payment-pip-toolkit-for-partners



http://disabilityrightsuk.org/personal-independence-payment-pip

https://crm.disabilityrightsuk.org/benefits-information/disability-rights-handbook-edition-41-2016-17

https://crm.disabilityrightsuk.org/benefits-information/disability-rights-handbook-edition-41-2016-17

http://www.advicenow.org.uk/advicenow-guides/problems-with-benefits/turned-down-for-dla-aa-pip-think-youre-not-getting-enough

The Rightsnet website is also primarily aimed at advisers but there are some excellent resources to be found within their toolkit at http://www.rightsnet.org.uk/resources and elsewhere within the site.

The RNIB PIP Factsheet can be found athttp://www.rnib.org.uk/information-everyday-living-benefits-and-concessions-benefits-people-working-age/personalHelpful guide to making an effective claim for people with a visual impairment, includes a sample diary and tips for completing the questions on daily living and mobility activities.

“Contact A Family” also have a guide to “Claiming DLA for children”, which can be found athttp://www.cafamily.org.uk/media/744270/claiming_dla_for_children.pdf This is aimed at parents and includes useful tips on completing the form, question by question.


http://www.cafamily.org.uk/media/744270/claiming_dla_for_children.pdf

http://www.cafamily.org.uk/

http://www.rnib.org.uk/information-everyday-living-benefits-and-concessions-benefits-people-working-age/personal

http://www.rnib.org.uk/information-everyday-living-benefits-and-concessions-benefits-people-working-age/personal

http://www.rightsnet.org.uk/resources



Face To Face Advice

Always check out your local Citizens Advice Bureau; local authority welfare rights service or independent advice centre. Good welfare benefits advice should ordinarily be available free of charge.

Support with form filling will vary between organisations depending on their staff resources and ethos.

Personal representation at social security appeal tribunals should be free but some organisations may assist with preparation with the appeals process but not attend on the day. This may be where they are funded by Legal Aid. Legal Aid does not fund representation at appeal tribunals.

This is something you may want to establish at the outset as changing adviser part way through is often not straightforward because there will be a need to

obtain copies of your case papers from one organisation to give to another.

notify the Tribunals Service of any change in representation if the case has been appealed.

Remember, for a successful claim you, will need to address everything in detail and be persistent. Many people with the highest award of PIP/DLA received nothing on first claim and had to challenge the original decision, often repeatedly. Do not give up.

At the same time, do not expect to successfully claim PIP/DLA simply because you or yours have Nystagmus. Getting good advice can save you a lot of potentially wasted time. Some advice agencies will complete a claim pack or help you challenge a decision simply because you have asked them to do so. It is much better to ask for an assessment of whether your claim has merit in the first place.


Disability Living Allowance (DLA) and Personal ... · Web viewMay 07, 2016 · If...

Documents

Transcript of Disability Living Allowance (DLA) and Personal ... · Web viewMay 07, 2016 · If...