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Thread: PIP success story and some reflections

  1. #21
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    Guides

    Guides

    There are various guides to claiming PIP available.

    Disability Rights UK's guide is free to download - amongst other things, it contains some helpful suggestions on how to complete the PIP2 form.

  2. #22
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    Only just read this, thanks Flymo. Very Interesting and helpful thread.

  3. #23
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    This is an excellent post. Can somebody please place this as a sticky? as it will only get lost in the threads.

  4. #24
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    Quote Originally Posted by toolook View Post
    This is an excellent post. Can somebody please place this as a sticky? as it will only get lost in the threads.
    Whilst I don't want to "blow my own trumpet" as thread starter, material that I and others have posted in this thread is directly relevant to a lot of PIP questions in this forum, and several forum members have attested to its usefulness. Is there any hope of the thread being made sticky?

  5. #25
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    Other people's PIP assessment experiences

    flowerangel has posted about her experience of a PIP face to face assessment (click to read).

    I recommend reading her recollection because it is well written and comes from a very different perspective to mine. My assessment was by ATOS, in an assessment centre, looking at health problems that are entirely physical. flowerangel's assessment was by Capita, at home, looking at her mixture of mental and physical health problems.

    She was subsequently awarded standard rate Daily Living and standard rate Mobility.


    Scotty1 has posted about his experience of a PIP face to face assessment (click to read).

    His problem is visual loss, so his experience of the assessment process is particularly relevant to those with sensory impairments. Again, his is a well written piece that passes on tips on how to handle the assessment process. His assessment was a home assessment by Capita.

    He was subsequently awarded enhanced rate Daily Living and enhanced rate Mobility.


    babyblu64 has posted about her experience of a PIP face to face assessment (click to read).

    Click to read her explanation of her mixture of physical and mental health problems in her own words.

    She was subsequently awarded enhanced rate Daily Living and enhanced rate Mobility.


    If I understand the comments of Mike Penning MP, Minister of State for Disabled People, to the 3 February 2014 meeting of the All Party Parliamentary Group on ME correctly (reported at item 2 of the minutes), the intention is that 97% of PIP claimants will have a face to face assessment. Certainly, face to face assessment is the norm for a PIP claim, unlike with DLA.

    Hopefully reading these personal recollections helps people to understand the PIP assessment process.
    Last edited by Flymo; 06-27-2014 at 11:01 AM. Reason: Add babyblu64's decision.

  6. #26
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    Thank you for posting the link to my experience, Flymo!

    Also, thank you for your kind words of it being well written - I personally thought it wasn't that well written as it was a quick type-up before I forgot all of the information.

  7. #27
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    My PIP claim: full timeline, comparison of time taken to assessment contract targets

    The full timeline of my claim

    I've now got a full copy of my PIP file, so I can give a more detailed timeline of my claim so far as I can discern from the DWP paperwork and my records.

    9 July 2013 DWP receive the DLA renewal claim they rejected.
    11 July 2013 DLA claim passed over to PIP section.
    16 July 2013 PIP section received DLA claim.
    17 July 2013 DLA claim entered on to PIP computer system with the date of claim set to 9 July 2013.

    PIP2 questionnaire sent for return by 17 August 2013.
    5 August 2013 DWP send a reminder letter for the PIP2.
    15 August 2013 I return the PIP2 and supporting evidence by Special Delivery (I cut that a bit fine - I wasn't well at the time).
    16 August 2013 DWP receive the PIP2.
    23 August 2013 DWP load PIP2 and supporting evidence onto PIP system.

    PIP2 and supporting evidence sent to ATOS.
    9 September 2013 A nurse working for ATOS reviews the file, creating PA1 review filenote.

    Determination: face to face consultation required.

    Time elapsed since referral to ATOS: 10 working days
    4 October 2013 I called DWP to enquire what was happening about my assessment, knowing the 30 working day contractual target was about to run out.

    Time elapsed since referral to ATOS: 29 working days
    9 October 2013 DWP checked with ATOS, whose quality assurance manager advised them:
    • I had been called for assessment
    • I should have received an appointment letter in the post
    • ATOS had no idea whether or not I had attended my assessment
    • ATOS were waiting to hear from the assessor on the outcome of my appointment date


    (I believe this to be a complete fabrication. ATOS never again claimed to me or to DWP that I had been offered an appointment at this point. Had I missed an appointment, DWP would have been advised and my claim would have been closed if I failed to show good cause for not attending.)

    DWP leave me a voicemail, advising me that I must contact ATOS at ATOS's request.

    Time elapsed since referral to ATOS: 32 working days
    10 October 2013 The person from the DWP handling my 4 October 2013 enquiry calls me again. I advise DWP that my postal service is very reliable and I had not received a call or letter from ATOS about an appointment. I advise DWP I will be complaining to ATOS.

    I call ATOS to enquire what is happening, and they advise me they cannot tell me when they will be able to offer me an appointment (which completely contradicts what they had told DWP the previous day). I ask to complain, and they tell me they will send a complaint form. I advise them that there's no point sending me a complaint form as I can't write, so I ask for someone to call me in relation to my complaint.

    I call my MP's Westminster office and speak to her Parliamentary aide. He advises me that I'm not alone in facing this sort of delay for PIP assessment. He says that the case worker in my MP's constituency office who handles benefits matters will be happy to take the matter up with ATOS and DWP on my behalf if I send written authorisation to act on my behalf.

    Time elapsed since referral to ATOS: 33 working days
    25 October 2013 I call ATOS to complain that they have not responded to my 10 October 2013 request to complain. I advise the operator that ATOS can take the easy option of dealing with me or the more difficult option of dealing with my MP's office, who are ready to pursue the lack of an appointment on my behalf. I am passed to a manager at my request, who is fairly obstructive and intransigent. A fairly heated discussion where I reiterate my complaints.

    I receive a call back from a more senior ATOS manager, who is friendly and business like. I explain briefly how we'd reached this point and that my desired outcome is to set an appointment date so that I know how long I must wait. She calls me back later in the afternoon to give me an appointment on 4 November 2013.

    Time elapsed since referral to ATOS: 44 working days
    4 November 2013 Face to face consultation takes place at an ATOS location.

    Time elapsed since referral to ATOS: 50 working days
    8 November 2013 ATOS assessor signs the PA4 consultation report.

    Time elapsed since referral to ATOS: 54 working days
    30 November 2013 DWP receive the initial details of the assessment report from ATOS (electronically, it seems).

    Time elapsed since referral to ATOS: 69 working days
    3 December 2013 DWP receive the PA4 consultation report from ATOS in the post.

    Time elapsed since referral to ATOS: 71 working days
    5 December 2013 DWP load the PA4 consultation report onto the PIP system.

    Case Manager makes a decision.
    9 December 2013 Manager rejects the original decision (guidance not followed on the review date)

    Case Manager remakes the decision.
    12 December 2013 Manager approves the revised decision,
    13 December 2013 Decision letter issued,
    19 December 2013 Money owed up to 12 December paid into bank account.
    10 January 2013 First regular four weekly payment paid into bank account.


    My assessment took far longer than the contractual targets

    As the DWP Response to the Disability Benefits Consortium report on PIP Assessment Providers document states (on page 15), the service level agreement in the assessment providers' contracts requires, amongst other things:
    • 99% of paper based reviews (to determine whether further medical evidence or a face-to-face consultation is required) to be completed within 2 working days
    • 97% of assessments, other than those relating to terminal illness, to be completed in their entirety within 30 working days


    DWP sent ATOS the PIP2 and supporting evidence on 23 August 2013. As I believe this information is sent electronically, I have assumed ATOS received it the same day in the table above. 26 August 2013 was a bank holiday in England.


    My paper based review took 10 working days compared to a target of 99% completion within 2 working days.

    The assessment process took 69 working days compared to a target of 97% completion within 30 working days. I'm being generous here, saying that the assessment process was complete on 30 November, when DWP received the initial details of the assessment from ATOS.


    Clearly, the service level agreement has to allow some flexibility. There will always be a handful of cases where additional evidence needs to be sought, specialist assistance must be obtained, or some other special reason applies. It is therefore impossible to set targets that apply to 100% of cases.

    However, I do not believe there was anything unusual about my case. I sent a comprehensive PIP2 along with supporting medical evidence. I attended the first face to face assessment appointment I was offered. Indeed, I pursued ATOS aggressively to get the appointment I did, as I've outlined above - had I not done so, the assessment process would likely have taken even longer. The assessment report confirms that the only evidence used in the assessment process was the PIP2, the medical evidence I sent and the 4 November assessment.

    Despite me pushing aggressively for an assessment date, it still took ATOS over twice the time allowed for 97% of cases to complete the assessment process.


    Ultimately, ATOS failed to come anywhere near either of the contractual targets relevant to my case. I will be making a formal complaint to ATOS, with copies to DWP and my MP, in relation to the failures outlined in this post. I will also be complimenting my assessor for dealing carefully and comprehensively with my case, asking that this is noted down and, if possible, communicated back to her. I will similarly be complimenting the ATOS manager who arranged the assessment date.


    I appear to have been paid PIP starting from the wrong date

    As I had previously explained, my claim started in an unusual manner - a renewal DLA claim that was rejected and routed to PIP.

    For reasons I don't understand, PIP was only paid from 17 July 2013. The file shows the date of claim is 9 July 2013 and the decision maker decided I was eligible for PIP from 9 July 2013, but, oddly, the period from 9 July 2013 to 16 July 2013 is marked "Eligible: no" and "Nino supplied: no". The latter annotation doesn't make sense, as they had my NI number all along. There is no other reason for ineligibility showing on the file.

    It's not a huge amount compared the back payment of over £2800 I have already received. Enhanced rate Daily Living and enhanced rate Mobility for 8 days amounts to £153.60. Still, that is a sum I believe I am entitled to and could use.


    Update: DWP have now agreed I was entitled to PIP for those 8 days and have corrected the error - see the follow-up post for details.
    Last edited by Flymo; 02-22-2014 at 07:26 AM. Reason: Link to the update on the start date of my claim

  8. #28
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    I should add, to be fair to ATOS, that the situation I describe on 9 October 2013 could be a simple mistake, with either ATOS or DWP getting another case mixed up with mine. Exactly what happened may become clearer when I pursue a complaint with ATOS.

  9. #29
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    PIP assessment reports

    My PIP assessment report

    My PIP assessment report, written by a physiotherapist working for ATOS, was very detailed. There were around 1200 words of "Functional history" (mainly an attempt to describe a typical day) with around 1600 words of "Summary justification" for the report's findings.

    The "Summary justification" in my assessment report is extremely fair, accurate and unbiased - in some cases, more so than my mental picture of how well I cope. It's not that I am in denial about how bad things are sometimes, just that I tend to look past the bad bits and carry on with life as best I can.

    It might have helped that I was quite open about my legal background and my familiarity with the PIP regulations. I'm amused that the report notes "Today at assessment, he was able to fluently communicate with the assessor and at times directed the assessment himself".

    The limited testing undertaken was reported accurately, as were the "informal observations", where the assessor attempts to capture their observations about what you say and do whilst not being directly assessed. The informal observations are not a trick as such, but you are being watched and the assessor will attempt to record anything that supports or conflicts with the reported functional problems. In my case, the informal observations were:
    • I heard my name called in the waiting area
    • I negotiated the door into the assessor's room in my electric wheelchair
    • I bent my trunk on several occasions to reach things in a bag sitting on my wheelchair footplates
    • I was able to retrieve objects from this bag and hand them to the assessor



    I would like to think all assessment reports are as carefully and accurately prepared as mine. Unfortunately, in the real world, those who have greater difficulty explaining their problems in relation to the PIP legal tests could be poorly assessed and not get the award they deserve.


    Getting a copy of your assessment report

    You can ask for a copy of the assessment report once the decision is made - indeed, I recommend that people ask for their assessment reports even if they are content with the decision. It will be useful to have the assessor's findings when it comes to renewing a fixed-term PIP claim or reporting a change of circumstances.

    It might be possible to use a PIP assessment report when completing an ESA50, though it is important to remember that the context of the tests and the details of most of the activities are different between PIP and ESA.

    If you wish to complain to the assessment provider about your assessment, it would seem best to obtain a copy of the assessment report first so that you can refer to it in your complaint.


    If you fail to get the award you feel you deserve, I recommend asking for the evidence on which the decision was based before making a detailed reconsideration request.

    If you are content with the award made, it's probably best to send a subject access request under the Data Protection Act 1998. DWP do not charge for responding to subject access requests, but ask that you use the form in their Personal information charter. Until the form is updated to include PIP, I recommend putting "All computer and clerical records relating to Personal Independence Payment" in the "Any other personal information" box.

  10. #30
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    PIP award lengths and reviews

    N.B. this information is the best I can discern, largely from Chapter P2 of DWP's Advice for decision making. However, I cannot find clear and unambiguous information on some of these points.


    PIP award lengths

    PIP awards are in three bands - short fixed-term (up to two years), long fixed-term (over two years) and ongoing period (open ended). Claims based on terminal illness are handled slightly differently.


    The length and type of award is based on the assessment provider's suggested time before review, which is a judgment call on when the needs might have increased or decreased sufficiently to change PIP entitlement. The decision maker is entitled to reach a different conclusion on time before review, though I would expect this to be rare.

    The time before review runs from the date of claim or review initiation, not the date of assessment.


    There is a three month qualifying period for each PIP component during which that component is not payable. This starts from the date of claim unless the decision maker is satisfied the relevant need existed from an earlier date. PIP is not normally payable before a claim is made.


    Short fixed-term awards - up to two years

    If the time before review is two years or less but the claimed Daily Living and/or Mobility needs will exist for at least a year, a short fixed-term award of PIP is made ending on the review date. Needs lasting for less than a year do not satisfy the 'prospective test', so the affected component(s) cannot be awarded regardless of the assessed needs.

    This means the shortest possible PIP award is nine months - the minimum one year for the prospective test, less a three month qualifying period starting on the date of claim.


    The claimant will be written to near the end of the award, giving them the opportunity to make another claim. This seems likely to work similarly to the letter inviting renewal of a fixed-term DLA awards sent twenty weeks from the end of the award.

    As with DLA renewals, there does not appear to be any guarantee a new decision will be made before the existing award expires, nor any system to extend the existing award until a renewal decision is made.


    Long fixed-term awards - three years and over

    If the time before review is over two years, you get a long fixed-term award of PIP lasting one year beyond the review date. This appears to makes the shortest long fixed-term award of PIP three years (and one day, I guess!).

    The review process for these awards appears to start with re-referral to the assessment provider on the review date. It is unclear whether this re-referral happens automatically as with ESA reviews, or whether the claimant will be asked to instigate a review claim.

    This review system means a decision based on the new assessment is likely to supersede the expiring award at some point during the final year, rather than these awards running to their expiry date. Starting the review a year from expiry should ensure those who still meet the criteria keep continuous entitlement to PIP and entitlements based on PIP, such as a Blue Badge.


    "Ongoing period" awards - no defined end date

    If the decision maker agrees no review of the award is necessary as future change is unlikely, PIP is awarded "for an ongoing period".


    Most "ongoing period" awards have scheduled entitlement check. I am aware of two "ongoing period" awards so far, my own and one other, which both have a check scheduled after ten years. This might turn out to be the normal time to entitlement check for "ongoing period" awards.

    It is unclear whether these entitlement checks will use the same review system as long fixed-term awards or whether a more lightweight check will be used reflecting the opinion that change is unlikely.


    Some "ongoing period" awards will have no review date, though I would only expect this when there is clearly no change of change.


    Awards made under the Special Rules for Terminal Illness

    The Special Rules for Terminal Illness cover cases where PIP is claimed on the basis of having a progressive condition from which death is reasonably expected within six months. A DS1500 report needs to be sent to confirm this prognosis, which is checked by an assessment provider using a fast track system. If DWP agree the Special Rules criteria are met, enhanced rate Daily Living PIP is awarded, usually for three years though possibly for a shorter period. The Mobility component is only included if the usual qualifying criteria are met.

    It appears that a renewal process similar to that used for short fixed-term awards will be used for those Special Rules claimants who live long enough for renewal can be relevant.


    Guidance on the length of award and review date

    DWP's documentation refers to "procedural guidance on Award Periods and Reviews (within the Decision Making Process Guidance)", but this appears to be unpublished internal guidance.


    Components seemingly cannot be awarded for different periods

    DLA awards containing both Care and Mobility components could have both components awarded for the same fixed period, one component awarded indefinitely and the other for a fixed period, or both components awarded indefinitely. If a DLA decision maker considers different fixed periods apply to the two components, both must be awarded for the shorter period.


    Under PIP, it appears that both components will be always awarded for the same period. I cannot find any provision in the law or DWP guidance that allows for a mixture of "ongoing period" and fixed-term awards. My ATOS assessment report contains a single review date recommendation applicable to the entire report.


    All awards are subject to continuing to meet the qualifying criteria

    As with DLA, all PIP awards are subject to continuing to meet the qualifying criteria and there is an ongoing obligation on those with a PIP award to notify any relevant change of circumstances.


    Ability of DWP to change a PIP award (or decision to refuse PIP)

    The power to change a PIP award or refusal decision exists:
    • when an existing award is coming to an end
    • when a claimant reports a change of circumstances
    • when a claimant makes a valid reconsideration request
    • following determination of an appeal by a tribunal or court (DWP must either implement the decision or appeal against it on the grounds that an error of law was made by the tribunal or court)
    • whilst an appeal is pending, at any time up to a decision on that appeal being made by a tribunal or court
    • if official error comes to light
    • if ignorance of, or mistake over, a material fact led to a decision more advantageous to the claimant than it should have been (for example, it comes to light the claimant misled DWP about their walking ability by failing to disclose relevant information)
    • following the appeal decision against an earlier decision (once the decision on an appeal is made, the decision on a later fresh claim or report of change of circumstances can be changed to reflect the appeal decision)
    • if the expected facts leading to an advance award of PIP fail to materialise
    • to reinstate PIP withheld on a mistaken belief that the claimant was resident in a care home at public expense
    • to reinstate PIP withheld following a decision to remove entitlement based on error not materially contributed to by the claimant (for example, a claimant fails to attend a review assessment and it transpires the claimant had notified a change of address that had not been acted on)

    N.B. this list contains revision, supersession and appeal powers mixed together, which have differing periods of operation and different limits on backdating


    An increased PIP award on change of circumstances is only possible after the claimant notifies the change of circumstances. This is an application for supersession, which is normally backdated to date of notification when relevant, but cannot normally be backdated any further even if documentary evidence exists that the change of condition took place earlier. This embodies the general principle for benefits that you cannot receive what you do not claim.

    Withholding information about a change of circumstances can lead to retrospective reduction of a PIP award via revision under the 'ignorance of a material fact' route, followed by action to recover any overpayment.


    DWP has complete discretion to look again at an existing PIP award at any time

    Regulation 11 of The Social Security (Personal Independence Payment) Regulations 2013 (SI 2013/377) gives DWP the power to require anyone on PIP to undergo a new assessment at any time, for any reason.
    Last edited by Flymo; 06-07-2014 at 09:24 PM. Reason: Add correct information about power of DWP to look again at a PIP award

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