07.07.20

Many of the people we help at Renaissance Legal are either trying to claim Personal Independence Payment (PIP) or are trying to challenge unsuccessful claims they have already made.

Coronavirus has brought changes to all our lives. It has also brought a number of changes to the world of PIP. This blog brings you up to date with these.

The background – in case you haven’t heard of PIP

For anyone who has not heard of PIP, it is a non-means-tested benefit, paid by the Department for Work and Pensions (DWP) to help with some of the extra expenses that a disabled person may incur. It can help with both daily living and mobility needs and has a number of payment rates. Claimants may receive just daily living PIP or mobility PIP or both. How much is payable depends on their level of need. The weekly payment rates are:

Daily Living: Enhanced £89.15/Standard £59.70

Mobility: Enhanced £62.25/Mobility £23.60

Not only does PIP provide extra income, but where someone also receives means-tested benefits (such as Employment and Support Allowance –  ESA), that benefit may pay additional elements because the individual receives PIP. The award of PIP confirms to the DWP that the person has additional needs.

Claiming PIP

Claiming PIP before Coronavirus

Very simply, claimants would phone the PIP office to start their PIP claim. Following a telephone interview (which checked general qualifying rules) the claimant would be sent a PIP2 form, which needed to be completed in great detail. This form would then be returned, hopefully, with a wealth of supporting medical evidence. In most cases, the claimant would then be asked to attend a medical with a Health Care Professional (HCP). This person may be a nurse, doctor or physiotherapist and, following the medical, they would send a detailed medical report to the PIP office. The PIP officer would then make their decision based on the PIP2 claim form and attached evidence, and the report from the HCP.

Claiming PIP since Coronavirus

• New PIP claims are still being processed
• PIP claimants now have three months in which to return their PIP2 claim form. Previously, the time limit was one calendar month from when the form was sent out.
• All face-to-face medical assessments with Health Care Professionals have been suspended.
• Where possible, a paper-based assessment will be done, to see if a favourable decision can be made simply using the paper evidence.
• Where a medical assessment needs to take place, it will be carried out over the telephone. Indeed, both providers of medicals (Capita and Atos) have been conducting telephone assessments for the last few weeks. Make sure that if you are offered a telephone-based assessment, you advise them that you will need someone with you for support (a parent/family member/friend). This will help you feel better supported and ensure that all relevant information is explained to the HCP.
• PIP claimants can now receive and return the PIP2 form electronically after the initial starter call to the PIP office. Supporting evidence can also be submitted electronically, at the same time as the PIP2. Anything emailed in must be sent from the same email address that was given when the claim was registered, for security reasons.
• All PIP awards that are coming up for review soon may be automatically extended. PIP payments will continue and the DWP will be in touch about a review in due course.
• Anyone who is currently claiming Disability Living Allowance (DLA) and who has already been invited to claim PIP, need take no further action. DLA payments will just continue and the DWP will be in touch in the future to discuss the transfer to PIP.
• Hopefully, your PIP claim will be successful. However, do not despair if it is not. You can always challenge the decision.

PIP Mandatory Reconsiderations and Appeals

Unsuccessful PIP claims can be challenged and, from experience, PIP decisions can be rather inconsistent. Sometimes claims are unsuccessful simply because the HCP was not very thorough or did not fully acknowledge or understand the claimant’s needs – which sadly does happen when those needs are related to learning disability or mental health. In other cases, perhaps the claimant did not feel able or comfortable enough to express their needs to an unknown HCP. Sometimes the claim form has not been filled in with sufficient detail.

How to appeal a PIP decision

Unsuccessful claimants must first of all request a Mandatory Reconsideration. This ‘reconsideration’ is carried out in-house at the PIP office. They will re-look at the PIP decision to see if it was correct.

If that stage is unsuccessful, the next stage is a formal appeal to the First Tier Tribunal of the Social Entitlement Chamber. This can be rather daunting for a vulnerable claimant and their family. It is this stage of the process which has had to change due to Coronavirus.

PIP appeal hearings before Coronavirus

This formal appeal stage often culminated in a formal hearing, usually in the Tribunal offices. This was after an exchange of substantial paperwork from both parties – the PIP office and the appellant.  An appellant who has asked for an oral hearing (rather than a paper hearing) would be invited to attend together with their representative to help them argue their case.

The appeal panel comprised a legally qualified Chair, a doctor and a person with knowledge of disability (perhaps a carer or someone who has a disability). The appeal decision would usually be given on the day.

Statistics confirm that appellants who attended their hearing in person and had representation were generally much more successful at this appeal stage.

PIP appeals since Coronavirus

Well, the ‘make-up’ of the Tribunal panel and exchange of detailed paperwork remains the same.

However, due to Coronavirus, Her Majesty’s Courts and Tribunals Service have had to stop holding hearings in person. So, what happens now?

• Appeals are looked at and ‘triaged’ to see if a provisional decision can be made without the need for a hearing at all. If appropriate, the claimant will be telephoned and offered a ‘provisional’ decision. Should they wish to accept it, the appeal will end. Appellants should try not to feel pressured by such a phone call, as the decision does not need to be made immediately. It is definitely worth seeking advice to check that the award is appropriate and sufficient before accepting.
• Where no provisional decision can be made, the appeal will proceed for hearing. However, the hearing will, in most cases be ‘remote’ and held over the telephone, by way of a large conference call. The panel will include the same members as before, and the claimant and representative can be present. The appellant can also have a family member or friend present for support.
• All parties involved in a telephone appeal hearing must be in a private room, free from interruption. The appeal hearing carries on much like a face to face hearing, except for the fact that no-one can see each other. This can cause difficulties as the tribunal panel may not be able to see just how much pain the appellant is experiencing or see someone’s body language or judge the appellant’s ability to understand what is happening at the hearing.
• Decisions are not given on the day but, instead, they are sent out by post.
• It is generally accepted that telephone hearings are a necessary process, but they do disadvantage the claimant. Hearings are longer, it is difficult to work out who is speaking, and panel members have said they ‘wish they could see’ the appellant. So, not ideal, but this is the new normal. It is always a good idea, if possible, to get some advice about how to prepare for a telephone hearing.

On 25th June 2020, the Justice Minister announced that arrangements are being made to make video hearings available for all Social Security appeals. The decision about how a hearing is conducted is a matter for a Judge who will decide how best to uphold the interests of justice. S/he will take into account which benefit is being appealed. and any issues the use of video/audio technology may present for the participants in the hearing. So, even more changes ahead!

For more general information about PIP visit the Government Website: https://www.gov.uk/pip

How we can help

Our specialist benefits team offer a casework service including assistance with PIP claims, Mandatory Reconsiderations and Appeals, so please contact us if you would like to discuss help with your PIP. We will always provide you with a quote for our services before going ahead.