Three reasons your PIP claim can be denied and how to dispute a decision

PERSONAL Independents Payment (PIP) awards are a benefit designed to help people with long-term health conditions or disabilities.

The award is not based on the specific illness or disease you have, but how it impacts your day-to-day living.

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You can dispute a decision to deny you PIP[/caption]

However, shocking statistics show that many people who should receive PIP are having their applications rejected.

The Government’s own data shows that a quarter of new applicants who were initially denied PIP had the decision changed in their favour after appealing, while a further 3% of dismissed claims were overturned at tribunal.

For existing applicants whose awards had been removed or reduced after an assessment, 47% of appeals saw the DWP change the decision in the customer’s favour before tribunal.

A further 2% were overturned at tribunal.

And over 40% of applications from people with multiple sclerosis, cerebral palsy, and arthritis were rejected, according to analysis by the Observer. The same investigation found that one in four amputees had their claims denied. 

Michelle Mitchell, chief executive of the MS Society said: “It’s insulting that so many people who are diagnosed with a long-term condition are being told they don’t qualify for support.

“These latest figures show PIP isn’t just hurting those who’ve been moved across from the old system, but also new people who are trying to get support for the first time.”

Michelle Cardno, a welfare benefit lawyer and founder of Fightback4Justice told the Guardian: “Often PIP assessors believe that a prosthesis can be worn constantly and do not account for rubbing, inability to wear due to discomfort, and heaviness and pain…

“We win all [appeal] cases where a client is an amputee.”

Why Personal Independence Payment awards are rejected

There are lots of reasons why PIP awards are rejected, but they typically fall into one of three groups.

The first is administrative error on the part of the claimant, such as if you missed the deadline for filling in the form, failed to respond to a letter, or failed to attend a medical evaluation or interview.

The second is if you haven’t submitted enough evidence about your condition.

For instance, if you don’t have doctor’s reports explaining exactly how your disability or illness impacts your day-to-day life.

Alternatively, this could be because you’ve focused on the wrong thing without following the assessment guidelines.

The most common reason is because the DWP assessment has found that your condition doesn’t have a significant impact on your ability to carry out certain tasks or get from place to place.

This could be because you genuinely do not meet the criteria for PIP, or because the assessor has not understood the impact of your condition.

To get the daily living component of PIP, you must have a physical or mental health condition that limits your ability to carry out some or all of the following activities:

• preparing food
• eating and drinking
• managing your treatments
• washing and bathing
• managing toilet needs or incontinence
• dressing and undressing
• communicating verbally 
• reading and understanding written information
• mixing with others
• making decisions about money 

To get the mobility component of PIP, you must have a physical or mental condition that limits your ability to plan and follow journeys or move around.

Kate Smith, senior benefits expert at Citizens Advice, told the Sun: “There are many reasons for Personal Independence Payment (PIP) claims to be rejected. For example, the healthcare assessment might not have recorded, or misunderstood, all of your needs.”

They may have written down that you don’t need any help preparing meals, when in reality you are unable to cook meals from scratch as you cannot stand for long periods, and so are forced to rely on a microwave.

Alternatively, they might record that you can do a certain action, for instance lift a pan, but not include that it would cause you significant pain and leave you unable to do other tasks for the rest of the day.

If you disagree with the decision that’s been made, you can challenge it with the DWP.

This includes where you didn’t get the benefit, got a lower rate than you expected, or if you think your award isn’t long enough.

How to appeal the decision

Smith says that if you want to challenge the decision, you need to apply for a mandatory reconsideration first.

“This can be done by phone, by downloading and posting a form which is available on the gov.uk website or by sending a letter setting out the reasons why the decision is wrong,” she explained.

If you want a mandatory reconsideration, you need to apply within one month, although there’s no time limit for the DWP to respond.

If you miss this deadline, you can still appeal as long as you had a good reason, such as a hospital appointment and you are still within 13 months of the original decision.

You need to give specific reasons why you disagree with the decision that has been made.

You should look carefully through your decision letter and ask the DWP for a statement of reasons if one hasn’t been provided.

You should also comb through your medical assessment report and make a note of any statements you disagree with – and why.

You also should look at the points system the DWP uses to assess PIP claims to see where you think you think the key areas of your appeal should be.

You can even include how many points you think you should have got in the appeal documents, along with evidence.

When an assessor is deciding whether you can carry out an activity, they must look at whether you can do it reliably. This means you must be able to do it:

• safely, without causing you or others harm both during and after the activity
• to an acceptable standard
• multiple times a day, according to what might be reasonably needed
• in a sensible amount of time, typically taking no more than twice the time it would take someone who did not have your condition

Citizen’s advice has shared the following examples of the types of evidence you can give and what to say:

• I don’t think you have adequately assessed the extent of my mobility problems. You say I can walk 50 metres unaided. In reality, doing this causes me significant pain and would mean I can’t walk for the rest of the day. I have enclosed a letter from my physiotherapist which explains this in more detail.
• I don’t think you’ve taken into account the effects of my severe depression when it comes to preparing food and eating. I find it hard to concentrate, so even if I push myself to start I can’t finish making a meal. I only eat meals I can heat up in the microwave. On the times I have tried to cook from scratch I have burned myself because I lose concentration and forget I have a pan on the hob.
• I don’t believe all the findings from my medical assessment are accurate. The assessor asked me if I could lift a cup. I did as asked but it caused shooting pains up my arm that took several hours to subside and meant I struggled to hold anything else for the rest of the day. I wasn’t given the opportunity to explain this in the assessment.

Give real-word examples of how attempting the various activities has impacted you, and get as much evidence and corroboration from medical professionals as you can.

Remember, if you’re challenging the length or amount of your award, it could end up getting reduced, so it’s worth speaking to Citizen’s Advice or another disability or debt charity first.

Once you have submitted your mandatory consideration, you will usually get a call from DWP.

Use this opportunity to talk through why you think your decision was wrong and the evidence you have. Let them know of any documents you want them to consider.

Once the DWP has re-examined your case, it will send you a Mandatory Reconsideration Notice. Keep this safe as you will need it if you want to appeal.

Going to tribunal

If your mandatory consideration doesn’t change your award, you can consider going to tribunal.

This is well-worth doing, as Government data suggests between 25%-50% of decisions are overturned either by the DWP before the tribunal date or at the tribunal itself.

Smith says: “You can appeal to an independent panel (called a tribunal) which is part of the court system.

“A tribunal can be a complex process so it’s always worth going to Citizens Advice to work out what support you can receive.”

To start the appeal, you need to either complete an online appeal form on GOV.UK or fill in form SSCS1 on GOV.UK then post it to HMCTS.

Once again, you will need to detail the reasons that you’re appealing, but you can reuse any evidence that you had in your mandatory reconsideration and then add extra detail or more medical advice.

Citizen’s Advice says: “It’s always better to ask to attend in person, called an oral hearing.

“This may sound daunting, but it’s just an informal meeting and you can get someone to go with you for moral support. Having an oral hearing gives you more opportunities to put your case forward and a better chance of winning.”

You can ask for adjustments to allow you to attend the hearing.

This could be detailing dates you cannot make, or certain hours you can’t attend due to things like childcare responsibilities. It could also be things like having a sign language interpreter or any other aids you might need.

You will receive a letter that includes the DWP’s response, information about what happens next, and details of when the hearing will be and what court it will take place in.

You will be asked if you want to join a handy “track your appeal” service. Agreeing to this is a good idea as you’ll get email updates and reminders. 

Before your tribunal date, you should make sure you’ve read all the information you’ve been sent, and submitted the extra evidence you have. You may be able to claim certain expenses, such as travelling to the court date or childcare costs, but you will need to keep receipts. 

Take notes on everything you want to say as you can refer to these throughout the tribunal to make sure you don’t forget anything.

At the appeal itself, you will be asked questions about your reasons for appealing and what your typical or average day looks like.

Someone from the DWP might be there to ask questions, but they will not be involved in making the final decision.

Towards the end, when everyone has spoken, you’ll be asked if there is anything you want to add, then you will be asked to leave the room while a decision is made.

Citizen’s Advice says you must:

• Arrive in plenty of time – if you’re late, the hearing might start without you
• Don’t make a special effort to look smart – it’s important the panel sees you as you are on a normal day
• Tell them if someone has helped you on the day, eg helping you to dress, driving you to the hearing or reading signs for you

You may be asked questions outside of the details of your appeal about how your condition affects your life.

Give as much detail as you can around why you think should be getting PIP payments, based on the DWPs points assessment system.

If your appeal is successful, your payments will be backdated to the day you submitted your claim.

Speak to either Citizen’s Advice or another debt charity to get help and support through the appeals process.

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