This includes, but is not limited to, their gait, their speed, the risk of falls and symptoms or side effects that could affect their ability to complete the activity, such as pain, breathlessness and fatigue. The agent will go through the claim with the claimant. We believe that in most cases all health professionals should be able to assess the individual, even if they are not a specialist in their condition. Ability to Work with Kidney Failure Ability to Work with a Heart Attack Ability to Work with a Herniated Disc Ability to Work with a Macular Degeneration Ability to Work with Neuropathy Ability to Work with Obesity Ability to Work with Organ Transplant Ability to Work with Osteoarthritis Ability to Work With Osteoporosis When considering whether an activity can be carried out safely it is important to consider both the likelihood of the harm occurring and the severity of the consequences. We are providing advice and information to external support organisations to ensure that they understand the PIP process. If the health professional feels they need more support before assessing someone, for example because the claimant has a condition they are unfamiliar with, the assessment provider will make someone with the appropriate skills available to either assist the original health professional or carry out the assessment themselves. At age 15 years and 7 months a letter will be sent to the parent or guardian to explain that: The letter will also ask whether the young person will need an appointee when they turn 16. Payment will usually be made every 4 weeks in arrears. The daily living component of PIP ceases to be payable after 28 days of residency in care home where the costs of the accommodation are met from public or local funds. We need to know the date the claimant was taken into prison or legal custody and the length of time they are expected to be there if known. It is important that the claimant has their basic information ready before they call the PIP claim line. The plan is to replace the disability living allowance (DLA), money paid to help disabled people cover the cost of care and mobility, with a new system, the personal independence payment (PIP).. In all cases the decision maker will make a decision based on all the available evidence, such as: If the decision maker is not satisfied with the report from the assessment provider or has any queries about the report or the evidence, they will be able to discuss the issue with the assessment provider. A 33 page guide to PIP mandatory reconsideration and appeal submissions and sample submissions for health conditions: Chronic Fatigue Syndrome; Anxiety & depression; Schizophrenia; Mobility problems; Fibromyalgia; Anxiety disorder, depression & agoraphobia and; Osteoarthritis & obesity Best possible ways to challenge a PIP medical report The daily living component will be paid at the enhanced rate in all cases. The Welfare Reform Act 2012 includes the introduction of changes to the appeals process to ensure more disputes against DWP decisions are resolved without being referred to His Majestys Courts and Tribunals Service (HMCTS). Read about how to apply to vote by proxy. Sometimes we can make a decision by using just the written information a claimant sends us, but some people will be asked to attend a face-to-face consultation with a health professional. You must be at least 16 years old to get PIP. PIP is not a subjective benefit; it is not a case of looking at their lives as a whole and the way in which the illness or disability has stopped them doing what they used to do. At age 16, a letter will be sent to the young person, or their appointee, to invite them to claim PIP. This includes the ability to stand and then move up to 20 metres, up to 50 metres, up to 200 metres and over 200 metres. For example, if taking medication in the morning (such as painkillers) allows the individual to carry out activities reliably when they need to throughout the day, although they would be unable to carry out the activity for part of the day (before they take the painkillers), the individual can still complete the activity reliably when required and therefore should receive the appropriate descriptor. If you're in a hospital or care home If you've lived outside of the UK Feed yourself. When considering whether it is reasonable to expect a claimant to use an aid or appliance that they do not usually use, the health professional will consider whether: We recognise that guide, hearing and dual sensory dogs are not aids, but have attempted to ensure that the descriptors capture the additional barriers and costs of needing such a dog where they are required to enable claimants to follow a route safely. There will be no right of appeal against the decision to terminate entitlement to DLA unless DWP has incorrectly applied its legislative requirements (for example if we have invited someone who is outside of the qualifying age criteria to claim PIP). Read more about special rules for end of life on this page. When you are looking at how many points you score for . Assistance is support that requires the presence and physical intervention of another person to help the claimant complete the activity - including doing some but not all of the activity in question. Conditions most likely to lead to claimants being eligible for PIP backpay. Entitlement can continue after State Pension age if a claimant is already in receipt of PIP when they reach this age, providing they continue to satisfy the conditions of entitlement. This will make sure the assessment provider has the right contact details to gather any further details they may require. [The claimant's] ability to carry out an activity is to be assessed - (a) on the basis of [the . The DWP decision maker will make a reasoned decision on entitlement. The assessment does not look at the availability of help from another person but rather at the underlying need. Once a decision has been made on a claim, a decision notification will be sent to the claimant advising them of their award or disallowance, giving the reasons for the decision and advising what steps the claimant needs to take if they dispute the decision. As the assessment principles consider the impact of a claimants condition on their ability to live independently and not the condition itself, claimants with the same condition may get different outcomes. It may be possible to backdate passported benefits to the start of the PIP award. If the harm caused would be less severe, then the likelihood of that harm occurring would need to be higher for the activity to be deemed unsafe without supervision. For example, this could be relating to their ability to dress and undress, make budgeting decisions, communicate and getting around. The claimant should contact us using the contact details in the Changes of circumstances page of the PIP claimant guide. It is important that the DS1500 is sent in quickly to support the PIP claim. This form will be unique to the claimant and cannot be used by anyone else. The decision letter will advise the customer that they can contact the DWP if they wish to discuss the decision further. Diseases of the immune system. The assessors will provide advice to us we make the decision about entitlement to PIP. If the claimant is unable to answer these questions, the agent will continue to go through the rest of the questions on the application to gather as many details as possible, but DWP will need to take further action to verify the claimants identity. . Claimants will need to be present in Great Britain, habitually resident in the United Kingdom (UK), Ireland, the Channel Islands or the Isle of Man and not subject to immigration control. We will monitor the performance of the assessment providers to make sure they are conforming to the detailed specifications for the assessment laid out in their contract with us. For some schemes, such as Blue Badge, there are alternative ways of accessing the benefit that do not rely on a particular rate or component of PIP. Both components are payable at a standard or enhanced rate, depending on the claimants needs. Their research with disabled people and their organisations showed that most claimants would prefer their consultation to take place at home. The PIP residence and presence conditions are the same as those for Disability Living Allowance (DLA), Attendance Allowance and Carers Allowance. Claimants should seek advice if in doubt. At the beginning of the telephone call the agent will ask the claimant a series of questions to verify their identity. In each section and for each question there is a tick box for the claimant to state yes, no or sometimes. PIP ceases to be payable after 28 days where someone is being detained in legal custody. Health conditions or disabilities may be physical, sensory, mental, intellectual or cognitive, or any combination of these. This means that existing DLA claimants whose 65th birthday is after 8 April 2013 will be invited to claim PIP. Regulation 2 of the main PIP regulations provides -. The form will have a personalised barcode and contain basic claimant details, so it should only be used by the person it is sent to. As such claimants may be awarded descriptors for needing help even if it is not currently available to them for example, if they currently manage in a way that is not reliable, but could do so with some help. Children under the age of 16 are not eligible to claim PIP they can claim DLA and continue to do so until they are 16. Mayo Clinic's highly specialized heart experts diagnose and treat more than 200 heart conditions, including many rare and complex disorders, providing the most appropriate care for you. A PIP decision will automatically end the DLA claim. All existing DLA claimants who are invited to claim PIP will need to decide if they want to make a claim for PIP. The changes to the appeals process for DWP are: We introduced mandatory reconsideration and direct lodgement for PIP from April 2013. It is very important that claimants provide us with any relevant evidence or information they already have that explains how their condition affects them. Dont include personal or financial information like your National Insurance number or credit card details. If the claimant has not been awarded PIP, the letter will give all the same information as the award letter and will constitute a full statement of reasons for the decision. There is no link for the mobility component because payment is not affected when in a care home. The claimant has one calendar month from the date on the mandatory reconsideration notice to appeal direct to HMCTS. This figure is an absolute maximum and it is expected that travel time will be far less for the majority of cases. Its important to use the full address, including the 10, to avoid unnecessary delay in processing the claim. This list is only an overview of conditions, disorders and diseases and how the DWP lists the main disabilities being claimed for. To apply, assistance only needs to be required for part of the activity. However, claimants should inform other benefit offices about their entitlement to make sure theyre paid the correct amounts, particularly if there are any changes in their circumstances and awards. Spells in hospital are linked if the gap between them is no more than 28 days. We also need to know if the claimant spends any nights at home and the date the claimant comes out of this place as soon as this happens. The claimant must be present so that they can confirm the person supporting them has their permission to make the call. The activities explored during the PIP assessment are: Daily Living (10 activities): preparing food taking nutrition managing therapy or monitoring a health condition washing and bathing managing toilet needs or incontinence dressing and undressing communicating verbally reading and understanding signs, symbols and words Standing means to stand upright with at least one biological foot on the ground with or without suitable aids and appliances. Left untreated, excess blood sugar can . The telephony agent will use this on any call where the claimants first language is not English or where the caller is not comfortable continuing in English. If the claim is being made under these rules, the telephone call can be made by someone supporting the claimant (such as a support organisation or family member) without the claimant needing to be present. If the claimant sends the appeal in error to us, we will not forward the appeal request to HMCTS. Where one single descriptor in an activity is likely to not be satisfied on more than 50% of days, but a number of different scoring descriptors in that activity together are likely to be satisfied on more than 50% of days, the descriptor likely to be satisfied for the highest proportion of the time should be selected. Haematological Disease - 5,877 Infectious disease - 4,718 This change is important so that we can make payments to the right person at the right time. If the claimant loses the How your disability affects you form, they will need to contact us to request another form. If an existing DLA claimant contacts us to say that their condition has deteriorated and they have been told by their doctor or a medical professional that they might have 6 months or less to live, they will be invited to claim PIP under the special rules for end of life. The key conditions are: Agoraphobia. The claimant will need to include a copy of the mandatory reconsideration notice from DWP with their appeal. The providers were encouraged to develop innovative solutions for some aspects of the process such as how appointments are booked, where assessments take place and how they communicate with claimants (for example, letters, text messages, email and so on). Those receiving Armed Forces Independence Payment will not be entitled to claim PIP. Everyone will be able to bring a companion, see a same-sex assessor, claim back their travel expenses and so on. If the claimant is still not happy with the decision after discussing it with the decision maker, the claimant can ask for a mandatory reconsideration. Where the claimant has an appointee, corporate appointee, power of attorney or curator bonis, the person appointed to act on behalf of the claimant must telephone to make the claim; the claimant does not have to be present. decision granting a waiver in all age groups for the listed condition(s). For example if B applies on 20% of days, D on 30% of days and E on 5% of days, D is selected. The decision maker will make an award of PIP based on the impact of the claimants health condition or disability on their daily life and their ability to live independently. If you're under 16, you may be eligible for Disability Living Allowance . Two or more separate periods in legal custody link if they are within one year of each other. Failure to tell DWP this straight away could result in an overpayment. We have asked the assessment providers to ensure that claimants travel no more than 90 minutes (single journey) by public transport to their assessments. Law on the Need for Portability and Liability of Health Insurance. PIP is a benefit which is gradually replacing Disability Living Allowance (DLA). The claimant will have the opportunity to tell us more about their health condition or disability and how it affects their daily living in the next stage of the claim process. Where a claimant is unable to deal with us by telephone, or needs extra help and they have no one to support them making a claim by telephone, they can request that we post a paper claim form to them. do you need someone else to plan any journey for you that you wish to take? Capita Health and Wellbeings approach also allows claimants to choose their preferred method of contact (for appointment reminders and so on) and, once a health professional has decided that a face-to-face consultation is required, select their appointment time from a target range. HMCTS will administer and process the appeal, advising all parties of hearing dates if an oral hearing is to be held. We will write to parents or guardians of young people, who are currently in receipt of DLA and are living in reassessment areas as they approach age 16. We will write to claimants individually and in plenty of time to explain what action they need to take and by when if they want to claim PIP. The claim information and the DS1500 report will be sent to an assessment provider either Independent Assessment Services or Capita Health and Wellbeing who work in partnership with DWP. Aids or appliances that a person uses to support their physical mobility may include walking sticks, crutches and prostheses. Endocrine disease. When you are looking at how many points you score for feeding yourself, think . WV98 1AE. This change will not affect payment or eligibility for PIP and is not mandatory once a decision on the PIP claim has been made. Main physical or mental conditions that have qualified for PIP can include the diagnosis of anxiety, depression and stress as well as musculoskeletal and neurological diseases. Only claimants whose 65th birthday was on or before 8 April 2013 will remain on DLA. In these circumstances their DLA will continue to be paid for a further 13 days following their next payday. An award of PIP may enable claimants to access means-tested benefits even if they have previously been told they are not entitled to do so. Dont worry we wont send you spam or share your email address with anyone. We treat serving members of His Majestys Forces and their families as habitually resident in Great Britain when serving and stationed abroad. Within each activity there are a number of descriptors, each representing a varying level of ability to carry out the activity. There is no automatic entitlement to PIP even where an indefinite or lifetime DLA award has been made. These details are for new claims to PIP only. The DS1500 report can be sent to us either by the health professional or by the person requesting it but it is important that it is sent in quickly to support the PIP claim. Claimants phoning from a landline in Wales will be able to select the option to speak in Welsh from the automated telephony service and be connected to a Welsh speaker at a DWP contact centre. The claimant will not be sent the form How your disability affects you if they meet the criteria for an award under the special rules. Read the guidance for claimants on how to appeal a benefit decision. However, for this activity this only refers to the physical act of moving. The PIP daily living component overlaps with Constant Attendance Allowance. For example, do you need: do you have difficulty walking short distances up to 50 metres? Around 35% of claimants are receiving the top level of support - 152.15 every week or 608.60 each month. 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