Have a problem.

Client receiving IB long term and gets IS top up for housing costs. IS stopped last week called and was told as client had failed to attend a medical in October 2004 and decision not being implemented until now. No IS decision as yet just ‘suspended’, which leads me and CPAG helpline to feel they do not know what to do. Problem being that client claims not to have received (1) invitation to attend medical or (2) decision following failure to attend saying benefit would be affected. Client cannot make a late appeal as 13 months from date of the IB decision.

If client reclaims IS and IB then she will face losing her long term rate, as well as having to re-qualify for housing costs and waiting 39 weeks. Client would also possibly not qualify for IB this time but IS on basis of incapacity as may not have sufficient NI contributions.

I was thinking of asking for consideration to be given to official error of IS not being implemented at time and seeking an anytime revision as the client remains incapable but even if this is accepted, which it probably wont be then she cannot claim IS reduced as did not fail the PCA…..any ideas?

i gather from your post that you have been told that an IB decision was given around October 2004, but not implemented by IS. it is worthwhile finding out precisely what errors occurred - did IB section fail to notify IS, or did IS fail to action the notification? - and what record of a date of issue of IB disallowance notice is held? i think this is usually a clerical notification - if IS weren't notified, other errors could have been made, eg client not notified. what discovery has now prompted action by IS?

also, was there any change of address or problems with the address at the time?

i would have expected client to have been asked to give her reasons for not attending before disallowance was made. not receiving the notification of the medical would normally be accepted as good cause, and another medical arranged, rather than disallowance - both such an enquiry, and the disallowance notice would have alerted her to the problem of the missing medical notification, and prompted action. it's possible no enquiry was sent, but worth finding out. also, did client satisfy any other conditions of entitlement for IS?

if you can obtain back dated medical evidence of incapacity from the date of the decision, you may be able to persuade IB section that decision that she failed to attend a medical exam without good cause should be revised as erroneous (no consideration of good cause), but much may depend on what can be reconstructed of the actual events, and balance of probabilities...it's probably a good idea to submit new claim and backdated med ev in any event, for disability premium.

if entitlement to IB and /or housing costs is lost because a disallowance notice wasn't issued, you may have a case for extra-statutory payment to make good the loss - all of this may be over-optimistic, and if it comes down to no more than she says she did not receive notifications which were in fact issued, it's much more difficult...
hope this is some help

jj

Some very good points there many thanks for the time will let you know how goes...cheers

IS has replied answering no points saying that no incapacity claim so income support acnnot be claimed a decision will be sent to the client a bit miffed as not one point raised dealt with.....help!!

hiya

it's a lot easier in theory than in practice... : )

it's as well to bung in an IB claim asap, and claim 3 months backdating, as a fall-back position. you are entitled to the factual information, so persist in your requests - suggest separate letters to the IS and IB sections - complain as necessary if you meet with obstruction - how loudly and where is best left to your judgement...

stamina is called for... they never mention it in the job description, do they?...sometimes i'm surprised we welfs aren't made to eat dogfood...

jj

cheers jj and you mean you dont eat dogfood?

I note the failure to attend the PCA decision is said to have been made in October 04- normally that would put you outside the 13 month period and no appeal possible.

HOWEVER....

• Claimant states never received notice of this decision.
  
• IS (and I assume IB?) remained in payment... indicating that in all probability the IB section never told the IS section (or the medical services never told their masters in the DWP about the failure to attend).
  

Have stated that in my letter which prompted the reply no IB so no IS. However as you pointed out IS was paid for 14 months from date of supposed disqualification anyway I await IB’s reply and for client to bring in IS decision letter. I just did not want it to get complicated as client is very unstable and is what makes it in my mind more unjust as she has without doubt been incapable throughout and remains so. We have requested medical evidence from GP and client has approached for med to include backdate for new claims she is having to submit as no way can she consider JSA.....so we shall see many thanks for the post.

Good.

Make sure that DWP send your appeal to TAS as where there is a dispute about whether an appeal in time or not this is a matter for TAS and not DWP.

: ) shhhh! it could become a new government policy... don't want to give them ideas...

well if it does Pal Chunky rules.....not chicken flavour though but more seriously thanks again for the post

I would be tempted to get to get the local MP involved to force the DWP to issue full reasons/ give a decent response to your questions. The above comments are all good points and i would also make a formal complaint with a view to seeking a compensation payment.

Some good news!

DWP, Makerfield benefit centre has accepted evidence that client had good reason for failure to attend and that letter was not sent so reinstated from that date. Client has although now been paid IS from 3rd, January 2006 when the payments stopped but new decision means client only entitled to top up of IS for housing costs as will have her incapacity reinstated at the long term rate plus addition. So now have to get that sorted. Oh and it also seems that when IS began paying they had no reason to as client's IB stopped in November 2004 and IS not claimed until December 2004 and as such the client satisified none of the conditions of entitlement so another case to make your brain bleed.

Many thanks again for those who replied and the support cheers.