Health deteriorates between PIP claim and medical

Hi

This is probably completely obvious but we are struglging to be sure here so any help much appreciated.

Client applied for PIP October 13, medical June 14, decision August 14, awarded Enhamced Mob but no care.

Which date relates to clients health problems for the decision is it date of claim, date of medical or date of decision?

eg if health deteriorates from application to medical asessment do I need to do a supersession?

Thanks

Extremely good question actually!

I’ve been trying to figure that one out as well and would be very interested to hear what everyone thinks.

I posted the following a few weeks ago but did’nt get any replies.

Not sure if it put things in context in terms of the PIP regs.

Hope someone might have some thoughts on this -

“I’m posting to check if I’m on the right track with interpreting the rules for making advanced payments of PIP.

The rules for making advanced payments of DLA seem straightforward – provided you claim no more than three months before you would qualify for DLA a decision can be made in advance of your date of entitlement –

“Where, although a person does not satisfy the requirements for entitlement to disability living allowance on the date on which the claim is made, the Secretary of State is of the opinion that unless there is a change of circumstances he will satisfy those requirements for a period beginning on a day (“the relevant day”) not more than 3 months after the date on which the claim is made, then Secretary of State may award disability living allowance from the relevant day subject to the condition that the person satisfies the requirements for entitlement on the relevant day.”
(Reg 13A Claims and Payment Regs 1987).

The rules for advance awards of PIP are different –

“Where, although a person does not satisfy the requirements for entitlement to personal independence payment on the date on which the claim is made, the Secretary of State is of the opinion that unless there is a change of circumstances the person will satisfy those requirements for a period beginning on a day (“the relevant day”) not more than 3 months after the date on which the decision on the claim is made, the Secretary of State may award personal independence payment from the relevant day subject to the condition that the person satisfies the requirements for entitlement on the relevant day.”
(Reg 33(1) The UC, PIP, JSA and ESA (Claims and Payments) Regulations 2013)

My take on this is that it’s possible for an advanced PIP award to be made at the latest three months after a decision maker makes a decision on the claim.

But does Reg 33(1) not also mean that an advanced award after the actual date of claim can be made also at any time before the date of decision on the cliaim?

For example, someone’s condition clearly deteriorates 4 months after their date of claim.
Can a decision maker under Reg 33(1) make an award of PIP starting 7 months after the date of claim?

Given that PIP decisions are taking up to 12 months at present, would Reg 33(1) form the basis of an ‘in the alternative’ submission at mandatory reconsideration/appeal i.e. that if a client does not meet the qualifying criteria at the date of their claim that they did so at some point up to and including the date of decision on their claim.

What do other people think?”

To Julie 1

It all depends if you think the entitlement decision is wrong or not.  If the deterioration occurs between the date of claim and the date of the decision and the decision is more reflective of circumstances at the date of claim rather than the date of decision then the proper route is a revision.  If you think the decision was right and he keeps on deteriorating then the appropriate route then is supersession.

Ken

“Can a decision maker under Reg 33(1) make an award of PIP starting 7 months after the date of claim”?

As long as the three month qualifying period is satisfied no later than three months after the date of the decision.  That might sound rather obvious but I don’t know how else to put it.

Thanks Nevip,

What I think that this means is that in advising a client about the merits of disputing a PIP decision then, perhaps particularly with a client who has a deteriorating condition, it is worth checking their situation both at the date of claim and thorough the period up to the date of the decision.

Given that people are waiting up to a year for a decision then in many cases their condition will have got worse.

It could be say that while they did not have a case for PIP at the date of claim they did say six months later.

Normally a decision is made refusing the claim from the date of claim.

Couldn’t a challenge be made on the grounds that the decision maker should have made an award beginning nine months from the date of claim (three months after the deterioration began)?