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Should DWP always carry out a medical to determine PIP entitlement? 

 

EKS_COTTON
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Dear all,

I don’t think this issue has been covered anywhere else in relation to PIP.  Apologies if I am repeating things.

To what extent can a new PIP claimant effectively challenge the decision to refer to a medical examination?  Including those who are being migrated from DLA?

I have read through http://www.rightsnet.org.uk/forums/viewthread/6224/P30 ‘ESA - Should the DWP always carry out a medical when determine fitness for work’ which was helpful, although there was no reference given on the FOI response which stated that ‘No claimant can be found fit for work without undergoing a face-to-face assessment.’

I take the point that the decision to refer to a medical is a discretionary one (both for ESA and PIP) in accordance with the regulations, and that the decision maker can make the decision on the papers if there is sufficient evidence.  But I am wondering what in practise you can effectively do about this? And whether there are any differences in the case of new PIP/DLA to PIP claims?

I am advising my clients to send in a massively detailed re-write of the PIP claim form with direct reference to the descriptors as quoted in the regulations (the ‘weapons grade approach’ to all of you who have been on CPAG training with Steve Johnson), to add supporting evidence and to write a covering letter quoting the regs on referral to a medical and asking the DM to make the decision on paper instead.  To date, there has been no success (all claims have been brand new) apart from a highly articulate and tenacious appointee who complained repeatedly to both DWP and medical services prior to her husband who she cared for, being asked to attend a medical - he had had a stroke and found communicating and especially with those he didn’t already know, extremely stressful and confusing.  She completed the PIP questionnaire as recommended and there was lots of medical evidence.

I work with some people who have been severely disabled and on DLA from youth and I am wondering whether there will be any different treatment for them when they move onto PIP (a bit like with ESA and those moving over from IB, see again the thread http://www.rightsnet.org.uk/forums/viewthread/6224/P30).  Has anyone else had any experience of this?  Or whether there is anything more that can be done to prevent a referral to medical services? 

Should I or can I ask for a decision maker to provide reasons for the decision to refer to a medical? 

Also I have heard anecdotally that DWP decision makers do not make the decision to refer to a medical because the PIP and ESA questionnaires are simply sent directly to medical services (who of course have a financial incentive to advise that a medical is necessary).  Anyone else heard about this and can this practise be challenged in some way if it is so?

Any thoughts gratefully received.

Best wishes,

EKS

     
Dan Manville
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Whether to refer for a medical is at the discretion of the Sec State but that discretion is contracted out to the AP so in practice they make the call.

I have good responses from Capita; they’ll usually do a Paper Based if I ask them to but they are understandably reluctant to do it on the claimant’s word alone; usually they need at least one professional’s word that there is a degree of disability there. There are exceptional cases where they will go on the PIP2 alone but they are very exceptional. I can understand their take on it.

     
EKS_COTTON
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Thanks Dan - the fact that the decision to refer to a medical is given to medical service seems like an abuse of process to me. Troubling.

     
Wensleyfoss
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I have started doing Risk Assessment forms for clients and sending those in. We had one fella, who threatened to ‘punch them in the face, for asking *** stupid questions.’ We told the AP we were not prepared to attend with him and sent the risk assessment. Someone saw common sense and he had a PBA!

     
Geri-G
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I argue for PBR whenever possible for clients. I also stick my name down on PIP2 medical questionnaires if there is a lack of other “professionals” if I have had knowledge of the client (ie worked with them on other issues). I have had a fair few assessors from ATOS phoning me.Obviously that is difficult if you have only met the client once, but I have had a few that I have worked with for a while. I do state I have no medical knowledge and answer their questions on what I know.

     
Sally63
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Certainly I have had clients who have been awarded PIP straight off the PIP2 form without a medical. I didn’t ask for it without a medical so presumably they just had a compelling case. Ditto ESA though that’s not under discussion here

     
Dan Manville
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EKS_COTTON - 17 March 2017 12:16 PM

Thanks Dan - the fact that the decision to refer to a medical is given to medical service seems like an abuse of process to me. Troubling.

It’s been going on for years; they get paid per assessment, whether it’s PBA or F2F so I don’t really see the problem.

     
Dan Manville
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Sally63 - 20 March 2017 07:47 PM

Certainly I have had clients who have been awarded PIP straight off the PIP2 form without a medical. I didn’t ask for it without a medical so presumably they just had a compelling case. Ditto ESA though that’s not under discussion here

Bet you a tenner they at least wrote to the GP…