Client got better, lost PIP, then got worse again. Best course of action?

Hi,

Client was on ER Mob. Had steroid injections in foot in Nov 2019.

Contacted PIP Jan 2020 to report improvements in mobility. Was reassessed but it took a long time due to Covid and finally lost all PIP mobility in May 2020.

Meantime injections stopped working around Feb/Mar 2020. Client now back to how she was before injections unable to walk again. Waiting for next steps medically may need surgery or other options.

Questions -

1 Sadly I don’t see many people who get better, so it’s rare to come across this. Do positive health changes not have to have some sort of qualifying period just like negative ones do? Or do they take effect from the moment you feel better?

2 Whats the best course of action. MR? another CoC?

I would normally try an MR for the potential backdating, but her health has fluctuated so much I am not sure how they will assess it. What is the relevant period here, the decision was made May 2020 so is it just how her health was in May that is relevant? Or do we need to consider the time period between the reporting of the change and the decision date too?

Thanks

I see this fairly often in mental health cases. Client’s depression gets better, only to get worse again after financial hardship from benefits stopping…

In order to consider an appeal you’d have to look at whether DWP were justified to stop the award based on the client’s circumstances at the time. If you think there’s at least entitlement to SRM you could consider an appeal.
DWP typically overestimates how much a claimant has improved.

When was the actual assessment? By the sounds of it your client may have gotten worse again between notifying DWP he had improved and actually being called for an assessment. If so, the HCP should have written a report that reflected his conditions at the time of assessment.
Otherwise I suppose DWP would have to do a closed period supersession to stop and then reinstate the award, but I’ve never heard of anything like that happening.

I think MR is the best course of action.  Decision has to be based on condition at the time of decision, ie May 2020, and 3 month qualifying period is met if deterioration began in Feb 2020.

Thanks both. Yeah this seems more common in mental health, only times I’ve seen it before have been mental health cases.

For future reference whats the best approach with this? Surely there has to be some sort of period of improvement i.e. the same 3 month qualifying period would make sense. If this client had waited a while this wouldn’t have happened. Then again wouldn’t want a client to be penalised for waiting to notify.

It’s a tricky one.  I have to confess I haven’t looked closely at the regs to see what they say about this.  I think you want to wait long enough to be sure that you’ve had a long term improvement instead of just a fluctuation.  That length of time will be individual to each case.  It’s rare that people are penalised for not reporting an improvement in condition, so you don’t need to get overly worried about that - again it will depend on how stark the improvement is.  3 months seems like a good starting point to me, but this is just my gut feeling.
But then I only deal with mental health - where improvements are gradual - and PIP awards are short!

DWP can decide to apply a supersession from the date a claimant ‘ought to’ have notified them if s/he has notified them later.

You’ll have to consider each case on its merits. If a blind client has regained 100% sight overnight, it would be reasonable to realise s/he ought to report the CiC as soon as practicable. However, recovery at that rate is fairly rare.

I’d consider whether the CiC warrants a change in award. If not, DWP can’t supersede to reduce the award regardless, and you might just prompt a new assessment (and stress) for no practical reason.
However, if the client still qualifies, but on a different or new ground, you might want to notify DWP, otherwise when the normally scheduled assessment comes down the line DWP might (wrongly) supersede to stop the award from when the CiC occured, and you’d be looking at an appeal for a longer period. Better to deal with it when you’re prepared for it etc.

If you think the client qualifies, but for a lower award, you might want to use careful wording when notifying DWP. They’re not known for considering the finer points…

If the award is likely to be stopped you should prepare your client for that eventuality. Of course at this stage some clients may chose to not report the CiC, and it’s important that they understand the possible implications of that route, in terms of overpayment recovery etc.
If they claim both PIP and ESA and you think it’s likely they’ll lose the SDP it might be appropriate to claim UC, rather than wait for DWP to stop both PIP and ESA - to protect any LCWWRA etc.

Thanks both, interesting points. That’s helpful.

Seems it’s a tricky area for sure. I haven’t been able to properly discuss with this particular client exactly what the improvements involved so I am not sure if she actually ever actually got better enough to lose all her PIP (DWP obviously thought so but that’s what we are challenging). Even if she did improve miraculously and was walking okay, it’s clearly only very temporary.

If someone has a temporary illness they don’t get PIP so seems very unfair that if someone has a temporary improvement they lose all their PIP. Definitely going to challenge.

Helen - might be worth us seeing what other NWMHWRAG members think at the next meeting as like you say it is very relevant to MH claims despite this particular case being physical health.