Personal Independence Payment (PIP) - A Guide to the Rules.

Transcription

1 Personal Independence Payment (PIP) - A Guide to the Rules. (See also Personal Independence Payment A Guide on how to complete the Medical Assessment Form.) An information factsheet produced by the Welfare Rights (Mental Health) and Assertive Inreach Teams. Leicestershire Partnership NHS NHS Trust June 2013

2 Contents Introduction..3 What is Personal Independence Payment?..3 Personal Independence Payment and Other Benefits.4 PIP for Existing DLA Claimants 4 Qualifying Periods..5 Age Limits...5 Residence & Presence Conditions...5 How Much is Payable?...5 Going into Hospital..6 How to Claim and the Claims Process...7 Challenging Decisions Reconsiderations & Appeals.10 Appendix 1 The Descriptors Appendix 2 Useful Addresses Appendix 3 Where can I get advice or assistance 2

3 Introduction This guide looks at the main rules for Personal Independence Payment (PIP). There is also a separate guide on how to complete the medical assessment form. PIP is a new benefit which replaces Disability Living Allowance (DLA) for most people. DLA will continue for children under 16yrs old, for people who are already receiving DLA including people over 65 years old. People currently receiving DLA of working age (i.e. 16yrs to 64 yrs) they will eventually be migrated/transferred to PIP if they satisfy the new rules. (see below PIP for Existing Benefit Claimants for details). If you receive Attendance Allowance (AA) you will not be affected by the changes to PIP and will continue to receive AA. What is Personal Independence Payment? Personal Independence Payment is a benefit for people who have a disability or a long term illness. This could be a physical or mental health problem, or a combination of both. Personal Independence Payment is paid to the person with the disability. It is paid as a recognition that due to their disability they will have extra costs/expenses. However, once an award is made they can spend the money on whatever they choose. Personal Independence Payment looks at the help needed if in an ideal world this was available. It doesn t matter whether or not this help is received at the moment. You do not have to have a carer to be awarded PIP. Personal Independence Payment can be paid to people who live on their own. Personal Independence Payment is paid in two parts, called components. One is based on care needs (called the Daily Living Component) and the other on mobility needs (called the Mobility Component). One or both components can be awarded at the same time. 3

4 Personal Independence Payment and other benefits. Some people are put off from claiming Personal Independence Payment as they think it may affect other benefits they receive. Personal Independence Payment will not lead to a reduction in any other benefit you receive. Personal Independence Payment is always paid on top of your other benefits. In fact if you receive a means-tested benefit such as Income Support, Housing or Council Tax Benefit/Reduction or if you receive Working Tax Credit your award of this may increase. Personal Independence Payment is not means tested and you do not have to have paid National Insurance contributions to receive it. Personal Independence Payment is not affected by any savings, income or earnings that you have. Carers can claim Carer s Allowance where a claimant they look after receives the Daily Living Component either rate. People will qualify for the Motability Scheme for cars or other transport if they receive the Mobility Component at the enhanced rate. People will qualify for a Blue Badge if they score at least 8 points under the Moving Around Descriptors. In practice this means they can walk less than 50 metres. PIP for Existing Disability Living Allowance (DLA) Claimants Most people currently receiving DLA will be asked to claim PIP at some point in the future. This will occur when the earliest of one of the following occurs after October 2013:- Your current fixed term DLA award ceases instead of receiving a DLA renewal you will be invited to claim PIP If you have a change of circumstance and report this then you will be asked to claim PIP All other claimants will be reassessed at some point between October 2015 and October 2017 they will be invited to claim PIP but will continue to receive DLA until a decision is made on their PIP claim Most people will have to go through the normal claims process and undergo a face to face consultation /medical. In limited cases on transfer this will not be deemed necessary. 4

5 Qualifying Periods In order to qualify for Personal Independence Payment you must have had your disability or health problem for at least three months. You must also be likely to continue to need help for a further nine months. Age limits You must be under 65 years old when you first claim Personal Independence Payment. If it is awarded you can continue to receive Personal Independence Payment after you are 65 years providing you still meet the qualifying conditions. If you are over 65, and haven t yet made a claim, you will need to claim Attendance Allowance (AA). Children under 16 years old you will continue to claim Disability Living Allowance rather than PIP until their 16 th birthday. Residence and Presence To be able to claim PIP you must have been in the country for 104 weeks in the last 156 weeks i.e. 2 out of the last 3 years (unless you have a terminal illness). If you go abroad you are entitled to PIP for 13 weeks (or 26 weeks if you are receiving medical treatment abroad). People will have to pass the habitual residence test, this usually applies to people coming to the UK from abroad, including returning British citizens. The test looks at things like the reason for coming to the UK, your future intensions, and any continuing links with the country you came to the UK from. This will make it more difficult to claim PIP than it was to claim DLA. How much is payable? The weekly rates of benefit for April 2013-April 2014 are:- Daily Living Component Enhanced Rate Standard Rate Mobility Component Enhanced Rate Standard Rate PIP will usually be paid every 4 weeks in arrears into a bank account or Post Office account. 5

6 Going into Hospital After 4 weeks in hospital then Personal Independence Payment stops. However, it could stop before the 4 week period if the person has been in hospital in the past 28 days. If the person has been in hospital during the previous 28 days then the periods are linked together. For example, if the person had been in hospital for 3 weeks, went home for 2 weeks and was then in hospital for a further 3 weeks, their Personal Independence Payment would stop after 1 week of their second stay, as they count as being in hospital for a linked period of 4 weeks. If the person goes on home leave which includes an overnight stay away from hospital they can be paid for each of those days at home, including the day they leave hospital and the day they come back. For example, if the person returns home on Friday and comes back to hospital on Sunday, they can be paid Personal Independence Payment for those three days. It is important to tell the Department for Work & Pensions when someone goes into and comes out of hospital to ensure they are not overpaid or underpaid benefit. If you make a claim for PIP whilst you are in hospital you cannot be paid until you leave hospital. 6

7 How to Claim and the Claims Process Your initial contact to claim PIP will be by calling a DWP Call Centre on During this call you will be asked basic information such as your personal details including your name, National Insurance Number, date of birth, address, contact details and bank account details. They will also ask about any periods you have spent in hospital or abroad. You will also usually be asked who is the healthcare professional who knows the most about your condition, this could be your GP, a social worker or support worker, your consultant, your CPN. It helps to speed up the call if you have this information ready before you call. The call will take about 20 mins. This call determines whether you meet the basic criteria for PIP e.g. age and residency requirements. If you don t you will be sent a disallowance letter telling you that you are not entitled to PIP at this stage. If you meet the basic eligibility criteria shortly after your initial phone call you will be sent an assessment form called How your disability affects you, which asks about your condition and the day to day affects on your life. (See the separate PIP guide for advice on completing this). This form needs to be completed and returned within one month. If you state you have a mental health condition you will usually be given an extra 2 weeks to return the form. You can also at this stage provide other supporting evidence e.g. a letter form a support worker or health care professional or a care plan. You don t have to provide any further evidence and should think carefully about the evidence you do provide as it often won t address the specific issues that the PIP assessment considers. The assessment is based on a points scoring system. (See Appendix 1 for details.) It is important when completing the form to try and give answers which demonstrate which of the points in each category apply to you and how your condition affects you. 7

8 To be awarded the Daily Living Component you need to score 8-11 points for the standard rate and 12 or more points for the enhanced rate and to be awarded the Mobility Component you need to score 8-11 points for the standard rate and 12 or more points for the enhanced rate. Once the assessment form has been returned it will be considered by a Health Professional (HP) along with any other evidence that might have been provided. At this stage they will decide one of the following:- That they need more information and will send for further evidence this would usually be a standard letter requesting information to someone involved in your care e.g. GP, CPN, Social Worker, Consultant Make a decision on the basis of the evidence they have, a Paper Based Review these will be fairly rare and strong evidence will be needed to support this type of decision Determine that a face to face consultation or medical is required, or a telephone consultation (see below for details) It is likely you will have to go to a face to face consultation or medical assessment. Capita, the company responsible for the assessments in Leicester & Leicestershire, say they aim to undertake the majority of consultations in the persons own home, if this is what they want. Otherwise assessments will take place at a medical or assessment centre. You will be given at least 7 days notice of the appointment. Your claim can be refused if you fail to return the medical assessment form or attend/take part in the medical unless you can show good cause for not doing so. Good cause could be due to the fact that you were too ill to deal with paper work or attend the medical, but you will usually need to provide evidence to demonstrate this. If you are unable to attend on the date and time you have been given you will need to telephone to rearrange the appointment. The telephone number will be on the envelope detailing your appointment. You can take someone with you to the assessment, or have someone with you if it is at home, and they are also able to provide information about your condition. 8

9 You will be seen by a Health Professional (HP) who will either be a doctor, nurse, Occupational Therapist, Physiotherapist or Paramedic. The Health Professional will ask you about your condition and how it affects you on a daily basis. They will assess you with reference to the twelve activities that make up the test (see Appendix for details of these). They will ask about the history of your health problem or condition and what investigations or treatments you have had or are planned in the future, and what medication you take. They will ask about fluctuations in your condition, and the good and bad days you have. They will look at how your condition affected you over the past 3 months and how it is likely to affect you over the next 9 months, rather than just how you are on the day of the medical. For your condition to be relevant to their assessment of the descriptors then the problems you experience will have to affect your ability to complete an activity on more than 50% of the days within a 12 month period. The Health Professional will complete an assessment on the basis of what you have told them at the medical and any other information they have. You can for example take copies of any supporting evidence or letters to provide to the Health Professional. This assessment will be sent to a Case Manager at the Department for Work & Pensions who makes the decision on your entitlement to PIP. The Health Professional will not make the decision on your entitlement to PIP, however, they will give advice on what points from the descriptors they consider appropriate and will indicate when they think it is appropriate for your case to be reviewed again. It is likely that the Case Manager at the DWP will follow their guidance. You will receive a decision letter informing you of the Case Manager s decision. This provides information on how the decision was reached and what information was used to come to the decision. People can call the DWP for more information on the decision if they want to. Any award of PIP will usually be for a fixed time period. It is expected that short awards, for example of 2 years length, will be awarded where a significant reduction in needs is expected in the future. Longer term awards, such as 5 or 10 years, will be given where changes are less likely. There will be a limited number of indefinite period awards but even these will be subject to review at some point to check that the entitlement conditions are still being met. If there has been no award of benefit or if the current award will be reduced then the Case Manager will try and telephone the claimant to explain the reasons for the decision. A request to look at the decision again can be made at this stage. This is called a reconsideration (see below for more details). 9

10 If you have been turned down it is often worth discussing the reasons with an advisor to get independent advice on whether to pursue your claim further. The Case Manager has been asked to telephone people to explain the decision to stop people appealing where they have no chance of success, but often the Case Manager will not know as much about your condition as the people who assist you to deal with your condition, such as Support Workers, CPN s, GP etc, therefore don t be put off even if the Case Manager believes you have little chance of success as this may not be the case. Challenging Decisions Reconsiderations & Appeals If you disagree with a decision you can challenge it. The decision letter will provide details on doing this. It is important to challenge decisions as soon as possible as there are strict time limits that mean you usually need to make the request within one month of the decision. You have to ask for a decision to be reconsidered before you can appeal. Mandatory Reconsideration to the DWP If you are not happy with a PIP decision, either because you have not been awarded PIP or because it is for a lesser amount than you believe is appropriate you can ask for the decision to be looked at again. Many claims are initially refused but successful when the decision is challenged. You may be called by the Case Manager at the DWP to explain why they made the decision (see above under Decision Letter). To begin with you have to ask for a Mandatory Reconsideration within one month of the date of the decision letter. (You can no longer request an appeal without having a reconsideration first). This request is made to the Department for Work & Pensions who made the decision on your claim. The request can be made over the phone but it is always best to send a written request. The request should be as specific as possible about why you believe the original decision is incorrect and try to address which of the descriptors apply. It is also helpful to provide any further evidence and/or supporting letters for example from a GP, Consultant, CPN, Social Worker etc. The reconsideration request will be looked at by a different Case Manager and a letter called a Mandatory Reconsideration Notice will be sent out giving the new decision. 10

11 Appealing to Her Majesty s Courts & Tribunals Service (HMCTS) If after the Mandatory Reconsideration by the DWP you are still not happy you can appeal directly to Her Majesty s Courts & Tribunals Service (HMCTS). You have one month from the date on the Mandatory Reconsideration decision to appeal. It is important that the appeal is sent to HMCTS as if it is sent to the DWP they will just return it to you and not act on this. There is a new appeal form SSCS1 (this replaces the old appeal form GL24). You can get the new form from the DWP or download online from: You must include a copy of the mandatory reconsideration notice you received from the DWP with the appeal form. Forms need to be returned directly to HMCTS at: HMCTS SSCS Appeals Centre PO Box 1203 Bradford BD1 9WP The appeal form asks whether you may want an oral hearing at which you attend in person or a paper appeal where a decision is made just on the written evidence. It is important to remember that in most situations an oral hearing where it is possible to provide additional evidence and you have an opportunity to state your case offers the best chance of success. When HMCTS receive the appeal form they will then ask the DWP for their response to the appeal request. When this is received you will also be sent a copy. It is always a good idea to get help and/or advice if you are going to appeal or attend an appeal hearing. (See appendix for places to get help or assistance). 11

12 Appendix One: Daily Living and Mobility Activities and Descriptors The entitlement thresholds (pass mark) for the rates and components of the PIP are: Daily Living component (activities 1 to 10) Standard rate: 8-11 points Enhanced rate: 12 points or more Mobility component (activities 11 to12) Standard rate: 8-11 points Enhanced rate: 12 points or more Daily living activities and descriptors Activity 1 - Preparing Food a. Can prepare and cook a simple meal unaided 0 b. Needs to use an aid or appliance to be able to either 2 prepare or cook a simple meal c. Cannot cook a simple meal using a conventional cooker but 2 is able to do so using a microwave d. Needs prompting to be able to either prepare or cook a 2 simple meal e. Needs supervision or assistance to either prepare or cook a 4 simple meal f. Cannot prepare and cook food 8 Activity 2 Taking Nutrition a. Can take nutrition unaided 0 b. Needs either (i) to use an aid or appliance to be able to 2 take nutrition; or (ii) supervision to be able to take nutrition; or (iii) assistance to be able to cut up food c. Needs a therapeutic source to be able to take nutrition 2 d. Needs prompting to be able to take nutrition 4 e. Needs assistance to be able to manage a therapeutic 6 source to take nutrition f. Cannot convey food and drink to their mouth and needs 10 another person to do so 12

13 Activity 3 Managing Therapy or Monitoring a Health Condition a. Either (i) does not receive medication or therapy or need to monitor a health condition; or (ii) can manage medication or therapy or monitor a health condition unaided b. Needs either (i) to use an aid or appliance to be able to manage medication; or (ii) supervision, prompting or assistance to be able to manage medication or monitor a health condition c. Needs supervision, prompting or assistance to be able to manage therapy that takes no more than 3.5 hours a week d. Needs supervision, prompting or assistance to be able to manage therapy that takes more than 3.5 but no more than 7 hours a week e. Needs supervision, prompting or assistance to be able to manage therapy that takes more than 7 but no more than 14 hours a week f. Needs supervision, prompting or assistance to be able to manage therapy that takes more than 14 hours a week Activity 4 Washing and Bathing a. Can wash and bathe unaided 0 b. Needs to use an aid or appliance to be able to wash or 2 bathe c. Needs supervision or prompting to be able to wash or 2 bathe d. Needs assistance to be able to wash either their hair or 2 body below the waist e. Needs assistance to be able to get in or out of a bath or 3 shower f. Needs assistance to be able to wash their body between 4 the shoulders and waist g. Cannot wash and bathe at all and needs another person to 8 wash their entire body Activity 5 Managing Toilet Needs or Incontinence a. Can manage toilet needs or incontinence unaided 0 b. Needs to use an aid or appliance to be able to manage 2 toilet needs or incontinence c. Needs supervision or prompting to be able to manage toilet 2 needs d. Needs assistance to be able to manage toilet needs 4 e. Needs assistance to be able to manage incontinence of 6 either bladder or bowel f. Needs assistance to be able to manage incontinence of both 8 bladder and bowel 13

14 Activity 6 Dressing and Undressing a. Can dress and undress unaided 0 b. Needs to use an aid or appliance to be able to dress or 2 undress c. Needs either (i) prompting to be able to dress, undress or 2 determine appropriate circumstances for remaining clothed; or (ii) prompting or assistance to be able to select appropriate clothing d. Needs assistance to be able to dress or undress their lower 2 body e. Needs assistance to be able to dress or undress their upper 4 body f. Cannot dress or undress at all 8 Activity 7 Communicating Verbally a. Can express and understand verbal information unaided 0 b. Needs to use an aid or appliance to be able to speak or 2 hear c. Needs communication support to be able to express or 4 understand complex verbal information d. Needs communication support to be able to express or 8 understand basic verbal information e. Cannot express or understand verbal information at all 12 even with communication support Activity 8 Reading and Understanding Signs, Symbols and Words a. Can read and understand basic and complex written 0 information either unaided or using spectacles or contact lenses b. Needs to use an aid or appliance, other than spectacles or 2 contact lenses, to be able to read or understand either basic or complex written information c. Needs prompting to be able to read or understand complex 2 written information d. Needs prompting to be able to read or understand basic 4 written information e. Cannot read or understand signs, symbols or words at all 8 Activity 9 Engaging with People Face to Face a. Can engage with other people unaided 0 b. Needs prompting to be able to engage with other people 2 c. Needs social support to be able to engage with other 4 people d. Cannot engage with other people due to such engagement 8 causing either (i) overwhelming psychological distress to the claimant; or (ii) the claimant to exhibit behaviour which would result in a substantial risk of harm to the claimant or another person 14

15 Activity 10 Making Budgeting Decisions a. Can manage complex budgeting decisions unaided 0 b. Needs prompting or assistance to be able to make complex 2 budgeting decisions c. Needs prompting or assistance to be able to make simple 4 budgeting decisions d. Cannot make any budgeting decisions at all 6 Mobility activities and descriptors Activity 1 Planning and Following Journeys a. Can plan and follow the route of a journey unaided 0 b. Needs prompting to be able to undertake any journey to 4 avoid overwhelming psychological distress to the claimant c. Cannot plan the route of a journey 8 d. Cannot follow the route of an unfamiliar journey without 10 another person, assistance dog or orientation aid e. Cannot undertake any journey because it would cause 10 overwhelming psychological distress to the claimant f. Cannot follow the route of a familiar journey without 12 another person, an assistance dog or an orientation aid Activity 2 Moving Around a. Can stand and then move more than 200 metres, either aided or unaided b. Can stand and then move more than 50 metres but no more than 200 metres, either aided or unaided c. Can stand and then move unaided more than 20 metres but no more than 50 metres d. Can stand and then move using an aid or appliance more than 20 metres but no more than 50 metres e. Can stand and then move more than 1 metre but no more than 20 metres, either aided or unaided f. Cannot, either aided or unaided, (i) stand; or (ii) move more than 1 metre

16 Appendix Two Useful Addresses and Telephone Numbers PIP Telephone Claim Line: (Textphone: ) Open Mon-Fri 8am-6pm PIP Postal Address: FREEPOST RTBS-CBYC-SCZS DWP Personal Independence Payment (4) Warbreck House Blackpool FY2 0UZ Appendix Three Where can I get more information? If you are a mental health service user or carer or a member of staff working in mental health, advice and information is available from the:- Benefit Advice Support Line on Tuesday Friday am. For people living in the City, information and advice is available from the:- Benefits Campaign on Monday Wednesday pm. There are a number of other advice agencies within Leicester. Please see the link below for an Advice Services Guide: 16

17 If you have any comments or suggestions on this factsheet then please send them to:- Senior Welfare Rights Officer Brandon Mental Health Unit Leicester General Hospital Gwendolen Road Leicester LE5 4PW WARNING The information in this guide is as accurate as possible at the time of production. However, it is only a guide, and therefore cannot be completely accurate and cover every possible situation. We recommend that you always seek advice from a competent person in cases of doubt. 17