A BASIC GUIDE TO CLAIMING DISABILITY LIVING ALLOWANCE (DLA)

Transcription

1 A BASIC GUIDE TO CLAIMING DISABILITY LIVING ALLOWANCE (DLA) Foreword: The Royal British Legion uses all reasonable endeavours to ensure the content of this guide is accurate at the time of writing. However, it is only a basic guide and cannot cover every possible situation. It is further recommended that when using this guide you read this document first before starting completion of your own Disability Living Allowance (DLA) form. We further recommend that you print off the sample DLA application form attached for further information, guidance. If you have any questions in regard to your eligibility for claiming this particular benefit please contact the Department for Work and Pensions (DWP) for further information.

2 Overview New Claims You can only make a new claim application for Disability Living Allowance (DLA) if you re claiming for a child aged under 16 this is known as DLA for Children. Please note that DLA for Children is not covered in these guidance notes. Anyone over 16 must now apply for Personal Independence Payments (PIP) instead of DLA if they live in England, Wales and Scotland if they are not already in receipt of DLA. Exceptions might be in regard to renewing current awards coming to the end of the award. You may also be able to reclaim DLA if all of the following apply: You were 65 or over on 8 th April 2013 You stopped getting DLA after the age of 65 You make a new claim to DLA within 12 months However, Personal Independence Payments (PIP) has not yet been rolled out in Northern Ireland subject to the Northern Ireland Welfare Reform Bill, which is currently completing its passage through the Northern Ireland Assembly. Therefore any new claimants in Northern Ireland may still be able to make a new claim application for Disability Living Allowance (DLA) but you should check with the Northern Ireland Benefit Enquiry Line at: Telephone No: Text phone: Telephone Lines Open: Freephone Minicom (for deaf and hard of hearing users only) Monday, Tuesday, Wednesday and Friday 9.00am to 5.00pm Thursday 10.00am to 5.00pm (An answer machine is available 24 hours a day where a message can be left for a call back during office hours) Existing DLA Claims PIP is gradually replacing DLA for people aged 16 to 64, even for those with an indefinite or lifetime award. If you were 65 or over on the 8 th April 2013 you can continue to get DLA if you re eligible. Aside from this age group your DLA probably won t be affected until 2015 or later. If your current award of DLA is up for renewal the DWP might still send you a DLA application form until they are ready to proceed with any transfer over onto PIP.

3 Current DLA Rates Disability Living Allowance (DLA) is a tax-free benefit and totally disregarded for income purposes. The rate you get is made up of 2 components (parts); a Care Component and a Mobility Component. How much you get depends on how your disability or health conditions affect you. The Care Component consists of three levels of award; lowest, middle or highest and the Mobility Component consists of two levels; lowest and highest. The current rates from April 2014 to April 2015 are listed below (reviewed annually): Care Component Weekly Rate Lowest Middle Highest Mobility Component Weekly Rate Lowest Highest How you will get paid DLA is usually paid every 4 weeks. All benefits, pensions and allowances are paid into an account e.g. your bank or building society account. Extra Help You could get extra benefits or tax credits if you get Disability Living Allowance check with the Disability benefits helpline or the office dealing with your benefit. Eligibility You may be entitled to Disability Living Allowance (DLA) for adults if your disability or health condition means one or both of the following are true: You need help looking after yourself You have walking difficulties You must tell the Department for Work and Pensions (DWP) if your circumstances change e.g. your condition improves or you need more help. Care Component You might get this part of DLA if you: Need help with things like washing, dressing, eating, using the toilet or communicating your needs Need supervision to avoid putting yourself or others in danger

4 Cannot prepare a cooked main meal for one (yourself) Need someone with you when you re on dialysis You may be eligible to get an award of the care component even if no-one is actually giving you the care you need or you live alone; it s not the help you get, it s the help you need that counts. Mobility Component You might get this part of DLA if, when using your normal aid (if you use one) you: Cannot walk Can only walk a short distance without severe discomfort Could become very ill if you try to walk You might also get it if: Have no feet or legs Are assessed as 100% blind and at least 80% deaf and you need someone with you when outdoors Are severely mentally impaired with severe behavioural problems and get the highest rate of care for DLA Need supervision most of the time when walking outdoors Are certified as severely sight impaired and you were aged between 3 and 64 on 11 th April 2011 Special Rules Someone aged 16 to 64 who is terminally ill can make a claim for Disability Living Allowance (DLA) under special rules. Claiming under these special rules ensures that the claim is dealt with quickly, normally within eight working days. The meaning of terminally ill The law on DLA says that someone is regarded as terminally ill if they have a progressive disease and their death from that disease can reasonably be expected within six months. Although there must be a reasonable expectation that death will occur within six months, naturally there is no certainty about this. DLA will normally continue to be paid under the special rules for three years. At the end of this time the person claiming DLA may be asked for further information about their health and how it affects them so that their entitlement can be reassessed.

5 The rate of DLA paid If someone's claim is accepted under the special rules they will automatically qualify for the highest rate care component of DLA. They will not automatically qualify for the mobility component of DLA. However, if they satisfy the disability rules for either the lower or higher rate of the mobility component, they will not have to satisfy the usual qualifying period. Making a claim under the special rules If someone is claiming under the special rules it is a good idea to discuss the claim with their GP or consultant. The GP or consultant will need to complete a form (called DS1500), which asks for information about the claimant's diagnosis and treatment. Your GP or Consultant may already hold these forms. The DS1500 form should be sent to the Disability Benefit Centre with the completed DLA claim form. When claiming under the special rules, the questions about help with care do not have to be completed. However, if a claim is being made for the mobility component of DLA then the questions about mobility need to be completed. If the person claiming is already receiving the lowest or middle rate care components of DLA or any mobility component of DLA then they do not need to make a separate claim under the special rules. They or you should ask for the existing award to be looked at again by the DWP under the special rules and enclose a DS1500 form. A decision maker will decide if the claim qualifies for entitlement under special rules. If the claim is refused under the special rules, you or the person you are looking after may want to consider asking the DWP to look at the decision again. Even if the claim is refused under the special rules they may qualify anyway under the normal disability rules. Making a claim on behalf of someone else A claim can also be made on someone else s behalf by a carer, family member, friend or professional person. The person who is terminally ill does not have to sign the claim form. They will simply be notified that they have been awarded the benefit, and payment will be made to them. The claim can be made without their permission or knowledge. A decision not to award DLA under the special rules can also be challenged without their permission or knowledge. Assessments You might get a letter saying you need to attend an assessment to check the level of help you need. The letter will explain why and where you must go. Your benefit may be stopped or refused if you do not go.

6 At the assessment you will be asked for identification. You can use a passport of any three of the following: Birth certificate A full driving licence Life assurance policy Bank statements Existing Claims Moving from DLA to PIP Your DLA probably will not be affected until 2015 or later but there are exceptions. Exceptions: You will be invited to claim PIP if either: There s a change in how your condition affects you Your current award of DLA is due to end This applies if you live in: Wales East Midlands West Midlands East Anglia This also applies if your postcode begins with: DG (Dumfries and Galloway) EH (Edinburgh) TD (Galashiels) ML (Motherwell) CA (Carlisle) DL (Darlington) HG (Harrogate) LA (Lancaster YO (York) In these areas changes to your circumstances can also affect when you ll be invited to claim PIP When you apply for PIP You can apply for PIP when asked or you can choose to claim PIP (if you choose to claim PIP before you are asked too you need to be aware that should your PIP award not be successful you will not be able to opt to remain on DLA after you made

7 the decision to apply). Your DLA will continue for at least 28 days after the decision is made about your PIP claim. You cannot get PIP and DLA at the same time. Your DLA will end: If you decide not to apply when requested by the DWP When DWP make a decision about your PIP claim Change of circumstances You must contact the Disability Benefits helpline if your circumstances change (contact details are at the end of this document), as this can affect how much Disability Living Allowance (DLA) you get. For example: The level of help you need or your condition changes You go into hospital or a care home for more than 4 weeks You go abroad for more than 13 weeks You re imprisoned or held in detention You must also contact the helpline if: You change your name, address or bank details You want to stop receiving your benefit Your doctor s details change Please Note: You could get a 50 civil penalty and have to repay overpaid benefits if you do not report changes and are overpaid as a result. Appeal a decision You can appeal against the decision about your Disability Living Allowance if you are unhappy with it. Check the date on your decision letter (you have one month from this date). Decisions made on or after 28 th October 2013 Check the date on your decision letter, you must usually: Phone or write to the Department for Work and Pensions (DWP) and ask them to explain the decision made If you do not agree with their decision ask for the decision to be looked at again this is known as a Mandatory Reconsideration. It is recommended your put your request in writing and keep a copy of your written request for reference You should explain why you think the decision is wrong and show any evidence you have to support this.

8 Following a Mandatory Reconsideration the DWP will issue you with a new decision, which may or may not be a more favourable outcome decision If you are unhappy with the decision following mandatory reconsideration you have the right to Appeal What Happens Next? Once the mandatory reconsideration stage has been completed the DWP will send you 2 copies of the Mandatory Reconsideration Notice, which explains the reasons for changing or not changing the decision. They ll telephone you if they re not going to change the decision or going to change only part of it. Mandatory Reconsideration does not apply if you are trying to bring a late appeal against a decision that was made before 28 th October Appeal the Decision You can appeal to the Social Security and Child Support Tribunal if you are still unhappy with any decision made in regard to your DLA claim. These are independent tribunals, called a First-tier Tribunal, who will look at the decision and replace it if they think it is wrong. The tribunal is part of Her Majesty s Courts and Tribunals Service. You can download the SSCS1 form from: Please Note: you must send the completed SSCS1 form and 1 copy of your mandatory reconsideration notice to the address on the form and it must reach them within 1 month of receiving your mandatory reconsideration notice (this will be dated). When returning the form we recommend that you ask for a proof of postage from your post office or send it by special next day delivery postal service if you are getting near to the one month date time limit. Asking for an Oral Hearing Form SSCS1 also includes questions about whether you want an oral hearing (and dates you can or can t attend) or whether your want your appeal to be determined on the papers (known as a paper hearing). It is generally recommended that you opt for an oral hearing particularly if you are appealing a decision relating to your fitness for work or disability. This is because the tribunal can ask you questions in an oral hearing about anything that is unclear. The tribunal cannot do this with a paper hearing and so it cannot give you the benefit of the doubt over any gaps in your evidence. Your chances of being successful at an oral hearing are higher still if you can attend the tribunal with a representative. The Royal British Legion has a specialist Independent Living Advice Team, who may be able to take your case on and provide representation for you. You can contact the Legions ILA team by:

9 Go online Call us (calls are free from UK landlines and main mobile networks) Pop in - to one of our local centres, contact us to find out where you re nearest Pop in centre is. Time Limits to Appeal Your appeal must normally reach the Courts and Tribunals Service within the standard one-month time limit, which starts on the day after the DWP, sends you the mandatory reconsideration notice. If your appeal is late you must explain why and the tribunal will consider your reasons and can extend the time limit. It has the power to accept late appeals up to 13 months after the date of the mandatory reconsideration notice. The Appeal Response The Courts and Tribunals Service will send a copy of your appeal to DWP and ask them to provide a response to explain how they came to their decision. As from October 2014 the DWP will have a time limit to provide this within 28 calendar days, although they can ask for an extension. The Courts and Tribunals Service will provide you with the appeals pack known as the Statement of Case (SOC) and a copy of the SOC will also be sent to your representative if you have appointed someone and let the Tribunals Service have their contact details. The Appeal Hearing Date If you opt for an oral hearing the Courts and Tribunals Service will arrange a time and date and must tell you at least 14 days in advance of any hearing date set. Contact Details for the Disability Benefits Centre: Disability Living Allowance Helpline Dcpu.customer-services@dwp.gsi.gov.uk (if you are 16 or over) Midlands-dbc-customer-services@dwp.gsi.gov.uk (if you are under 16 years old) Telephone: Textphone: Monday to Friday 8.00am to 6.00pm

10 Postal address for DLA Adult (aged 16 or over): Disability Benefits Centre Warbreck House Warbreck Hill Blackpool Lancashire FY2 0YE