«Updated on 28 July 2015 Foreword This document has been produced by the Department for Work and Pensions (DWP) to provide guidance for providers ...»
2. Carrying out PIP assessments 2.0.1. PIP assessment providers are responsible for carrying out the PIP assessment. HPs advise DWP on the impact of the claimant’s health condition or impairment, on their ability to carry out key everyday activities and recommend which of the assessment criteria set out in legislation they believe apply to that individual. The decision for benefit entitlement rests with the Case Manager.
2.0.2. This section describes how to carry out the assessment. This includes the different processes for terminal illness cases, paperbased reviews and face-to-face consultations, including guidance on when the different types of assessment should be used. This section also covers other areas on which the HP may be asked to advise.
2.1. The PIP assessment process Case received from DWP 2.1.1. If they pass the basic entitlement conditions (for example, age, residence and presence), claimants will be issued with a How your disability affects you form (referred to in this document as the claimant questionnaire). This form asks the claimant to explain the impact of their health condition or impairment on their ability to carry out the daily living and mobility activities. A copy of the claimant questionnaire can be found at https://www.gov.uk/government/publications/how-your-disabilityaffects-you 2.1.2. Claimants will return their completed claimant questionnaire, and any supporting evidence they may have (such as a letter or report from their GP, Community Psychiatric Nurse or social worker), to the Department. The questionnaire and any evidence will be scanned and saved in the Document Repository System (DRS). The documents will then be available to be viewed via the claimant’s record in the PIP Assessment Tool (PIPAT) and/or PIP Computer System (PIPCS) 2.1.3. Once this has been completed, the case will be referred in the usual way via PIP Computer System to the appropriate AP for them to complete on the PIP Assessment Tool or clerically as appropriate.
2.1.4. The PIP Assessment Tool allows the provider to provide advice to DWP in an electronic format.
2.1.5. The following referrals will be sent to providers:
Initial review of case file 2.1.6. On receipt of referrals from DWP, providers should arrange for an
HP to conduct an initial review of the case file to determine whether:
2.1.7. See section 2.2 for more information on the Initial Review.
Further evidence needed 2.1.8. Providers should seek additional evidence from professionals involved in supporting claimants, where HPs feel that would help inform their advice. See section 2.3 for more information on seeking further evidence.
Terminal Illness process 2.1.9. Cases identified as SRTI will be flagged as such and must be fasttracked and follow a different process to standard claims. The HP should provide advice on whether the SRTI provisions are satisfied and advise on the claimant’s mobility. See section 2.4 for more information on the SRTI process.
Paper-based review 2.1.10. HPs should carry out assessments on the basis of a paper-based review in cases where they believe there is sufficient evidence in the claim file, including supporting evidence, to provide robust advice on how the assessment criteria relate to the claimant. See section 2.5 for more information on paper-based reviews.
2.1.11. In the majority of cases, a face-to-face consultation is likely to be necessary to accurately assess the claimant’s functional ability. This gives the claimant the opportunity to explain to the HP how their impairment or health condition affects them. It should enable the HP to gather sufficient factual information about the claimant and the functional effects of their disabling condition(s), in order to advise DWP. See section 2.6 for more information on face-to-face consultations.
Advice produced for DWP
2.1.12. The assessment process, whether involving a paper-based review of the claim evidence or a face-to-face consultation, will result in a report advising DWP on the claimant’s circumstances, the functional impact of their health condition or impairment on their everyday life and how the assessment criteria relate to the claimant. Reports should be clear, fully reasoned and justified. See section 2.8 for completing assessment reports and 5.2 for more information on report writing.
2.2. Initial reviews 2.2.1. On receipt of a referral from DWP, HPs should conduct an initial review of the case file to determine the next steps in the assessment process.
2.2.2. HPs should consider, as part of their initial review, whether the claim is likely to be a SRTI case. Although claims where individuals have claimed under the SRTI provisions will be flagged as such, some claimants may be unaware of the SRTI provisions and make a claim under the normal claim process, despite being terminally ill. Should the HP discover a case that appears to fall under the SRTI provisions, it should be processed under the fast-tracked SRTI arrangements (see section 2.4 on SRTI below).
2.2.3. The HP should then scrutinise the evidence and complete either clerical form PA1 where used or record the information in the PIP
Assessment Tool when they decide whether:
2.2.4. The Department expects that face-to-face consultations are likely to be required in the majority of cases to ensure full evidence based advice to the Department. However, in a proportion of cases there will be sufficient evidence available to advise on the case without the need for a consultation.
2.2.5. The HP should ideally wait for the return of any further evidence requested before deciding on whether a face-to-face consultation is needed. However, this is not necessary if it is likely that a face-toface consultation will still be needed – for example, if the claimant has not returned a claimant questionnaire or where the HP considers that further evidence is only likely to be of limited value.
2.2.6. APs may receive some referrals from the Department from customers who have a mental health or behavioural condition, learning difficulty, developmental disorder or memory problems (and be flagged as having “additional support needs”) and have not returned their claimant questionnaire. In these cases HPs will need to consider the appropriate approach to completing the assessment.
See section 2.11 for further information.
2.2.7. The HP should document the choice of further action taken during the initial review and justify this, providing this to DWP as part of the case documentation.
2.2.8. HPs should consider the needs of vulnerable customers. A vulnerable customer is defined as “someone who has difficulty in dealing with procedural demands at the time when they need to access a service.” This includes life events and personal circumstances such as a previous suicide attempt, domestic violence, abuse or bereavement. If a claimant has been in contact with DWP and threatens self-harm or suicide, information about the incident will be included in PIPCS – Medical Evidence screen comments box. It should be noted that in the context of PIP, the definition of vulnerability differs from that of additional support which relates to a defined range of health conditions and is covered at section 2.10.
2.2.9. The HP should complete a PA1 – Review file note where used or the relevant screen in PIP Assessment Tool explaining the action taken on the case, how the decision was made on the type of assessment and the evidence used.
2.2.10. If further evidence is requested and returned, a further PA1 where used or the relevant screen in PIP Assessment Tool should be completed to inform on the next steps after the review of the further evidence.
2.3. Further Evidence 2.3.1. The Department will send claimants a questionnaire to gather information on how their health condition or impairment affects their ability to carry out the daily living and mobility activities. This will be returned to the Department and scanned into the Document Repository System before the case is referred to the assessment provider, although the questionnaire may not be provided when the claimant has additional support needs – i.e. where the claimant has a mental health or behavioural condition, learning difficulty, developmental disorder or memory problems and has not returned the questionnaire.
2.3.2. The claimant questionnaire gathers basic information about the claimant’s health conditions or impairments, including treatment. It then focuses on each of the daily living and mobility activities in turn.
Claimants are asked a series of questions for each activity about their ability to carry out the activity. The questions also include whether the claimant needs to use an aid or appliance and whether they are able to complete the activity safely, to an acceptable standard, repeatedly and in a reasonable time period.
2.3.3. Claimants will be encouraged to submit alongside their claimant questionnaire any additional evidence they may have that they think is pertinent to their claim. This is not a requirement and some case files may therefore contain no additional information other than the claimant questionnaire (and in some cases will not even have that).
2.3.4. Claimants will receive guidance on documents that may be particularly useful. They will only be encouraged to provide evidence that they already have and not to delay their claim to seek evidence or ask for evidence for which they might be charged – such as a letter from their GP.
2.3.5. HPs should consider all claims at initial review and, if they believe that further evidence would help inform their advice to DWP or negate the need for a face-to-face consultation, they should take steps to obtain this. The consideration of whether further evidence should be sought should take place before any decision to schedule a face-to-face consultation is taken.
2.3.6. In the claimant questionnaire, claimants are encouraged to list the professionals who support them and are best placed to advise on their circumstances. HPs should consider which professionals identified can provide useful evidence. They should not simply request evidence from all professionals identified as standard.
2.3.7. It will not always be necessary to request further evidence in every case but the HP should always consider whether it is likely to add value to the assessment process and the quality of their advice. This will include both where they feel that further evidence will allow them to offer robust advice without the need for a face-to-face consultation and where they feel that a consultation is needed but that there would still be value in gathering further evidence.
2.3.8. The circumstances where obtaining further evidence may be
appropriate include (but are not limited to):
2.3.9. On the return of further evidence, the case should, wherever possible, be reviewed again by an HP to see whether this evidence is sufficient to provide advice to the DWP on the impact of the claimant’s health condition without a face-to-face consultation, whether more evidence is required or whether a face-to-face consultation should be arranged. If a face-to-face consultation has already been arranged and, following receipt of further evidence, the HP concludes that they can now advise on the basis of paper evidence, the face-to-face consultation should be cancelled.
2.3.10. If a claimant brings further evidence to a face-to-face consultation, the HP should take a copy of it and take it into account when completing their assessment report. A copy of the evidence should also be sent to the Case Manager with the completed report (see 2.7.26 for details of taking further evidence while undertaking a home visit).
Sources of further evidence 2.3.11. The HP should consider the most appropriate evidence for the case under consideration. There is a variety of sources of further
evidence, including, but not limited to:
Seeking further evidence from professionals 2.3.12. The Department has three standard proforma for use in seeking evidence in writing from (a) GPs; (b) hospitals and (c) other professionals. These proforma are provided separately.