«Updated on 28 July 2015 Foreword This document has been produced by the Department for Work and Pensions (DWP) to provide guidance for providers ...»
2.12. Requests for Supplementary Advice 2.12.1. Case Managers may make requests for supplementary advice at any stage in the decision-making process. The supplementary advice option will be used where the report overall is fit for purpose but there is a need for some aspects to be clarified further.
2.12.2. If a report is not capable of comprehensively providing advice to the Department (e.g. due to a lack of clarity, legibility, impartiality, or there is inconsistency in the advice) then the report is not fit for purpose and will be sent for rework rather than a request sent for supplementary advice. For more information on rework see section 4.6.
2.12.3. Reasons for supplementary advice might be (but are not limited to):
2.12.4. Supplementary advice may also be requested for a reconsideration where the claimant challenges a decision made about entitlement to PIP, or for the early revision of a decision as part of the appeals process. The case manager will re-examine the facts of the case, the law and any other issues which applied when the decision was made. The purpose of the reconsideration is to try and resolve disputes without the need for appeal. The HP may be asked for advice on further evidence from the claimant and may request further evidence before providing advice to DWP.
2.12.5. HPs should answer questions posed by the Case Manager but must avoid giving any prescriptive advice that refers to possible benefit entitlement, as final decisions rest with the Case Manager. Advice should be clear, succinct, justified and in accordance with the consensus of medical opinion.
2.12.6. Where consideration of Supplementary Advice requests results in the HP changing their previous advice to the DWP, this should be clearly flagged.
2.12.7. Requests for Supplementary Advice may be made to providers by telephone and/or through the PIP Computer System and/or via PIP Assessment Tool, depending upon the nature of the request.
Telephone requests can be resolved by a discussion. Requests for advice through the PIP Computer System should be responded to using clerical forms PA5 or PA6.
2.12.8. HPs should use clerical form PA5 to provide supplementary advice that does not affect the descriptor choices or advices on prognosis in the original report. For example, it maybe used to respond to a request for clarification about medication or treatment that affects the claimant’s health condition or impairment. The PA5 should also be used where additional information does not change the original advice.
2.12.9. If there are changes to the descriptor choice, the HP should complete clerical form PA6 to highlight the evidence used to support any changes and provide full justification for their choice. The PA6 may also be used for changes to advice that does not relate to descriptor choice, e.g. prognosis.
2.12.10. Where the assessment was completed using the PIP Assessment Tool, it will be necessary to create the appropriate supplementary advice on the PIP Assessment Tool and once submitted a PA5/PA6 will be output to DWP.
2.13. Advice on substantially the same condition 2.13.1. One area that HPs may be asked to advise on is whether a claim for PIP is being made for “substantially the same condition” as an earlier claim.
2.13.2. Where the functional effects of a claimant’s health condition or impairment reduce – for example, as a result of remission – their entitlement to PIP may stop. Re-claims to PIP by individuals who have developed a new condition or conditions which are unconnected with the condition or conditions that gave rise to the previous entitlement will be treated as an entirely new claim and have to fulfil the Qualifying Period of three months.
2.13.3. Some conditions, however, can subsequently deteriorate leading to a further entitlement to PIP – for example, certain types of multiple sclerosis have periods of remission and deterioration, while a person with cancer may respond well to treatment and then relapse.
2.13.4. As such, the legislation allows for a linked claim where the claimant
is claiming for either:
In such cases, if the claimant re-claims PIP as a result of a deterioration in their condition, they do not need to satisfy the threemonth qualifying period for any component or components to which they previously had been entitled – provided they re-claim within two years if of working age (16 to 64 years) or one year if they are aged 65 or over. All claimants need to satisfy the prospective test regardless of previous entitlement.
2.13.5. In most cases it should be possible for Case Managers to identify those cases where a claim has been made for substantially the same physical or mental condition or range of conditions. However, in cases of doubt HPs may be asked for advice, based on their knowledge of the disabling effects of physical and mental conditions and considering the evidence of the case.
2.13.6. Considerations that the HP should make include, but are not limited
2.13.8. In Miss B’s case the link can be made as it is merely a different way of expressing her mental health condition. However, care should be taken to ensure that the advice given is appropriate for the individual
case as opposed to general advice. For example:
2.13.9. Miss T’s mental health condition is the same as Miss B’s, but the root cause of her mobility problem was not the same.
2.14. Consent and Confidentiality Consent 2.14.1. Consent is an integral part of claims for benefit but it cannot be assumed that in an individual case consent has been given or that consent previously given remains valid. Thus in every case, before each instance that information is obtained or released, checks should be made to ensure valid consent is held.
2.14.2. Consent may be written, verbal and in certain circumstances given by a third party.
2.14.3. For consent to be lawful under the Data Protection Act 1998 (DPA) it must be ‘fully informed and freely given’.
2.14.4. For consent to be fully informed and freely given the claimant must know exactly why the information is needed, what is going to be done with it, and with whom it might be shared. The claimant must not be coerced into giving consent when he/she is unwilling to give it – e.g. it is inappropriate to say things such as “unless you agree to a report from your GP being obtained we cannot advise on your claim’. HPs may, however, flag that a DWP Case Manager will make a decision on benefit entitlement based on the evidence available in the case and it is important that they have access to the best evidence.
2.14.5. In the case of information defined as ‘sensitive’ in Schedule 3 of the DPA, consent must be explicit. The categories of sensitive
information under DPA are:
2.14.6. For consent to be explicit, in the case of sensitive information, the claimant must be fully aware of the nature and content of the information being processed.
2.14.7. Consent to contact third parties will be sought by DWP during the initial claim information gather – regardless of whether the claimant made a claim over the telephone or on a written claim form. The fact that consent has been given (or not) will be made clear in the referral from DWP. Providers should check that this has been provided.
2.14.8. Should there be no claimant consent provided at the initial claim stage, it can be sought verbally by providers over the telephone.
Timescales for consent applying 2.14.9. All staff (HPs and administrative staff) should be made aware that it is important to be confident that the consent is still valid. Depending on how it is worded, consent - and in particular implicit consent may only cover a particular stage in the processing of a claim, and thus fresh consent may need to be sought. If there is any doubt as to whether the consent is still valid, fresh consent should be sought.
2.14.10. Consent can be withdrawn by claimants at any time in the claim.
2.14.11. In order to ensure that consent remains valid, the Department advises that in any case where consent is over 2 years old, action should be taken to confirm that it still reflects the claimant’s wishes.
The Department is exploring opportunities to gather refreshed consent when PIP claims are subsequently reviewed.
2.14.12. It is good practice to check that there is valid consent every time further evidence is sought.
Consent to a physical examination 2.14.13. Although it could be taken that, by attending a face-to-face consultation, the claimant has given consent to a physical examination; it should not be assumed that this is the case. At every stage of the proceedings the claimant should be advised as to what is going to happen and agree to it happening.
Appointees 2.14.14. Claimants who are unable to manage their own financial affairs can have a person appointed to do this for them. Appointee action is only taken where the claimant is incapable of managing their affairs. This is usually because the claimant is mentally incapable but, exceptionally, may also be appropriate when the claimant is physically disabled – e.g. if they have suffered a stroke which has resulted in a significant impact on their functional ability. An officer acting on behalf of the Secretary of State authorises an appointee to act for the claimant in specified circumstances.
2.14.15. An appointee becomes fully responsible for acting on the claimant’s
behalf in all the claimant’s dealings with the DWP. This includes:
2.14.16. The fact that claimants have an appointee will be flagged by DWP in the initial referral to providers.
2.14.17. Any paperwork supplied by a corporate appointee using a signature stamp rather than a manuscript signature is not acceptable. The paperwork would need to be returned for a manuscript signature. If a person is acting for the corporate appointee then they should ideally sign “Joe Bloggs acting as the agent/representative of the corporate appointee” or similar. Where there are doubts, providers can check matters relating to appointees with DWP.
Power of Attorney/Deputy 2.14.18. A Power of Attorney/deputy is a formal instrument by which one person (a donor/the Court of Protection) empowers another (a donee, who is the attorney/deputy) to act on his behalf either generally or in specific circumstances.
2.14.19. The responsibilities of an attorney/deputy may include, but are not
Proof of consent 2.14.20. Proof of consent given by claimants need not be routinely sent by providers when requesting further evidence. The NHS accepts that consent is an integral part of claims for benefit, and proof of consent is not necessary before information is released by hospitals, trusts and clinics funded by the NHS or local authorities. From time-to-time hospitals are reminded of their obligations to provide information in connection with claims for benefit and that proof of consent is not necessary.
2.14.21. The position that proof of consent is not required is supported by the General Medical Council, which advises that: ‘…you may accept an assurance from an officer of a government department or agency or a registered health professional acting on their behalf that the patient or a person properly authorised to act on their behalf has consented’.
2.14.22. If GPs, consultants and doctors request proof of consent they should be reminded of the General Medical Council’s advice. If they still require something in writing, the HP should email them a letter assuring consent is held and quoting the GMC advice.
2.14.23. Occasionally an HP may be asked to provide evidence that consent is held in the form of the claimant’s signature before the information is forthcoming. Only in exceptional circumstances where the GP or hospital has given a valid reason as to why they do not follow the GMC and/or the NHS guidance should proof of consent be sent when requesting further evidence.
2.14.24. In such cases the provider should contact the Department for information.
2.14.25. In non-Terminal Illness (TI) cases it may be appropriate to obtain further evidence from an alternative source should proof of consent be an issue.