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Thread: So, your claim has been rejected. What now ?

  1. #1
    Senior Member
    Join Date
    Feb 2017

    So, your claim has been rejected. What now ?

    Whether you are transfering from DLA to PIP, renewing your claim for PIP or making a new claim, many people are having their claim rejected or reduced, so what are the next steps to take to get what you deserve ?

    In all cases it is important to understand the points scoring system, the descriptors and the criteria for an award. A good starting place is the B&W self test

    Many people have a lifetime DLA award but the criteria for PIP is different. PIP is a benefit based on functionality rather than condition. It looks at the help you need with certain daily living tasks, medical evidence is only important as a means to back up your claim, It will not win you an award on its own.

    Having completed the PIP 2 form to the best of your ability, attended a f2f assessment with a HCP, and requested a copy of the report (PA4), you receive the brown envelope with the result.

    At first you think the report is about someone else. It does not bear any relevance to your evidence or what transpired at your f2f. Then you realise that at best the HCP has overlooked things and at worst they have told blatant lies. Your money has stopped or been reduced and your car has to go back. Panic now sets in.

    How can a supposed HCP not see what is wrong with you ?
    What more can you do to prove that you deserve your award ?

    You can request a call back from a DM to discuss your concerns about the report but don't expect it to change anything. Make certain that they understand that this is not a request for an MR.

    Keep calm. You now have to request a mandatory reconsideration. This is your primary job now. Forget about the lies and complaints about the assessor for now, this will not win the award you deserve.

    The only way to get what you deserve is to prove that you meet the criteria for an award.

    Prepare your case. Take each descriptor that you disagree with and reference your evidence to each specific point.

    Often, difficulties in one activity will indicate difficulties in others, preparing food, washing and dressing can all be interlinked, don't assume that a DM or HCP will make the connection.

    Remember the reliability factors and apply them to each descriptor

    If you can get more relevant evidence ie. a GP letter detailing specifically the problems you have then this will help.

    You have one month from the date of your decision letter to ask for an MR. In reality by the time you receive it you will probably only have two weeks. You can request an MR by phone but make sure that you inform them that you will be sending further evidence, giving you time to collect anything that you want to submit. You should also confirm your request in writing, signed for is always a good idea when dealing with DWP.

    Having submitted your best case to the DWP you can now turn to the HCP and making your complaint to the AP if you so desire. This will not win your award but may go a little way to changing the system and of course, revenge is sweet.

    Officially, success at MR is around 20%, the reality is more like 10% for a successful outcome.

    If you have sent more medical evidence the the DWP will send your file to the AP for their assessment as DM's do not have medical knowledge.

    When you receive the "new" decision, there will be two copies, one of which is for you to submit to the tribunal if you are still unhappy with the decision. This must be done within a month of the date of the new decision letter. However, late appeals should be allowed, with good reason, up to thirteen months.

    Most claims that fail do so not for a lack of evidence but by the way it is read ( or not ). The reader does not want to wade through the equivalent of "War and Peace" to find the snippets of relevant evidence and so they favour the concise report of the HCP. Try to keep your evidence to the point and lead the reader to the facts that prove your claim.

    If at all possible, you should at this stage have submitted any and all your evidence, don't hold anything back in case you have to appeal to the tribunal. Always put forward the best case you can to give yourself the best chance of getting your just award.
    Anything expressed is my opinion only and is offered in good faith. It is either from my own experiance or what I have learned on my journey. Take it for what it is or leave it alone. With best wishes D.

  2. #2
    Senior Member gus607's Avatar
    Join Date
    Jul 2016
    Thank you, very informative.

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