I wanted to add some clarifications, additional information and suggestions to the material in the original post.
PIP Assessment Guide
The PIP Assessment Guide gives information to the assessment providers about the conduct of PIP assessments. It is a useful source of information for a wider audience on the PIP assessment process and PIP in general, though it is a document written for a specialist audience rather than for the general public and is not a definitive statement of the law.
The activities, descriptors and points
The official version of the activities, descriptors and points is found in Schedule 1 to The Social Security (Personal Independence Payment) Regulations 2013 (SI 2013/377). This version contains definitions of several key concepts, such as "simple meal".
Problems are only count if they are a result of your medical condition(s)
A problem only counts for PIP if it is caused solely by your medical condition(s) (a consequence of regulation 4(1) of The Social Security (Personal Independence Payment) Regulations 2013 (SI 2013/377)).
This can often be assumed. For example, someone with severe arthritis in their knees and hips will be expected to have walking problems because of their condition.
Sometimes, especially with mental health problems or with high levels of disability for the underlying medical condition, the assessment provider or DWP might argue the problem is not forced by the claimant's condition, but is at least partly a choice to do or not to do something. To help prevent this, you should explain why you have no choice in the matter. It will help if any supporting evidence explains the medical reasons for the problems claimed.
It helps to paint a clear picture for the reader. For example, someone who cannot go out unaccompanied because of anxiety could explain how anxiety affects them when going out, the difference someone accompanying them makes and any incidents that illustrate how anxiety affects them away from home. Merely stating "My anxiety means I cannot go out unaccompanied" does not give the reader a clear understanding of how anxiety limits you.
PIP awards "for an ongoing period"
Open-ended awards of PIP are "for an ongoing period". This is similar to an indefinite DLA award, but "ongoing period" PIP awards may include a date for an entitlement check.
Section 2.9.21 of the PIP Assessment Guide suggests that "ongoing period" awards may be limited to situations where the claimant's condition "is highly unlikely to improve or deteriorate". Anyone obtaining medical evidence on prognosis to submit with their PIP claim in the hope of the longest possible award should ask for this evidence to cover the likelihood of deterioration as well as the likelihood of improvement.
In situations where both PIP components are being awarded at the enhanced rate, meaning there is no scope to award extra PIP if your needs increase, a failure of the available evidence to consider the possibility of deterioration in your condition might lead the Case Manager to shy away from an "ongoing period" award.
Requesting medical evidence - some suggestions
It is best practice when requesting medical evidence for benefits purposes to put the request in writing. Your request should avoid leading the clinician in any way over what they write, so as not to undermine the objectivity of their comments. You should include a copy of the letter of request along with the evidence received, so the DWP can see the clinician was given open-ended instructions.
For example, I could have written to my neurologist along the lines of:
My reference: <yyyymmdd>/<NI number>
Dear Dr X,
In connection with a claim for benefits, I write to request a report on my condition. In particular, I would like your report to include:
- the length of time I have been under your care
- your diagnosis or other description of my condition
- the ways in which my condition fluctuates
- your opinion on the potential extent and likelihood of a change in my condition in the future (it would be helpful if your comments addressed the potential for deterioration and for improvement)
Please send your report to me at the above address, quoting the reference above (<yyyymmdd>/<NI number>). I will include a copy of this letter when I send your report to the Department of Work and Pensions.
I am content to pay a reasonable sum not exceeding £50 for your report. If you feel it necessary to levy a higher fee, please discuss this with me beforehand.
It would be helpful if you could send my your report before <date needed>.
Yours faithfully,
Obviously, you can adapt this model to cover other relevant factors. In my case, I would have also asked my neurologist for his opinion on whether there are any reasonable diagnostic or treatment avenues remaining to be explored. A statement suggesting that nothing further can be done to diagnose or treat your problems tends to support a stable prognosis.
The bit about the reference serves two purposes. It gets your NI number onto the report, also it makes it clear that the report was written with sight of your letter. <yyyymmdd> is the date in numerals - today would be 20131224.
By requesting opinion, you step away from the strictly factual reports usually sought by the DWP's assessment providers. The DWP tend to argue their health professional has specialist training in occupational and benefits medicine, which suggests DWP's health professional should be seen as having the most definitive voice. However, on issues where a clinician involved in your care possesses a level of expertise or insight that the DWP's health professional is unlikely to have, having their opinion available can assist both the claimant and the DWP.
It would have been difficult for a physiotherapist engaged by the DWP to argue successfully against the diagnosis or prognosis applied by a consultant neurologist working in the relevant department of a specialist tertiary hospital.
The NHS does not cover the cost of providing reports for benefits purposes. £50 is some way short of the full private rate for a consultant's report, but it is polite to offer something if you can afford to pay, also offering payment acknowledges the burden your request places on the author. You might be lucky if you offer what you can reasonably afford. I was really lucky, as both the consultants who wrote reports for me did so free of charge.
Reconsideration
PIP is subject to mandatory reconsideration, which means you must ask for a PIP decision to be looked at afresh before you can appeal to the First-tier Tribunal.
Reconsideration gives a potentially powerful opportunity to strengthen and clarify your case whilst dealing with any misconceptions.
A PIP decision letter contains written reasons for the decision, but it might be hard to understand those reasons without all the evidence used. A potentially helpful approach to reconsideration is to phone the DWP to:
- state that you want the decision reconsidered
- give broad reasons why you feel the decision is wrong, such as "the decision underestimates the difficulties I face with daily living activities and my mobility"
- request all the evidence upon which the decision was based
- state that you do not want the reconsideration to take place until you have had chance to make a more detailed submission in the light of the evidence used
It is a good idea to reiterate these requests in writing, stressing that the more detailed submission is to follow.
Once you have all the evidence, you can put together a carefully constructed reconsideration request which aims to guide the decision maker to the correct decision. If you are still unhappy after reconsideration, you have the right to appeal to the First-tier Tribunal.
IMPORTANT: Your reconsideration request must arrive at DWP on a working day within one month of the date of the decision letter, otherwise you have to show 'good cause' for its lateness. It is not enough to post the reconsideration request within one month. You are advised to use a trackable delivery method and keep the receipt.
If you are waiting for additional evidence, you should send the reconsideration request in time, noting that additional evidence will follow. "Waiting for evidence" may well not be accepted as 'good cause' for lateness.
An example of how to explain your problems in a way that maximises the points scored
A good example of how to maximise the points you score is seen in perditaf (Helen)'s experience. She started with 0 points for both components, so set about thinking why the decision maker might not have understood her problems. Having had her phone call from the decision maker, which is standard when PIP is refused, she made a reconsideration submission that painted a much clearer picture of her problems. She was awarded the enhanced rate of both components following reconsideration, with the award letter making it clear that many of her new explanations had helped.
I recommend reading the three threads linked in the last paragraph, as they give an excellent picture of how Helen set about explaining her problems in order to maximise the points she scored. Her approach would work just as well at initial claim.