The PIP claim process for people who are terminally ill

For anyone who is terminally ill and not expected to live more than 6 months, there is a special fast-track PIP claim procedure called Special Rules for Terminally Ill.

The UK Government Welfare Reform Act defines someone who is terminally ill as ”suffering from a progressive disease, and death in consequence of that disease can reasonably be expected within six months.”

Obviously this is a very stressful and challenging time for any individual and for their family and friends. Both DWP and our staff will try to simplify and ease the process for claiming PIP.

People who meet the criteria for claiming under the ‘Special Rules’ for terminally ill people:

  • Don’t have to complete a ‘How your disability affects you’ form
  • Don’t need a face-to-face consultation
  • Are guaranteed to receive enhanced rate of the daily living component of PIP
  • May also receive either the standard or the enhanced level of the mobility component depending on individual circumstances

How it works:

1. Someone needing to claim under the ‘Special Rules’, process should start by Atos-Healthcare-pip-terminal-illness-phonetelephoning the DWP on the PIP new claims line on 0800 917 2222 – callers should select option 1 for a new claim and then option 3. A dedicated special rules team will take the call and complete the claim. This phone call can be made by the individual or someone calling on his or her behalf. Some people are unaware that they have a terminal illness and it is not always in their interest to inform them. This is something that should be discussed with the health professionals providing care to the individual. The individual could still be entitled to PIP even if they are unaware of their diagnosis. When claiming on behalf of someone with a terminal illness it is important to let DWP know if they are not aware of the situation.

2. We understand that this is a very difficult time for individuals and their families and our health professionals will try to be as tactful as possible.

3. During the call the DWP agent will ask some questions about you and the person on whose behalf you are calling.

4. In most cases where there is a diagnosis of a terminal illness the GP or other Health Professional dealing with the case will have provided a DS1500 medical report. You will not be charged for this report.

5. The DS1500 should be sent to the DWP when you apply for PIP, however, you should not wait for this if it will significantly delay your application. If you have already sent a DS1500 form to DWP in the last six months, then you don‘t need to send a new one unless the condition has changed.

6. Once the claim has been registered by DWP, they will refer it to an assessment provider who will review the information and the evidence provided and respond to DWP, generally within 48 hours.

If you, or the person on whose behalf you are claiming does not meet the DWP criteria for terminal illness they will ask you to make a claim under the ‘Normal Rules’, and will send a ‘How your disability affects you’ form. This is likely to result in a face to face consultation and may take significantly longer to arrange. If the condition then deteriorates during this time it is important that you let DWP know that the circumstances have changed.

If you are already receiving Disability Living Allowance

If you are already getting Disability Living Allowance (DLA) under ‘Special Rules’ for terminally ill people, you will be invited to claim PIP once your DLA award has ended. If you are already getting DLA under the ‘Normal Rules’ and you have become ‘terminally ill’ as defined by the DWP, you should speak with DWP to find out if you will be invited to claim PIP.

If you are claiming for another person

Once an award has been made DWP will send payment directly to the person with the terminal illness. He or she does not need to know that that the claim has been made under the ‘Special Rules’ for terminally ill people and this will not be mentioned by DWP.

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How are fluctuating medical conditions handled under Personal Independence Payment (PIP)?

We know that many people have conditions or disabilities that may vary over time. They may have good and bad days, good and bad months, or good and bad times within a day. If you have a fluctuating condition, you will want to be sure that it will be fully considered during your assessment.

Atos-Healthcare-pip-fluctuating conditions-calenderHealth professionals are asked to establish how your condition affects you over a 12 month period. If your condition means you are unable to undertake a certain activity for the majority of days in the year, you will be considered unable to undertake the activity. Someone who is unable to perform an activity four days a week will be considered as effectively unable to complete the activity. Conversely if you are unable to perform an activity only two days a week you would be seen as able to perform the activity for the majority of days.

Where an activity cannot be performed for part of a day it is deemed that it cannot be done at all on that day.

In addition to the health professional establishing how your condition affects you over a period of time, he or she will also consider reliability – i.e. whether an activity can be completed safely, to an acceptable standard, repeatedly and in a reasonable time period.

Atos-Healthcare-pip-fluctuating conditions-diaryIf your condition varies, it’s a good idea to keep a diary to provide a picture of how your health condition impacts on your ability over time. In a diary over a typical period, you could note down that you need help doing certain activities; perhaps preparing meals may have been difficult for 5 days one week but OK on the other two days. This will help you answer any questions you might be asked about managing these activities. Longer-term diaries can be useful to record any difficulties lasting several days or weeks. The health professional will ask you specifically about variability of your conditions during your assessment, and will want to know if your ability in any of the PIP activities differs from time to time.

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What are the ‘reliability’ criteria that are used during the PIP Assessment?

Personal Independence Payment (PIP) is a benefit aimed at helping people to live an independent life. PIP assesses your ability to perform 12 daily living and mobility activities, such as preparing food, communicating verbally, and planning and following journeys. It is not sufficient to be able to complete these activities once, or occasionally; PIP assesses your ability to undertake tasks “reliably”.Atos-Healthcare-PIP-reliability-criteria-crossing

Reliability has four components each of which must be satisfied in order for an activity to be undertaken ‘reliably’. The
four components are:

  • Safely
  • To an acceptable standard
  • Repeatedly
  • In a reasonable time

Activities must be performed safely. This means you must be able to undertake them in a way that is unlikely to cause harm to you or anyone else. This could be either during or after you have done the activity. For the purpose of PIP, something is unsafe only if harm is likely to occur; it is not sufficient for you to feel harm may occur.

They must be performed to an acceptable standard. This means that the task must be done to a standard that would reasonably be acceptable to most people.

Atos-Healthcare-PIP-reliability-criteria-clock-faceIt should be possible to undertake the activity repeatedly. This means as often as reasonably required. For example if you are able to prepare a meal once without help, but the exhaustion from doing this means that you could not prepare another meal that day, you would be treated as being unable to prepare a meal unaided. This is because it is reasonable to expect someone to be able to prepare more than one meal a day.

The activities can be completed in a reasonable time. This means not more than twice as long as the maximum amount of time that a person without your health condition or impairment would normally take to complete that activity.

The ‘reliability’ criteria must be considered for each activity and will be considered as an integral part of the information-gathering process whether at a face-to-face consultation or during a paper-based review.

 

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Mental function champions: their role in the WCA

We know that people with mental health problems who are going through the Work Capability Assessment (WCA) are often concerned about whether their illness will be properly taken into account.

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The WCA is carried out by fully-qualified, experienced health professionals who are trained to assess people with a variety of conditions, including mental health.

As part of ongoing improvements to Work Capability Assessments, we have mental function champions to assist our health care professionals when carrying out an assessment of a person with a mental health condition.

The role of the mental function champions is to spread best practice and provide advice and coaching to health care professionals at any stage in a referral to us from the Department for Work and Pensions (DWP). They do this in a variety of ways. They can provide specific advice to health care professionals by phone and in person at both the initial scrutiny stage of a referral and in relation to a face-to-face assessment. They provide ad hoc skills transfer depending on the needs in their area. They also see people face-to-face like any other health care professional.

What are their qualifications?

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The mental function champions are all qualified clinicians who have at least three years post-registration experience. In addition, they have postgraduate clinical qualifications and/or experience in psychiatric practice as well as an ongoing interest in this area of medicine.

All health care professionals undergo a regular random audit of their work to ensure it meets the required standard.

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Arrangement of a PIP consultation

Most people making a claim for Personal Independence Payment (PIP) will be asked to attend a consultation either in a consultation centre or in the home.

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The initial appointment letter will contain:

  • The time, date and location of your consultation
  • Maps and directions to the consultation centre
  • An information leaflet that will answer some common questions about the consultation process
  • The phone number of the Customer Services Centre should you need to change the appointment

If you are unable to attend on the date you are given

If you are unable to attend your appointment please let us know as soon as possible so that we can rearrange it to a suitably convenient date and time. You can rearrange your appointment by calling our Customer Service Centre; the telephone number is written on your appointment letter.

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It is important that you try to attend your appointment. However, if you have to rearrange it we can usually offer you an alternative appointment on one occasion. If you do not attend your re-scheduled appointment, we may refer your claim back to the DWP.

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