Ask CPAG Online - Are there errors and gaps in the evidence?

This is a common ground for disputing a decision, which interacts with the issues of the correct choice descriptors and the proper application of the frequency and reliability rules. The problem usually arises because of the inadequacies of the assessment process and the difficulties claimants often have understanding the rules and providing sufficient appropriate evidence.

What errors can arise from the PIP2 questionnaire?

The PIP2 questionnaire tries to adopt a ‘claimant friendly approach’ to obtaining relevant information from a claimant using plain language, but it does not accurately reproduce the wording of the descriptors, or adequately reflect the requirements of the ‘frequency’ and ‘reliability’ rules. The questions relating to each activity allow for responses of ‘yes’, ‘no’ and ‘sometimes’, but the distinction between ‘yes’ and ‘sometimes’ is unclear and there are no specific questions which relate to the ‘frequency’ rules. The open text boxes are difficult to complete, even allowing for the bulleted guidance, which mention but do not explain the ‘reliability’ rules.

It is often necessary to point out the shortcomings of the PIP2 evidence when you disputing a decision, both in terms of the format of the questionnaire, and the way it has been completed by a particular claimant, which may not accurately reflect the difficulties s/he has.

What errors can arise from the medical assessment?

The assessments follow a similar model to employment and support allowance medical assessments, which have been heavily criticised in a number of independent reports, as often being inaccurate, impersonal, judgemental, and non-specialist. Section 2 of the PIP Assessment Guide gives detailed guidance to health care professionals carrying out the assessments, setting high standards in relation to interviewing skills, eliciting and recording relevant information, dealing with fluctuating conditions, and completing report forms (including the PA4).

In practice, inaccuracies frequently arise as a result of the following factors:

  • The assessments are carried out by a doctor, nurse, paramedic, physiotherapist or occupational therapist, who may have no specialist knowledge of your condition. When assessing what weight to give their medical reports, it was held in CE/4111/2012 (a case about employment and support allowance rather than PIP) that the qualifications and experience of the assessor was relevant, but that there was no requirement for them to have specialist knowledge of your condition (e.g. a mental health condition).

  • The assessor may not have elicited sufficient information about your difficulties, including in relation to the ‘frequency’ and ’reliability’ rules, either because of inadequate questioning, or because you found it difficult to explain your problems or were not properly listened to.

  • Inaccurate and inadequate information in the PA4 medical report (including stock, judgemental comments about you can do).

It is often necessary to address the above issues in your grounds for disputing a PIP disability decision (see ‘Step two: Identify errors, omissions and inconsistencies’). Do you need further medical evidence? You may need to get further medical evidence to support your case and to counter the evidence used by the DWP to make the decision you are disputing (including the PA4 medical report). See ‘How should you present your case?’ for more details about getting medical evidence.

Case law has long held that decision makers and tribunals must take account of all relevant evidence and give it appropriate weight, and not automatically give more weight to the reports prepared for decision makers by health care professionals.