Ask CPAG Online - How do you identify grounds?
Step one: Identify the DWP’s reasons and evidence
The first step is to establish the DWP’s reasons and evidence for making the decision you wish to dispute. The following documents will be relevant.
- The first document to look at is the decision letter on your claim for PIP, which you should receive from the DWP. This will summarise what you stated in your PIP2 questionnaire about each of the prescribed activities and whether the DWP decision maker accepts this in the light of the evidence (particularly the PA4 medical report form, which is completed by the health care professional (HCP) who assessed you at your medical examination arranged by Atos or Capita). It will then set out your score in relation to each of the prescribed activities, listing the descriptors which apply to you.
- You can request a copy of the PA4 medical report form. This sets out your medical conditions (including a brief history) and treatment, how you said you spend a typical day (and how your conditions affect your activities), clinical findings on examination, and the HCP’s opinion of your scores in respect of each of the PIP descriptors with a summary justification. The report is normally highly influential when the decision maker decides your claim (some critics say decision makers often ‘rubber stamp’ the HCP’s scores).
- You can also request copies of any other evidence referred to in your decision letter, for example a ‘GP Factual Report’ requested by the DWP, and your PIP2 Questionnaire (if you did not keep a copy). It is important not to delay requesting a mandatory reconsideration (MR) while gathering evidence, to ensure you comply wth the time limits. You can always make further representations after you have requested a MR and received copies of relevant evidence.
- After your request for a mandatory reconsideration has been considered, you should receive a mandatory reconsideration notice which explains the DWP’s revision decision in similar terms to the original decision letter.
- After you have appealed, you will receive a full bundle of appeal papers which includes the DWP’s submission to the appeal tribunal and a full schedule of evidence.
Step two: Identify errors, omissions and inconsistencies
This involves studying the above documents in detail and identifying:
- omissions and factual inaccuracies (e.g. in the PA4 report and decision notices) about your medical conditions and how they affect you;
- inconsistencies between the findings and your own or independent evidence (you will need to address these when you dispute the decision);
- any failures to choose the correct descriptors in the light of the evidence, taking into account the wording of the descriptors, the legal definitions of the terms used, and the PIP Assessment Guide which sets out detailed guidance for HCPs (but be aware that the Guide is not law and some of its statements are arguably wrong) (see ‘Have the correct descriptors been chosen?');
- any failures to properly consider and apply the ‘frequency’ and ‘reliability’ rules (see ‘Have the frequency rules been properly applied?’ and ‘Have the reliability rules been properly applied?’).
Step three: Identify which descriptors you satisfy
This involves identifying which descriptors you satisfied when the disputed decision was made, taking into account:
- the DWP’s reasoning and evidence, as identified in step one above;
- any errors, omissions and inconsistencies identified in step two above;
- the wording of the descriptors (see ‘Have the correct descriptors been chosen?) and any helpful guidance in the PIP Assessment Guide.
- the ‘frequency’ and ‘reliability’ rules (see ‘Have the frequency rules been properly applied?’ and ‘Have the reliability rules been properly applied?’);
- any more evidence you have or can get which supports your choice of descriptors.
You must establish that you would be likely to satisfy the relevant descriptors during the ‘required period’, which is normally 3 months prior to your claim and the following 9 months, so any evidence you submit should relate to this period. You must score at least 8 / 12 points to be entitled to the standard / enhanced rate of either component of PIP.