Ask CPAG Online - How should you get more medical evidence?

Supporting medical evidence is often the key to successfully disputing a PIP disability decision, as the overall issue is how your disability or medical condition affects your ability to carry out the prescribed activities. The DWP decision is normally based on the PA4 medical report and any other evidence submitted by the health care professional following your medical consultation and you may need to provide your own medical evidence to counter this.

Who should you ask for medical evidence?

You could ask your GP, hospital doctor, occupational therapist, community psychiatric nurse or any other health professional who treats you. Your own evidence (e.g. in a diary or written statement) and evidence from relatives or other people who know or care for you is also entirely valid.

How should you ask for medical evidence?

It is normally best to write to the health or social care professional who knows about the difficulties you have carrying out the PIP activities, explaining that you are disputing a decision to refuse PIP and that you need extra evidence to support your case. You should briefly explain the test for qualifying for PIP (you may want to include the list of descriptors and activities) and ask for an opinion as to whether you satisfy relevant descriptors because of your medical condition or disability, taking into account the ‘frequency’ and ‘reliability’ rules.

Each request will be different and there are no hard and fast rules about how to frame it, but you should bear the following points in mind:

  • It is generally best to stress that you only need a short letter addressing specific points, rather than a lengthy medical report. Doctors are generally very busy and are more likely to respond to requests for specific information, and short letters or reports may be more effective in mandatory reconsiderations (MRs) and appeals.

  • You should avoid ‘leading questions’ e.g. stating that you satisfy certain descriptors, rather than seeking an independent opinion.

  • The evidence should relate to the ‘required period’ of 12 months. It does not matter when it is provided or dated, as long as it relates to the relevant period. Changes in circumstances subsequent to the decision you are disputing cannot be taken into account by the DWP or tribunals.

When should you ask for medical evidence?

You should ask for medical evidence as soon as possible, although you can submit additional evidence at any time during a dispute process. You should not delay requesting a MR or appeal while you are getting medical evidence, if you may miss the one month time limits. You can explain that you are seeking extra evidence and will submit this as soon as possible. In the case of MRs, additional evidence may increase the chances of a successful outcome, but may delay a decision.

How do you deal with problems getting evidence?

Problems include refusals to provide evidence, delays, demands for fees from doctors, and inaccurate and unfavourable evidence. 

There are no easy answers when these difficulties arise and you may need to seek alternative sources of evidence and explain to the DWP or the appeal tribunal why you were unable to obtain more evidence. Note that you are not obliged to submit unfavourable evidence and that the DWP and tribunals have the power to obtain more evidence themselves (but the nature of their requests will be out of your control).