How long does it take to claim PIP?

The steps involved in making a claim

• Get hold of a claim form
• Complete the form and send it in
• The assessment stage
• Receiving the decision on your claim

All being well, the decision is right and you have the award you should have. That does not always happen. Just on the off chance that you are not happy with the decision, you need to know that the following steps could be involved.

• Ask that your claim is looked again – a Mandatory Reconsideration
• Appeal to an independent tribunal if you are still unhappy
• Challenge the tribunal’s decision if you believe that they got it wrong

Let us break that down – getting hold of the claim form

The number to call depends on where you are; call 0800-012-1573 if you are in Northern Island but 0800-917-2222 anywhere else in the UK. Have your GP’s name, address and phone number in front of you as well as your bank details and National Insurance number. You will be asked if you have arranged for help in making your claim, so if you are going to have help, have their name, address and number with you. There is no doubt in my mind that you will are more likely to get the right award if you work with someone experienced and knowledgeable. Think how you will know what the right award is without having that help.

You can deal with this first stage using a textphone by calling 0800-012-1574, and if you cannot start the claim by phone, you also have the option of providing the required information in a short form, which you can request by writing to:

Personal Independence Payment New Claims, Post Handling Site B, Wolverhampton WV99 1AH

Completing the claim form

Essentially, get help – good quality help, so use the days before the form arrives to find that help. The form asks for details of health professionals who know how you are affected; remember that this is the key, how you are affected, not what is wrong with you. They include people such as occupational therapists, physiotherapists, social workers, community psychiatric nurses, counsellors and support workers. Remember though that they are unlikely to approach any of these as they prefer to rely on their own assessment of you. Do not rely on them asking for anyone else’s opinion of you, reports or GP notes. If you have any letters or reports that give information about how you are affected by your conditions, then take advice from the person helping you with the claim on whether they should be sent or not. Things like appointment letters say nothing about how you are affected, so there is no point in sending them. Two people with the same medical condition could be affected in quite different ways, which is why they ask that you do not send general information about your condition. I sometimes ask myself why a client has sent in some medical letters when I am brough in to help with an appeal. You could say that the Department should see everything, warts and all, but the fact is that some clients send in material that undermines their case because they could not see that. Take advice from whoever is helping you. If you have no choice but to do this alone, then read everything twice before you decide to send it in; once to make sure that it is relevant, so it tells the reader something about how you are affected by your condition and a second time from the Department’s point of view, looking for something that a negative thinker could latch onto as a reason not to believe what you have said in your form, a reason not to award points. Having said that, I cannot see why anyone would opt to do this without help; there is good quality help available without charge, and if the wait for that free help is too long, or you cannot get to them, then help is available on the basis that you pay affordable instalments until the claim is successful and you receive your arrears dating back to when you made the first call to PIP.

You need to know where you ought to score points; this is the only way for you to know what the assessor and Decision Maker need to understand if they are going to award those points. If the person you approach for help is not going to give you advice on which points ought to be awarded, walk away as this suggests that they do not know enough to help you. You can find useful information in my articles, PIP Descriptors. The form will have a date by which you should return it. If you can see that you are going to need more time, call them on 0800-121-4433 to ask for an extension. You can expect to be asked why you need more time so have an answer. Reasonable requests are usually allowed.

Sending it in

Send only copies of that supporting evidence, and put your name and National Insurance number at the top of each page, then send the whole thing off ‘signed for’, keeping a note of the Royal Mail tracking reference. Make sure that the Post Office reduce the cost of posting by the value of the pre-paid postage on the envelope that came with the form. 

The assessment stage

Ordinarily, I would suggest that you will almost certainly have a face-to-face assessment somewhere between 3 and 10 weeks after sending in the completed form. The assessor is unlikely to have any prior knowledge of your condition and while most assessors are qualified nurses, that title can cover a huge range of knowledge and experience. You could instead be assessed by a physiotherapist, a paramedic or an occupational therapist. For some claimants, that could be a good fit, but you can understand the concern of someone whose problems are partly or entirely based on mental health or autism, for example, when the assessor introduces themselves as physiotherapist. I do not recommend that you express that concern in the assessment as clients who have come to me to have problems sorted out have described obvious resentment on the part of the assessor when their ability to do the job is questioned. The Department would probably reassure you that the assessor is not there to examine or to diagnose or treat you, but simply to assess the impact of the person’s conditions, looking at the activities set out in PIP test, and that the assessor was a trained disability analyst. All of that is true, but I have seen enough reports that the system can be pretty broken. There are undoubtedly good and highly competent people out there doing assessments, but equally, there are assessors that should not be doing the job. It is a lottery and all that you and I can do is to prepare you for the assessment. Hopefully the person who is helping you with your claim includes that preparation as part of their service. If not, then I recommend that you read my article, Questions asked at PIP assessments. You might have to wait 2 to 10 weeks before you hear back from them.

The decision

You should have either your own list of which points you ought to be awarded, or the written advice of whoever helped you. Compare that with the points set out in the decision letter. If you have the award you set out to achieve, then very well done. Go back and have a look at the first couple of paragraphs and see how long your award is to run. A lot of awards are for three years, but awards of 4, 5 and 10 years are made. If it says that you have your award ‘for an ongoing period’, this means that there is no end date and you are likely to be left alone for around 10 years before they approach you to see if anything has changed. When deciding on the length of the award, the issue is whether they expect your symptoms/abilities to change, either way, and if so, within what time frame. You can expect them to invite you to make a renewal claim 3 to 6 months before any end date.

The wrong decision – mandatory reconsideration

If you are not happy with the decision, call them on 0800-121-4433 to request a copy of the assessment report; what you have in the decision letter are excerpts from a report of 28-30 pages. You will know much more about where things have gone wrong after looking carefully at the full report. 

My advice to someone at this stage in the process depends on what points they have scored. Where someone has scored no or very few points, I do not recommend putting effort or resources into a reconsideration. Even working together, the chances of getting from where they are, to where they should be would be remote. Better for that person to go through the motions and ask for the Department to look at the claim again. You might point out where the assessor’s thinking was wrong and you can supply additional information and evidence, but please do not say that the assessor has lied, no matter what the provocation. The assessor presumably has nothing to gain by lying on your report, so if it comes down to who to believe, then you are likely to come off second best as you do have something to gain from the claim process. Better I think to suggest that the assessor has misunderstood what you said or meant, or the report is mistaken. Look for examples of things that are just factually incorrect, not matters of opinion. Turn to the back page of the report and see if there is a gap between when the assessment was carried out and when the report was finished. Many are done on the same day but I have seen gaps of up to 14 days, which you could put forward as a possible reason for the assessor having got things wrong. 

Not far from the points you should have

If you are not too far from having the points you ought to have, then by all means put effort and resources into the reconsideration. It is worth trying to avoid the delay, stress and (potentially) expense of a tribunal appeal. You can do what I would do, I begin by going through the PIP test to see where additional points should have been scored, why you should have scored them and how strong a claim you have for those points, so what it is we are trying to prove. I would talk to you about possible sources of evidence to support that view, so medical evidence and witness statements from people who know for themselves how you are affected. I would look at the evidence you have but would gather more. Get hold of GP notes for say the last 18 to 24 months. See above for how you should assess that evidence before you send it in. Set out your reconsideration request in a letter, better I think than the form provided by the Department. Try not to focus on rubbishing the assessment report. I don’t think that you can succeed by just doing that. Instead, explain why you should have scored the points you are asking for under the different heading, Preparing food, etc. Explain why the evidence supports that and where you can, explain where the assessor went wrong. They may have based their opinion on a misunderstanding about your medication or specialist support. Perhaps they point to you being able to carry out some movement in the Musculoskeletal section that you say has been wrongly recorded, or which you could only manage with a great deal of pain, or you were not in fact asked to do. You have a month from the date on the decision letter in which to lodge your reconsideration request. If you can see that you will need more time, call them on 0800-121-4433 to ask for more time. You can expect to be asked why you need this, so have an answer in mind. A reasonable request is very likely to be accepted. Expect a decision on your reconsideration somewhere between a few and several weeks.

Appeal to a tribunal

You do not have the option of an appeal until you have been though the reconsideration process. You will need the date of the mandatory reconsideration notice when putting in your appeal, either online or using a paper form SSCS1, which you can find online. Your appeal needs to be with them within one month of the date on the mandatory reconsideration notice. There is a section on the appeal form for you to explain why you are putting it in late. Your appeal will still be passed by the tribunal office to the DWP, who have the option to object, but I have never seen them raise an objection with a reasonable reason given. The law allows an additional 12 months, so 13 months in all to what is called the ‘absolute time limit’. There is case law that allows even that absolute time limit to be breached, but only in the most exceptional of circumstances. Get experienced advice if you are in this position. Please see my article The PIP Appeal Process for all you need to know about doing an appeal. The time from putting in an appeal to having a hearing varies around the country but think in terms of 6 to 12 months.

Challenging the tribunal’s decision

Hopefully the tribunal will have found in your favour, but if not, then this need not be the end of the line. You should take a cold hard look at why your appeal was refused, and you might need help to be this objective. Maybe the tribunal was right and you are not entitled to any award or to more than the Department awarded. It is also possible that even though you should have had more, the tribunal were entitled to reach the decision they did because something you said to them undermined your case, or because they saw some piece of evidence that was wrong but again, it undermined your case and they chose to believe that rather than what you said. You can only challenge a tribunal’s decision on a point of law, not just because you think that they got it wrong, and not because you now have a powerful piece of evidence or a new diagnosis. You would begin by asking the tribunal office for two documents, a statement of the tribunal’s reasons for their decision, and a copy of the judge’s record of proceedings. This is the note of the evidence that was taken at the hearing. Your request for the statement of reasons must be made within one month of when the tribunal’s decision was handed to you/sent out to you. 

The alternative to trying to challenge the tribunal’s decision is to begin a new claim, but making a better job of it this time. I would recommend that you get help, especially if you did it on your own last time. You can do both of these; you can begin a new claim that will be based on how you/what you can do now, and at the same time pursue the arrears back to the date of the first claim. Remember though that if an award is made on the new claim, a new tribunal that re-hears your appeal would be limited to making an award from the date of claim to the date of the award on the new claim.

You will need to identify one or more errors of law in the statement of reason, on which to base an application for permission to appeal to the Upper Tribunal. This application needs to be made within one month of the letter that came with the statement of reasons. That process is outside the scope of this article. If I have not written that article when you look, please contact me.