PIP Claim - Change of Circumstances

If you have an award of less than the enhanced rate of both components of PIP, then you might wonder if a change in your circumstances should be reported to the Department. Many awards of PIP are made for three years but they can be 4, 5, 10 years or ‘ongoing’, without an end date. You might wonder if it is a good idea to wait until a fixed period award ends or to open up the whole process by notifying them of a change of circumstances. The purpose of this article is to encourage you to think along the right lines if you find yourself in this situation.

What counts as a change of circumstances?

Medication 

A relevant change of circumstances would be one which was capable of affecting your entitlement, so we are talking about something that would affect the points that you should be awarded. Being prescribed different medication would not normally be seen as a relevant change as I cannot see how this alone would affect entitlement to points. Instead, look at why the medication has been changed.

You could have uncontrolled epilepsy and your specialist would like to at least reduce the frequency of seizures. I cannot put myself in the shoes of an epilepsy sufferer, or of any other debilitating condition; my daughter’s seizures are uncontrolled and a cluster was once the cause of her travelling to hospital by air ambulance, but this does not give me special insight into the life of a sufferer. My task here though is to be objective and give advice on how symptoms and changes in medication are viewed by the DWP and the law. All medication has side effects and epilepsy medication may well be worse than most, but even though the process of weaning off one and then increasing the dose of the new one has to be endured, I do not see this affecting entitlement to PIP, so I would not encourage you to report this process as a ‘change of circumstances’. 

I would be delighted to hear that any sufferer was no longer experiencing seizures, and when that became clear, this would be a relevant change of circumstances because it would affect entitlement, so it should be reported to the DWP. An increase in the number of seizures experienced must be devastating, I cannot begin to Imagine, but in my view, that increase is unlikely to affect the points that they should score, and therefore their entitlement to PIP. To take an extreme example, I would recommend talking to us if someone had moved from two seizures a year to an average of one a month. For someone with epilepsy, entitlement is based on risk and the need for supervision, rather than the functional impact of a seizure or the lengthy post-ictal recovery period. If memory and/or cognition were affected, this could feature in an appeal, but a tribunal would probably stop counting after reaching 12 points for the daily living component, avoiding consideration of the impact on memory or cognition. Whether an epilepsy sufferer has a useable warning of a seizure can affect entitlement, so take advice in that situation. 

Staying with epilepsy for a moment, a vital point to leave with you is that the assessors and decision makers are not good at assessing claims based on epilepsy. They will often get the mobility award right and award the enhanced rate, but they rarely assess the daily living component correctly, so again, get advice from a reliable source before you accept an award.

Requesting a copy of the full assessment report is always a good idea, unless you have been awarded the enhanced rate of both components or you are otherwise delighted with the award. Many people believe that the reasoning in the decision letter is the report but this contains only excerpts from a report that is normally more than 20 pages in length. You will not see it unless you ask for it and it can be most revealing. It is essentially split into three areas; where they took details of your conditions and how they affect you; the section that is supposed to be the history you gave about your ability to manage the 12 activities in the PIP test, so from Preparing food to Moving around (walking), and finally, the assessor’s choice of point-scoring descriptors (the statements that have points attached to them) and their reasoning. You are likely to find examples of mistakes, misunderstandings and reasoning that you disagree with. The point is that if, for example, the assessor relied on you being on a low dose of pain relief or anti-depressant, or on there being no specialist input for a relevant condition, and that has changed, then you may feel that they could see your entitlement differently if they looked at you now. 

New diagnosis

The law says that there does not need to be a diagnosis, that the issue is how you are affected but assessors and decision makers seem to be unaware of that case law or wary of applying it. If you suspect that your difficulties were not taken seriously for that reason or that is clear from the assessment report, and you now have a diagnosis that explains why you have been suffering, then you might feel that you would be assessed differently now.

Worsening symptoms/able to do less

Someone in this situation would understandably think that a change of circumstances claim would be a good idea. It certainly can be but such problems will not always lead to more points. Take Washing and bathing as an example; suppose that you scored 2 points for needing an aid or appliance for this activity, but in addition to needing a grab rail, you now need help to wash your hair as you cannot lift your arms, if you look at the test (see the score sheet that follows this article) you will find that the need for an aid and the need for help to wash your hair are both ways to score the same 2 points for this activity. This brings us back to what is a relevant change of circumstances and to answer that, you need to know where you should score points and compare this with where you did score points.

Do you risk losing points awarded last time?

The Department certainly has the power to leave things as they are, to award additional points or to take away some or all of your points. Generally speaking, this will only happen where the evidence points that way. A mistake made time and again is where someone believes that the existing problems and points are safe and ringfenced and they just focus on what has changed. This has led to some or all of their points being lost, where it need not have happened. You are starting with a clean slate and everything needs to re-stated and explained, not just the new problem or what has got worse.

Changes in the law

Not an obvious one but this may surprise you. I cannot think of a change to the PIP test but new decisions on PIP are made by the Upper Tribunal every week and some of these can have a significant impact. You will see from the following score sheet that there are just two descriptors in the entire test which have an odd number of points attached to them but you are no better off with 6 points or 7 – still no award, you need 8 points for an award. Similarly, neither 10 or 11 points will give you the enhanced rate; you would need the other odd point, which could make a huge difference. I mention this because your existing award could have been made before the assessors and decision makers began to properly apply the Upper Tribunal decision that scores 3 points under Washing and bathing. 2 points is a common award and the wording for the descriptor that scores 3 points has not changed; it is just that Judge Rowley clarified what the wording meant and how it should be applied. It does not matter whether your home has a bath, the issue is whether you could get in and out of a standard bath (without any aids such as grab rails, bath boards, steps, etc) without assistance from another person. If this describes you, then you ought to score 3 rather than the usual 2 points. If that takes you from 7 points to 8 and an award of standard rate, or from 11 to 12, then clearly that is relevant to you. You would probably need to justify your change of circumstances claim by saying that there had been a change in how a medical condition affects you.

What if my award was just wrong

It probably was wrong. I would say that with a large majority of people, someone experienced would be able to go through the test with you and point out where additional points should have been scored. Yes, that means that a lot of people who did not get an award or who were awarded standard rate, should have had an award or a higher award. As above, you would probably need to say that your needs had increased to have a change of circumstances claim carried out. Remember though that if less than 13 months have gone by since the date on the decision letter, then you may be able to get the decision changed right back to the date of claim, not needing to do a change of circumstances claim at all.