PIP Appeal?

mary123

Hello - appreciate any advice/sign-posting please:
My son has epilepsy.    
He's had text this morning advising he's been awarded PIP for Enhanced Mobility only. Nothing for DLA.
We rang DWP and call centre advised he had 12 points for Mobility but only 7 for DLA and needed 8 to get an award.
I did enquire if they took into account his nocturnal seizures and bedwetting: he needs help changing (post-seizure I can't rouse him - he's like a drunk for 5/6 hours afterwards: sorry if that's wrong wording I'm new to this and trying to explain his state). So I have to manually move him, strip bed, change him etc etc.  Although he's on Meds he's still having breakthrough seizures and this can be 3/4 times a week or more depending on triggers.  
Call centre said this wasn't on original report but had been added when we rang a few weeks ago but that the decision maker hadn't changed the original points from the assessors report.  
So in summary - on report he got:
DLA
1. Preparing Food (e) - 4 points
3. Managing Therapy (b) - 1 point
4. Washing & Bathing (c) - 2 points
[All other Activities scored 0 points]
So 7 points in total for DLA
Mobility 
1. Planning & following journeys (f) - 12 points
So 12 points in total for Mobility

Whilst he's thankful for the mobility allowance, we're just wondering if it's worth appealing the DLA - the lady at the call centre said he was very close to 8 points so might be worth it; however, if they've already considered the '5. Managing Toilet needs' and given him 0 points I'm not sure it'll make any difference?  I did ring them to highlight this issue, and it was on his file, but they've still not given it any points. 
I'm not experienced in applying for benefits and if he's not entitled then so be it; but it just seemed a little harsh - as I'm his mum and won't leave him soiled all night but not sure if that's what is expected?
Can anyone advise what an appeal involves - I'm not sure what kind of evidence to supply? Does he need to be wetting himself over 50% of the week and will I need to take pictures or such like in order to provide evidence?
Sorry if this all sounds a bit basic but I just don't want to waste lots of time on it if we're not likely to get anywhere or not appeal in correct way as appreciate my appeal will probably need to be stronger than the original application.
Grateful for any thoughts/ advice and apologies for very-longwinded message. 

calcotti

It's not called DLA, it's the Daily Living part of PIP.

PIP is based on the difficulties he experiences on the majority of days doing the specific activities looked at.
https://www.citizensadvice.org.uk/Global/Migrated_Documents/adviceguide/pip-9-table-of-activities-descriptors-and-points.pdf
Whether the soiling problems will score points will depend on how often they occur.

You can request a Mandatory Reconsideration of the PIP award. If, as is likely, the decision remains unchanged he can then appeal to the tribunal service.
https://www.citizensadvice.org.uk/benefits/benefits-introduction/problems-with-benefits-and-tax-credits/challenging-benefit-decisions/

chiarieds

Hi @mary123 - I'll quote from the Benefits & Works guide (for PIP) June 2018 hoping it may help with a Mandatory Reconsideration as your son has epilepsy:

'Safety and supervision
Until now, the DWP have argued that a claimant can only score points for being unsafe if harm is likely to occur on more than 50% of the occasions on which they attempt an activity.
So a claimant with epilepsy who has seizures twice a week would not get points for needing supervision when cooking. This is because they could not show that it is ‘more likely than not’ that they will have a seizure on any given occasion when they prepare food.
However, on 9 th March 2017, in CPIP/1599/2016 a panel of Upper Tribunal judges held that the DWP were wrong.
Instead, they said, the decision maker should look at whether there is a real possibility that harm might occur and also at how great the harm might be. The greater the potential harm, the less likely it needs to be that it would happen on any specific occasion.
So, if there is a real possibility that a claimant with epilepsy might have a seizure whilst cooking then then they reasonably require supervision for this activity, even though the chances of a seizure happening on any specific occasion may be quite small.
They should score points for needing supervision even if they don’t actually have anyone to provide it.
But the Upper Tribunal went even further than this.
They ruled that where a claimant is at risk all the time, then they may also be at risk when carrying out PIP activities that do not carry any additional likelihood of harm.
So, a claimant may not be at any additional risk of harm if they have a seizure when using the toilet or taking medication, for example. But, because they are at risk whatever they are doing, then we would argue that they still reasonably require supervision during these activities, because they cannot do them safely without supervision.'

So, with epilepsy, the occurrence of problems the majority of days isn't always a factor. However, PIP is about the difficulties a person faces during the day, so unless your son's epilepsy impacts his daily functioning with regard to the activities/descriptors that are looked at with PIP, it may not be taken into consideration.

A Mandatory Reconsideration is best put in writing, giving a couple of detailed examples of the difficulties your son faces with any applicable descriptor, i.e. when did it happen, where, what happened, did anyone see this, such as yourself, & were there any consequences to attempting/doing an activity? Say if he can't do an activity 'reliably,' i.e. safely, to an acceptable standard, repeat as often as one would reasonably expect, or if it takes him much longer than someone without a disability.

yanni

.

easy

Surly if op son is under 16 it would be DLA ?

poppy123456

easy said:

Surly if op son is under 16 it would be DLA ?

Where does it say in this thread that he's under 16? In a previous thread Mary123 said her son is 17.

https://forum.scope.org.uk/discussion/91623/pip-advice-please#latest

yanni

@mary123

Re bedwetting during night seizures,  I think the issue may be that you changing your son and his bed is not covered by this activity so the DWP can’t / won’t award points for you doing this for your son.  The toileting  activity specifically excludes dressing and undressing as this is covered by activity 6.

Even the highest descriptor for the toileting activity refers to ‘assistance’ e.g. assisting the claimant to manage the activity, not doing it for them. Unfair though this may seem the DWP can’t award points for any ‘help’ that doesn’t fall into one of the descriptors.

The toileting activity is about how he manages the incontinence. If he could manage the incontinence himself by using pads then he needs an aid or appliance (2 points) to manage his toileting needs reliably.

That he does or doesn’t actually use an aid or appliance (e.g. pads) to manage incontinence is irrelevant. PIP is about the help that a claimant needs to manage an activity reliably not about what help they actually have. The descriptor reads  “Needs to use an aid or appliance to be able to manage toilet needs or incontinence” not “Uses an aid or appliance to manage toilet needs or incontinence”

 There have been several Upper Tribunal decisions about the use of incontinence pads for Activity 5 including:

 “A reasonable need to use incontinence pads at night, whether used as a precautionary measure or not used at all, may be enough to satisfy descriptor 5b”

and

“Precautionary use of incontinence pads can help satisfy the 50 per cent test in regulation 7”

 

He doesn’t need to be bedwetting more than 50% of the time, the criteria is, as I understand it, that  he reasonably needs to use an aid or appliance (e.g. a pad) on the majority of days / nights in order to manage incontinence . As he doesn’t know which nights he will lose continence he would need to use them every night as a precautionary measure so he then meets the requirement of needing an aid or appliance more than 50% of the time.

 

You can read the decisions here:

https://pipinfo.net/activities/managing-toilet-needs-or-incontinence

 

https://epilepsysociety.org.uk/living-epilepsy/benefits/personal-independence-payment-pip/how-activities-are-described-and-assessed/managing-toilet-needs-or-incontinence

 

You may have already seen this but the Epilepsy Society suggests that points may be available for communicating if your son has difficulty communicating after a fit.

 https://epilepsysociety.org.uk/living-epilepsy/benefits/personal-independence-payment-pip/how-activities-are-described-and-assessed/communicating-verbally

 Also for engaging with others:

https://epilepsysociety.org.uk/living-epilepsy/benefits/personal-independence-payment-pip/how-activities-are-described-and-assessed/engaging-other-people-face-face

 

mary123

Hello all - thank you for all the advice, above, really helpful and appreciated.  We decided to reapply for Mandatory reconsideration as son was 1 point shy of meeting Daily Living Activities threshold (scored 7 points, needed 8 or above), so thought we may have a reasonable chance if a strong case could be made. 
I just wanted to double-check a few things with regard to reconsideration if possible:
- We completed Form CRMR1 (it does say it's 'easier to call' but I thought it might be better to put in writing as I was able to quote some of the previous decisions etc).  Is this what most people do who follow this process?
- Does anyone have any approx. idea of how long the reconsideration usually takes - weeks, months, longer? 
- Will the reconsideration require another 'mini' assessement - e.g. to discuss the scoring on the activity being queried etc?  Or will we not hear anything until we get a written reconsideration notice in due course?
- If it's still unsuccessful will the (new) decision maker at DWP explain in detail as to why? 
- Will the (new) decision maker also re-review the rest of the PIP application, or will it solely be on the activities queried?
- If it is successful will payment be back-dated to the original applicaiton date?
- What are the usual succcess/failure rates at the mandatory reconsideration stage: I realise reconsiderations may vary widely but just wondering if it's extermely difficult across the board eg an average of only 10% succeed or if it's 50/50 or similar.  Want to manage expectations etc. 
Many thanks for any advice and help in advance.

calcotti

mary123 said:.. (it does say it's 'easier to call' but I thought it might be better to put in writing as I was able to quote some of the previous decisions etc).  

Definitely recommended to do it in writing so good decision.

mary123 said: Does anyone have any approx. idea of how long the reconsideration usually takes - weeks, months, longer? 

Allow up to 12 weeks, but it varies.

mary123 said: Will the reconsideration require another 'mini' assessement - e.g. to discuss the scoring on the activity being queried etc?  Or will we not hear anything until we get a written reconsideration notice in due course?

There will not be another assessment. Occasionally the Decision Maker will ring the claimant if they want to clarify something but it is not the norm.

mary123 said: If it's still unsuccessful will the (new) decision maker at DWP explain in detail as to why? 

You will simply get a new decision letter headed Mandatory Reconsideration Notice. It will not directly address your MR (indeed it may well appear to completely ignore it!).

mary123 said: Will the (new) decision maker also re-review the rest of the PIP application, or will it solely be on the activities queried?

The whole award will be reviewed.

mary123 said: If it is successful will payment be back-dated to the original 

application date?

Yes.

mary123 said: What are the usual succcess/failure rates at the mandatory reconsideration stage

Latest statistics indicate that only 27% of MRs result in a changed award.