Im a PIP assessor - AMA

[pipfs]

Im a regstered nurse and have worked for PIP for a few years. I work in this role due to my personal health, i could not longer stand for 12 hours to do ward based work, i could no longer travel for the requirements of community. The jobs market when my health took a turn for nursing was limited, i had my own family to support, my options were very limited.

I do not do assessment via phone or in a clinic. That is not my role. I check claims as they come in, and will send to phone, clinic, or both where appropriate. If they are not suitable for asssessment, i will try everything i can to avoid an assessment, try to gather the evidence from health care providers, schools, social care, support contacts, appointees etc, and i write them as what is know as a paper based report. Some do end up having to go to assessment despite my efforts.

95% of claim reports i write, get awarded. Over 2/3 of reports i write get an enhanced/enhanced award. Half of the reports that i write are for 16 year old transitioning from DLA to PIP. Followed by cancers on active treatments, significant mental health, following a stroke, condition or incident where they are fully reliant on other people for their care, and cases where an attempted assessment has failed. But the transitioning cases build up the majority of my case load on an avergae week

I fully understand the frustrations and limitations of the system, i fully underand the stigma that comes from being an assessor, and how these reports can at times, be written. However the area of pip i work in is very claimant centered due to the nature of the cases we write, and i spend hours ensuring that these people, the people who cannot attend an assessment because of their health restrictions, get the support they require. It is a rewarding role.

So if anyone has any questions regarding the transistioning process, or in general, i am happy to answer where i can.

Do you mean not filling in renewal forms?

Sometimes DWP will just auto-renew based on previous reports and evidence.

If it comes to us and theres no complete forms, we request as much medical evidence as we can, and it goes to a phone assessment, if thats unsucessful it come back to us, then a second phone assessment is tried, then if that also fails it comes back, and we do the best interest review. 9/10 that type of review is the same award for a further 2 years, but they are really time consuming and complex, and although in the best interest, they arent always as if we didnt get any medical evidence back, then its basically guessing that nothing has changed. Even a small amount of information on forms is better than none, as atleast we can consider what a claimant is telling us about their restrictions.

No, im not a DM, i just recommend the award, DM ultimately make the decision, i try to provide enough evidence to ensure they agree with me. But thats not always the result.

I end up writing a very small amount of the claims i see, due to the amount of evidence required and the restrictions around which claims are eligible to be written paper based. I keep 10% of the cases i check. I end up writing around half of those. So its a very small amount. Certain ones, appointee cases being on if them, should be atleast tried to be written as PBR, but if i cant reach an appointee by phone, or i havent received enough information, thats going out to assessment too. Where, and i dont know statistics or facts, but its seems, most people get claims declined. So although im awarding virtually every award i write, and most of those are enh/enh, out of how many claims delt with, its a very small amount,

@pipfsDS1 is enhanced daily living but standard mobility. I don’t agree with points awarded for daily living but didn’t see the point of appealing as he’s already on enhanced. He was awarded 10 points for mobility. Since the original award he no longer leaves the house with support staff (OT and youth mental health team) and now only leaves the house twice a week to visit private dog field in my company that I drive him to. He has severe social/generalised anxiety related to ASD. It would be nice if the review was actually completed to take account of this as I am struggling pay for petrol (nearest suitable (for him)) dog field is a 20 minute drive and upkeep of an old car (I am full time carer) and with maintenance pending suit (divorcing) have a monthly income of £850 (no rent or mortgage but bills). Without the car he would never leave the house. I think he would have been awarded enhanced mobility (he is only 2 points short and evidence was submitted at first review) and this should be backdated. We are now at second review with no end in sight.

Are you worried about how much the welfare bill is growing and how we can support it long term?

My PIP was back paid for the two+ years it had taken once the tribunal awarded me. This is normal I believe, it’s back paid to the day the initial application goes in.

And yes, the assessors/decision makers do lie. I have paperwork from the DWP that clearly demonstrates this. It’s disgusting. It seems that @pipfs is one of the few with a soul.

Unfortunately, from what you are saying, he will only be eligible for the 10 points in mobility still. If he is not able to leave the house on the majoirty of days, that would be 11E, which is 10 points. To be eligibly for the 12 he would have to be able to leave the house every day with support. However, if his condition is anxiety based, and he experinces overwhelming psychological distress, then he can only be the 11E as he meets the OPD criteria, and only receives the 10 points.

11 can be a hard one to get your head around, but basically, even though not being able to leave the house majority of days is more restrictive than being able to leave but with support, the cost aspect of it is less, so standard is awarded.

Sorry if that isnt the answer you hoped for, and i understand the finanical cost to yourself, but unforunately the 10 points and standard will remain in a review based on what you said.

As i said, every report i write the claimant is truly in need and deserving of that award. I believe in a society whereby we support those in need of support. The cos of the welfare bill is quite frankly not my concern when considering an application. The needs of that person is my only concern.

What is your opinion on how the progressive neurological conditions such as muscular dystrophy are assessed? Most are rejected because their condition can fluctuate whilst progressing, so one day you can walk the magic number of metres and the next day will cramp and fall and have no energy due to the way dystrophies and myopathies affect the muscles.

I believe the majority of days element is a good idea in some areas, not so much in others. I think that same rule applies to some conditions. I think certain conditions, once diagnosesd, that are progressive, and unlikely to ever show significant improvment, should not be subject to the same set of guidlines, there should be exceptions to that rule, more so than there are currently. Theres other conditions i believe should be awarded automatically as soon as there is a diagnosis. Theres conditions where i think it should be an automatic no review period granted for. I think the 3month/9month rule is flawed at times too. Theres so many elements i disgaree with. But there were elements of ward nursing i fundementally disagreed with too. At the minute i just have to work within the guidelines, even if i disagree with them, and hope that i can gather enough evidence to support if im writing, if not hope they have an assessor who can ask the right questions and get them an award.

My son is nearly 15 and has been on DLA (middle rate care, lower rate mobility) for about three years for autism and learning difficulties. He's in a specialist resource base in a mainstream school and has an echp. It's becoming increasingly likely that we are going to have to apply for PIP for him when he's 16 since his difficulties are still significant. I have two questions, please:

1. Does him already being on DLA enhance his chances of being awarded PIP?

2. What evidence should I start gathering now since some of the things I used for DLA (edpysch reports, etc.) will be quite old by the time we apply for PIP?

Thanks for doing this and sorry if this question has already been asked - about to go a read the whole thread now...

We dont see a DLA report or assessment, but most of the times we have access to evidence submitted and can see a DLA claim has been made, not if it was awarded or the rates. That evidence can help make a decision if new evidence is limited, but it is not a guarentee either way.

EHCP is your best evidence, even if its a year or 2 old by the time you apply for pip, its still very much valid. A GP report or hospital letter than simply states diagnosis. Autism and Learning Disability in black and white and your good. Psycholigist reports are great too, not referral letter or confirmation of appointments, as they dont provide evidence that they have been seen. A letter that they have sent to a GP folllowing an appointment that outlines what was discussed is also really good evidence. Supporting letters from a SEN support or teacher can help. If transitioned to college or similar and have a support worker contact information for them and them being willing to have a quick conversation is good. Any evidence that they require transport for safety concerns is really strong too. But, in all honesty, the full EHCP (some councils are better than others however) and forms completed by an appointee if more often than not enough to support award.

You mention a lot about providing evidence. DH has multiple physical conditions that in turn have varying effects on his mobility and abilities to perform daily functions. They are getting worse as he ages. What sort a of evidence would you require? For example his orthopaedic consultant/spinal surgeon, hand surgeon or GP know what conditions he has and could provide evidence of that, but don’t know how much they affect him on a day to day basis.

@pipfs thank you for that. ATM we are visiting the dog field 2 times a week for a 50 minute session each time but could switch this to 4 visits a week for 20 minute sessions. I think that DS1 would benefit from this and had suggested it but he was worried we couldn’t afford the extra petrol. Would he need to leave the house every day or would the majority of days be sufficient? It would really help me to incentivise him to leave the house more frequently if petrol costs weren’t a reason to stay home. If he did have to leave the house every day would it count if he accompanied me on the drive but then stayed in the car whilst I popped into the local shops? I’m not trying to game the system. I really want to encourage him to leave the house more often and build on the progress made. When we first started attending the dog field he was very anxious with nausea and diarrhoea and we couldn’t stop at the shop on the way home. Now he is much calmer and I can stop at the shop on the way home. But I can’t extend it because of his worry about extra cost.

So the evidence of conditions can be enough if what you are reporting is only consistent with them conditions, does that make sense? So if you report mobility and grip restrictions, and then you have evidence to show he has significant spianal issues and surgeon reports (not a referral or appointment, it must contain information from them), and hand surgeon, thats good solid evidence. He would likely go to assessment as there wouldnt be enough to justify paper based, but they still use that evidence, along with what he says.

More evidence of the effects becomes invaluble when the factual evidence doesnt quite give a full picture. So, for example PP earlier who said they they had GP and phsyio but was being bounced between them with no firm support, in that situation where the factual evidence is maybe not as strong, supplementry evidence from an OT who can report on the day to day affects is invlauble, as it cannot be contested.

Ultimately anything you can send that supports the fact you (he) have these conditions is helpful, but the more you have, that is clear and succinct, and shows the effects they that have day to day is just supporting it even more.

Lots of people willl send screen shots of their NHS app. This isnt great as it does not have name, dob, nhs on every screen shot, its not dated, we cant see the GP name, it could be from anyones NHS file and match what you are reporting. Its not great and will not be used to support a claim. As i said referrals and appointments, not worth sending, it means nothing. Photos of letters and prescriptions, please dont send these, they dont scan properly, send the orginals, or photocopies of originals. But as much as you have, thats relevent, is helpful.

Thank you. This is very helpful.

DS has actually been backyeared, so will be in Year 11 when the application is made, I think. His SENCO and/or the leader of the specialist resource will likely write a letter about his multiple interventions/difficulties. Also, his EHCP will be 'fresh' since it gets renewed annually. Plus I'll send everything else!

You've really reassured me and I suspect I'll go into it with much less anxiety now than I would have done.

So this is where it gets complicated. The pip guide says the following.

A claimant who satisfies 11e cannot also satisfy 11f. If they cannot undertake a single journey on the majority of days, then 11e will be the applicable descriptor, even if there are occasions when they could follow a familiar route, if accompanied.

So if he meets the criteria for OPD and cannot go out the majority of days, then its the 11E. If he could go out the majority of days with support, he wouldnt meet the criteria for OPD, and would be a different descriptor.

To meet the criteria for 11F, there has to be a significant risk of harm, cognitive or developmental, or learning restrictions etc. Basically saying,he cannot cross a road safely without another person. Its he cannot make any journey alone, and the theshold is quite high. If he could go to a shop alone, even once a week, without the risk of harm, he wouldnt be 11F.
The pip guide says this

Although psychological distress cannot contribute to the satisfaction of this descriptor if the claimant also has symptoms of cognitive or sensory impairment they may satisfy this descriptor. A claimant who is actively suicidal or who is at substantial risk of exhibiting violent behaviour and who needs to be accompanied by another person to prevent them harming themselves or others when undertaking a journey would meet this descriptor.

It depends on what you have evidence to support. If you can support that he cannot make any journey alone, but not because of OPD, then absolutely go for a review and try for that descriptor. But if you cant support that, and it is the OPD, its probably best to just let the claim roll.

11 if really complicated at times, and hard to explain, it took me a while to get to grips with it and where my early reports failed audits.

No sorry, I meant on the initial application forms.

Ok, sorry. It depends what you reported. Theres certain conditions we would not send out and attempt to do paper based, then if we get the evidence, we write. So its pretty common to keep a claim based on whats on the pip form, less common to be able to gather the evidence to write. So yes your GP must have provided really strong solid evidence for you to avoid assessment. But you clearly gve enough information the first half you did complete for them to justify paper based, and deem it inappropriate to try and send you for an assessment without trying paper based first.

Trigger to attempt paper based include (but not limtied to) an appointee, personaility disorders, significant risk of self harm, sucidal ideations, significant phsyical restrictions, cognitive, deveolmental, or learning disabilities, active cancer treatments, or if they reside in a care home, supported living facility, hospital, or prison

@pipfs thank you for explaining the complexities. I think it’s better overall to roll with it and fingers crossed for a decent divorce settlement so cost is not a barrier to enabling increased ability to leave the house. Crap to leave it to carers without adequate support though.

Its not great, the amounts given are not enough to live on not for anyone. Espeically when realistically you are capped at the standard rates, not even enhanced. I wish i could offer better advice to help you get decent support, but unfortunately im not sure given what you have said you would get the 12 and enh and i agree, sticking with teh 10 and standard is the safest, rather than risking them taking the mobility element away entirely.

Understood, appreciate the explanation. Just incredibly frustrating for a welfare specialist like myself how many I have to take to tribunal when decisions could have been more accurately made earlier in the chain- generally speaking, DM stage.

My dh gets £26 a week PIP. He's got leukemia, lung cancer and heart failure, surely he's entitled to more, would it be worth making a new claim, as things have got worse since he was awarded years ago? TIA

Oh my goodness, absolutely. Send iin what you have, and cancer nurse specialist contact details if you have them, CNS are so good at talking to us, they give everything we need in a 5 minute call 99% of the time if we have their information. But absolutely ask for a renewal, tell them on the phone the severity of conditions.

That's the shittiest part. He was entitled to it from day 1 and yet it took two years for a judge to say that.
It's disgusting. He wasn't going to bother appealing - so worn down and ill from the process. I persuaded him as I saw the mounds of evidence and the lies on the reports and the unpleasant attitudes...awful

I think the issue too with cancer treatment is that side effect symptoms can be cumulative as treatment progresses. For eg, I filled my form in after first cycle of chemo/immuno when it wasnt so bad. Now side effects are much worse just a few weeks later.