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.

Thankyou

Yes, same for me. I should’ve got it the first time I applied, 8 years ago. Instead I was turned down and lost at tribunal appeals, twice, before finally being awarded at my third tribunal. The back pay only went to the beginning of the last application, not the very first, because once a case has been to tribunal there’s no further action you can take, even if the tribunal findings are clearly wrong.

Now I’m waiting for my review to be decided. It’s excruciating.

Hi, thank you for this thread - you sound so lovely and caring!
Could I ask a quick question please - my DS is changing over from DLA to PIP, I have requested the forms and I have been accepted as his appointee. My DS has high functioning autism and struggles a great deal with anxiety, depression and suicidal thoughts. He hates his autism diagnosis and talking about it with anyone always ends up in a downward spiral of depression and thoughts of hurting himself. He is currently going through an extended course of CBT.
I really think him being assessed in person would be detrimental to his health and I’m worried sick about the negative impact of a face to face assessment. Do you think he will be made to go to an in-person interview or could I attend for him with his permission? I know I’m appointee but I have heard he would still need to attend even if I speak for him.
Thank you!

Make sure all that is on the pip2 form. Mention throughout the risks of self harm and suicidal thoughts.

At the very end of the form there is an additional information regarding assessment box, its very small and often left blank. However, complete that box and reiterate that being subject to assessment will increase the risk of harm, that he finds discussing his conditions distressing and increases intrusive thoughts and risk of him self harming. Should assessment be required, it would need to be an appointee only assessment due to his restrictions. It would be in his best interests for a PBR to be attempted.

It again, cannot guarnetee you a paper based, however, that information should ensure they attempt it paper based and hopefully you can avoid the assessment process entirely.

If you need any further advice, please post or even drop me a maesage, im happy to help where i can to try and reduce a little bit of the stress

#pipfs - thank you so much that is really kind of you and I really appreciate it

Great thread, thank you. Having just gone through an application for my ill husband I cannot fathom the hoops we and others need to jump to for such a small amount of money. People applying are obviously in desperate need for this and it's the most frustrating process we've ever gone through for the sake of a tiny sum of money. There is also little support or information available. It almost feels like you are dis- encouraged from applying when you make the initial call. I think it needs an overhaul.

Says a lot of nothing sorry. I despair at this, people with progressive conditions being assessed by people with little to no knowledge about them. I sincerely hope MD UK are still campaigning this.

Sorry I haven’t read the whole thread, but I wonder what you think about the change suggested with regard to having to have four points in one category to be able to claim PIP. I have fibromyalgia and long term depression and anxiety, have two points in many categories and am unable to work due to the pain I’m in most of the time, the fatigue, brain fog and the inability to get out of bed a lot of the time. I struggle to leave the house most days. How can this suggested change be fair?

I’m very similar, if they applied the 4 point rule to my application I wouldn’t qualify, but I am genuinely restricted and impacted by my fatigue and pain. I can see how the 4 point rule could be applied to qualifying for advanced rate, but not for standard.

There’s so much about the PIP system that needs addressing, the 4 point rule is possibly the worst thing they could change.

1: Asked for my telephone assessment to be recorded and I haven't received the copy yet. Assessment was five weeks ago. Why the delay?
2: Why ,when I was asked if I had a pet and answered ' yes ,a cat' ,was I asked who walked the cat? I informed her we have a cat flap and the cat walks herself. The assessor repeated the question several times to the point I asked if the assessment was still being recorded.

I have endometriosis. Some days I am ok, can dress myself, can walk a few miles, can cook and bathe unaided. Other days I am bed bound, with a sick bowl by my bed. I lay in bed for days if not weeks at a time, no energy to shower or cook or I am in too much pain that opioids can’t even help with.

I have significant time off work. Which results in poor mental health. I have had to cut my hours down from full time to part time office work. Luckily I can WFH, but I work from my bed most days.

Is it worth me even trying to claim PIP?

Unfortunately i do not work in the face to face clinic or phone assessments, so i do not know their time lines or how long requests take.

I also agree, the question seems ridiculous.

You need to be able to provide evidence that it restricts you more than 50% of the time, and with a conditions such as endeometriosis, that can be vary difficult to prove as it can be so variable. But its always worth a try, gather your evidence and do the application. Ive seen people awarded for it before, but your evidence has to be very strong.

Ok. I have a very good base knowledge from years of nursing in varied roles. As i said, some progressive conditions i feel should be an immediate award with no review once diagnosis is made. Im not sure what there is about that comment to despair over. Im saying they should not be subject to assessment and reviews once their is evidence of diagnosis.

I agree, the 4 point rule is insane and massively unfair. It takes away all support for people reliant on aids in daily activities, which just seems crazy. If you need aids to cook, eat, wash, and dress, then you should be entitled to support. Taking that support away just makes zero sense to me.

Are you able to spot fraudulent claims?

Thats a hard one. Some claims stick out like a sore thumb, they know the trigger words that mean they have to be paper based, the evidence is rubbish, cant send to assessment, and it becomes a claim we have to write taking what they say at face value and awarding based on it. They are very very rare though. And we obsiously cannot prove they are being dishonest in what they say. They just feel off. The vast majority of cases i see have zero evidence, just the forms, and then i have to send to assessment. Some of these have trigger phrases to do what is called a suitability call, say it reports agoraphobia, so i do a call to ask them if they could manage a telephone assessment only, and have someone to support them with it. Then i call and they are very obviously out of their home. Again though, there exceptions to this. Someone may be able to go out one time a week with a tonne of support and ive caught them that one time they can go out. Does it make me hmmm, yes, absolutely. But i would still document the reported agoraphobia as it being fact, and make sure that a clinic assessment is removed as an option and that they have someone to support them.

The role i am in, if i have any doubts over what their restrictions are though, i send to assessment when possible, as the slightest inconsistency has to be addressed or it would fail at audit, and you can guranteee the report im on the fence about is the one that would randomly get auditted that month! So i dont write them if i have even the slightest bit of concern that its dishonest, exagerated, or fraudulantly submitted. Unless i have to in the a best interest report.

But what evidence can someone provide in such a situation? Doctors aren't interested.

My DS has a lifelong physical disability and we've just sent out the PIP forms to transfer from DLA. We have a lot of evidence from 3 or 4 years ago when he transferred from primary to secondary, outlining his needs, what he struggles with at school, OT report, physio report etc.

His condition is obviously ongoing and lifelong so his needs haven't changed significantly since then. We don't have much evidence from the last few years as we just keep doing very similar physio exercises etc. I'm wondering if they will take this evidence into account as it's not very recent? I'm also wondering how likely is it that we'll get a paper based decision rather than an assessment. The evidence is very thorough and backs up everything we said in the forms.

My DH had a stroke 4 yrs ago. He had clot busting drug and on the surface made an excellent recovery. Because it was during the pandemic follow up and therapy was non-existent. We had a visit from OT a couple of weeks after so the long term cognitive damage wasn’t obvious.
We applied for PIP because his pre-existing osteoarthritis knee deteriorated making walking difficult he also has had longterm severe fatigue, it’s like being married to rip van winkle.

The assessment was ok but the assessor was still in training and much of her report was frankly incorrect. I’m a dentist so have 40yrs of history taking experience and was convinced that we’d been sent someone else’s report. He scored zero but at the time I didn’t have the energy to pursue it. I was recovering from breast cancer and had my own problems to deal with.

Anyway, 4 yrs on the cognitive deficits are much more defined. He’s currently waiting for a knee replacement ( now postponed due to bone cement shortage) so mobility is hopefully a temporary issue. However some of the other areas he scored zero for are now a problem. He can take his medication but, for example, only notices he needs his prescription ordering when he actually runs out. Since he is asthmatic it means that he often has to go a few days without his preventative inhaler. With the rest of his medication I have managed to aline them with mine so order repeat prescriptions for both of us. If left to his own devices he’d just run out. He struggles with technology so needs someone to process request.
Eating is also subtle, he can help himself to snacks and heat up ready meals but quietly chooses meals that are easy to eat. He had dysphagia post stroke and I suspect it’s still a problem at times ( too proud to admit it) so he likes to eat food that isn’t difficult to swallow. For example, he will crush up breakfast cereals and leave them to soak in milk for up to an hour before eating it. He frequently forgets to eat a meal and just snacks on unhealthy stuff.

He does drive but will not attempt to drive to new places he can’t navigate to. Again subtle because his job was driving locally so is very familiar with local routes. When the assessor asked if he could deal with a diversion he correctly answered yes because the small town we live in has very limited routes through it so he would automatically recognise a detour. He doesn’t attempt to drive to new locations or in areas where there is congestion because it panics him.
He doesn’t have to use aids to walk mainly because he can just about manage to walk to the car. In our home he relies heavily on furniture and rails to support himself. Like most previously fit and hard working individuals he finds it hard to accept that he is now effectively disabled. He can manage overnight on his own but I prefer to go away ( family visits) when my DS is home from uni. He’s happy to cook for his DF and just keep an eye on him.

Superficially DH doesn’t seem to have problems but without me he would not be able to live independently. He just no longer notices things. I have to remind him to bathe, to put the bins out, sometimes to drink. He can do all these things but the part of the brain that notices when stuff needs doing is damaged. Before his stroke he was meticulous to the point of OCD. His timing is defunct so if he has an appointment he will often miss it because he forgets to add in preparation and travel time into planning. Initially it was very frustrating but we have adjusted.

Unfortunately it’s difficult to demonstrate his deficits. I worry that if I’m not around he will really struggle.

Ironically, having survived breast cancer, in all probability the physical problems associated with ongoing treatment would probably mean that I have a much greater chance of qualifying for PIP than a stroke victim.

@CrwysmamYour DH should reapply for pip. It's how his condition/s affects him, not the conditions themselves. He obviously needs help, support and prompting to function. Gather your evidence, prescriptions, letters etc and reapply!. Ask for the assessment to be recorded & keep copies of any paper assessments to prove any irregularities between what is actually said & the assessors version .Even if he gets the lower rate it all helps. If he is refused then you need to do a mandatory reconsideration and be prepared to go to tribunal if necessary. Good luck.
@ImFinePMSLEndometriosis is a very painful debilitating condition. I know a few ladies with it & it rarely comes on its own, it often causes chronic pain, fatigue, anxiety and depression, fibromyalgia and mobility issues. Statistics show 34% -53% of pip applicants for endometriosis are successful. You should definitely apply if it's impacting your life, which it clearly is.

Thank you OP.

What percentage of claims are fraudulent, do you think?

Pain team input can be good. Evidence also include what medication you are taking for pain. Evidence that you have repeatedly seen the GP, even if they are unsuprisingly not acting on it, the appointments are all on your record. Any occupational health refferal through work for time off. As i say, its a hard one, as its not one where you just have the test result and that proves restrictions, but there are things you can get to support a claim.

Yes absolutely that evidence would be enough - if you are also an appointee. In that situation i would keep your claim, and attempt to call you to get confirmation of restrictions. What happens with cases like yours is, even though you as the parent write an application, that is viewed as the claimants voice. Not yours. We would then try to speak to yourself and then whatever information we get on the phone is supporting, even if its almsot identical. We can say claimant resports x y and z, Telephone call confirms x y and x. Even though its from teh same person. And appointee evidence is good evidence. Even with just a GP letter confirming diagnosis, that phone call with an appointee is enough to justify a report. Im not sure for other companies, but the one i work for we are not allowed to leave voice mail messages, which is the most infuriating part of my role. So if you are appointee, please look out for and try to answer with held number calls.

You should reapply. 100%. Fill out the forms on his behalf. Mention memory in every area. Cooking - short term memory issues, fire risk. meds, risk he has forgotten he has taken them - overdose risk. Food forgets to eat, though prompting is hard, he may not score here. forgetting to wash and dress. You can mention poor swallow and needs to be supported to make good choices. Menton any difficulties word finding he has if he has them too, and if you need to support him to communicate as it can take him longer to find words, even if he can still communicate well, if it takes longe than is considered.

However, it does become difficult to get that over the line when he is driving. For me, that is one i could not keep. Generally, a stroke with some cogntivie restrictions is one i would keep and attempt to write, as if cognitive restrictions are reported, information gained at assessment isnt always reliable. But the driving adds a layer of inconsistency to whats being reported. Which means it becomes a case i cant write. But it is absolutely worth applying, make sure you are there to support with assessment, prompt him through answers regarding short term memory, and the risks associated with them.