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.

I couldnt possibly say. I do think claims get awarded where they know what to say etc where maybe they wouldnt based purely on evidence alone if i was doing their cases. Symptoms and restrictions get exagerated. I think more than that are cases refused where they should be entitled, but they dont have evidence. Im glad i work in an area of pip where its more evidence based than having to make a judgment based purely on whether i think they are being truthful. I can look at conditions and what they have provided and say "this restriction is clinically reasonable/likely due to..." which they cant do as much in the inperson assessment. Im applying the evidence to what they have reported, plus converstaions with hcps, social care, teaching staff, and carers such as family member. In assessment they are applying what you say to counter the evidence, theres less room for clinical reason and judgement, its whether they say the right things, and people get coached on it.

So yeah, i think theres fraud, i dont think its huge numbers, it would be a very small minority of claims granted, but it does exists.

Thanks for this. I am noy his appontee, he wrote the forms himself but we came up with the wording together. So you think he will receive a call asking him to confirm certain things?

Do you get many claims from people with narcolepsy and cataplexy?

It must be very difficult being an assessor @pipfs . Take the endometriosis for ex. I found out I had it 3 years ago when undergoing another exam. It doesn't bother me in my life. I have a friend who really suffers but who manages to work ft and wouldn't want to apply for PIP because she's very "anti-benefits" proud.

Anecdotically I have four people in my entourage that claim PIP ; two "rightfully" so because they are very ill (cancer and stroke), two who openly admit to exaggerating their anxiety and depression symptoms- numerous dr visits to document this. They encourage others to do the same when anyone has the slightest problem. So if I would just go with people around me I would say 50% of the claims are fraudelent.

The thing is, I know my friend who had a stroke had to reapply because she got denied PIP the first time which is just so unfair because I have seen for myself how she struggles in her daily life. That's why I think that mh claims should be more investigated than when there are documented physical illnesses such as aggressive cancer, severe strokes etc.

Approx 50% claims are fraudulent.

Thank you - that’s staggering…No wonder many people are upset with the scale of benefits in the UK!

My DS has been on DLA since 2019 - ASD as the primary reason. He has an EHCP and a place at a special school which goes through to 19.

He is turning 16 soon and I'm really worried about the transition to PIP - if he isn't eligible then financially we are sunk as his school place will rely on me being able to drive him (it's a 20 mile round trip, he won't get school transport once he turns 16, and there's literally no way to get there on public transport even if he could reliably manage it!).

We don't really have any medical evidence as such because ASD isn't a medical condition - his physical health is great. All reports (ed psych, speech and language, OT) are from 2019 when the original EHCP was completed. It's reviewed every year but no new reports have ever been commissioned. We do also have a social care assessment which is updated every year - its very detailed and grants him 3 hours direct payments a week but, despite his needs not changing, that plan is about to be discontinued because I haven't been able to find a suitable PA for over a year so the payments haven't been used.

Also part of my worry is that he thinks he is fine - at least in part because we have all tried so hard to boost his self esteem and make him feel valued and proud of himself to bring him back from where he was at age 10 (excluded from school and suicidal). He has no clue about the amount of scaffolding that is holding his show on the road, but the minute any of it is withdrawn things don't go very well at all. Hence still having an EHCP and still being in a special school... But if he walks into an assessment he is likely to tell them he doesn't need extra support and can manage everything just fine.

So its really only his EHCP that I have as evidence 😬

I’ve got PIP, it’s for a disease I was diagnosed with a couple of hours ago, had PIP approx a year. Is it worth letting them know I’ve been diagnosed with further conditions (fibromyalgia and CFS) since my last application? It’s certainly affected me physically but I’m worried as they can reduce support, and I’ve just been approved I’ll health retirement so my salary will dramatically reduce anyway with just pension income, plus I can no longer work due to pain and crippling fatigue. TIA

@BoobsOnTheMoonyou can apply to be his appointee which is very straightforward and means you can be at any assessments I think. Also photocopy the bits of his EHCP which are relavent to his level of functioning etc in things like feeding, cooking, travelling without support etc. That’s the only evidence we had for ds as like yours he doesn’t see any professionals.

@BoobsOnTheMoon thats why i asked if the evidence is good will a badly filled out form have an impact. My son is also unaware of all the support he has and is at a special school with 1 to 1 support.

He would say he does everything himself fine. Its also the school travel that pushed us to claim. He cant go to a local provider like our other son and yet transport stop at 16. They dont even put special schools in places with public transport round here. They seem to all be in tiny villages far out of town.

Exactly. Him being ok and managing relies on me being available! Another example of how saving money in one area just pushes the costs up elsewhere - if he could continue to get transport post 16 (that didn't require me to be present at pick up and drop off, which the current arrangements do) my ability to work would be very different. But losing his disability benefits means losing my carer status (I don't actually even claim carers allowance as I am self employed and some weeks earn over the limit) which in turn means I have to work full time which isn't going to be possible 😭

As, I said, anecdotically. Which means just that. I do not think 50 % are fraudelent claims. I do think there are many fraudelent claims to all type of benefits because of cost of living. If I would speculate I would say the most usual fraudelent claim is UC claiming you are living by yourself with children when there is actually a partner living with you, albeit written on another adress (family).

@TheBlueKoalaI agree. Pension Credit fraud for instance, often not mentioned,it's always disabled and UC claimants getting lambasted.
As for pain clinics, I've been waiting 3 years since I was referred by my GP & it's been chased up, to no avail.

Sending support to you.

I'm waiting too. I was told the waiting list is 3.5 years.

@catshatsandchatsWow, you too! I thought it was just me overlooked, so thanks for the heads up! The clinic I'm waiting on is better than the local hospital one, according to my neurologist so I'll just have to hang on in there. Im wondering what they can offer, more drugs I guess? One thing I've realised with me is if I crumple up on the sofa I feel dreadful all day but keep pushing myself through an horrendous pain barrier for a hour or two every morning eventually seems to drive down the pain & lethargy but some days I just don't want to face that! The rheumatologist told me don't be inactive but it's easier said than done as you'll probably know yourself.

I have severe dyspraxia and dh has Aspergers syndrome. We manage to muddle through between us most of the time and thankfully he is good at the things I can't do and vice versa. I often joke that between us we are a whole person. Is it worth claiming, for him or for me? We can both dress ourselves, shower, etc. He needs reminders to take meds and he can't speak on the phone or sort out his repeat prescriptions. I can't drive and it takes me ages to do most things.

@elliejjtinyprobably not, you are both living independently and obviously have low needs so I would say no. If you didn’t remind dh to take meds he would probably find another way

Yes I understand that. I try to go out for a walk a few times a week, afterwards I'm in a lot of pain and exhausted, but whilst doing it I usually feel exhilarating - until I'm unable to walk anymore!

My GP told me the pain clinic is more holistic, so not sure what to expect but I'll try anything.

I would advise looking into being added as his appointee. I would advise the same for all under 18 claims. The assessments are hard going, lengthy, so in depth, the same question asked in different ways to try and get to the inconsistencies. Even if they are capable of comepleting an assessment, a young person needs supporting through it as its so stressful and draining. An appointee case in the first instance, should be attempted paper based, which avoids that assessment. It gives what you say as a parent so much more weight. A quick phonecall with an appointee is just as good evidence as a call with an educational psychologist, consultant etc. Its such good strong evidence. Is the exact same converstaion is had with a parent who is not an appointee, it cannot be used the same. Then if it has to go to assessment, even if the young person attends, the questions can be directed to the appointee not the claimant, and if not you are 100% allowed to answer entirely on their behalf. You can remove the appointeeship when he is of age, but i would say, in 95% of cases, it is in the best interests of a young person to have one. I absolutely hate sending 16 year olds to assessment, but unless they have an appointee, i often have no choice.

Ive probably seen it a handful of times, very uncommon.

Exagerration is common, defintely. I can spot cases that are exagerrated a mile away. Its hard to explain why, but the ones for anxiety and depression where it is seriously restricting, they cannot leave thier home, they cannot complete basic activities without support, are written in such a way that it feels different when writing them. Its very hard to put into words why though. A few pages in and i know im not sending out and im trying to keep it and gather evidence to avoid adding to their difficulties as best i can.

Strokes are another that required such solid evidence. And that evidence can sometimes work against a person. They will often score only for aids, which in some cases, isnt enough to hit the points thershold for an award. And this 4 in one area malarky is going to truly harm. As the consistent aids across all the activities where aids are considered, wouldnt be a 4. Its cases like that where i think the 4 in one area is harmful and should be scrapped.

All that evidence is really really strong, and if you are an appointee, your evidence is equally as strong. When you do the forms, document it all really clearly across the activities. Take your time with forms, dont go ointo loads of details taht could affect the activity, or are loosely realted, state the facts of exactly where the risks are. Especially around the ones where safety comes in to it. Cooking theres a risk of harm. medications but only prescribed are considered, washing and dressing, would he do them without prompting? Would he chose appropriate clothing without support or just wear shorts and tshirt? Does he have difficulties with sequencing of tasks and need prompting to make sure all the steps are complete? Activity 9 engaging, is he vulnerable? Open to manipulation? Too trusting? This feeds into money as well, is there a risk of financial abuse? Activity 111 planning a journey vulnerbility os considered too. Have it all documented factually. send the EHCP even if dated, social care assessment is really strong too, even if he is not able to benefit from it, the document itself is strong. The school is also really strong evidence. Have a support staff write a supporting document, and information to contact them. and 100% include any educational psychologist reports even if dated, its still very much applicable. But the most important part is be an appointee, and once the application is in, try to answer any withheld number calls incase, as that avoids the assessment entirely.

If you are already on enh/enh then i wouldnt bother updating them, as your award wont change, its just unecessary stress. But if you are standard, and have to evidence to support new restrictions, absolutely inform them.

Its very unlikley you will score high enough to get awarded. Those conditions in them self as adults, its very hard to prove you need the level of support required to be awarded. Often claims where they are awarded its alongside other conditions. I would never advise anyone not to bother claiming, if you feel you need the support and have the evidence, its always worth it, as the worst they can do is say no, which would not change your current situation. But if you apply, apply knowing the likelihood is all A reports and no award.