PIP- do DWP tend to agree with the assessment?

[NoEffingWay]

DH had his assessment last week, we got the report and he has been scored 8 for daily living and 10 for mobility.

Do DWP tend to agree with the assessor? They have ignored one of his health conditions entirely, and I'm nervous because 8 is the lower threshold for both awards.

Disclaimer-DH is seriously ill, can't work and is awaiting an organ transplant before anyone comes for me. He was an NHS nurse for almost 30 years until Christmas 2023. Please be kind.

Yes I think in the majority of cases they do, so hopefully will be awarded standard for both components. If you don't agree with the decision you can ask for a mandatory reconsideration.

Is he classed as terminally ill? (If he’s reliant on transplant to get well, sorry it sounds insensitive). It should be a full award, if it isn’t please appeal. I’m so sorry 💐 hope you receive some better advice soon.

Hi OP, DH is a welfare benefits adviser and this is what he says:-
"It's not unknown for a DWP decision maker to make a different decision from the health care professional who does the assessment but it's unusual. The likely outcome is an award for Standard Rate of both components, which means a total of £95 per week. Your husband can then decide whether he accepts that or wants to request a Mandatory Reconsideration and, if necessary, an appeal. Challenges are much more often successful at the appeal stage, so if your husband thinks he's entitled to a better award, he should not give up if knocked back at appeal. Look carefully at the descriptors and think about how they apply.

Is your husband getting contributory ESA? It requires National Insurance contributions. It's not affected by savings or partner income."

Hope this is useful.

Thank you all 

@KatianaLindsdottirsGhost he's getting UC, and SSP (was on a bank contract due to ill health so not entitled to OSP).

We are in no mans land waiting for any kind of carers allowance.

He isn't terminally ill, can luckily have dialysis and then hopefully a transplant (two years waiting list) if his heart is strong enough 🙏🏻. Averaging 4 appointments a week at the moment whilst I'm working full time, luckily my work are allowing me to take him and make the time back.

All caused by diabetes, which the assessor didn't seem to take into consideration-his sugars are all over the place due to his kidney function so I'm doing a lot of monitoring, rescuing and general looking after-ing.

@KatianaLindsdottirsGhost-sorry meant to say that he applied for ESA but got denied due to SSP. We got £40 UC this month as he had some pay come in from previous work, but hopefully there'll be more next month or we're in trouble money-wise.

@NoEffingWay I've asked DH again for his advice, and he says:
"That makes sense, make sure your DH is assessed for Limited Capability for Work Related Activity within the UC claim after the claim has been running for 13 weeks. That may increase the amount of UC."

So sorry you and your DH are going through this.

Ask for mandatory reconsideration, he is requiring active treatment on the majority of days. Does he have dialysis at home or clinic?

@Remotedreams he's going to be having dialysis in hospital 3 times a week

It may be that because he worked until Xmas, his condition has not been as debilitating as it is now, they like a 3 month history. But as soon as dialysis starts, it should be reviewed as his award can change from that date, but you would need to request this.
Is the mobility aspect related to this condition or is at a separate health issue?
Scoring a 10 would say he doesn't leave the house on Majority of days or that he cannot mobilise very far.

Diabetes, if well controlled would not score, however if having repeated hypos that require others to intervene with rescue meds, this would increase his score in daily activities section. There is lots to this and the opinion of an Assessor may not reflect the extent of the restriction. However, unless you request a mandatory review, dwp unlikely to disagree in first instance.
Appeals are usually very successful

@Remotedreams he can't walk very far at all due to the breathlessness and fatigue due to his kidney function, so is only going out for appointments. I have to drive him as he can't manage the bus (can't drive due to diabetes).

Will add more to the claim once he starts dialysis, thank you.

It's been ongoing for over a year, but struggled on until it became very evident he couldn't carry on. We've never claimed anything as both worked since our mid-teens. It's a scary proposition to have to depend on the state. Taken so long to get sorted out, but I can't fault UC for the speed of their decision and appointments.

Waiting for DWP to come back to DH after his appointment is dragging. £380 a month will make a big difference to DH's quality of life, which is just crappy at the minute.

You can't really just add more to a claim once he starts dialysis, it doesn't work like that. You would need to ask for a review which would mean the whole award being looked at again. you would be best to ask for a mandatory reconsideration if you don't agree with the award although that can be risky too. If he is awarded LCWRA after assessment on Uc that is another £390 a month and if you don't already get a work allowance ( you will have this already if you have dependent kids) then you would also get that meaning a good proportion of your earnings would be disregarded before deductions are taken. Once his SSP has ended ne should make a claim for new style ESA assuming he has paid enough NI contributions over the past 2-3 years.

To me, it sounds like he can't leave the house without another person due to health condition. So appointments and general life requirements mean he cannot go out without another person on Majority of days. So even if he scores 10 for mobility, I would be arguing a 12 (high rate) as unsafe to be out alone due to uncontrolled condition. Its always worth a try.
With that level of fatigue, I would push for higher scores wit daily living too. They score using STAR, can you complete an activity Safely, Timely, Acceptable standard, Repeatedly.
All this info can be found online with a copy of how the scoring criteria works.
They cannot award for future planned treatment (dialysis) until it actually starts, but in your position, I would be requesting a copy of the assessment, and also ask for mandatory review.
You can then update as things change and treatment starts. Don't wait until his treatment starts.
Hope this helps

Is it definitely the assessment report you've received? Did you request it? It's not usually sent as standard unless you request it.
Usually a claimant would just get the DWP's decision letter with the points, summary of reasons (including references to assessment) and the award.
8 points for daily living would mean the standard rate and would entitle you to carer's allowance so you will be able to claim it and should also update your UC claim; your CA will be deducted but you get the carer's element added so you'll be slightly better off overall.
As a PP said, the important thing is to ensure he has a work capability assessment for UC, because if he's assessed as having LCWRA (limited capability for work-related activity) - which seems likely based on what you've said - he'll get an extra £390/month.

Anyway, double check the letter, if it's not the decision letter you'll have to wait for that obviously. But standard rate for both is a decent result and if you were hoping for more (to get enhanced rate he'd need 12 points so that's 4 more points for daily living and 2 for mobility) I would suggest getting advice from a benefit specialist before trying for it. For example your local citizens advice may be able to advise. You will need to show them all paperwork including decision letter, assessment report, medical evidence.

You may find that the hospital that he will be attending will have a service that helps you complete the form too.

You won't be able to claim carers allowance yourself if earning over £139 a week but can still get the carers element on your joint Uc claim if he is awarded standard daily living.
As Another Emma says please seek specialist advice before asking for MR or reporting changes as there is an element of risk with the existing award.

Having been a PIP assessor, I can tell you the DWP are BRUTAL. They often reduce the awards and points that have been awarded by the assessor. If the assessor refuses to do this, they get other people to do it over their heads. I know because I've had it done to my reports?!

BUT.....appeal!! Don't give up and go in person to your appeal.

@AnotherEmma he requested the assessors report, so that we could have an educated guess at the award-that can take up to 8 weeks after the assessor but hoping very much for a quicker turnaround (having worked in public services for all of our adult lives we appreciate that there's always immense pressure from all angles!)

I think, based on what everybody's saying, he will wait to get the decision letter and most likely ask for an MR). I'm just nervous they could reject the whole thing and then we'll be back to the start of the process

As above if awarded standard for both that is a reasonable award. If asking for an MR you need to identify where he is likely to score the additional points for enhanced.

@Blueuggboots This is one of the concerns. Reading through the report, I can see why he only scored 8 on the daily living component. He can, for example, dress himself and shower but he needs prompting and support to do so, and then only after 3pm when he's slept all morning, and then needs a 2 hour nap afterwards. He scored 0 there because the tick box doesn't seem to allow for those nuances.

It was a fair report but the points don't reflect the difficulties, I think but what do I know?!

Could it be the case that when he actually starts dialysis he will actually feel improved / less fatigued ? I know the travelling will be tiring but surely if he is actually getting the treatment he needs he could feel better ? has any indication been given to him as to how things might improve once dialysis starts? I'm only asking because I have had patients say they felt a lot better on dialysis.

@Babyroobs I really, really hope so. Transplant is the only long term cure, but that's a long way off. I'm just living day by day and clinging onto the hope that he hangs on long enough to get a transplant

There are a few things to remember about PIP.

First, you can usually only claim if you've been affected by your condition(s) for 3 months and expect to be affected for another 9 months. (There is an exception for terminal illness, which according to the rules means that a doctor says the patient is likely to die within 12 months - sounds like this does not apply in your DH's case, thankfully.) The 3+9 month rule means that if your DH's health deteriorated significantly very recently, and if it is likely to improve with dialysis, it might be difficult to get PIP and will certainly be difficult to get the 12 points needed for the enhanced rate.

The other point to remember when looking at the descriptors and points is whether he can carry out the activities "reliably", including whether he can do them safely, to an acceptable standard, repeatedly and in a reasonable time period. So, for example, if it takes him 3 times as long as "normal" to get dressed and then he needs a 2 hour nap afterwards, he should score points for that.
see https://www.citizensadvice.org.uk/benefits/sick-or-disabled-people-and-carers/pip/help-with-your-claim/how-decisions-are-made/#h-can-you-carry-out-the-activities-reliably

Lastly, with fluctuating conditions it's important to describe better, average and worst days and how often each occurs - you would usually only get points if you are affected at least half the time.

Have you tried doing the online questionnaire to compare and check he's been awarded the points you feel he should get against each question?
Given what you have explained, I'm really surprised he would only be entitled to the lower rate on both components.

Assume you mean this, purple rain?
https://www.benefitsandwork.co.uk/personal-independence-payment-pip/pip-self-test