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  • FIRST POST
    • Thanatos
    • By Thanatos 28th Oct 08, 8:33 PM
    • 863Posts
    • 1,060Thanks
    Thanatos
    DLA / AA Decision Maker - CLOSED - REFERENCE ONLY
    • #1
    • 28th Oct 08, 8:33 PM
    DLA / AA Decision Maker - CLOSED - REFERENCE ONLY 28th Oct 08 at 8:33 PM
    Hi,

    I am a Disability Living Allowance (DLA) & Attendance Allowancence (AA) Decision Maker based in Warbreck House in Blackpool.

    If I can help out with any queries about the rules and regulations of DLA/AA please feel free to Message me or post your queries in this thread and i will answer what I can. All advise I give is my own personal opinion based on my knowledge of the benefit and obviously not official government guidance.

    I have compiled some tips of what I would suggest based on my own method of dealing with claims and that of the people I work with.

    I see many tips from people suggesting you put the details down for your worst day. This is my number one No-No! We have a very in depth detailled computer system called CCM (Customer Case Management) that tells us what needs should arise from the stated conditions.
    For example, someone with mild Arthritis is bound to have the odd bad day where they are in considerable pain and struggle with stairs, getting in and out of chairs etc etc. However, we know that under normal circumstances mild Arthritis does not cause that level of problem most of the time. All DLA and AA awards are based on your needs most of the time and not your worst days only. By putting your worst days on the forms for lesser conditions all you are doing is making the Decision Maker suspicious of your claim.
    It is not our job to "police" the benefit system, but if we see a claim that does not add up, it will fall under close scrutinisation from our in-house Doctors (who we use for advise) as well as GP Factual Reports (GPFR), Hospital Factual Reports , Occupational Therapists, Physiotherapists etc etc etc the list is endless. The bottom line is to tell it exactly how it is, if you have 2 bad days a week on average, 3 average days and 2 good days, say so in the form. Honesty is the best policy in this case!

    I would also advise you send in any medical evidence you have with your claim (photocopy everything too!) as this can speed your claim up by weeks. Certain cases (those with Higher rate mobility Component and Middle or higher Care component) must undergo what we call "Initial Scrutiny" e.g we have no choice but to go for medical evidence under management instruction. This takes at least 2 weeks for a GP, or considerably longer for hospitals. We do not get charged for Hospital reports so are encouraged to try hospitals before GP's. A simple letter from the hospital can make a massive difference to the speed of your claim. Obvioulsy these are not the only cases we go for medical evidence, some times we simply require confirmation a condition has got worse (or better) or things do not add up etc so always include any evidence you have.

    If you are claiming for a child 9/10 times we will go to the school for confirmation of needs first so a letter from them, or even the back section of the form filled in by them is beneficial.

    I have some guidance at work that I will grab tomorrow and post in this opening thread of exactly what qualifies for what in terms of needs.


    If anyone wants to ask about official rules etc, feel free to ask and i can post that information as it is all freely available in the legislation anyway (just simplified for lay people rather than the lawyers that wrote it! )


    I thought this general guide to what qualifies you for what level of the benefit might help:

    MOBILITY COMPONENT:

    HIGHER RATE QUALIFICATION (AGED 3+):

    MUST BE:

    VIRTUALLY UNABLE OR UNABLE TO WALK
    OR
    BOTH BLIND AND DEAF
    OR
    DOUBLE AMPUTEE
    OR
    HAVE A SEVERE MENTAL IMPAIRMENT

    LOWER RATE QUALIFICATION (AGED 5+):

    MUST BE ABLE TO WALK BUT IS SO SEVERELY DISABLED PHYSICALLY OR MENTALLY,
    THAT THEY CAN NOT TAKE ADVANTAGE OF THE FACULTY OF OUTDOORS WITHOUT:

    GUIDANCE
    OR
    SUPERVISION
    MOST OF THE TIME WHEN WALKING IN UNFAMILIAR SURROUNDINGS

    IN LOWER RATE CASES OF CHILDREN AGED 5-16

    CHILD MUST SATISFY THE NORMAL CRITERIA PLUS SUBSTANTIALLY MORE SUPERVISION THAN A PERSON THEIR AGE WOULD NORMALLY REQUIRE
    OR
    SUPERVISION THAT A PERSON YOUNGER THAN THEM IN NORMAL PHYSICAL HEALTH WOULD NEED, BUT A PERSON THEIR AGE IN NORMAL PHYSICAL AND MENTAL HEALTH WOULD NOT REQUIRE.

    CARE COMPONENT:

    DAY QUALIFICATION (MIDDLE RATE CARE):

    FREQUENT ATTENTION FROM IN CONNECTION WITH BODILY FUNCTIONS
    OR
    CONTINUAL SUPERVISION TO PREVENT SUBSTANTIAL DANGER TO THEMSELVES OR OTHERS

    NIGHT QUALIFICATION (MIDDLE RATE CARE):

    PROLONGED OR REPEATED ATTENTION IN CONNECTION WITH BODILY FUNCTIONS
    OR
    ANOTHER PERSON TO BE AWAKE FOR A PROLONGED PERIOD OR AT FREQUENT INTERVALS TO WATCH OVER THEM TO AVOID SUBSTANTIAL DANGER TO THEM OR OTHERS

    IF BOTH DAY AND NIGHT NEEDS ABOVE ARE PRESENT, THEN AWARD IS HIGHER RATE CARE

    [COLOR=red]LOWEST RATE DLA

    ATTENTION WITH THEIR BODILY FUNCTIONS FOR A SIGNIFICANT PORTION OF THE DAY
    OR
    MAIN MEAL TEST

    KEY:

    FREQUENT: SEVERAL TIMES, NOT ONCE OR TWICE
    PROLONGED: 20 MINUTES (APPROX.)
    REPEATED: MORE THAN ONCE
    SIGNIFICANT PORTION: LENGTH OF TIME ABOUT 1 HR
    CONTINUAL: ALL OF THE TIME (SUBJECT TO BRIEF INTERRUPTIONS)

    IN ALL CASES OF CHILDREN AGED 0-16

    CHILD MUST SATISFY THE NORMAL CRITERIA PLUS SUBSTANTIALLY MORE CARE THAN A PERSON THEIR AGE WOULD NORMALLY REQUIRE
    OR
    CARE THAT A PERSON YOUNGER THAN THEM IN NORMAL PHYSICAL HEALTH WOULD NEED, BUT A PERSON THEIR AGE IN NORMAL PHYSICAL AND MENTAL HEALTH WOULD NOT REQUIRE.
    Last edited by Thanatos; 19-12-2008 at 4:11 PM. Reason: Additional Information
Page 3
    • D&DD
    • By D&DD 29th Oct 08, 5:05 PM
    • 4,365 Posts
    • 30,234 Thanks
    D&DD
    Welcome to MSE Thanatos
    I have a quick question please with regards to my sons new award.His current award runs to 26/12/08 is for MRC and LRMob he's been awarded HRC and HRM to start when this award runs out,which we are more than grateful for but just wondered why it didn't start from now? Thanks very much for helping us out on here in your own free time it's much appreciated
    • Thanatos
    • By Thanatos 29th Oct 08, 5:07 PM
    • 863 Posts
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    Thanatos
    Thank you for your answer Thanatos. Yes, that makes sense to me. You are right, there was an increase in my last award, from Higher Rate Mobility for 2 years, to HRM and Lower Rate Care for 3 years.

    If someone's health were to improve slightly (mainly 'cos I'm no longer trying to hold down a full time job, having been dismissed on the grounds of my ill health), would that automatically mean that my DLA would be removed this time? Bearing in mind that as soon as I try to increase my activity levels my pain levels and the tiredness rocket, so actually I'm not really any better as such just doing less to compensate.

    I'm not expecting a definitive answer here, just a general guide - i understand that you're not doing this in an official capacity so I wouldn't take anything you say as binding on DWP.
    Originally posted by somebody_else
    Tricky queston - and not one I can answer definitivly based on the info you have supplied. In gerneral though, getting better will not automatically mean a removal of all DLA benefit, it may be reduced, it may be changed from a long term to a short term award and it may also mean totally removing it etc etc.

    However, if you can do things one day, but that means you are really bad the next day, you need to explain that in the free hand boxes as if you simply tick yes you can do it with no explination its not going to help the DM understand the full extent of your problems - by the same token, putting you cant do anything may make the DM suspicious of your claim. Try to go overboard on the info you provide.
    • Thanatos
    • By Thanatos 29th Oct 08, 5:14 PM
    • 863 Posts
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    Thanatos
    Hi
    My wifes dla is up for renewal her present claim ends early january 2009, at the moment she receives (hrm) and (lrc) my first question is this if the dm were to reduce or even decline the renewal would that take immediate affect
    or would it still run till the renewal date ?.
    my second question is if the dm were to increase the care conponant would it increase immediatly or from the renewal date ?

    My wifes renewal claim has now been at blackpool for 8 weeks yesterday she
    received a letter to say they had writen to her gp how much longer do you think it will take as my wife has a car on motability and if it is'nt sorted out
    i assume the car will have to be returned, do you think it should be sorted in time?

    thanks steve :confused:
    Originally posted by steve-kaz
    Ok, dinners ready so short answer only

    Part one: If they keep in the same then it runs from the renewal date, if they increase it then from the day day they recieved the claim pack. If they reduce it (probably) from the date of renewal and if they remove it entirely (probably) from the date of the renewal - eg it runs until current award expires.
    Its only exceptional cases (rare!) where thats any different.


    Part 2: You will be fine - The Mota sections currently have one of the best statistics for turnaround times and last report that came out had only 4 cases that were out of payment so chances are you will be fine. Best thing you can do is hassle your GP to return the report asap - as thats what can hold up a claim... but if you have waited 8 weeks so far, if wont be long before your case is pulled out and handed to a DM who specifically targets old cases.
    • Thanatos
    • By Thanatos 29th Oct 08, 5:17 PM
    • 863 Posts
    • 1,060 Thanks
    Thanatos
    Welcome to MSE Thanatos
    I have a quick question please with regards to my sons new award.His current award runs to 26/12/08 is for MRC and LRMob he's been awarded HRC and HRM to start when this award runs out,which we are more than grateful for but just wondered why it didn't start from now? Thanks very much for helping us out on here in your own free time it's much appreciated
    Originally posted by D&DD

    Ok, chances are the date of this award is wrong. It might not be, if for example your son has an increase in his needs recently - you have to have the need for 3 months before you qualify (6 months for AA) so if for example he got worse last month, this would explain the reason it wont go up until december, but unless thats happened, I would challenge the date by asking for a reconsideration. (it will get back dated if its wrong)
  • somebody_else
    .. .by the same token, putting you cant do anything may make the DM suspicious of your claim. Try to go overboard on the info you provide.
    Originally posted by Thanatos
    Oh, I wouldn't do that, but understand why you've written it. As with a lot of disabled people, some days are better than others, and at times I can do a reasonable amount, other days it's all I can do to do the absolute basics. I try, as much as I can, to be fairly objective about it all, but I'm not sure I succeed all the time.

    I have been keeping a diary for the past 6 months (I don't keep it all the time as i just find it too depressing (not to mention time and energy consuming) to keep writing it all down all the time, but I do appreciate the time you're taking to answer all our questions.

    s/e
  • annamc75
    Firstly, many thanks for taking the time to help us all understand DLA and AA. I have a couple of questions please if you might be able to help.

    My aunt is 58 and for the past 15 years has been in bad health - this has been misdiagnosed and mistreated by the NHS but it is some sort of digestive problem (they still havent given it a proper name but over the years it has been diagnosed as crohns, colitis, suspected bowel cancer, ibs to name a few). She also suffered a huge benign brain tumour 4 years ago and although it was removed it has left her with some level of brain damage.

    When applying for dla it is very difficult to measure what she needs help with as she has "vacant spells" - examples of these can be getting the bus into town to do something - getting there and then getting the bus straight back without doing anything or starting something on the hob and then just wandering away. It is so difficult to say when these periods will happen and because of that she is reluctant to speak to her GP about it. Her check ups show that there is no brain tumour returning. We notice these spells more than she does and unless there is some enevitable outcome - like burning a pan - then she doesnt know she has done anything out of the ordinary.

    At the moment she gets low rate mobility I believe but I cant help thinking that she might want to have this looked at again.

    Thoughts or pointers would be gladly recieved.

    Anna x
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  • lasor
    Thanatos...
    No questions here just a very big thank you for your time in this thread. You are an absalute star.. Thanks Again
    • Thanatos
    • By Thanatos 29th Oct 08, 10:53 PM
    • 863 Posts
    • 1,060 Thanks
    Thanatos
    Firstly, many thanks for taking the time to help us all understand DLA and AA. I have a couple of questions please if you might be able to help.

    My aunt is 58 and for the past 15 years has been in bad health - this has been misdiagnosed and mistreated by the NHS but it is some sort of digestive problem (they still havent given it a proper name but over the years it has been diagnosed as crohns, colitis, suspected bowel cancer, ibs to name a few). She also suffered a huge benign brain tumour 4 years ago and although it was removed it has left her with some level of brain damage.

    When applying for dla it is very difficult to measure what she needs help with as she has "vacant spells" - examples of these can be getting the bus into town to do something - getting there and then getting the bus straight back without doing anything or starting something on the hob and then just wandering away. It is so difficult to say when these periods will happen and because of that she is reluctant to speak to her GP about it. Her check ups show that there is no brain tumour returning. We notice these spells more than she does and unless there is some enevitable outcome - like burning a pan - then she doesnt know she has done anything out of the ordinary.

    At the moment she gets low rate mobility I believe but I cant help thinking that she might want to have this looked at again.

    Thoughts or pointers would be gladly recieved.

    Anna x
    Originally posted by annamc75
    Hmmm... this is a tricky one, firstly you mention she is reluctant to speak to the doctor about this - well from a DLA point of view, if you are thinking about asking to get the claim looked at again it is imperitive the doctor knows all about this aspect of her condition as if we write to him and ask, and he replys he is not aware of the problem, it will not help the claim one little bit.

    As far as the spells are concerned, it would be very dependent on how often they occur and how much danger is she is when they do occur. It is very unlikely she would get any extra mobility component, as regardless of how much supervision she requires outside its only lower rate. The only thing she could fall under is "The act of walking causes her harm" but I think it very unlikely this could be proved to be the case most of the time...

    And its most of the time that causes a problem with the care side too. It might be possible in conjunction with her other ailments too, but without the full details I cant really advise much more than that - I suggest giving it a go and applying for more. If she is only on lower rate mobility at the moment, I would think it unlikely that would be taken from her based on what you have told me so far.

    Sorry, that wasnt much help was it...
    • Thanatos
    • By Thanatos 29th Oct 08, 10:54 PM
    • 863 Posts
    • 1,060 Thanks
    Thanatos
    Thanatos...
    No questions here just a very big thank you for your time in this thread. You are an absalute star.. Thanks Again
    Originally posted by lasor
    Cheers I must admit, I didnt think this thread would be as busy as it has been!

    I am away next week, so will have to put things on hold unless the hotel has the internet!
    • jetcat
    • By jetcat 30th Oct 08, 9:07 AM
    • 741 Posts
    • 421 Thanks
    jetcat
    Cheers I must admit, I didnt think this thread would be as busy as it has been!

    I am away next week, so will have to put things on hold unless the hotel has the internet!
    Originally posted by Thanatos
    think it shows how much confusion there is surrounding meeting the criteria for dla!

    i too would like to offer my thanks, not only for the excellent thread, but also for kindly repsonding to my pm

    have a good holiday!
  • Thorntonone
    My thanks also go out to Thanatos, i an in the middle of filling out a claim form for DLA a daunting task i can tell you. i take it a little at a time untill i get to a question that i feel is difficult to answer, then it's time for a break.
    • Ames
    • By Ames 30th Oct 08, 11:52 AM
    • 17,728 Posts
    • 31,354 Thanks
    Ames
    I had an increase in my award but it was paid from the end of my previous award, which was later than the date of the decision, are you saying the new award should have started when the decision was made? As it was quite a substantial amount of money.
    Unless I say otherwise 'you' means the general you not you specifically.
    • Thanatos
    • By Thanatos 30th Oct 08, 1:49 PM
    • 863 Posts
    • 1,060 Thanks
    Thanatos
    I had an increase in my award but it was paid from the end of my previous award, which was later than the date of the decision, are you saying the new award should have started when the decision was made? As it was quite a substantial amount of money.
    Originally posted by Ames

    There are times it doesnt apply, but in general, yes. A renewal claim turns into a supersession (a decision that superseeds the previous decison) if there is an increase in the level of DLA/AA payable.

    The reason behind it is that if at the point of renewal it is recognised there is an increase in needs at the time we recieved the renewal, by the same token had the customer asked for a supersession, the same decision would have been reached and would have been payable with imediate effect.

    Also, its not the date of decision it should be payable from, its the date the form was recieved by us in the DLA. We de-register the renewal and re-register it as a supersession.

    Like I say, this is only a general rule of thumb (9 out of 10 times) there are exceptions like with the 3 month/6 months rules I mentioned earlier.



    Normally i would suggest asking for a reconsideration - if its over the 4 week period in which a recon is allowed you will have to explain that you could not have possibly known that the date of the decision was wrong and ask for them to accept it as late. Any DM worth his/her salt will know it was our mistake and accept it.

    Aplogies for the error - its one of the areas that is incredibly easy to overlook when making a decision, fortunetly its one of the easier ones to fix.
    Last edited by Thanatos; 30-10-2008 at 1:53 PM.
    • Chrysalis
    • By Chrysalis 30th Oct 08, 2:58 PM
    • 2,373 Posts
    • 1,143 Thanks
    Chrysalis
    Hi Thanatos, first off thanks for spending time to do this and confirming what I thought that decisions made depend heavily on diagnosis.

    My question I hope is a simple one, how should claimants who dont have a diagnosis proceed with a claim?
  • annamc75
    Hmmm... this is a tricky one, firstly you mention she is reluctant to speak to the doctor about this - well from a DLA point of view, if you are thinking about asking to get the claim looked at again it is imperitive the doctor knows all about this aspect of her condition as if we write to him and ask, and he replys he is not aware of the problem, it will not help the claim one little bit.

    As far as the spells are concerned, it would be very dependent on how often they occur and how much danger is she is when they do occur. It is very unlikely she would get any extra mobility component, as regardless of how much supervision she requires outside its only lower rate. The only thing she could fall under is "The act of walking causes her harm" but I think it very unlikely this could be proved to be the case most of the time...

    And its most of the time that causes a problem with the care side too. It might be possible in conjunction with her other ailments too, but without the full details I cant really advise much more than that - I suggest giving it a go and applying for more. If she is only on lower rate mobility at the moment, I would think it unlikely that would be taken from her based on what you have told me so far.

    Sorry, that wasnt much help was it...
    Originally posted by Thanatos
    That is helpful to know - it is along the lines of what I expected tbh. We dont know how often the vacant spells are as she lives alone and doesnt often notice when she has them (or at least doesnt admit to knowing). You can be having a conversation with her on the phone and she will go quiet and then repeat a part of the conversation she has just had (a bit like a jumping record). I will ask her to report it to the GP - I dont think that he will be suprised by this as she has been back and foward for treatment because of the brain tumour.

    Thank you so much for sparing your time and I wish you well

    Anna x
    10 per day Challenge (Oct)

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    • Thanatos
    • By Thanatos 30th Oct 08, 4:03 PM
    • 863 Posts
    • 1,060 Thanks
    Thanatos
    Hi Thanatos, first off thanks for spending time to do this and confirming what I thought that decisions made depend heavily on diagnosis.

    My question I hope is a simple one, how should claimants who dont have a diagnosis proceed with a claim?
    Originally posted by Chrysalis
    Hi, actually no, the decisions made do not rely heavily on the diagnosis, but on the needs of the customer. To try explain myself a little clearer here is an example:

    Two men travelling in a car have an accident. Both men are left paralysed below the waist. One man looks at this as the end of his life and sits around watching tv. His muscles waste and he is unable to transfer from his wheel chair to the toilet, or bed. He requires someone to help him wash because he has not motivation to do it himself. The other man looks at his predicament as a challenge. He excersises his upper limbs and even takes up wheelchair basket ball. He gets the occupational health in to adapt his bathroom so he can manage himself and is insistant he does anything he can himself without help.

    In this senario, both men have an identical diagnosis, however the level of help needed is totally different. As a result of this, one man will be on a different level of DLA to the other irrelevent of the fact they have the same physical problems as each other.

    Hope that explains how we look at it a little better. ...and on that basis, if you do not have a diagnosis, it really does not matter providing you have some evidence from a medical proffesional of the needs you have. I myself see about 3 or 4 cases a week where a diagnosis has not yet been decided upon, some short term, some long term.

    Hope that helps
  • alexcross
    Id just like to say thank you for all your help.
    If it weren't for the very patient people who have helpped with the DLA applications I would not have got extra help for my Son.
    From the moment he was born things were not right and it took me till he was 8 to fight tooth and nail for him to be asseses for a few things (my doctor where I live now was the one who pushed for these tests.) I often thought it was my parenting skills at fault and the fact that I had bed post natal depression when DS was born.
    This is an amazing thing you are doing and I can not thank you enough.
    keep up the good work.
    • Thanatos
    • By Thanatos 30th Oct 08, 4:09 PM
    • 863 Posts
    • 1,060 Thanks
    Thanatos
    Out of curiosity - how did this thread get stickified?
  • somebody_else
    As a DLA claimant, could I back up what Thanatos has just posted?

    I've been in receipt of DLA since around 2002 - although I don't actually have what I would call a definitive diagnosis of what is wrong with me.

    Fortunately after many years of hitting a brick wall of "we can't find anything physically wrong with you", from a variety of both GPs and specialists of one kind or another, I ended up with a new GP and a Rheumatologist who both wanted to get to the bottom of my abnormal blood tests. They are also adamant that there is something physical going on, because they've both said I couldn't possibly 'imagine' the blood results. Even if they can't pin it to 1 specific cause.

    Obviously, if you've got certain diagnoses, it's easier for the DMs to know how your condition is going to affect you, but if you can give them plenty of information about your symptoms and how they affect you then a decision can be made in your favour.
    s/e
    • altocumulus
    • By altocumulus 30th Oct 08, 4:47 PM
    • 567 Posts
    • 305 Thanks
    altocumulus
    Hi Thanatos, may I thank you for joining MSE and putting answers to many questions. I am sure most people here will appreciate your guidance and patience.

    It has been mentioned on an earlier post, but may I ask what the official line is with deafness and DLA.

    My sister is a trained social worker and maintains that I am eligible for DLA, but my own interpretation of the info on the directgov website begs to differ.

    My hearing loss is severe enough that my employer chose to offer me ill-health early retirement, and also not to offer me a different posting. It is also severe enough for me to be able to get a Disabled bus pass for Scotland buses, where the criteria was a minimum bilateral hearing loss of 82db. For medical reasons I am unable, any longer, to wear hearing aids....
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