DLA / AA Decision Maker - CLOSED - REFERENCE ONLY

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! :D)


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

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.
«13456733

Comments

  • Why do the dla people not end your claim if you ask them to? I tried to end my claim ealier this year and they got in contact with my doctor and over-ruled my letter. I have just sent another letter ending my claim again as i do not want the money. I don't deserve the money as god wants me to suffer hardship so that i can become a saint but i cant do if if they won't stop the money. How do i get through to them?
  • hi can anyone answer my question a lady was paid a personal injury claim payout following a really nasty rtc out of her award she had to pay back DLA {paid to her during her years whilst awaiting settlement} what i would like to check is this normal procedure and if she was due to pay it back out of her settlement - should she not have received a statement/evidence that DLA that they got the money i would be greatful if anyone could help me get her an answer thankyou
  • Thanatos
    Thanatos Posts: 882 Forumite
    scooby1001 wrote: »
    Why do the dla people not end your claim if you ask them to? I tried to end my claim ealier this year and they got in contact with my doctor and over-ruled my letter. I have just sent another letter ending my claim again as i do not want the money. I don't deserve the money as god wants me to suffer hardship so that i can become a saint but i cant do if if they won't stop the money. How do i get through to them?

    If the DLA think you are entitlled to the money, they are normally not keen on removing it, especially if a doctor has confirmed your needs.

    That said, we will stop it if you demand it and ask to Voluntarily Relinquish the benefit. This is of course assuming you are in charge of your own affairs and do not have an appointee.

    Its worth remembering that in some cases, especially with mental health, the DLA will sometimes not take your request to end the benefit at face value if they have reason to believe part of your condition may result in a lack of judgement.

    From my own personal perspective the last line in your post regarding god wanting you to suffer is likely to be what triggered the request for information from your doctor to be made. I would suggest speaking with your doctor if his opinion about your condition differs from yours.
  • Thanatos
    Thanatos Posts: 882 Forumite
    hi can anyone answer my question a lady was paid a personal injury claim payout following a really nasty rtc out of her award she had to pay back DLA {paid to her during her years whilst awaiting settlement} what i would like to check is this normal procedure and if she was due to pay it back out of her settlement - should she not have received a statement/evidence that DLA that they got the money i would be greatful if anyone could help me get her an answer thankyou

    This one is a little out of my league as its not one dealt with by my area. I am in work breifly tomorrow (technically on annual leave atm) and take a look at the Internal Intranet policy guidance and see what I can find out for you :)

    My initial reaction is something not right there, but couldnt guarantee it at this point without checking. Could you confirm, was the payout as a result of suing the person who caused the accident, or a goverment payout?
  • i would be most grateful the sum of money is large and the lady in question doesnt want to offend her solictor by questioning this incase he thinks she doesnt beleive him (apparently he is a friend of family etc etc) personally i would want reciept or some evidence thankyou again
  • sharon59
    sharon59 Posts: 1,051 Forumite
    Thanatos wrote: »
    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! :D)

    Just wanted to say thank you for offering us the chance to get some easy to understand help with our benifit questions!I was told always put your worst day-yet what you say made good sense so thank you for explaining that and maybe thats where l went wrong and my DLA care component was cut 2yrs ago.I shall give my next form more thought
    thanks again sharon:T
    :j this money saving is such fun:T
  • pipkin71
    pipkin71 Posts: 21,821 Forumite
    hi can anyone answer my question a lady was paid a personal injury claim payout following a really nasty rtc out of her award she had to pay back DLA {paid to her during her years whilst awaiting settlement} what i would like to check is this normal procedure and if she was due to pay it back out of her settlement - should she not have received a statement/evidence that DLA that they got the money i would be greatful if anyone could help me get her an answer thankyou

    I received a substantial amount following my insurance claim after a car accident, and the DSS did indeed recover what they had paid in benefits from the award.

    HTH

    Pipkin xxxx
    There is something delicious about writing the first words of a story. You never quite know where they'll take you - Beatrix Potter
  • zzzLazyDaisy
    zzzLazyDaisy Posts: 12,497
    First Anniversary Combo Breaker
    Forumite
    But that would be income support, or Incapacity benefit as they are paid when you are unable to work due to ill health or injury and would have overlapped with the loss of earnings part of your PI claim.

    DLA is not means tested, and can be paid to people who are working, so I cannot imagine a situation where DLA would be recovered from someone who made a successful PI claim against a third party?
    I'm a retired employment solicitor. Hopefully some of my comments might be useful, but they are only my opinion and not intended as legal advice.
  • Thanatos
    Thanatos Posts: 882 Forumite
    But that would be income support, or Incapacity benefit as they are paid when you are unable to work due to ill health or injury and would have overlapped with the loss of earnings part of your PI claim.

    DLA is not means tested, and can be paid to people who are working, so I cannot imagine a situation where DLA would be recovered from someone who made a successful PI claim against a third party?

    Yeah, that is my first thought, but then there are examples where it does actually happen, for example residential care home funding...

    I am guessing wildly here and really need to check at work tomorrow, but the only thing I can think of was if the money given in court for the RTA was split into sections, such as X amount for damages, X amaount for loss or earnings and X amount for the care they paid out for while recouperating...


    Other factors that may affect it are private hospital, nursing care at home etc etc... so impossible to give a clear cut answer atm without looking up the legislation.
  • RoxyK
    RoxyK Posts: 2,245 Forumite
    Thanks for your advice Thanatos. It is really appreciated. I'm just about to put in my DLA form once I get it back from my doctor. I went to the CAB for help with filling mine in and got the same advice as many others to put down your worst day. However, in my case my care needs vary very little from day to day and we did put down what I can manage when I'm at my best. Just hoping thats ok.......

    I had planned on asking my NHS Homeopathic GP (referred to by my regular GP) for a report but she had to cancel my appointment and I won't see her till Dec and was passed a message that my GP would normally do the report and we'll talk about it in Dec. Is it worth pushing for an additional report? I have CFS and have been attending for that and allergies.

    Thanks so much!
    16 x Sanyo HIT 240w panels, 3.84kWp, south facing, 30 degree slope in the SW, 4.4 Eltek HE-t inverter installed 27/03/12 :D
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