PIP Award Reviews
From the 27th June 2016 when making an award review decision for Personal
Independence Payment (PIP) the Case Manager (CM) will be able to decide the
level and period of award based on all current evidence and evidence from the
previous assessment without the need to refer the case to an AP (Assessment
Provider). Where the CM is unable to make a decision, they may still refer the case
to the AP.
An Award Review (AR) is instigated by the Secretary of State (SofS) to review an
award set at a time prescribed by the CM, using advice from the Assessment
Provider (AP) when the original decision is made. This is where the claimant is still
likely to have daily living or mobility needs at the point of review but those needs may
Although Planned Interventions have now been renamed to ARs, various
computer system screens will still refer to Planned Interventions.
You’ll look at or consider looking at, an existing award, to decide if you need to
amend or change it, prior to the termination date.
Changes when setting a review date with effect from 31st May 2019
From 31st May 2019 CMs will no longer regularly review PIP awards for claimants
who have reached State Pension age (SPa), unless they tell us that their needs have
When setting an award period, you must identify the appropriate level and
duration of award as normal, then check the claimant’s age. If the claimant is aged
57 or over, you must check the date on which the claimant will reach their Spa.
If the Award Review date goes beyond the claimant’s SPa date, you must set a
ten year ongoing award.
AE deferred ongoing event identified
An Administrative Exercise (AE) is the process for looking at cases to see if
claimants are impacted by the Upper Tribunal (UT) decisions. AE cases will be dealt
with by the AE teams.
If there’s an ongoing event registered the case won’t be reviewed.
When AE action has been deferred because an ongoing event has been identified
you must defer the task until the event is cleared.
How the Review Date was Set
When making the previous decision to award PIP, the CM would have decided
based on all evidence available whether the functional restriction would likely be
present at the recommended point of review regardless of whether it was considered
likely to improve, remain the same or deteriorate.
Where the AP considered a claimant had a stable health condition or impairment
and it was highly unlikely to improve or deteriorate, they would have advised that
they considered there to be no medical justification for a review. In such cases the
CM would have given an on-going award of benefit (with reviews at least every 10
Where an individual’s needs are likely to continue but may increase, the AP
would provide advice on a medically appropriate review point, rather than no review;
this is need to ensure the case is reviewed and increased support provided where
The CM would have considered all evidence available and set an award end
date and review date as appropriate.
PIP Award Duration
Type of PIP Award
When making award decisions, CM/APs will put cases into one of three groups.
Fixed period award no review date - where there is a reasonable expectation to see
a significant improvement in needs arising from the claimant’s health condition or
disability, to the extent they no longer require PIP. These cases won’t have an AR.
Fixed period award with review date - where it’s likely the claimant’s level of
restriction in daily living and mobility activities may change at a later stage. That is
the claimant may have some improvement or deterioration that could result in a
change in the rate of PIP entitlement. The CM decides the review point and then sets
the end date of the award for 12 months after the review date.
On-going award - where the claimant’s restrictions on daily living and/or mobility are
unlikely to change significantly, or where the Award Review date goes beyond the
claimant’s SPa, these cases will have an AR at least every 10 years.
The resulting AR is designed to ensure the correct level of entitlement is in place.
Award Review action will start on the review date.
If an Advance Claim or Change of Circumstances (CofC) AR is on-going, the
planned AR is no longer required.
PIP Award Reviews record created
From 1 April 2019, the date on which the AR1 is actually issued will be set by the
business as needs arise. This means that AR1 may not be issued on the exact date
the review date is reached.
Values available when you complete the determination are:
Disallowed - no AR1
Disallowed - FTA
Disallowed - other lay
Disallowed - Assessment
Extended same rate
Form AR1 is automatically issued with covering letter PIP.1043 and the claimant
is given 1 calendar month from the day after the date of issue to return the AR1. For
example, the AR1 covering notification PIP.1043 issued 03 February asks the
claimant to return the AR1 by 04 March.
AR1 replaces PIP2(UI) from 25 June 2016 for PIP Award Reviews only.
The AR1 return date is 40 calendar days from the date of issue. After 19
calendar days the reminder notification PIP.1045 will be automatically issued if the
AR1 hasn’t been returned.
An AR is not created if there is a CofC review, advance claim in progress or PIP
is not in payment.
For any cases where an AR was created before the 25 June 2016, and the
claimant requests a duplicate form, a PIP2(UI) must be sent clerically and NOT an
AR1 form. All PIP2(UI) received after 25th June 2016, will be referred to the AP for
AR1 not returned - Additional Support (AS) identified
Where the AR1 is not returned by the agreed deadline and the claimant requires
AS, the AP will consider a Face to Face Assessment or Paper Based Report.
AR1 not returned – no Additional Support identified
If an AR1 isn’t returned within the agreed timescales and AS hasn’t been
identified the CM must disallow and issue a Lay Disallowance notification PIP7041.
The date of Disallowance will be the day the decision is made. Where a PIP2(UI) has
been issued prior to the 25th June 2016 the CM will still receive a task to consider
disallowance on non AS cases.
Change to Additional Support status
If at any point following a new claim, the claimant’s AS indicated status changes
from ‘No’ to ‘Yes’, you must update the PIP computer system accordingly. Failure to
do so will result in the AR1 Part 2 being recorded as ‘not returned’ and a
disallowance notification will be issued showing an incorrect end of award date. As
the benefit case remains active and in payment, this could generate a possible
A negative determination can be made at several points in the PIP journey. A
negative determination is a disallowance if the claimant fails to comply with the PIP
process for example:
Failure to return the AR1 Within the 40 day deadline
Failure to Attend Assessment (FTA)
Failure to Comply (FTC)
The effective date of a Negative Determination will always be date of decision.
The claimant has the right to request a reconsideration on any decision within the
dispute time limit. Where any decision has been made and is being looked at again
it’s a Reconsideration. This is even where you have decided that the negative
determination was incorrect and the claimant did have good reason.
Reconsideration following removal of PIP – FTA/FTC – New Claims (NC) CM
When the AR claimant requests Reconsideration following a FTA/FTC
disallowance they will be handled by New Claims (NC) CMs.
The NC CM will need to ask a line manager or Quality Assurance Manager
(QAM) to re-activate the case if the case is closed or in pending closure mode.
The NCs CM must register the Reconsideration, consider ‘good reason’ and
conclude the Reconsideration on the Same Day.
The NC CM will then refer the case to the AP as usual if ‘good reason’
If ‘good reason’ is not accepted the NC CM will conclude the Reconsideration
as unchanged, issue clerical PIP7024 and create a copy to be retained on the
system. AR1 Received Late
When the AR1 is received late the CM with the right skillset will take the
appropriate action depending on the claimant’s ‘Additional Support Determined’
status and where the case currently sits. AR1 Received Late – AS case currently with AP
Where ‘Additional Support Determined’ is ‘yes’, the case will have been
automatically sent to the AP.
You therefore need to make the AP aware an AR1 has been received.
AR1 received late, non-AS and case has been disallowed on negative
Where ‘AS Determined’ is ‘No’, the claim is disallowed automatically on
negative determination grounds.
You will therefore need to consider whether there is ‘good reason’ and decide
whether to revise the disallowance decision and, if appropriate, reinstate PIP and
then conduct the PIP Award Review.
A Reconsideration must
be registered first and concluded on the same day.
Complete a manual reconsideration notification PIP.8022 and continue with the
Award review action.
The Process When the AR1 Is Received In Time
The Claimant receives the AR1 and completes it to indicate whether or not there
has been a change in their condition since they were awarded PIP.
When the AR1 is received the Mail Opening Unit (MOU) will scan it into the
system and send it to the CM with the right job role and skill set.
The claimant may tell us that their condition hasn’t changed at all, or if there has
been a change, they will indicate whether they have improved or deteriorated since
the last assessment, and provide some details about the changes for example, what
has changed? When did things change? Once you have established the date when
the changes occurred you need to apply the Qualifying Period (QP) where
You must check the AR1 to see if it was signed by the claimant or appointee. If
the AR1 was not signed by the claimant or their appointee/Personal Acting Body
(PAB)/Corporate Other Payee (COP), the CM should print off a copy of the AR1 and
return it to the claimant with PIP.0009 to be signed. A 14 day return date is set for
reply and on return of the signed rescanned AR1 the CM can continue action to
scrutinise the claim.
The Claimant might say one of the following: my health has:
- with good supporting evidence - with limited or no supporting evidence
- with good supporting evidence - with limited or no supporting
- with good supporting evidence - with limited or no supporting evidence
How to Assess Each Claim
In all cases there must be consideration of the content of the AR1, the original
evidence and any other relevant evidence, such as NHS sites that cover conditions
and detail about variability of those problems.
Look at the AR1 for
What changes does the Claimant describe? Are these actual changes (rather
than re-iterations of the original problems, or detail re variability of those
problems)? If the change is accepted, which descriptors will be affected?
evidence of anticipated changes at previous decision change taking place for
example, expected surgery or treatment
all evidence, in terms of;
robustness, for example, from reliable source
relevance, in terms of whether it’s recent
whether it corroborates the changes described in the AR1
look at the Original Claimant Evidence
What conditions has the claimant reported?
How long had they had the condition/s for which descriptors were awarded
points, and what were the justifications for those points?
What medications or treatments was the claimant taking at that point?
Have these changed now?
Were there any planned treatments that might alter the claimant’s level of
disability/functionality, for example, planned joint replacement surgery,
referrals to Pain Management Clinic?
What was the reasoning for the initial review period given?
Motability mailshot question
Under the General Data Protection Regulation (GDPR), Motability UK allows a
claimant to opt-in to automatically receive a Motability mailshot. To support this, the
PIP AR1 form now includes a question asking if the claimant wishes to opt in to or
opt out of the Motability scheme.
An ambiguous reply, for example, ‘Don’t know’ or a clear ‘No’ reply is to opt-
out and a ‘Yes’ reply is to opt-in. If the claimant has failed to indicate their
preference, this must also be treated as an opt-out. Do not return the form to the
claimant for completion of this question only as it may delay the customer journey.
Look at other Resources Available
Contact the claimant/appointee/carer/PAB/COP or other non Health Care
Professional such as support worker, key worker, Social worker for clarification of
any uncertain points
For example ‘the condition would usually have been better by now, is there any
reason why you feel that in your case your condition has worsened’?
‘Surgery/treatment was anticipated at the time of the previous decision, has this
taken place/been delayed/was it successful’?
In most cases Health Care Professionals (HCPS) should not be contacted directly.
The only exception should be when a claimant is regarded as vulnerable, lacks
insight into their condition and there would be nothing to gain by sending them for
another AP assessment. In these a Community Psychiatric Nurse (CPN) or similar
could be contacted.
Or the claimant may hold a useful piece of medical evidence which could aid
your decision, for example, Care Plan.
Employment and Support Allowance ESA85 Reports
ESA report may provide a good source of evidence to assist in reaching a
decision at scrutiny stage, particularly where the ESA assessment was performed
more recently than the previous PIP assessment.
: Only authorised reports over 20 working days old can be used to allow for
any rework activity.
However, you need to remember that the advice given on those reports is in
the context of the Work Capability Assessment (WCA) not the PIP Assessment.
When considering these reports you must be careful to separate the “facts”
they contain from the “opinion”.
Facts could include things like clinical findings, record of conversations
between the assessor and the claimant, picture of a typical day. Opinions would
include the descriptors chosen or any advice given (for example on prognosis).
You also need to remember that the PIP Assessment is different from the ESA
one. The outcome of the WCA should not affect your consideration of the
claimant’s entitlement to PIP.
In all cases where you have used evidence from an ESA 85 report you must:
refer to this as evidence considered within your reason for decision
create a copy of the report and save it on the system
Use of ESA85 report for an Administrative Exercise (AE)
Following consultation within the department, it’s been decided that with
regard to further evidence (FE) the supporting information does not
need to be
recent but should be relevant to the claimant’s current condition.
With immediate effect, ‘only using ESA reports that are within 2 years of the
date of your AE decision’ no longer
applies. As of now the ESA report does not
need to be recent, however, you must
carefully consider all the evidence and facts
before making your decision in line with the relevant UT judgments. Structure of the ESA report
Although the assessments for PIP and ESA are different there is potentially
useful information in the ESA85 report particularly in the first six sections:
(1). A list of medical conditions, previously diagnosed, found at the medical
assessment or reported by the claimant.
(2). Medication, (may include dosage and the reasons for its use)
(3). Side effects of the medication reported by the claimant
(4). History of the medical conditions and how they affect function.
(5). Social and occupational history
(6). Description of a typical day.
(7). Medical opinion – Physical. This section records the disability analyst’s choice
of descriptors for the ten physical activities (if they were claimed as a problem
when they applied for ESA).
(8). Medical opinion – Mental function. This section records the disability analyst’s
choice of descriptors for the seven mental functional activities (if they were
claimed as a problem when they applied for ESA).
The medical opinion, descriptor choices, justification and summaries are of
little or no relevance to PIP. The criteria are very different and whilst some may
seem similar, for example, mobilising may be thought to be similar to activity 12 in
PIP, the legislation and application of the criteria in ESA is very different.
Accessing ESA reports
ESA reports are retained for 5 years. As long as an ESA report is still relevant
to the claimant’s current condition, the age of that evidence is irrelevant. Save a
copy ensuring it is indexed as ESA85 report.
If you are unable to use the ESA report to make a decision and are referring
the case to the AP then you should not save it but, should make a note that
consideration has been given.
These may be helpful although, of course, their purpose is different. They may
offer a valuable insight into the Claimant's day to day functioning, activities, and
Beware, however, of allowing the outcome of the WCA to influence your own
assessment of entitlement to PIP review. Consideration can also be given to
reputable internet resources, for example, for conditions, diagnoses and
NHS Choices, Macmillan Cancer.
An online medical dictionary
These can give very useful guidance.
There are many on-line sites run by various disability groups, but these vary
greatly in quality and objectivity. Some for example, Parkinson's UK, Macmillan
Cancer Support, are excellent (although even these may shrink from giving a
really poor prognosis for some conditions). Others, like Wikipedia, can give biased
or unproven data, and should be avoided.
CM decides whether they can make a decision
In all the above, we are seeking one main thing – Consistency:
Is what the Claimant tells us Consistent with the condition/s they have?
Is it Consistent with the medication they are prescribed?
Is it Consistent with any further evidence provided?
Is it Consistent with what the medical web resources tell us?
If ‘Yes’, then you should feel confident in making a decision without referral
to the AP
If ‘No’, then discussion with the QAM is likely to be helpful and referral to
the AP may be appropriate.
Case Manager (CM) Assessment
CM assessment is appropriate because:
we have existing evidence – from new claim stage
it is supported by advice from the AP at new claim stage
we have considered why the review date was set in addition to the new AR1
and anything provided by the claimant for the review
These factors should mean that you are able to make robust decisions in around
50% of cases
When making a decision, the CM must consider:
use of all the evidence to reach a decision
sources of evidence available to you
use of ESA reports
other suitable sources of information
contact with claimant or third party to obtain information where appropriate
seeking QAM advice if necessary
Case Manager Empowerment
When considering a case, you must decide whether the descriptors provided
reflect the needs described in all evidence provided. This is no different to the
standard process. If after reviewing the evidence, you need to change the selected
descriptors or change the length of award/review date, you may do so without
seeking advice from either the QAM, or Health Professional (HP). The normal
rules of evidence apply. However, under the revised rework criteria, if using
empowerment would result in a change in level of award, the report is classed as Category 4 – Unacceptable
be returned for rework through the QAM. -
You are permitted to change any number of descriptors where appropriate,
providing there is sufficient evidence and you are confident in doing so.
If a decision can be made you will follow current instructions for completing the
PIP computer system Assessment Questionnaire and recording Reason for
Decision, recording your justification for any descriptor that you change. 69.
If you are unsure about:
any of the descriptors,
the new length of award /review date, or
you don’t feel you can make a robust decision from the evidence to hand or
require clinical information,
you can discuss the case with your QAM or seek advice from the HP for your site.
Note: Do not
contact the AP for advice, unless
the case has already been
referred for a further assessment.
Decisions without referral to the AP
You must consider all existing evidence including payability and residence and
presence including exportability and compare it to the new evidence (form AR1
and any other relevant evidence supplied by the claimant) in order to:
identify any changes that have occurred since the previous decision
decide whether a decision can be made by carefully considering whether the
AR1 returned by the claimant is reasonable and supported by sufficient
evidence and fully utilise on-line resources to gain an understanding of the
Consideration of evidence – making a decision where the claimant reports no
You must ensure your decision is evidence based and must decide if
something is probable given the evidence before you.
Where a claimant reports no change your first consideration should be whether
they have supplied medical evidence that indicates there has been no change for
example, a recent letter from their relevant HP. Where this exists you are likely to
be able to make a decision on this basis.
If the medical evidence isn’t provided, you should consider whether other
evidence backs up that there has been no change for example, they are on the
same level of medication and the National Health Service (NHS) Choices
website indicate that this medication is consistent with the claimed level of needs.
If they have not undergone a treatment and that was the reason a review point
was set then an extension is likely to be reasonable. If the treatment was planned
but this has not taken place you should seek clarification from the claimant, PAB
If medical evidence isn’t provided then you should consider whether it’s likely
that the condition would not have changed and if so look to make a decision
unless there are factors that require further investigation.
Some indications that you can make a decision would be when:
the condition has been on-going for a substantial period of time
there was no planned treatment listed in the previous decision
there was no clear reason for the review date to be set at the original decision
and this appears to have been done in error
the condition is one that is unlikely to change – use online resource to check
the condition can deteriorate rapidly and they are already on the highest level
their condition can sometimes deteriorate over time but they have not
reported any change.
The above list isn’t exhaustive.
Grounds to change a decision
ARs are when the SofS looks at the claimant’s award again. CMs can
supersede or revise it. It’s essential to establish the correct grounds to supersede
a decision and must be supported by the evidence.
A decision can be superseded or revised when:
there has been a relevant CofC since the original decision took effect
it’s anticipated that a relevant CofC will occur
medical evidence is received from an HP or other person authorised by the
SofS, by which we mean the AP using a form PA3 or PA4.
a negative determination decision has been made on an existing award of PIP
the decision was erroneous in law, or the decision was made in ignorance of
a material fact or based on a mistake as to a material fact
Relevant Change of Circumstance
A relevant CofC is a change which happens after the original decision takes
effect and has relevance to the award of benefit. A supersession is defined as a
decision which changes, but doesn’t entirely replace an outcome decision.
For example a claimant:
states their needs have increased/decreased, or
is admitted to a hospital or care home.
This also means that a decision to disallow benefit cannot be superseded by a
CofC that takes effect from a date after the decision took effect.
The change doesn’t allow for that disallowance to be looked at again. Instead
the claimant must make a fresh claim.
Establishing a Relevant Change
To establish that a relevant change has occurred:
refer to the previous decision
decide if there has been a relevant CofC since the last outcome decision or
since the date the claim became effective, and
establish the date from which the change takes effect.
You will need to identify what has changed to show that there has been a
Remember that just because the claimant has told us about a change it’s for
you to decide how the change might affect the award. Original Level of Award Unaffected
A relevant change may not always result in a change to the award.
'A claimant was originally awarded 4 points for the mobility component because he
could only walk 150 metres unaided. The AR1 notifies us that his mobility needs
have increased following a fall on 07/01/2015 and he can now only walk 50 to 60
metres with the use of a walking stick. Although the claimants needs have
increased it’s still within the descriptor choice originally selected and isn’t enough
to change anything other than the length of award'.
The change, although relevant has no change on the award but a formal AR
decision will still need to be made.
Establishing Date of Change
You will need to identify:
the date of the change itself
the date from which the change takes effect and
if the change results in an increase in benefit, the date of entitlement.
If needs have increased, first establish the date the change took place then
apply the three month qualifying period (QP) to establish the date the increase in
needs affects the benefit.
It’s important to establish the most accurate date of the change but sometimes
the claimant either doesn’t give a date at all or the date given is unclear.
If you are unable to establish the date of change from all evidence available
you will telephone the claimant or appointee/COP/PAB to obtain the date of
If the claimant can only provide the month of change, you will use the last
day of the month as the date needs changed
Below are two examples where there has been a change in the claimant’s care
Original decision awarded standard rate daily living:
increased needs began 23/04/2014
earliest date the change could affect benefit is 23/07/2014
Original decision awarded standard mobility:
increased mobility needs began in May 2014
earliest date the change could affect benefit is 31/08/2014
Because the claimant could only provide a month you must use the last day of
the month as the date needs increased. Decision Advantageous
The effective date of the change will be either:
the date the QP is satisfied; or
the date the SofS first instigated the action
whichever is the later
Late Notification of Change
Late notification of change can be considered providing the claimant,
appointee or representative:
give reasons for the late notification, and
report the change within 13 months of the date the change occurred
There is a 13 month absolute time limit, which for PIP means that the
intervention application must be made within 13 months of the date on which the
claimant first satisfied the conditions of entitlement to the particular rate of benefit.
Therefore if the change isn’t notified within one calendar month of the QP
being satisfied but is notified within the 13 month absolute time limit for lateness
and the claimant has asked us to consider their late request; reasons for lateness
will be required.
Lateness can be accepted provided all the conditions are met and provided.
There are ‘special circumstances’.
The principle that the ‘later the application the more compelling the special
circumstances must be’, should be taken into consideration.
If you do accept reasons for lateness, the application is treated as received
within the calendar month (the prescribed period) and you can supersede from the
effective date of the change (date Qualifying Period (QP) satisfied).
If you don’t
accept reasons for lateness, the effective date of supersession
would then be the date the change was notified.
Lateness cannot be considered, irrespective of whether or not there are
special circumstances, if an application is outside the 13 month absolute time limit.
The effective date of supersession would then be the date the change was
Example: Increased needs from 27/06/2013
QP satisfied 27/09/2013
Change notified 08/12/2014
Effective date 08/12/2014
Decision not Advantageous
If a CofC isn’t advantageous to the claimant, the effective date of the
supersession depends on whether or not the claimant or appointee if applicable
could have been reasonably expected to know when the change should have been
If a disadvantageous change doesn’t relate to disability conditions but rather
to payability issues, the question of reasonableness isn’t an issue. The effective
date in such a case is the date of change.
When deciding if a claimant could reasonably be expected to know to notify
if the claimant would recognise that something had changed, would the
claimant realise that the change affects benefit
If the claimant has an appointee, they should know when to report a change
A slight change in a claimant’s ability to carry out activities would normally not
be a change a person would reasonably be expected to know. Where the change
is gradual however, there may be a point when the claimant would reasonably be
expected to notify the improvement. The disability conditions are complicated and
involve a degree of judgement.
You should consider what was on the notification letter. Was there specific
information about what had been awarded and why? You should also consider
whether or not the claimant has a disability that may have prevented them from
'A claimant who had severe arthritis of the left hip and could walk only 40 metres
unaided was awarded standard mobility. Two years later the claimant had a total
hip replacement and two months after that, was able to walk two miles'.
'The claimant should have known that the hip replacement had improved their
walking ability. The notification letter will have told them they had been awarded
standard rate mobility because they can stand and move unaided more than 20
metres but no more than 50 metres and that they must notify any changes'.
If you decide the claimant could have reasonably been expected to know
should notify us, then you would supersede from:
the date of the change, or
the date the claimant should have notified us.
'A claimant has an award of the enhanced mobility and enhanced daily living
components of PIP because of the effects of progressive heart disease. On
08/11/2015 the claimant underwent a successful heart bypass operation, but
doesn’t report this until the AR1 was returned on 01/08/2016. Further evidence is
obtained from the hospital showing a significant improvement in the claimant’s
walking ability and reduced care needs, within three months of the operation'.
'The CM decides that the claimant isn’t entitled to either component from
08/02/2016. The claimant was aware of the basis of the award and could
reasonably have been expected to know that the improvement should have been
notified. The supersession decision takes effect from 08/02/2016'.
As shown above even though the claimant did notify the CofC in the AR1, the CM
decided that the claimant should have notified it sooner as they were reasonably
expected to know that their condition improved following surgery'. Claimant could not reasonably be expected to know that the change should be
Following a stroke the claimant was awarded enhanced daily living and mobility.
Over the following 12 months the claimant experiences a gradual improvement in
his condition and he notifies us on the AR1 he requires less help to care for
In this case it might not be possible to establish a precise date to supersede from
before the notification of the change of circumstance. If you decide that as it’s not
possible to establish a precise date, the claimant could not have reasonably been
expected to know to notify us of the change.
If you decide the claimant could not reasonably be expected to notify us,
supersede from the date of your decision.
When to try to contact the Claimant, Appointee, Carer, PAB, COP or non HP
Where you don’t have relevant information to make a decision and you think
that further information can be obtained from the
claimant/appointee/carer/PAB/COP or non HP about their daily life or routine,
might enable you to make a decision you need to:
clarify whether the claimant has undergone an expected treatment or
change, that is, they reported no change but their previous claim indicated
they were waiting for an operation, you should check if this has happened
and the result of it
consider where a piece of medical evidence which the claimant is likely to
hold and be able to supply is likely to allow you to make a decision
confirm other details to enable you to take a lawful decision for example,
confirming when a change took place
create a communication record of all queries made and
information/evidence obtained however any relevant information/evidence
obtained and used to make the decision
: You must not
contact any of the claimant’s HCPs but it may be appropriate
to contact non HCPs. When Referral for an Assessment is the likely outcome
When the claimant is reporting a significant change you should only make a
decision where this is supported by clear and conclusive medical evidence. Note:
For these purposes, a significant change is where a claimant has:
reported a change across more than 4 activities; or
reported a change which would mean an increase of 4 or more points in either
component, which would also lead to a change in award level
Although it’s not possible to provide an exhaustive list of cases where a
referral to the AP is required, the following are examples of cases where one
would be expected unless a decision was strongly supported by evidence on the
changes to descriptors on the AR1 are inconsistent with the detail of the
previous AP report
an expected change leading to an improvement has occurred but the claimant
states they still have the same level of impairment and hasn’t provided clear
evidence to the contrary
claimant reported significant change of deterioration with no supporting
new conditions are stated where the claimant states they lead to difficulties
but have not provided any FME to support the claim
the claimants’ initial decision indicates a high chance of improvement and the
claimant hasn’t provided sufficient medical evidence to demonstrate their
condition hasn’t changed
where you believe that the original decision may have been made on
insufficient evidence and you don’t have sufficient evidence to confidently
make a new decision
Questions to ask your self before referring to the AP
considered all the evidence that the Department holds which might allow me
to make a decision?
considered the implications of all medical evidence – for example have I
considered the implications of prescription lists?
consulted online resources to gain information about the condition?
considered whether contacting the claimant/carer/COP/PAB would be
considered consulting QAM where appropriate?
considered ESA reports where appropriate
Where a CM is unable to make a decision, the case may be sent to the AP
for assessment. The case will include form AR1 and any additional information
obtained by the CM will be included in the medical evidence screen in PIPCS.
You must refer to the AP if you feel necessary.
Case returned from the AP where assessment could not be completed due to
Failure to Attend (FTA) or Failure to comply (FTC)
. Where a case was referred to the AP for an assessment but completion
hasn’t been possible, the AP returns the case to DWP with details.
A FTA task will be generated for the CW to action and consider good reason.
The (CW) will follow appropriate procedures under normal Business As Usual
154. There is no requirement to contact the claimant to gather reasons for
FTA/FTC unless the claimant has been identified as requiring Additional Support
(AS). In Additional Support cases normal procedures will apply in order to gather
the reasons for FTA/FTC if required.
FTA/FTC considered by CW and good reason accepted
If ‘good reason’ has been considered and accepted for FTA/FTC and the
claim is being referred back to the AP for an assessment, system action must be
completed to allocate to the APs work queue.
FTA/FTC considered by CW and ‘good reason’ not accepted
Where the AP has applied the process correctly and there has been no effort
to comply on behalf of the claimant and the case does not have an Additional
Support (AS) marker, the Task is forwarded to a CM with the right skill set with the
subject heading ‘Consider Negative Determination action’.
: If upon receipt of the ‘Consider Negative Determination’ referral, the CM
disagrees with the CW and decides there is ‘good reason’ for the FTA/FTC the CM
will refer the case back to the AP.
The CM must not refer the case back to the CW as this will add unnecessary
delay to the claimant journey.
FTA/FTC Negative Determination Decision – CM action
Once good reason has been considered and not accepted for FTA/FTC and
the negative determination is being made on the claim, the CM must complete all
relevant system action to record the decision.
If there is a Motability agreement present, you will notify MOTA that benefit
AP action complete – AP report returned
AP and PIP systems are linked therefore assessments and reports can be
completed and returned through system action.
Once the assessment questionnaire is submitted in the PIP system, the
report is uploaded automatically. The case is tasked to the CM with the right job
role and skill set.
The status of the determination remains ‘In Progress’ until you complete your
action. The questionnaire completed with the AP’s answers will be the latest
‘active submission’ available for you to view.
The AP may be able to provide advice on:
PA2 Paper Based Report (SRTI)
PA3 Paper Based Report
PA4 Face to Face meeting
PA5 Supplementary advice note
PA6 Supplementary advice note (change of advice)
CM reviews all evidence
You should decide the facts from the evidence and apply the law to the facts
to make a decision. If there are any contradictions or inconsistencies in the
evidence you should discuss them with the QAM.
The AP’s assessment includes medical evidence which can be both fact and
opinion and there may also be medical evidence.
Fact and opinion
A fact is either a relevant circumstance or an occurrence which exists at the
time the decision is given and is from direct experience or observation:
proved to be true
An opinion is either
a judgement or belief not founded on certainty or on proof
an evaluation or judgment given by an expert
Medical evidence can be:
factual or opinion or both
clinical findings, diagnosis, treatment, investigation findings,
observations of function, and claimants reported functional ability as
recorded in their medical records, information about treatment and
response first hand from the claimant or reported by a relative or carer
for example diagnosis, medication
A medical fact is something that is:
objectively verifiable such as a confirmed diagnosis, amputation, pulse
or blood pressure measurements, treatment and results of tests
based on direct observations (for example of getting up and walking
A medical opinion:
usually involves some interpretation of facts and expert interpretation to
answer a given question. An opinion is more robust if justified using facts
is an expert evaluation or judgement based on established fact.
Whether a medical opinion can be regarded as fact depends on if the opinion
is supported by sufficient established facts. For example, medical opinion may
identify fluctuating needs despite medical and observable facts only applying at
the time of a face-to-face consultation.
In the consultation report the better the physical findings and observations
from the AP that is clinical findings and observations of function, then the more
reasons to accept them as fact.
The ADM contains detailed instruction on evidence, including types of
When considering all the available evidence, you will justify how you reached
your decision on the selected descriptors and that all information obtained is
You should include key evidence in support of your descriptor choice in your
reason for decision (RFD).
Selecting a descriptor where more than one applies in one activity
There will be cases where more than one descriptor in an activity area
applies to a claimant but only one descriptor can be selected in any activity area.
In such cases the highest scoring descriptor that applies to the claimant for
the majority of the days (defined as over 50% of the days) should be selected for
the activity. For example, in the daily living activity ‘Dressing and Un-dressing’ the
claimant meets both of the following two descriptors for the majority of the days:
‘Needs prompting or assistance to be able to select appropriate clothing’ this
is the case for the majority of the days, this attracts 2 points, and
‘Needs assistance to be able to dress or undress their upper body’, and this is
also required for the majority of days and this attracts 4 points
The higher scoring of the two descriptors should be selected and you must
consider the claimant’s likely ability before selecting the most appropriate
descriptor for each activity area.
When you have considered all the evidence and are satisfied there are no
issues that need to be clarified or discussed with the QAM, you should record your
reasons for decision. You can then proceed to complete the assessment
questionnaire, complete the determination and make the decision.
Setting Review Dates
Deciding award durations and reviews when making decisions without advice
You will need to consider a range of factors when deciding what review date
and duration to give on your new decision. These include:
Onset of condition
– Is the condition(s) leading to impairment recently
diagnosed (or undiagnosed) are investigations still on-going
Stability of condition
– what is the natural course of the condition(s)? Are
they associated with improvement, deterioration or likely to remain
unchanged? If associated with improvement or deterioration what is the
expected rate of change
Treatment and medication
– have they recently changed, could an
improvement be expected because of them
– is there any future treatment or rehabilitation planned,
operations scheduled or is the claimant on a waiting list for either
– is the claimant still seeing their doctor or specialist on
a regular basis
You need to consider whether the evidence suggests the condition is stable
or may change in the near future in which case a shorter review date may be
Examples of review periods may be appropriate
One year review
– There should be a strong expectation of change. For
example because the conditions are associated with fairly short term change;
are still being investigated; there is new treatment or rehabilitation which will
result in fairly short term improvement; the conditions are of recent onset or
an operation is planned in the short term
Two year review
– There should still be a reasonable expectation of change.
This could be because the condition is associated with change over a longer
period of time; there is treatment or rehabilitation which may take time to
produce improvement or because the claimant is on a waiting list for
Three year review
– The condition will be associated with change in the
medium term and any response to treatment or rehabilitation will be slower
Five year review
– The condition will be stable and any change or response
to treatment is only likely to occur gradually, over time
– Where the claimant’s restrictions on daily living and/or
mobility are unlikely to change significantly, or where the Award Review date
goes beyond the claimant’s State Pension age
The evidence should fully support your consideration on the review
date. Don’t make assumptions about what something means, check with NHS
Choices or seek advice for clarification.
Medical information should be drawn from trusted sources for example:
Any UK hospital trust website
fully utilise the sources of medical information available and make
logical judgments based on that information and the evidence available in each
case in an effort to empower you to make decisions where possible.
Identify the effective dates
AR decisions where the award rates are staying the same - the effective date
will be the date you make the decision.
AR decisions where this leads to an increase due to a new condition or
specific change in circumstances of an existing condition - the effective date will
be the date the Secretary of State (SofS) instigated the AR action (Providing the
QP is satisfied).
AR decisions where there has been no specific identifiable change, but the
decision leads to an increase/reduction or disallowance due to a difference of
medical opinion - the effective date will be the date you make the decision.
AR decisions where it’s disadvantageous due to an improvement of a
disability condition - the effective date will be the date the improvement occurred
or a date the claimant could have reasonably expected to know that the change in
circumstances should have been notified. If the claimant could not reasonably
have known to report the change - the effective date will be the date you make the
You might come across cases where you have to split your AR decision
because one component goes up and the other down from different dates.
Examples of Effective Dates
To change the decision (supersede) there must
be grounds to change the
decision. The most common grounds will be ‘change of circumstances’ or ‘receipt
of further medical evidence or HP report’. If there is an identifiable CofC, action
under that ground should take precedence. The ground for the supersession must
be noted in the record of reasons.
If the claimant is still going to have needs beyond the date of the expiry of the
award but the award rate would remain the same, you should supersede and
extend the award. Unless you have medical evidence to support your decision, the
grounds you would be CofC. This is because the anticipated change has not
occurred. The effective date would be the date of the new decision. By doing this,
it will negate the need for the claimant to make a new claim.
Specific change of circumstances, such as: deterioration or a new condition.
Action taken depends on whether advantageous or disadvantageous.
Advantageous to the claimant
The effective date will be either the date the Qualifying Period (QP) is
satisfied or the date SofS first instigated action (date the AR1 was issued)
whichever is the later. The grounds for this would be CofC.
Disadvantageous to the claimant
If the claimant should have notified us of the change but could not have been
expected to know, the effective date is the date of decision. The grounds would be
If claimant should have notified us of the change and should have known to
notify us, the effective date is the date on which the claimant ought to have notified
the CofC. The grounds would be CofC.
If you decided or the HP has recommended different descriptors that would
change the award level, but there is no actual CofC identifiable, the grounds for
supersession would be ‘receipt of further medical evidence or HP report’. The
effective date for these decisions should be the date of decision, regardless of
whether the decision is advantageous or disadvantageous.
Decision not to Supersede
In exceptional circumstances you will need to do a decision not to supersede. Scenario 1
No change to award level or length of award. Existing award will run until it
expires. Decision not to supersede applies.
No change to award level or length of award, but descriptor changes. Existing
award will run until it expires.
Award Review action with no AP report
Check CIS/Searchlight for Address and DLA interest/Other Overlapping
Split Rate Decisions – Award Reviews
There may be instances during a AR process where you need to record a split
rate decision on the PIP Computer System:
the evidence you have supports the increased needs due to a CofC for one
component, but the evidence for the other component is disadvantageous to
as a result of an Upper Tribunal (UT) decision
In these cases you will complete two determinations, for example:
The claimant is currently receiving Standard Daily Living only. The SofS instigates
AR action on 27/06/2016. Following of receipt of the AR1, you identify a specific
change in circumstances. The change in circumstances occurred on 12/03/2016.
New evidence obtained, supports an award of the mobility component at the
standard rate from 12/06/2016 after applying the QP. However, the evidence doesn’t
support an award of the daily living component.
Your first determination will be to award the mobility component at the standard rate
and maintain the daily living component at the standard rate. The effective date of
your first determination will be 27/06/2016 using CofC grounds for example, the date
the Secretary of State instigated the AR action. Your second determination will be to
maintain the mobility component at the standard rate but remove the daily living
component altogether. The effective date of your second determination will be the
date you complete the determination using receipt of medical evidence as grounds (if
Although you are completing two determinations in these cases you will record
one decision for statistical purposes.
Before inputting your split rate decision into the PIP Computer System, check if
the claimant has a Motability agreement.
If there is only a provisional Motability agreement held (safe date only) on the
effective date you can input your split rate decision without referring to the actions
If the effective date is before the full
If the effective date is during the full MOTA
MOTA agreement start date the MOTA
agreement the MOTA agreement will need
agreement will need to be deleted by the
to be terminated by the specialist MOTA
specialist MOTA Spec team. Include
Spec team. include ‘Terminate full MOTA
‘Delete full MOTA Agreement – Split
Agreement – Split rate’ in the email subject
Rate’ in the email subject to request a
to request a call-back from MOTA Spec.
call-back from MOTA Spec. Take and
Take and save a screenshot of the MOTA
save a screenshot of the MOTA
agreement on PIPCS using snipping tool,
agreement on PIPCS using snipping tool,
as the agreement will no longer be visible
as the agreement will no longer be visible once terminated. When MOTA Spec
once deleted. When MOTA Spec contact
contact you ask the specialist user to
you ask the specialist user to delete the
terminate the MOTA agreement record
MOTA agreement record from the PIP
from the PIP Computer System using the
Computer System, apply the evidence
last date of enhanced rate mob entitlement,
changes to active pending deletion
with a reason of no longer entitled, apply
evidence and submit the Motability
the evidence changes and submit the
overpayment correction case for
Motability overpayment correction case for
approval, this will trigger a payment
approval, this will trigger a payment
recovery. If you will complete step C
recovery. If you will complete step D
arrange a suitable time to call-back
arrange a suitable time to call-back MOTA
MOTA Spec. You must close the claimant Spec. You must close the claimant
underpayment correction case with the
underpayment correction case with the
comment ‘Split rate’
comment ‘Split rate’
In the rare circumstances your split rate decision removes and reinstates
enhanced rate mobility complete:
Step C - if the end date of enhanced rate mobility was before the full MOTA
agreement start date; or
Step D - if the end date of enhanced rate mobility was during a full MOTA
If you re award enhanced rate mobility for
If you re award enhanced rate mobility for
the latest determination period call-back
the latest determination period call-back
MOTA Spec and ask the specialist user to
MOTA Spec and ask the specialist user to
re-input the MOTA agreement using the
remove the termination date and reason
original start date, and include the
from the existing evidence, and update the
comment ‘Split rate’.
mandatory safe date field to match the
earliest safe date displayed so that
payments will resume to the MOTA
supplier from this date.
MOTA agreements with an amount
less than the total enhanced rate mob have
a later safe date and the PIP Computer
System will pay the claimant mob from
enhanced rate mob entitlement start date
up to the safe date.
RFD Award review Split decision Example
In this example, the Mobility Component has been increased as a result of a
CofC’s from an earlier date. The Daily Living Activity Component has also been
reduced/removed as a result of medical evidence received from today.
In your reported change of circumstances on dd/mm/yyyy, you said your condition
Taking into account the information you provided regarding your mobility and the
further consultation with the medical assessor, I have changed the descriptors
previously awarded because your circumstances have changed. I have changed
the decision from dd/mm/yyyy as I cannot increase the rate for the mobility
component until you have satisfied the disability conditions for three months. I
have decided to maintain the daily living component as previously awarded from
this date until today.
As you have reported a change in circumstances all activities are reviewed to
make sure the money we are paying you is correct. Taking into account the
information you provided regarding your daily living activities and the further
consultation with the medical assessor, I have also changed the descriptors
previously awarded on the grounds of the medical evidence received. As you
could not be expected to know the evidence received shows you are entitled to
less benefit, I have changed the decision from today.
I made my decision using information about your illnesses and disabilities
including details of any treatment, medication, test results and symptoms. I
consider this information is the most suitable available and enough to decide how
much help you need.
Provide justification here for the descriptors selected by the Case Manager
detailing the level of restriction from the available evidence. Ensure descriptor
choices which are reduced are adequately explained. All issues claimed by the
claimant must be addressed in your reasons.
As your needs are likely to continue, I have given you a longer award. I have
limited the period of your award as your needs may change. I have decided not to
review your award before dd/mm/yyyy. If you are making a fixed award, an
appropriate sentence should be used.
If the decision resulted in a decrease an overpaid Payment Correction Case
may be generated. You need to check the Overpayment calculation is correct.
When you action an overpayment, you must put a note in the claimant
homepage to show:
the period of the overpayment
the affected component(s) and
the reason the overpayment has occurred - for example the overpayment may
have occurred because the claimant failed to inform us of a change or it might
have occurred due to business reasons
An overpayment task will be generated overnight and sent to a CW with the
right job role and skill set or the overflow work queue.
Due to the payment cycles sometimes the system creates a ‘recall payment’
and an over payment. If this happens you should put a note in claimant homepage
(containing information within bullet points above). Once payment returned,
adjusted amount can be issued and overpayment case closed by a CW with the
right job role and skill set.
If the award resulted in an increase of an existing component, an underpaid
Payment Correction Case will need to be submitted for approval. Before you do,
you must check if there is Debt Management interest in CIS/Searchlight first, but
only if the arrears are due to an increase of an existing component.
make a note in the claimant homepage to confirm you have carried
out the check in CIS/Searchlight and whether you have identified an Interest or
If you find a Debt Management interest, which displays a start date and a
close date, this means there is no longer a debt interest.
If the Payment Correction Case has been approved, the Decision Notification
will include details of any arrears due and the payment date.
If the Payment Correction Case has not yet been approved, due to a
management check being required or that details from Debt Management are still
outstanding, the Decision Notification will not include any details of arrears but will
include the text “Now I’ve made a decision we may owe you some money. You’ll
get a letter from us to tell you more about this.” Once the Payment Correction
Case has been approved, a PIP.4008 Notification, with details of arrears, will need
to be issued.
To enable Management Checks to be accepted or rejected, Task ‘
Correction: Validate payment correction cases submitted for approval’, must
If the underpaid Payment Correction Case is still open 24 hours after
creation, the PIP Computer System will generate a Payment Correction follow-up
task. The purpose of this task is to remind the PIP user of an outstanding payment
correction case and that it needs to be actioned urgently.
How to submit for approval
If there is no Debt Management interest and you are satisfied with the
amount of underpayment, you will submit the case for approval.
There are different methods to navigate to Payment Corrections, for example,
through Evidence Summary, Benefit Delivery Case and Financials or Search
Change of Rates – over State Pension age
Although a claimant who is over State Pension age cannot claim PIP, if the
claimant was entitled to PIP before reaching State Pension age, they can continue
to receive benefit for as long as the entitlement conditions are still satisfied.
However, the rates of PIP that the claimant may be entitled to are affected once
the claimant reaches State Pension age.
Where the term ‘State Pension age’ is used in these instructions it refers to
the age of when a person can claim their State Pension or age 65, whichever is
Where the previous award is in respect of only the daily living component,
you cannot additionally award any rate of the mobility component (or increase from
standard to enhanced rate of the mobility component)
on an award review unless
a relevant CofC occurred before the claimant reached the age of 65 or State
Pension age. If a CofC has occurred before the age of 65 or State Pension age
the increase can be paid but the effective date is likely to be either the date:
SofS instigated the award review
The claimant is in receipt of the standard rate of the daily living component of PIP.
On 11/05/18 the Secretary of State issues an AR1 for a planned award review.
The Secretary of State discovers the claimant had a stroke on 02/02/15 (age 64
and 11 months) and following investigations the CM decides the claimant now
qualifies for a enhanced mobility component. In this case the AR1 was issued to
the claimant on 11/05/18 therefore the effective date of supersession would be
The claimant is in receipt of the standard rate of the daily living component of PIP.
On 11/05/18 the Secretary of State issues an AR1 for a planned award review.
The Secretary of State discovers the claimant had a stroke on 02/04/18 (age 64
and 11 months) and following investigations the CM decides the claimant now
qualifies for the enhanced mobility component. In this case the AR1 was issued to
the claimant on 11/05/18 but the qualifying period was not satisfied until 02/07/18.
Therefore, the effective date of supersession would be 02/07/18.
Due to the claimants needs starting over the age of 65 or State Pension age,
you must advise CMs how to input decisions where mobility either:
cannot be considered
cannot be increased
Prospective Test (PT) Disallowance
The AP will advise you:
how long the functional restrictions have been in place
how long the functional restrictions are likely to remain for
If you are disallowing the claim on the grounds that the PT isn’t met, you will
complete the Decision Assist questionnaire, selecting PT not met.
After you have applied the evidence and closed the intervention, you must
manually input the correct End date in the Benefit Delivery Case (BDC) so it
shows the entitlement period. Closing the Benefit Delivery Case
This action must be taken by a Higher Executive Officer (HEO), a Business
Champion (BC) or QAM the day after the end date has been input.
Death on Award Review Case
If death occurs prior to receipt of the AR1 you should close down the planned
intervention in the evidence summary.
If death occurs following receipt of the AR1 and there may be a change in the
existing award following your assessment of the AR1, you will consider the impact
on the current award:
if increase in award - is this due to a change in circumstances or due to
if it’s due to a change in circumstances, is a Qualifying Period (QP) applicable
if award remains the same; close the intervention event
Dead Letter office (DLO)
A claimant or recognised representative’s address can be changed to Dead
Letter Office (DLO) Terminate DLO
A clerical notification of suspension PIP.0420 will be issued and a task set to
mature in 4 weeks. If when the task matures, contact hasn’t been established, a
CM with the right job role and skill set will consider termination of entitlement.
Benefit is terminated with effect from the date on which the payment of benefit was
suspended. If the claim is terminated a notification PIP.0422 must be issued.
Outstanding Appeals and Reconsiderations during the Award Review process
If there is an on-going Appeal or outstanding Reconsideration, this should not
impact upon your AR action.
However, in Appeals cases, once you make your decision you must
High Priority Manual Task.
Appeals decision made whilst Award Review action outstanding
Seek QAM advice in these cases before you take any further action. Special Rules Terminally ill SRTI identified or claimed upon receipt of AR1
If upon receipt of the AR1 a request is being made or has been identified
under the SRTI provisions, the case needs to follow the SRTI process.
high priority 2 day Task must
be created and is forwarded to a CM with the
correct skill set role for appropriate action.
Out of Payment Award Reviews
There will be instances where benefit has ended before an Award Review
decision can been made. In these cases there is nothing left to supersede unless
there is an identifiable change in circumstances. However, it is possible to extend
the now-expired award by way of a supersession provided the claimant is still
considered to be entitled to PIP.
Such a supersession would be an advantageous decision made on the
Secretary of State’s own initiative. The grounds are there has been a relevant
change of circumstances, as the claimant’s needs have become more persistent
than the CM thought they were when the now-expired award was made.
The effective date would be the date on which the AR process started. As this
would be before the award ended, the extension can take effect.
if the CM is also increasing or reducing the rate of benefit awarded,
this should be considered a separate supersession with its own grounds and
effective date. It should not be presumed that both the extension and the change
of rate necessarily take effect from the same date.
The CM should always consider making a decision not to supercede where
there is no continuing entitlement to PIP and the Award Review has run out of
payment. In these cases a decision not to supersede decision should be made
and the claimant should be told how to make a new claim.
Third Party allegations received where disability is in doubt during AR process
The PIP Specialist Fraud Team will undertake fraud activities associated with
PIP awards for the whole of Great Britain, following fraud referrals and
investigation by the Counter Fraud and Compliance (CFC). However, third party
allegations received where disability is in doubt and no investigation has been
conducted will be dealt with by Regional Benefits Centres (RBCs).
In these cases, a Task will be routed through to a CM with the right job role
and skill set for consideration.
The CM is obliged to consider whether a Secretary of State (SofS) Change of
Circumstances (CofC’s) review should be instigated based on the strength of the
Third party allegation. However, there will be instances when Award Review action
has triggered and is pending.
Where there is no accompanying medical evidence with the AR1 to support a
robust CM decision, the CM should consider whether a referral should be made to
the AP for a New Assessment.
The 3rd party information should be marked as ‘harmful’ while the review
takes place and then once the decision has been made it should be marked as