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Claimants to lose DLA permanently if falsely accused of fraud, DWP decides

From 28 October, where a claimant is investigated by the DWP as a result of a false accusation of fraud, they will automatically lose their DLA and be forced to make a claim for PIP, even if found to be entirely innocent. The new DWP policy is legally questionable and is likely to cause enormous distress to claimants, whilst rewarding hate-callers.

The change in DWP policy has come about because of the roll-out of PIP to existing claimants which begins at the end of this month.

According to PIP regulations, after 28 October if ‘a DLA entitled person . . . notifies the Secretary of State of a change of circumstances’ they will be ‘invited’ to claim PIP instead.

In other words, if you are getting DLA and you inform the DWP that your condition is getting better or worse, then you will be assessed for PIP rather than for DLA.

In March of this year the DWP published a PIP toolkit which included a number of factsheets about the PIP claims process. Included in factsheet 6 was confirmation of how changes of circumstances would be treated:

From October 2013, DWP will start to write to the following existing DLA claimants, inviting them to claim PIP. The invitation will explain how to make a claim, and the time limits for making a claim:

• claimants who choose to claim PIP (selfselectors) can do so from this date

• those DLA claimants who report a change in their care or mobility needs will be invited to claim PIP

However, in September the wording of the second bullet point was changed, so that it now states that amongst those who will be invited to claim PIP will be:

• those claimants where we receive information that there has been a change in their care or mobility needs

So, it appears it will not just be where the claimant themselves inform the DWP of a change of circumstances that they will be assessed for PIP, as the law requires.

Instead, where someone else, including a malicious neighbour or relative using the anonymous National Benefit Fraud Hotline, reports that the claimant is no longer in need of help with care or mobility, the claimant will still lose their DLA and be assessed for PIP instead.

This approach appears to be confirmed by a poster on Rightsnet who explained:

“At our local JC+/customer/representative forum meeting last week a DWP partner support manager brought the following change of wording to the attention of the meeting (second bullet point on page one of link)

“In his words anyone who was ‘bubbled’ (shopped) would be taken as if they were a ‘self selector’ in the DLA/PIP reassessments.”

The decision about whether the claimant has been committing fraud must still be based on the DLA criteria.

But even if it is decided that there has been absolutely no change in their condition and they are the victim of a misguided or deliberately malicious informant, the claimant will still lose their DLA and have to claim PIP instead.

It will undoubtedly be cheaper and more convenient for the DWP to assess claimants for PIP at the same time as they are investigating them for DLA fraud. It saves coming back and looking at their claim again at the proper time.

However, we know that large numbers of people are likely to lose out under the transfer from DLA to PIP, including some people with mobility problems and some people who need supervision because of serious mental health conditions. Being assessed early for PIP, in some cases possibly by three or more years, will therefore be a serious blow.

That, simply for administrative convenience, the DWP are prepared to inflict this blow and in the process collude with hate-filled anonymous callers, says a great deal about the way that claimants are now viewed by the state.

Benefits and Work have made a Freedom of Information request to try to uncover what guidance has been issued on how to treat DLA claimants accused of fraud after 28th October.

You can download the PIP toolkit from this link.

Thanks to Mick Quinn on Rightsnet for highlighting this issue

Comments  

#38 Jim Allison 2014-06-25 19:39
Quoting Jim Allison:
[quote name="Jim Allison"]Quote from Lammy : So, as far as i can see, it's absolutely possible for a malicious caller to the fraud hotline to get someone forced off DLA and onto PIP.

In my opinion, you are wrong, the DWP response makes it clear that The DWP process for investigating allegations of fraud remains unchanged. If an allegation of fraud is received on an existing DLA claim (for example through the fraud hotline) DWP will look into the allegation and take any relevant action. Clearly malicious and unfounded allegations will be discounted and not followed up with any action.

However, you are entitled to your opinion also.

Further clarification is being sought on this issue and will be posted by me as soon as I receive it.



Mods and members will recall a story quite a few months ago where it was stated that DLA claimants who were maliciously reported as fraudsters would be forced to claim PIP as it would amount to a 'change of circumstances'.

I'm pleased to report that I recently challenged this decision for a client of mine at a DLA preliminary hearing before lodging a formal appeal.

Judge N. Warren dismissed the case after stating ' A DLA claimant who's claim is genuine, but is maliciously reported for fraud and after investigation is found to be entirely innocent, then there can be no 'change of circumstances' and therefore there are no grounds to supersede their claim'

Please note this will not be reported as a decision, because I sought a preliminary hearing before an official appeal was requested. I understand the Decision Makers Guide will advise DM's not to treat malicious allegations of fraud as a' change of circumstances' unless fraud can be proven to it's next update.
#37 Jim Allison 2014-01-28 19:54
Quoting Jim Allison:
Quote from Lammy : So, as far as i can see, it's absolutely possible for a malicious caller to the fraud hotline to get someone forced off DLA and onto PIP.

In my opinion, you are wrong, the DWP response makes it clear that The DWP process for investigating allegations of fraud remains unchanged. If an allegation of fraud is received on an existing DLA claim (for example through the fraud hotline) DWP will look into the allegation and take any relevant action. Clearly malicious and unfounded allegations will be discounted and not followed up with any action.

However, you are entitled to your opinion also.

Further clarification is being sought on this issue and will be posted by me as soon as I receive it.

Quoting Keith Allen:
What happens when you move address as that is classed as a change in circumstances ?

Do they stop your DLA and make you apply for PIP ?

Quoting Jim Allison:
Quote from Lammy : So, as far as i can see, it's absolutely possible for a malicious caller to the fraud hotline to get someone forced off DLA and onto PIP.

In my opinion, you are wrong, the DWP response makes it clear that The DWP process for investigating allegations of fraud remains unchanged. If an allegation of fraud is received on an existing DLA claim (for example through the fraud hotline) DWP will look into the allegation and take any relevant action. Clearly malicious and unfounded allegations will be discounted and not followed up with any action.

However, you are entitled to your opinion also.

Further clarification is being sought on this issue and will be posted by me as soon as I receive it.


Update to PIP Toolkit "Reassessing existing DLA claimants for PIP. See:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/275656/pip-toolkit-factsheet-reassessment.pdf
#36 Jim Allison 2014-01-23 16:25
Quote from Lammy : So, as far as i can see, it's absolutely possible for a malicious caller to the fraud hotline to get someone forced off DLA and onto PIP.

In my opinion, you are wrong, the DWP response makes it clear that The DWP process for investigating allegations of fraud remains unchanged. If an allegation of fraud is received on an existing DLA claim (for example through the fraud hotline) DWP will look into the allegation and take any relevant action. Clearly malicious and unfounded allegations will be discounted and not followed up with any action.

However, you are entitled to your opinion also.

Further clarification is being sought on this issue and will be posted by me as soon as I receive it.
#35 micksville 2014-01-23 08:57
Thanks Crazy Diamond. I understand where youre coming from on this now. Seems to me there are three scenarios. Unfounded allegations will never reach the DM i.e. section of the DWP which deals with the transfer programme. The unfounded allegations would simply be dropped at the fraud investigation stage.

Scenarios 2 and 3 are clear in that allegations found to be proven would lead to a) award being reduced presumably if there wasn't sufficient evidence of fraud, but enough to suggest the original award was now outdated or incorrect..

b) award terminated completely if clear evidence of fraud were found to be proven....
As you state, reconsideration and appeal would be an option in cases 2 and 3. However, as you quite rightly intimated, introducing the possibility of yet more appeals etc would make an already chaotic process even worse. The DWP must surely know this and they are swamped with appeals currently from every angle, whether it be ESA, DLA and now PIP. Beggars the question why did they decide to change the wording back in September re: changes of condition being reported? It's difficult to fathom what they're up to in this instance as the introduction of PIP has been chaotic enough as it is.
#34 Crazydiamond 2014-01-23 02:29
Quote:
Clearly malicious and unfounded allegations will be discounted and not followed up with any action as Decision makers don’t have access to the original allegation. This makes sure the outcome decision is fair and has not been influenced by a malicious or false allegation.
I think that the phrase "unfounded allegations will be discounted and not followed up with any action" clearly explains the situation and I have no reason to doubt that explanation.

Where there is a DLA award in place and the allegations of suspected fraud are unfounded, the DWP counter-fraud section will not refer the case to a decision maker to review (neutral word) the award. Suspected fraud enquiries are initially carried out in most cases without the knowledge of the decision maker, as the FOI response accordingly states ".... this makes sure the outcome decision is fair and has not been influenced by a malicious or false allegation."

I entirely agree that in a PIP reassessment area according to the unique procedure the DWP is using, they can simply terminate the DLA award and invite a claimant to claim PIP. In my view however, as I indicated in my last post, a claimant will still retain the statutory right to seek a reconsideration and if appropriate, to lodge an appeal against the revised DLA entitlement decision if their award is reduced or terminated as a result of a fraud investigation, as this would invariably pre-date and take precedence over a decision to terminate their DLA award in favour of PIP.

Inevitably, this would make an already complex procedure even more complicated!
#33 lammy 2014-01-23 00:20
Don't understand where grounds for supersession comes into it, crazydiamond. If you are in a PIP reassessment area the DWP can decide to reassess you whenever they choose, they don't need grounds to do so.

So,for example, you have severe degenerative disc disease and get higher rate mobility and middle rate care. A neighbour phones the fraud hotline and says they often see you walking back from the supermarket carrying heavy bags of shopping. It isn't true, but they have it in for you.

The DWP decide that there would be very little possibility of a successful fraud prosecution because you definitely do have degenerative disc disease and in any case surveillance would be very expensive for a slim chance of a successful prosecution.

But there's always the possibility that, for example, your pain meds have improved and you can now do more than you used to. So they use the right payment programme to send you a PIP form, because you are in the PIP reassessment area.

As a result, it doesn't matter whether your condition has improved or not, the only questions are: do you meet the criteria for an award of PIP and if so, at what rates. The decision maker who makes the decision knows that you came to him via RPP but has no knowledge of whether there were allegations against you or whether you were just chosen at random for a spot check.

So, as far as i can see, it's absolutely possible for a malicious caller to the fraud hotline to get someone forced off DLA and onto PIP.
+1 #32 Crazydiamond 2014-01-22 20:13
If a claimant is found guilty of fraud following the suspension of their DLA entitlement pending the outcome of the suspected fraud enquiries the DLA award will fall for supersession which will either reduce or terminate their DLA entitlement. I would very much doubt whether the DWP would invite a claimant who was found guilty of fraud and their DLA award was terminated to then claim PIP. It is certainly not the custom for the DWP to invite (renewal) claims where fraud has been proven as it would be up to the individual to claim PIP of their own volition should they choose to do so. Any claim to PIP would then be decided using the normal procedures.

If a claimant's DLA award was reduced following a proven allegation of fraud, then this will remain the case until such time as PIP is introduced. Only at this time will the claimant be invited to claim PIP and not before this date and again this will be under the normal procedure when the 'invitation' letter is sent out in accordance with the timetable. In the two scenarios as detailed in this and the preceding paragraph, the claimant will still retain the statutory right to seek a reconsideration and if appropriate to lodge an appeal against the revised entitlement decision.

If an allegation of suspected fraud is not proven the claimant will not be compelled to claim PIP. The suspended DLA award will simply be reinstated as there are no grounds for supersession in these circumstances and therefore the decision maker will not be involved with the reinstatement of payment. The DLA claimant would only have to claim PIP at the appropriate time and not before the invitation date.
#31 Jim Allison 2014-01-22 18:23
You need to read the two paragraphs I have made bold, i.e.

Clearly malicious and unfounded allegations will be discounted and not followed up with any action. and Decision makers don’t have access to the original allegation. This makes sure the outcome decision is fair and has not been influenced by a malicious or false allegation.

The forum used to have a moderator called CrazyDiamond, who was a DWP Decision Maker, and I passed the DWP reply to him before I posted it, and he agreed it was correct.

However, I do agree that it was badly worded and if any members still have cause for concern, they can always e-mail the sender at PAUL.BUNTING@DWP.GSI.GOV.UK or phone him on 01772 899344.

Also, please bear in mind that even before PIP was heard of, any recipient of DLA whatever their age could always be subjected to the Right Payment Programme (RPP) which ensures DLA recipients receive their correct award of DLA. Many claimants contacted under RPP have had their awards increased rather than lowered.

Steve gave me permission to post the DWP reply and not all members will no doubt be happy with the wording of the response.

I am no lover of many of the changes the DWP have made or are proposing.

Therefore, I feel it best that I make no further comment on this issue, and leave it to members to draw their own conclusions.

Jim Allison
retired Welfare Rights Lawyer, formerly DLA Tribunal Member (1994 -2005)
-1 #30 micksville 2014-01-22 16:33
To clarify my last post As I understand it, if a report of fraud is received but found to be malicious or unsubstanstiate d, i.e. completely outlandish and without foundation its finished with, no further action. Obviously, if the claimant has been claiming for something which has clearly been untrue all along then prosecution etc would begin. What I'm getting at is, during the course of the DWP looking at the reported "fraud", ok they might decide there isnt sufficient evidence for fraud but they find, in the course of their subsequent investigations that perhaps the claimant can now do slightly more than his/her original award suggested. They then initiate RPP. Thats perfectly proper, I get that.
However, what isn't clear is: wouldn't any allegation of fraud in the first case suggest the claimant is more able than the current award suggests. It then follows the DWP would be entitled to say they have received information that suggests they should review the award under RPP. This even though neither fraud nor a change in condition might be found during their investigation into the claims of the anonymous caller. Could the wording they have given mean they could simply initiate RPP anyway
#29 micksville 2014-01-22 14:12
You have to admire the deviousness of the DWP. Bottom line is that the rightsnet post was essentially correct.Since DLA isnt means tested it is safe to assume any report malicious or not would not concern financial eligibility, rather the person reporting a claimant will obviously be notifying DWP of a change in someones care and/or mobility needs. Usually this would likely be somebody walking unaided whilst claiming they cannot do so, or perhaps walking further than the rules allow or doing something unaided which they claim they require help to do. The phone call the DWP receive may be truthful, it might be malicious and untrue, the caller may or may not use the word fraud. Either way there is likely to be enough in that phone call for the DWP to feel it "suggests" a change in mobility and/or care needs and thus initiate a RPP review, which, unless the claimant falls outside the reassesment area at the time means they will be invited to claim PIP. Have I interpreted this correctly? Thank goodness My injuries and disabilities are easily defined and clear to see but for those whose conditions could easily be misread by a malicious neighbour it will be a worrying time.
#28 Jim Allison 2014-01-22 11:21
Steve has given me permission to post the e-mail I received yesterday from the DWP.

Good Afternoon Mr Allison

Again apologies for the delay in my response.

The DWP process for investigating allegations of fraud remains unchanged. If an allegation of fraud is received on an existing DLA claim (for example through the fraud hotline) DWP will look into the allegation and take any relevant action. Clearly malicious and unfounded allegations will be discounted and not followed up with any action.

Any potential fraud will be checked and investigated under current DLA rules. This will be the same for any DLA claimant regardless of whether they live in a reassessment area or not. Where the DWP receives information to suggest that a DLA award may be incorrect, but that no fraud is suspected, we will review the case and make sure the award continues at the correct rate.

This action is carried out under what is known as the Right Payment Programme (RPP). Where a case is referred for Right Payment Programme (RPP) action, we ask the claimant to complete a form to describe their care and mobility needs and provide any additional evidence they may have. The claimant may also be asked to attend a medical examination. RPP action under DLA rules will continue in areas where PIP reassessment has yet to start and in claims involving claimants who are outside the scope of reassessment: children under the age of 16; and older people who were aged 65 or over on 8 April 2013.

Claimants who live in one of the reassessment areas will not have their claim looked at against the existing DLA rules, but instead will be invited to claim PIP. Claims dealt with under RPP are not being investigated for fraudulent activity. DWP have a duty to investigate claims where we receive information that suggests that an existing award may be incorrect. In determining someone’s continuing entitlement to benefit, decision makers only use information provided to them by the claimant and, where sought, advice from a health or social care professional. This applies whether the claim is being looked at under existing DLA rules or PIP rules.

Decision makers don’t have access to the original allegation. This makes sure the outcome decision is fair and has not been influenced by a malicious or false allegation.

I hope this answers you enquiry.

Thanks Paul

Paul Bunting | External Stakeholder Engagement Team Member | Department for Work and Pensions| 10th Floor | Palatine House | Preston | PR1 1HB |
#27 Jim Allison 2014-01-21 16:18
I have now received official confirmation on the DWP's stance on this issue and have passed it to Steve Donnison the site owner to deal with, as the original post was done either by Steve personally or one of the part-time welfare rights advisers in the office

Hopefully, the DWP's response will be posted by them soon.

All I can say is it was worth the effort I put into it.
#26 Jim Allison 2014-01-20 20:53
Despite the information copied from RightsNet, I have been informed by a Senior Decision Maker, that the DWP PIP Toolkit has been amended and that DLA claimants who are maliciously reported to the Fraudline with different needs will not have their DLA removed and forced to claim PIP.

I will receive this in writing in the next five working days and post when I receive it. In the meantime, if a friend/neighbou r etc reports you to the Fraudline but it is subsequently found the report is malicious, you will not lose your DLA, and be forced to claim PIP instead.
#25 micksville 2014-01-14 15:03
Thanks for your efforts in attempting to clarify this Jim Its been a source of confusion since the original rightsnet post. However, I suspect it is a case of a local stakeholder/par tner jumping the gun and wrongky making assumptions about the wording as you previously stated. I look forward to reading the DWP written reply
#24 Jim Allison 2014-01-14 12:46
Hi Dennis,

I'm sorry to hear that what the DWP told me about this topic is 'bullshit' as you describe it. Despite being 73 years of age and suffering many diseases including MS, asthma and COPD, I have spent several weeks researching this topic along with Crazydiamond, a former moderator and ill-health retired DHSS & DSS Adjudication Officer ( now called Decision Makers).

I received the following e-mail from the PIP Team yesterday :

Good Afternoon Mr. Allison

My apologies for not replying sooner. We are currently dealing with your request and will issue a response ASAP. We receive a lot of questions and we deal with them in date order and this is the only reason we haven't replied. I have just got round to your question this morning and I have sent it to a relevant person who will provide me with an answer which I will then send on to yourself ASAP.

I hope this is acceptable to you.

Thanks Paul


Paul Bunting | External Stakeholder Engagement Team Member | Department for Work and Pensions| 10th Floor | Palatine House | Preston | PR1 1HB | Internal Telephone: 66344 | External Telephone: 01772 899344|

As soon as I receive a written reply, I'll post it here and in the forum
#23 Dennis 2014-01-13 23:56
Thanks for your actions in getting to the bottom of this, I can now get on with dying an ugly death a lot easier. As for what the DWP told you I can only class as bullshit. As soon as this thread hit the web page I followed all the links and looked up the offending article myself. It was there on page one for all to see. The document that all the links now lead to is a completely different document, or at least a heavily altered one. What I originally read was unquestionably straight forward. If someone informed the DWP that I was in receipt of DLA as a result of a bogus claim, whether true or false, I would have been fast tracked to PIP as a penalty. Thankfully though that offensive document has gone.
#22 Jim Allison 2014-01-13 16:21
I have had verbal communication with the Team Leader dealing with this issue, who contacted me as a result of an FOI request.

DLA claimants reported by a neighbour/frien d etc will not lose their DLA and be forced to claim PIP, if the report is found to be malicious, since as previously stated a malicious allegation IS NOT a change in circumstances.

I will post the written response as soon as I receive it. The delay is due to so many DLA claimants contacting the PIP team to question this.
#21 Jim Allison 2014-01-06 16:58
As I suspected there is nothing in the Decision Maker's guide (now renamed Advice for Decision Making for PIP and UC) about DLA PIP and the suspected fraud scenario and nor as far as I can see is there anything in the PIP legislation pertaining to this issue.

I think that any claimants wishing to challenge what amounts to an extremely dubious and potentially unlawful procedure would have to rely on public interest lawyers to argue their case by way of a judicial review which I note you have mentioned in the comments section. It is clearly in the public interest and a matter of particular importance to pursue this matter through the courts but the manner in which the High Court found in favour of the government with working-age disabled adults who require separate bedrooms under the under-occupancy rules (bedroom tax) doesn't always bode well. This is most likely because the judges involved with the case are probably true blue Tories themselves! The decision as you may already be aware was immediately appealed to the Court of Appeal who gave leave to appeal and will hear the case in due course.

This doesn't of course mean that claimants shouldn't use every legal avenue open to them but going through the tribunal system may be quicker and may be less expensive as in the event of an appeal to the Upper Tribunal these judges have the status of High Court judges anyway.

To be honest the whole approach to benefit claimants by this government has been an absolute disgrace and as has been correctly identified in the comments section what they are planning with the 'snoopers charter' beggars belief. The disability benefits unit are going to need a huge counter fraud section to deal with the anticipated amount of malicious allegations if this absurd strategy ever becomes law? It will be most interesting to view the revised legislation which would undoubtedly be required to enact this ridiculous state of affairs because without it what they are intending to do would most definitely be illegal. (Comment from Crazydiamond)

I have made a Freedom of Information Act request asking for clarification on this issue as there have been no additional memo's on this to DWP Decision Makers. I will post the outcome when I receive it.
#20 Jim Allison 2014-01-06 16:50
The post by RightsNet is wrong. After consulting with various colleagues, some legally qualified, and Crazydiamond a former B & W moderator, and former Adjudication Officer for the former DHSS/DSS ( now called Decision Makers) this is his opinion :

If a DLA claimant is maliciously reported for suspected fraud and is subsequently compelled to claim PIP If the allegation proves to be false. I cannot see how this can possibly constitute a relevant change of circumstances because the facts will remain unchanged and therefore the original award cannot be superseded. The award of DLA would have to be superseded in favour of PIP and I have never come across a situation whereby a supersession is undertaken where the facts remain unchanged and a claimant is transferred to an alternative allowance only if they meet the conditions of entitlement.

I sense that the statement may possibly have been made as an off-the-cuff remark and the Rightsnet member has accepted it as DWP policy. For one thing we don't know the status of the DWP official but more importantly there would have had to been some legislation in place to implement the policy and no such legislation exists. Furthermore I cannot identify on any of the welfare websites where any action of this type has been initiated by the DWP who in any case would be on very dodgy legal grounds if the policy was to become law.

Until such time (if at all) this situation comes to light and there is clear evidence of it happening I would be minded to disregard what the member of Rightsnet has inferred about this matter during the discussion with the DWP official as it is not unknown for these officials to make unsubstantiated allegations especially as it seems the conversation appears to have taken place at a local level.
#19 denise mcnally 2013-10-28 23:25
I am so outraged at this ruling I have contacted Polly Toynbee at The Guardian to see if she can highlight it and make it public.....sure ly the majority of the general public will see how unfair and morally wrong this ruling is!!!

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