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Assessment based on 'cognitively impaired' applicant

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3 days 4 hours ago #296913 by Whippety
Dear forum members and moderators

A relative was recently assessed for PIP over the telephone. His application form (completed by his daughter) was quite high level, and he wasn't accompanied during the assessment. The application declared spinal problems and long Covid.

However, in reviewing his medical information, he has numerous conditions including a long-standing alcohol problem (self-medication of long-standing depression) which he is in denial about, numerous physical conditions relating to the alcohol use, a historical mental health inpatient episode following an overdose and significant issues relating to depression and long-Covid. The assessment took 38 minutes, and he clearly didn't engage fully due to poor memory, depression, and denial of his alcohol problems. As a result, his application and assessment bear no resemblance to reality.

He is at the appeal stage. Does anyone have any advice or suggested wording for tying the submitted information and reality together and explaining the gap?

All and any help gratefully appreciated :)
Debs

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3 days 2 hours ago #296917 by BIS
Hi Whippety

You have said that his is at the appeal stage, but you haven't mentioned anything about putting in for a Mandatory Reconsideration so I'm not sure whether he has done that. So my answer will be slightly different depending on where you are.

If he has received the decision letter:

1. You have four weeks from the date on the decision letter to put in for a Mandatory Reconsideration.
2. You should ring the DWP and ask for copy of the PA4 (assessment report) - this can take up to 7 - 10 days to arrive so you need to do it quickly.
3. If you are sending in an MR don't miss the deadline date even if you don't have all the information you need - just add a note on the end that you will be sending in any additional evidence. (you would have to do this quickly as they tend to just go ahead and do MRs to their own timetable).
4. As well as seeing what is in the report - you need to send in additional information about his problems. Your issue here is explaining why the daughter didn't put this information in the first place. If it is because he didn't want her to = then you will have to show that he has changed his mind. The problem here is that the assessor can only judge on the information that was there and what he said. There is a real risk = here that they will say - the assessment was fair, and therefore, you will either have to put in for an appeal or start the process again with a more accurate form.
5. Cognitive impairment - if you're going to argue he has a permanent cognitive impairment, it will help if you have medical corroboration of it, whether you are arguing that's because of his alcohol misuse or his long Covid.
6. Look at our Guide to PIP Appeals (which also has the MR information in it) benefitsandwork.co.uk/guides-for-claimants/pip

If you have already done an MR and are moving towards an appeal.

1. You have one month from the date on the MR letter to put in for an Appeal
2. Although in your original submission to Appeal you have to give reasons - you can continue to send in additional information up to two weeks before the Tribunal takes place.
3. Appeals can take up to 52 weeks to process, though this can vary from one area to another.
4. Although your chances of winning an appeal are better than winning an MR - the panel can only judge whether the assessor made the right decision on the information they had available at the time. It's fine if you are saying that somethings were implied during an assessment - but it's only now one has a firm diagnosis - they will look at that - but if a person withheld all the information and it's a choice - I think you will struggle to get them to look at new information.
5. Look at the Guide to PIP appeals for further information. benefitsandwork.co.uk/guides-for-claimants/pip

At the end of the day, I think much of your approach depends on your relative. If he is cognitively capable of making a choice, then you are going to struggle to overturn what has happened because it's not the assessor's fault if he chose to keep some of his medical information to himself. If he is cognitively impaired, you could argue that the daughter didn't understand the PIP process and only included limited information - which made it difficult for the assessor - but if he appeared as if he could speak quite naturally at the assessment - I have no doubt they will dismiss it. That's where you will have to rely on medical evidence to show that he is not capable of making rational choices - however he appears.

I don't know whether one of the other mods - might have a more helpful idea.

BIS

Nothing on this board constitutes legal advice - always consult a professional about specific problems

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