DLA / AA Decision Maker

A question about : DLA / AA Decision Maker

Hi,

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

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

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

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

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

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

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

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

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

MOBILITY COMPONENT:

HIGHER RATE QUALIFICATION (AGED 3+):

MUST BE:

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

LOWER RATE QUALIFICATION (AGED 5+):

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

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

IN LOWER RATE CASES OF CHILDREN AGED 5-16

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

CARE COMPONENT:

DAY QUALIFICATION (MIDDLE RATE CARE):

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

NIGHT QUALIFICATION (MIDDLE RATE CARE):

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

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

[COLOR=red]LOWEST RATE DLA

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

KEY:

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

IN ALL CASES OF CHILDREN AGED 0-16

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

Best answers:

• Why do the dla people not end your claim if you ask them to? I tried to end my claim ealier this year and they got in contact with my doctor and over-ruled my letter. I have just sent another letter ending my claim again as i do not want the money. I don't deserve the money as god wants me to suffer hardship so that i can become a saint but i cant do if if they won't stop the money. How do i get through to them?
• hi can anyone answer my question a lady was paid a personal injury claim payout following a really nasty rtc out of her award she had to pay back DLA {paid to her during her years whilst awaiting settlement} what i would like to check is this normal procedure and if she was due to pay it back out of her settlement - should she not have received a statement/evidence that DLA that they got the money i would be greatful if anyone could help me get her an answer thankyou
• i would be most grateful the sum of money is large and the lady in question doesnt want to offend her solictor by questioning this incase he thinks she doesnt beleive him (apparently he is a friend of family etc etc) personally i would want reciept or some evidence thankyou again
• But that would be income support, or Incapacity benefit as they are paid when you are unable to work due to ill health or injury and would have overlapped with the loss of earnings part of your PI claim.
  DLA is not means tested, and can be paid to people who are working, so I cannot imagine a situation where DLA would be recovered from someone who made a successful PI claim against a third party?
• Thanks for your advice Thanatos. It is really appreciated. I'm just about to put in my DLA form once I get it back from my doctor. I went to the CAB for help with filling mine in and got the same advice as many others to put down your worst day. However, in my case my care needs vary very little from day to day and we did put down what I can manage when I'm at my best. Just hoping thats ok.......
  I had planned on asking my NHS Homeopathic GP (referred to by my regular GP) for a report but she had to cancel my appointment and I won't see her till Dec and was passed a message that my GP would normally do the report and we'll talk about it in Dec. Is it worth pushing for an additional report? I have CFS and have been attending for that and allergies.
  Thanks so much!
• I'm interested in what you say about the software telling you about how bad conditions can be. How does it deal with variable conditions? For instance, I have ME and bipolar and I have an award of Higher rates of both components. My worry is if the software says ME means xyz but that could be wrong - from what I've heard the software tends to play down ME saying that it's not severe enough for a HRM award. I'm a bit worried about what'll happen for my next award, as the decision makers guide for ME has recently changed. I hope that question made sense!
• My mums Social Worker has told her to claim attendance allowance.
  So I could do with some tips/advice on how to make sure that any necessary documentaton/evidence is included with her application.
  She is just about to come out of a rehabilitation hospital after injuring her back and will now suffer from the after effects permanently. In addition she has Diabetes and arthritis. Do I need any letters/reports from the hospital?
  She currently claims housing benefit and her only income is the basic state retirement pensions. She will be attending daycare and having meals on wheels and vitaline. Is there anything else she should be claiming in order to pay for all of this?
  I probably should add that she is 80yrs old.
• It's good of you to help us understand the decision-making process.
  I'm interested from the viewpoint of someone with ME. If someone is pacing themselves properly, they may be able to do most of the things on the form - but the effort of doing them will cause problems on the following days. How can the form be filled in to show this?
• hi some advice please my mum has got severe osteoarthritos in her hip and has been told she needs a complete hip replacement she cannot work,can barely walk and needs help with personal care...she applied for dla a couple of years ago and the forms we're filled in properly,accurately and very thorougthly..yet dla refused. she has seen a surgeon again today and i have made her ring the dla again to try and claim again her dr and surgeon are very aware of her situation and her limitations,she didnt push for tribuneral last time as she assumed what they said was more or less final.... with doctors report and surgeons report both last time and this time stating she can barely move,bend, walking is practically a no no for her is there such a thing with certain illnesses that just will not make it through dla regardless of what doc/surgeon reports say??this time im making sure that even if they refuse again that she will see it through till the end!!
• what a fantasic idea well done you for thinking of it.
  My Son has ADHD and bad bowel problems he has just been awarded the higher rate of care and lower mobility however I thought he would have remained on middle care but higher mobility as getting to hospital appiontments is vital and we live in such a rural area I have no choice but to have a good working car. He can not travel on public transport and even if he could it would take hours to get to hospitals. either way by the time we get to hospitals he always needs a full change of clothing.
  I have tried getting finance for a newer car but its a no go as Im on benefits.
  Is there anything I can do about this?