If you are aged over 16 and you have failed your PIP medical and not scored enough points to be entitled to any rate of PIP, there are steps you can take to challenge the decision. Your situation will be slightly different depending on whether or not you had a previous claim for Disability Living Allowance (DLA)
Previously in receipt of Disability Living Allowance?
If you had a previous award of Disability Living Allowance (DLA) this award will continue to be paid for 4 weeks after the decision about PIP is made. After this the claim will be terminated and, depending on which other benefits are paid, it can also have a knock on effect on your other benefits and any benefits that are paid to your carer. This may mean that the rate of other benefits is reduced or even that the other benefits are stopped.
Loss of mobility component of Disability Living Allowance?
If your DLA award included mobility component paid at the highest rate then you may have used this for a car through the motability scheme. You were eligible for the motability scheme if you were assessed as meeting the conditions for the highest rate of mobility component of DLA.
If after the PIP assessment you have no entitlement to either rate of PIP mobility component there is a compensation scheme for people who lose their motability cars. If you have an award of PIP for the enhanced rate of mobility you can continue to access the motability scheme.
Motability compensation scheme
If you previously received DLA and, after a PIP reassessment, fail to get enhanced rate of mobility component you keep the DLA mobility rate for 4 weeks after the new PIP decision and can keep the car for a further 8 weeks. This is supposed to give you time to challenge the decision although in reality it almost always takes longer than this to challenge a PIP decision. If the PIP reassessment leads to the loss of the motability vehicle and you were using the Motability scheme before January 2013 you are entitled to a £2000 lump sum from Motability to help you purchase a used car or you can keep your motability car for up to 26 weeks while you challenge the decision. If you took on Motability between January and December 2013 you are eligible for £1000 in the same situation or you can opt instead to keep the vehicle for up to 26 weeks while you challenge the decision.
For people who joined Motability after 1st January 2014 a Return to dealer payment is available if the vehicle is returned within 8 weeks.
If you are still in hardship despite the motability compensation scheme, you may wish to consider raising your concerns about this with your MP who might be able to intervene on your behalf.
How to challenge a PIP decision?
If you have kept a copy of the PIP 2 form (called how your disability affects you) from when you first claimed PIP you should review this information to see if it accurately reflected your situation at the date of the decision. This date will be given on the decision letter. Legally speaking the decision is about your difficulties at the date of the decision rather than the date you completed the form.
If you do not have a copy of the PIP 2 you should reconsider the points you feel you should have been awarded at this date by scoring yourself against the list of descriptors available here Benefits and Work
For more information about how to claim PIP and the scoring system see Disability Rights UK
If you aren’t sure how to review the scores or what this means or you need more help you should seek advice
In order to get an award of a standard rate component of Daily Living or Mobility you need to score at least 8 points from any combination of the descriptors listed under these headings. For an award of an enhanced rate component of daily living or mobility you need to score at least 12 points from any combination of the descriptors listed under these headings. If you are unable to identify sufficient points you should seek further advice.
If you feel that the reason you cannot score sufficient points is because your condition has deteriorated recently you might want to consider starting a new claim for PIP rather than asking for this decision to be reconsidered.
If you are confident of your scores the next stage is to reconsider any reasons given in the decision letter to indicate why these have been refused. You need to write a letter requesting a mandatory reconsideration which replies to these points and also addresses the points you feel you should have scored. You should give examples and reasons to explain this and consider whether you have any evidence you could submit. This might be a copy of a medical report from your GP or consultant, a copy of a report form DWP for ESA or perhaps a letter from someone else who knows about your condition. It could also be a copy of your own records such as a fits diary, a hypo diary or a diary of the effects of your condition. The Mandatory Reconsideration request should be made within a month of the date of the decision. A late Mandatory Reconsideration can also be made within 13 months of the date of the decision but you will also need to give reasons why it is late.
If the DWP do not accept a late Mandatory reconsideration you should seek advice.
What happens next?
The DWP will reconsider the further information you have sent them and they may change the decision they have issued. If they refuse to make any award of PIP or if they make a lower award than you feel you should be paid, you should appeal against the decision. It is important to always take advice at this stage particularly if you have a partial award as the outcome of the tribunal is that an award can go down as well as up. An advisor should be able to give you guidance in making the right decision so that you don’t lose out.
Your advisor will help you to lodge an appeal against the PIP decision. If you live in Coventry you will be referred to the Law Centre for representation at the hearing.
Unless you have a lower rate of entitlement to PIP you will not be able to get any payments of PIP until the appeal is heard. Your advisor will give you further advice about your entitlement to other benefits.
If you don’t think you can successfully challenge the decision
If you don’t think, you can successfully challenge the PIP decision you will need to monitor your health situation to see if at any time in future you could make a successful claim.
You might also consider making a claim to another benefit such as:
Employment and Support Allowance
Pension Credit (if you or your partner are over Pension Credit age)