Department for Work and Pensions

4. Mr O complains on behalf of himself and Mr Q about the actions of the DWP and IAS.

5. He says the DWP: • delayed the processing of Mr Q’s PIP claim between the date of claim on 9 July 2021 and the date it referred the claim to IAS on 22 September 2021, in particular in respect to the documents required to establish his nationality • gave him incorrect information on more than one occasion regarding the start date of Mr Q’s PIP claim between the date of claim on 9 July 2021 and the date of decision on 4 March 2022.

6. He says the IAS: • received Mr Q’s PIP claim on 22 September 2021 and delayed arranging the initial assessment until 20 January 2022 • cancelled the subsequent assessment due on 31 January at the last minute and he had to wait until 22 February for it to happen.

7. Mr O says as a result of: • the delays caused by both the DWP and the IAS, the final PIP decision was also delayed and Mr q missed out receiving the higher rate of PIP at the earliest date possible • the DWP giving him incorrect information about the start date of Mr Q’s PIP claim, he was led to believe that there was no urgency to submit the PIP claim and he did not need to be concerned about the ongoing delay.

8. Mr O would like: • the DWP to make an ex-gratia payment equivalent to the benefit Mr Q would have received had there been no delay in processing the claim • the DWP to agree to a further financial remedy to recognise the stress and frustration caused to him and Mr Q from both the delay and incorrect information • the IAS to increase its offered ex-gratia payment of £25 to recognise the stress and frustration caused to him and Mr Q by its delay in arranging the assessment.

Contextual background

9. Disability Living Allowance (DLA) is a non means tested benefit awarded to claimants who have additional needs due to mental or physical ill health. In 2013 the government introduced PIP to gradually replace DLA for claimants over 16 years old.

10. The DWP contacts parents or guardians of DLA claimants shortly after their 16th birthday and invites them to claim PIP. DLA payments will stop unless the child applies for PIP by the date given in the letter. This information is available on the government website page ‘Disability Living Allowance (DLA) for children: When your child turns 16’, available at https://www.gov.uk/disability-living-allowance-children.

11. Entitlement to PIP is not automatic at age 16, and DWP reassesses eligible claimants to determine if they meet the criteria. During the reassessment period, DLA remains in payment until four weeks after the date of the decision on PIP entitlement, at which point PIP will go into payment if it has been awarded. It is not possible for DWP to backdate PIP entitlement. The rules are set out in regulation 17 of the Personal Independence Payment (Transitional Provisions) Regulations 2013 (the Regulations).

12. To determine a claimant’s eligibility for PIP, a Healthcare Professional (HCP) from IAS carries out an assessment of their functional abilities. The IAS is the assessment provider and a separate organisation from the DWP. Having completed the assessment, the HCP sends a report to the DWP, and a DWP decision maker (DM) will make a decision from the report and any other supporting information as to the claimant’s entitlement to PIP.

13. On 23 March 2020, the DWP temporarily suspended all face-to-face assessments for health and disability-related benefits, including PIP. This was in line with government guidance and due to the COVID-19 pandemic.

14. On 4 May 2020, DWP introduced the first telephone assessments to carry out assessments. Face-to-face assessments were not resumed until May 2021.

Complaint background

15. Mr Q was awarded the middle rate care component of DLA from May 2020. He was sixteen on 9 June 2021.

16. DWP wrote to Mr O on 10 June 2021 inviting him to claim PIP on behalf of Mr Q. A further reminder letter was sent on 25 June.

17. Mr O called the PIP new claim line on 9 July. DWP told him it could not send out a PIP claim form at that point because Mr O had advised that Mr Q had Swiss nationality. Mr O says the DWP told him that in any case, the claim would be backdated to the date of Mr Q’s 16th birthday.

18. The DWP subsequently sent a PIP claim form to Mr O on 4 August, in addition to a form requesting proof of Mr Q’s nationality and his EU settlement decision.

19. Mr O sent Mr Q’s passport to the DWP on 10 August. The DWP records show it received his settlement verification documents on 27 August. Mr O says he did not send the latter and believes DWP was able to verify this information online once he had provided the passport.

20. On 14 September 2021, Mr O called the DWP. The DWP confirmed it had received the evidence relating to Mr Q’s nationality but was still waiting for the completed PIP application. The adviser said there were some delays with Royal Mail and the DWP handing site due to COVID-19. Mr O is not sure when he sent in the PIP application or if there was a deadline to do so. He tells us he was not in a hurry to submit the claim because he believed the DWP would backdate Mr Q’s PIP award to his 16th birthday.

21. On 24 September Mr O called DWP, who confirmed it had received Mr Q’s claim on 21 September and referred it to IAS on 22 September. The DWP told him the IAS would contact him to arrange Mr Q’s assessment but could not give him a timescale for this.

22. On 6 January 2022, the IAS wrote to Mr O to book a telephone assessment on 20 January. On 10 January Mr O called IAS to advise that Mr Q would not be available on that date and the assessment was rescheduled for 31 January 2021.

23. The IAS called Mr O on 31 January to cancel the assessment on that date and rearranged assessment for 22 February. It explained this was because there was not an available HCP. The assessment took place as arranged on 22 February and the DWP received the HCP’s assessment report on 23 February.

24. Mr O called the DWP on 28 February and asked if Mr Q’s award would be backdated to the date of his 16th birthday. He says that the adviser confirmed this was the case. They also told him the HCP report was currently waiting to be reviewed by a DM and this could take up to six weeks.

25. The DWP made a decision on 4 March to award Mr Q the enhanced care and enhanced mobility components of PIP from 6 April 2022 to 21 February 2025. The DWP wrote to Mr O on 4 March and explained that PIP would be paid in four weeks’ time, i.e. from 6 April.

26. On 9 March 2022 Mr O submitted a complaint to the DWP about: • the start date of Mr Q’s PIP entitlement • the DWP’s delay in processing the claim • the IAS’s delay in arranging the assessment

27. On 11 March the DWP provided its response to the complaint and explained it had found no failings in its service. It advised that Mr O would need to complain directly to IAS about any delay in scheduling his son’s assessment. Mr O subsequently complained to the IAS on 18 July. On 12 August he received a response and £25 ex-gratia payment for the late notice cancellation of the assessment appointment on 31 January.

28. Mr O contacted IAS again explaining he was not happy with its decision, and it advised him on 22 September to refer the matter to the Independent Case Examiner (ICE), which is the next step in the complaints process.

29. He referred both the DWP and IAS complaints to ICE in July 2022 and September 2022 respectively and received a final decision for both complaints on 27 September 2023. ICE did not uphold his complaints and Mr O then approached our Office.

DWP delay in processing PIP claim

33. Mr O says the DWP unreasonably delayed processing his son’s claim, particularly in regard to its request for evidence of Mr Q’s nationality. We have looked to see if the DWP followed all relevant guidance and standards in this regard.

34. The government webpage ‘PIP: Eligibility’ explains that if a claimant is from the EU, Switzerland, Norway, Iceland or Liechtenstein, they usually need settled or pre-settled status under the EU Settlement Scheme in order to be eligible for PIP.

35. Given the above, and as Mr O had told DWP that Mr Q holds Swiss citizenship, we cannot see the DWP made any mistakes in asking for evidence of Mr Q’s nationality and settlement status in order to progress his PIP claim.

36. This is in line with the requirements for PIP entitlement for European nationals as set out in the DWP’s ‘Advice for Decision Making: Staff Guide’ Chapter C2: Personal Independence Payment. It is also in keeping with Regulation (EC) No 883/2004 of the European Parliament and of the Council and our Principles of Good Administration, (our Principles) which expect public organisations to have regard to relevant legislation in their decision making.

37. We can also see that the DWP did not receive Mr Q’s PIP claim until after it had processed the evidence of his nationality, and it referred the claim to the IAS promptly the day after it received it on 21 September 2021. Therefore, we have not seen anything to suggest that the request for evidence of nationality and settlement status impacted on the overall time taken for the DWP to initially refer the claim to the IAS for assessment.

38. We have noted that the DWP referred to postal delays, which may explain the later arrival of the PIP form. We cannot hold the DWP responsible for any delays in the postal service and we can also see that Mr O is not able to remember when he posted the claim form, so we cannot make any comment on how long it took to reach the DWP.

39. The DWP received the HCP report from the IAS on 23 February 2022. It subsequently made and notified Mr O of the decision on 4 March. This was at a time when we understand, from the ICE report, that decisions were usually taking up to six weeks. This appears to be in line with our Principes, which expect public organisations to provide effective services and deal with people promptly, and we have not identified any indications of failings here.

40. The DWP records show that it did not send out a claim form or a request for proof of nationality until 4 August, which was over three weeks after Mr O contacted the DWP on 9 July. The DWP has not fully explained why it could not send out a PIP claim form and the request for proof of nationality on 9 July. We have referred above to our Principles relating to prompt and effective services. However, whilst we agree a three-week delay is not ideal, we do not consider it so significant that it indicated a service failing, for the reasons set out below.

41. The average time for processing PIP claims from the date of submission to date of decision was 26 weeks. This was due to backlogs resulting from COVID-19. We cannot hold the DWP for delays caused by COVID-19 since these were outside its control. We can see the overall time taken for the DWP to process Mr Q’s PIP claim from the date of receipt of claim was just under 24 weeks, which was therefore within the expected timeframe in that period.

42. In summary, we have not seen any evidence that the DWP did not act in line with our Principles here, or any indications of failings.

43. In making our decision we have also taken into account that Mr O did not contact the DWP to make a PIP claim on Mr Q’s behalf until 9 July, after the invitation was sent out on 10 June. This contributed to the overall timeframe. Mr O has told us that he did not act more swiftly to send the claim sooner because he understood any PIP award would be backdated to the date of Mr Q’s birthday, which we go on to consider below).

Information about start of PIP claim

44. Mr O is very clear that the DWP told him Mr Q’s PIP award would be backdated to the date of his 16th birthday, and he explains any delays on his part as being due to this understanding. We have explored the evidence available to us regarding the communication between Mr O and DWP.

45. We can see that it is set out in the Regulations that the claimant will not be paid PIP until four weeks after the date of the entitlement decision. Therefore, the DWP was correct to apply the law to Mr O’s son’s award and had no flexibility to do anything differently, i.e. it was not possible for it to backdate any payment to the date of his Mr Q’s birthday.

46. We have looked at Mr O’s complaint that the DWP provided incorrect information about the start date of the claim. He says this happened: • during the telephone call on 9 July when he called to make the PIP claim • during a telephone call to the DWP on 28 February 2022 • on further occasions during telephone calls with the DWP and IAS but he could not identify when this had happened

47. The DWP audio recording of the call on 28 February 2022 shows that the DWP adviser correctly advised Mr O that PIP would be paid from four weeks after the PIP decision date. We have not seen any evidence in any other available recordings that he was told that Mr Q’s payments would be backdated.

48. We can also see that the DWP provided an explanation of the date of payment, which included reference to the relevant legislation. It did so in its decision letter dated 4 March and during telephone calls with Mr O on 8 and 9 March, 1 April, 18 May and 4 July, after submitting his complaint to the DWP.

49. We have reviewed the available evidence and, based on this evidence and on the balance of probabilities, cannot see anything to suggest the DWP or the IAS provided Mr O with incorrect information about the start date of the claim and the date from which Mr Q would receive payments.

50. With this in mind, we have not seen anything to indicate DWP failed to act in line with its Customer Charter commitments to ‘provide you with the correct decision, information or payment’, and so we will take no further action here.

Delays by the IAS

Initial delay in contacting Mr O 51. We have looked at the timeline of events following the DWP’s referral of Mr Q’s PIP claim to the IAS for assessment on 22 September 2021 to see if IAS complied with relevant standards and guidance.

52. We see that initially the IAS did not contact Mr O until 6 January 2022 to arrange a telephone assessment on 20 January. We would expect the IAS to arrange an assessment promptly in line with our Principles, as set out above. We have looked to see why this delay happened.

53. The IAS explained to Mr O that face-to-face consultations were suspended in March 2020, in line with Government’s COVID-19 guidance. We know that the DWP subsequently gradually introduced telephone assessments from 4 May. We can see from IAS’s explanation that this, in addition to the redeployment of staff to manage the increase in benefit claims during this period, caused a backlog of claims. This backlog led to delays through the whole PIP system, including the assessment stage.

54. We have explained above that we cannot attribute responsibility for delays caused by COVID-19 to the DWP, and the same applies to the IAS. We have not seen any other evidence of delays on the part of the IAS in first arranging the assessment. As such, although there was a period of four months in arranging the assessment, we can see there were clear and exceptional reasons for this, and so we do not consider this to be an indication of maladministration.

Cancellation of assessment appointment on 31 January 55. We can see the IAS cancelled the assessment appointment booked for 31 January 2022 on the same date that it was due to take place and rearranged it for 23 February. It says this happened because the HCP booked to carry out the assessment was unavailable due to sickness, and this was not uncommon at this time due to COVID-19.

56. It explained that at the time of these events, when an HCP became unavailable it used an automated system to find another one. The cancellation would often be at short notice because the system was designed to look for a replacement up until the time of the appointment, so only then would it alert the cancellation and rescheduling team to call the claimant. The IAS says it would contact the claimant with 30 minutes of the scheduled appointment but nonetheless accepts this is not an ideal outcome for the claimant. However, at the time this system allowed the maximum number of assessments that IAS could facilitate to go ahead.

57. Having looked at the reasons for the cancelled appointment, we can see no indications of failings here. We acknowledge that staff sickness was very likely high at this time due to the pandemic.

58. We have also not identified any concerns about IAS’s use of the automated system in place since, although it resulted in a short notice cancellation, it also ensured that the maximum number of assessments took place at a time when there was already a backlog due to COVID-19. As such, we have not seen anything to suggest IAS failed to act in line with our Principles, which say that organisations should deal with people within reasonable timeframes.

59. We have also taken into account that Mr O had needed to cancel the earlier appointment that the IAS had offered for 20 January, which evidently added to the assessment waiting period and was not due to any actions on the part of the IAS.

Summary 60. Our Principles expect organisations to deal with people within reasonable timescales and whilst we have explained we cannot hold the IAS responsible for any additional delay due to COVID-19 and we have not seen any specific indications of failings on the part of the IAS, we recognise that overall the assessment process took more than the average 14 weeks at that time. This would still have been the case even if Mr O had not needed to cancel the first arranged assessment.

61. Although we have not seen any indications of maladministration by IAS, we can see that it has recognised that Mr O and Mr Q had been frustrated by having to wait a number of months to receive the assessment and so offered an apology and £25. This is in line with our Principles for Remedy, which say organisations should ‘behave professionally and with regard to individual circumstances’.

62. We understand that Mr O has experienced upset and frustration in response to the time taken to process his son’s PIP claim and the start date of his award. We hope our consideration of his complaint provides clarification and reassurance that DWP and IAS acted in line with relevant standards and guidance when it processed the claim.

63. With the above in mind, we will take no further action. We hope we have clearly explained how we have reached our decision in this case.

1. We have carefully considered Mr O’s complaints about the Department for Work and Pensions (DWP) and the Independent Assessment Services (IAS). We are sorry to hear about the difficulties he has experienced applying for Personal Independence Payment (PIP) for his son, Mr Q, and the frustration they experienced.

2. Having thought about the evidence available to us, we have decided to take no further action in this case. This is because we have not seen any indications of failings in the time taken by the DWP or the IAS to process Mr Q’s PIP claim. We also have not seen that, on the balance of probabilities either organisation provided him with incorrect or misleading information about the start date of the claim.

3. We have explained our decision in more detail below.