Department for Work and Pensions - gov.uk · 2019-04-11 · Department for Work and Pensions DECISION MAKING AND APPEALS D M G V 1 AP 58 – FU 2019 1. This letter provides details

D e p a r t m e n t f o r W o r k a n d P e n s i o n s

D E C I S I O N M A K I N G A N D A P P E A L S

Decision Makers Guide

Volume 1 Amendment 58 – February 2019

1. This letter provides details on Amendment 58; the changes have already been incorporated in to the Intranet and Internet versions of the DMG.

2. PDF amendment packages are also available on the Internet (see link below). These can be printed with the amended pages being reproduced in full. Each page will contain the amendment number in the footer. https://www.gov.uk/government/publications/decision-makers-guide-vols-4-5-6-and-7-jobseekers-allowance-and-income-support-staff-guide

Note: When printing PDF packages set the print properties to Duplex/Long Edge in order to produce double sided prints.

3. Amendment 58 affects Chapters 1, 2 and 4. The changes: Chapter 1 - expand the guidance at DMG 01405.

Chapter 2 – amend the date for claiming social fund funeral and maternity payments at DMG 02543.

Chapter 4 - remove out of date guidance on mortgages and loans. 4. If using a PDF amendment package remove the sheets as stated in the left

hand column of the Remove and Insert table below and insert the new sheets as stated in the right hand column (note the record of amendments at the back of the Volume).

Remove

Insert

Chapter 1 Chapter 1 01402 – 01419 (1 page) 01402 – 01419 (1 page) Chapter 2 Chapter 2 02541 – 02563 (1 page) 02541 – 02563 (1 page) Chapter 4 Chapter 3 Conts 04392 – Conts 04860 (3 pages) Conts 04392 – Conts 04860 (2 pages) 04511 – 04549 (3 pages) 04511 – 04549 (1 page) 04655 – 04686 (3 pages) 04655 – 04686 (1 page) 04696 – 04703 (1 page) 04696 – 04703 (1 page)

b e c ar ef ul i n a s s e s si n g t h e s e m att er s o n writt e n e vi d e n c e al o n e. It m a y b e

n e c e s s ar y t o i nt er vi e w t h e cl ai m a nt t o g et cl arifi c ati o n or f urt h er i nf or m ati o n.

0 1 4 0 2 If it i s cl e ar fr o m t h e c a s e p a p er s t h at a cl ai m a nt h a s pr e vi o u sl y m a d e st at e m e nt s

w hi c h h a v e pr o v e d t o b e i n c orr e ct, t h e D M i s e ntitl e d t o r e g ar d e vi d e n c e pr o vi d e d b y

t h at cl ai m a nt criti c all y, r e g ar dl e s s of w h et h er t h e s e st at e m e nt s w er e g e n ui n e err or s

or att e m pt s t o mi sl e a d.

E x a m pl e

A n I B cl ai m a nt i s cl ai mi n g f or a p art n er w h o h a s e ar ni n g s w hi c h h e st at e s ar e t h e

s a m e e a c h m o nt h. T h e p a p er s s h o w t h at o n o c c a si o n hi s p art n er h a s n ot t ol d hi m of

o v erti m e a n d b o n u s p a y m e nt s. T h e o v er p a y m e nt s ar e n ot r e c o v er a bl e b e c a u s e t h e

cl ai m a nt di d n ot k n o w t h e f a ct s a n d c o ul d n ot b e e x p e ct e d t o di s cl o s e t h e a d diti o n al

e ar ni n g s. T h e D M c a n n ot r el y o n t h e cl ai m a nt' s e vi d e n c e a n d a s k s t o s e e t h e p a y

sli p s e a c h m o nt h.

0 1 4 0 3 - 0 1 4 0 4

B ur d e n of pr o of

0 1 4 0 5 A cl e ar u n d er st a n di n g of w h er e t h e b ur d e n of pr o of li e s h el p s t h e D M t o w ei g h t h e

e vi d e n c e a n d d e ci d e w h et h er f urt h er e v i d e n c e s h o ul d b e s o u g ht. D M s s h o ul d n ot e

t h at

1. i niti all y t h e b ur d e n li e s wit h t h e cl ai ma nt t o pr o v e t h at t h e c o n diti o n s f or a

cl ai m or a p pli c ati o n ar e s ati sfi e d 1 b ut t h e y s h o ul d d o a s m u c h a s p o s si bl e t o

e n s ur e t h at t h e cl ai m a nt h a s e v er y o p p ort u nit y t o pr o vi d e all r el e v a nt

e vi d e n c e a n d w h er e t h e i nf or m ati o n i s a v ail a bl e t o t h e m r at h er t h a n t h e

cl ai m a nt, t h e n t h e y m u st t a k e t h e n e c e s s ar y st e p s t o e n a bl e it t o b e tr a c e d

2. w h er e t h e y wi s h t o s h o w t h at a n e x c e pti o n t o a c o n diti o n of e ntitl e m e nt i s n ot

s ati sfi e d, t h e b ur d e n of pr o of r e st s wit h t h e m 2

3. t h er e i s n o pr e s u m pti o n i n f a v o ur of t h e cl ai m a nt t h o u g h f or II D B t h e cl ai m a nt

i s n or m all y pr e s u m e d t o h a v e t h e P D if h e h a s w or k e d i n t h e pr e s cri b e d

o c c u p ati o n; f or e x a m pl e, a c ott o n w e a v er wit h b y s si n o si s ( s e e D M G C h a pt er

6 7 f or f ull g ui d a n c e)

4. w h er e a n all e g ati o n i s d e ni e d b y t h e cl ai m a nt it i s g e n er all y f or D M s t o pr o v e

t h e f a ct s.

5. t h e b ur d e n of pr o vi n g t h at t h e c o n diti o n s f or r e vi si o n or s u p er s e s si o n ar e

s ati sfi e d li e s wit h t h e p er s o n w h o a p pli e s f or r e vi si o n or s u p er s e s si o n

6. i n o v er p a y m e nt c a s e s t h e b ur d e n of pr o of f or t h e p ur p o s e s of d et er mi ni n g t h e

s u m t o b e r e c o v er e d f all s o n t h e m 3 ( s e e D M G C h a pt er 0 9).

7. w h er e a cri mi n al c o urt c o n vi ct s a p er s o n of a n off e n c e r el at e d t o o bt ai ni n g or

r e c ei vi n g b e n efit, t h at c o n vi cti o n s hift s t h e b ur d e n of pr o of r el ati n g t o t h e

s a m e b e n efit a n d p eri o d at i s s u e fr o m t h e m t o t h e cl ai m a nt 4 .

V ol 1 A m e n d m e nt 5 8 F e br u ar y 2 0 1 9

Note 1: An example of 2. is where there is a claim for a SF funeral payment, it is for the DM to show that the claimant is not entitled because a close relative is not in receipt of a qualifying benefit.

Note 2: Where 5. applies the question of whether the conditions for revision or supersession are satisfied must be considered separately from the question of whether the decision should be revised or superseded.

1 R(SB) 2/83(T); 2 Department for Social Development v Kerr [2004] UKHL 23; 3 SS A Act 92, s 71; CS Act 91, s 16 - 19 & s 71; R(SB) 34/83; 4 R(S) 2/80

01406 - 01419

Vol 1 Amendment 58 February 2019

0 2 5 4 1 A cl ai m f or M A w hi c h i s

1. m a d e b et w e e n t h e 1 4t h w e e k b ef or e t h e E W C a n d

2. m a d e u p t o t h e b e gi n ni n g of t h e 6t h w e e k b ef or e t h e E W C a n d

3. tr e at e d a s a cl ai m f or I B or S D A

will b e a cl ai m i n a d v a n c e f or t h o s e b e n efit s . T h e cl ai m c a n b e tr e at e d a s a cl ai m f or

I B u p t o t h e 1 4t h d a y f oll o wi n g t h e A D C.

I B - f ail ur e t o s ati sf y c o ntri b uti o n c o n diti o n s

0 2 5 4 2 W h er e a cl ai m f or I B i s m a d e a n d t h e D M i s s ati sfi e d t h at

1. t h e c o ntri b uti o n c o n diti o n s ar e n ot m et a n d

2. wit hi n t hr e e m o nt h s t h e c o n diti o n s w o ul d b e s ati sfi e d f or a PI W b e gi n ni n g i n a

l at er b e n efit y e ar

t h e D M m a y tr e at t h e cl ai m a s m a d e f or a p eri o d st arti n g wit h t h e fir st d a y o n w hi c h

t h e c o n diti o n s ar e s ati sfi e d a n d a w ar d b e n efit1 .

1 S S ( C & P) R e g s, r e g 1 3

S F f u n e r al a n d m at er nit y p a y m e nt s

0 2 5 4 3 A n a d v a n c e cl ai m f or a f u n er al or m at er nit y p a y m e nt c a n b e m a d e u p t o t hr e e

m o nt h s b ef or e t h e n or m al ti m e f or cl ai mi n g b e gi n s 1 . T h e n or m al ti m e f or cl ai mi n g i s

1. f or m at er nit y p a y m e nt s – t h e p eri o d b e gi n ni n g

1. 1 el e v e n w e e k s b ef or e t h e fir st d a y of t h e E W C a n d e n di n g si x m o nt h s

aft er t h e A D C 2 o r

1. 2 wit h t h e d at e o n w hi c h t h e cl ai m a nt b e c o m e s r e s p o n si bl e f or t h e c hil d

a n d e n di n g 6 m o nt h s aft er t h at d at e 3 o r

1. 3 wit h t h e d at e o n w hi c h a q u alif yi n g or d er i s m a d e a n d e n di n g 6 m o nt h s

aft er t h at d at e 4 or

1. 4 wit h t h e d at e o n w hi c h t h e g u ar di a n s hi p t a k e s eff e ct a n d e n di n g 6

m o nt h s aft er t h at d at e 5 or

1. 5 wit h t h e d at e o n w hi c h t h e c hil d i s pl a c e d wit h t h e cl ai m a nt or t h e

cl ai m a nt’ s p art n er f or a d o pti o n a n d e n di n g 6 m o nt h s aft er t h at d at e 6 or

1. 6 wit h t h e d at e o n w hi c h t h e a d o pti o n 7

1. 6. a t a k e s eff e ct i n r e s p e ct of a n a d o pti o n u n d er pr e s cri b e d

l e gi sl ati o n8 or

1. 6. b i s r e c o g ni s e d u n d er pr e s cri b e d l e gi sl ati o n a n d e n di n g 6

m o nt h s aft er t h at d at e 9


2. f or f u n er al p a y m e nt s - t h e p eri o d b e gi n ni n g wit h t h e d at e of d e at h a n d

e n di n g si x m o nt h s aft er t h e d at e of t h e f u n er al 1 0 .

1 S S ( C & P) R e g s, r e g 1 3( 1); 2 r e g 1 9( 1), S c h 4( 8) & S F M F E ( G e n) R e g s, r e g 5( 3)( a); 3 r e g 5( 3)( b);

4 r e g 5( 3)( c); 5 r e g 5( 3)( d); 6 R e g 5( 3)( e); 7 R e g 5( 3)(f); 8 A d o pti o n a n d C hil d r e n A ct 2 0 0 2,

s 6 6( 1)( c), ( d) & ( e); 9 s 6 6( 1)( e); 1 0 S S ( C & P) R e g s, r e g 1 9( 1) & S c h 4( 9)

0 2 5 4 4 T h e D M s h o ul d

1. d e ci d e w h et h er a cl ai m w hi c h h a s b e e n m a d e t o o e arl y c a n b e a c c e pt e d a s

a n a d v a n c e cl ai m a n d

2. if t h e cl ai m i s n ot a c c e pt e d a s a n a d v an c e cl ai m, di s all o w it b e c a u s e it h a s

b e e n m a d e o ut si d e t h e n or m al ti m e li mit s.

0 2 5 4 5 T h e D M s h o ul d a c c e pt t h at a n a d v a n c e cl ai m h a s b e e n m a d e w h er e t h e e vi d e n c e

s h o w s t h at t h e c o n diti o n s f or e ntitl e m e nt will b e s ati sfi e d

1. f or m at er nit y p a y m e nt s - o n t h e fir st d a y of t h e el e v e nt h w e e k b ef or e t h e

E W C

2. f or f u n er al p a y m e nt s - o n t h e d at e of t h e f u n er al.

B e n efit will b e p ai d o n t h at d a y, s u bj e ct t o all t h e c o n diti o n s f or e ntitl e m e nt b ei n g

s ati sfi e d1 .

1 S S ( C & P) R e g s, r e g 1 3( 1)( b)

0 2 5 4 6 - 0 2 5 5 9

S P C

M a ki n g a cl ai m b ef or e att ai ni n g q u alif yi n g a g e

[ S e e M e m o D M G 0 1/ 1 9]

0 2 5 6 0 A cl ai m f or S P C m a y b e m a d e, a n d t h at cl ai m m a y b e d et er mi n e d, at a n y ti m e wit hi n

t h e a d v a n c e p eri o d1 .

1 S S ( C & P) R e g s, r e g 4 E( 1)

0 2 5 6 1 T h e a d v a n c e p eri o d b e gi n s o n t h e d at e f o ur m o nt h s b ef or e t h e d a y o n w hi c h t h e

cl ai m a nt att ai n s t h e q u alif yi n g a g e a n d e n d s o n t h e d a y b ef or e t h e cl ai m a nt r e a c h e s

t h at a g e1 .

1 S S ( C & P) R e g s, r e g 4 E( 2)

0 2 5 6 2 W h er e a cl ai m m a d e wit hi n t h e a d v a n c e p eri o d i s d ef e cti v e, t h e cl ai m a nt m a y

c orr e ct t h e d ef e ct at a n y ti m e b ef or e t h e e n d of t h e a d v a n c e p eri o d 1 .

1 S S ( C & P) R e g s, r e g 4 E( 3)

0 2 5 6 3 W h er e a cl ai m f or S P C i s m a d e d uri n g t h e a d v a n c e p eri o d t h e i nf or m ati o n or

e vi d e n c e r e q uir e d b y t h e S e cr et ar y of St at e i n or d er t o d e ci d e w h et h er t o s et a n AI P

or t h e l e n gt h of t h e AI P t h e ti m e wit hi n w hi c h t h e cl ai m a nt m u st pr o vi d e t h at


Special rules - late or unpaid contributions ............................................ 04392

Special rules - Attendance Allowance and Disability Living Allowance

Advantageous change ................................................................................. 04395

Terminally ill ................................................................................................. 04402

Renewal claims ....................................................................................... 04403

Special rules - Industrial Injuries scheme benefits

Disablement determinations made before 5.7.99 ........................................ 04405

Disablement decisions made after 5.7.99 .................................................... 04407

Recrudescence of a prescribed disease ...................................................... 04408

Worsening after assessment period has ended .......................................... 04410

Worsening during an assessment period .................................................... 04412

Worsening in accident cases - no loss of faculty decision made

before 5.7.99 ........................................................................................... 04414

Claimant's condition has deteriorated .......................................................... 04417

Claimant's condition is unchanged .............................................................. 04418

Claimant's condition has improved .............................................................. 04419

Diagnosis or loss of faculty in doubt ............................................................ 04420

Posthumous claims ...................................................................................... 04425

Superseding current assessments and awards ...................................... 04426

Special rules - Incapacity Benefit and Severe Disablement Allowance

IB and SDA decisions - medical examination .............................................. 04430

Effective date ................................................................................................ 04433

Change in the rate of IB ............................................................................... 04440

Advance PCA testing ................................................................................... 04441

Medical evidence expires ............................................................................. 04450

Own occupation test ............................................................................... 04453

Personal capability assessment ............................................................. 04454

Effective date .......................................................................................... 04456

Medical evidence received after PCA carried out ................................... 04457

Special Rules common to Income Support and Jobseeker’s Allowance

General effective date rule ........................................................................... 04500

Advantageous change notified outside the time limits ................................. 04501


Changes not requiring supersession

Repayment of a student loan .................................................................. 04506

Alteration of component rates ................................................................. 04507

Age changes ........................................................................................... 04510

Change from IS to JSA or JSA to IS ............................................................ 04511

Special rules relating to Income Support

Introduction ................................................................................................... 04550

IS - change of circumstances - the general rule .......................................... 04551

Periods of temporary residence in connection with training ........................ 04555

Exceptions to the general rule - IS ............................................................... 04556

Change ceases to apply ............................................................................... 04557

IS and residential care breaks ..................................................................... 04558

Supersession resulting from payment of income ......................................... 04560

Reduction in IS ............................................................................................. 04561

Incomplete evidence - housing costs ........................................................... 04570

Incomplete evidence - other issues ............................................................. 04571

Special rules relating to Jobseeker’s Allowance

Change of circumstances - the general rule ................................................ 04580

Exceptions to the general rule ...................................................................... 04581

Change ceases to apply ............................................................................... 04582

Payment of income....................................................................................... 04583

Reduction in Jobseeker’s allowance ............................................................ 04584

Determinations on incomplete evidence ...................................................... 04585

Young people - sanctions ............................................................................. 04586

Sanctions ...................................................................................................... 04587

Supersession of JSA(Cont) awards ............................................................. 04590

Special rules - State Pension Credit

Information and Evidence ............................................................................ 04600

At the end of an assessed income period ............................................ 04601

Changes in retirement provision ........................................................... 04603


Rapid Review ............................................................................................... 04604

Supersession - assessed income periods ................................................... 04611

Supersession at the end of the assessed income period ............................ 04615

Information provided within time limits ................................................. 04617

Information provided late ...................................................................... 04618

SPC superseded but assessed income period cannot be set ............. 04620

Supersession - incomplete evidence

Housing costs ....................................................................................... 04630

Additional amount for the severely disabled ........................................ 04631

Supersession - change of circumstances

General effective date rule ................................................................... 04640

Change of circumstances - the general rule ........................................ 04642

Advantageous change notified outside time limits ............................... 04643

Exceptions to the general rule .............................................................. 04646

Changes in income ............................................................................... 04647

Prisoners .............................................................................................. 04648

Change of benefit week ........................................................................ 04649

Claimant ceases to be a patient ........................................................... 04650

Death of the claimant ............................................................................ 04653

Uprating ................................................................................................ 04680

Supersession on change of election - deferred entitlement ................. 04685

Special rules - ESA, IS, JSA and SPC

Housing costs - service charge adjustments ............................................... 04687

Special rules - Employment and Support Allowance ............................. 04696

Exceptions .................................................................................................... 04699

Other exceptions .......................................................................................... 04700

Other effective date rules ............................................................................. 04701

Non-dependent entitled to ESA .................................................................... 04702

Failure determination ................................................................................... 04703

Receipt of HCP report and cases where no examination is carried out ...... 04705

Terminally ill ................................................................................................. 04710


Treated as having LCW – medical evidence expires ................................... 04711

ESA appeal withdrawn, struck out or dismissed .......................................... 04714

Previous PLCW less than 13 weeks ............................................................ 04717

ESA and residential care breaks .................................................................. 04720

Supersession of BB, Cat A or Cat B RP, RP and SP – Class 2 contributions ................................................................................. 04751

Suspension and termination of benefit

Hardship ....................................................................................................... 04800

Loss of contact with claimant ....................................................................... 04802

Immediate suspension ................................................................................. 04810

Suspension where a question arises as to whether benefit should be revised or superseded .......................................................................... 04817

Suspension where an appeal is pending ..................................................... 04818

Notification ............................................................................................ 04821

When benefit suspended must be paid - appeal no longer pending .... 04822

Suspension where an appeal is pending against a decision in a different case ............................................................................................. 04830

What happens if the suspension is lifted ...................................................... 04840

Suspension where information has been requested .................................... 04841

Termination following suspension ................................................................ 04846

When is it appropriate to extend the time limit ............................................. 04850

Date from which benefit is terminated .......................................................... 04852

Suspension where claimant fails to have a medical examination ................ 04857

Termination where claimant fails to have a medical examination ............... 04860


C h a n g e fr o m I S t o J S A or J S A t o I S

0 4 5 1 1 W h er e

1. a p er s o n i s a w ar d e d I S or J S A (“t h e e xi sti n g a w ar d”) a n d

2. if t h at a w ar d di d n ot e xi st a n a w ard c o ul d b e m a d e f or J S A or I S (“t h e

alt er n ati v e b e n efit”) w er e a cl ai m m a d e f or it

t h e n w h e n a cl ai m i s m a d e f or t h e alt er n ati v e b e n efit, t h e D M m a y s u p er s e d e t h e

e xi sti n g a w ar d t o bri n g it t o a n e n d 1 .

1 S S C S ( D & A) R e g s, r e g 1 4 A( 1) & ( 2)

0 4 5 1 2 W h er e D M G 0 4 5 1 1 a p pli e s t h e e xi sti n g a w ar d e n d s o n t h e d a y i m m e di at el y b ef or e

t h e fir st d a y o n w hi c h t h e a w ar d of t h e alt er n ati v e b e n efit t a k e s eff e ct1 .

1 S S C S ( D & A) R e g s, r e g 1 4 A( 3)

0 4 5 1 3 W h er e t h e alt er n ati v e b e n efit i s J S A, t h e p er s o n d o e s n ot h a v e t o s er v e w aiti n g

d a y s 1 .

N ot e: S e e D M G 0 4 7 0 1 f or g ui d a n c e o n E S A

1 S S C S ( D & A) R e g s, r e g 1 4 A( 4); J S A A ct 9 5, S c h 1, p a r a 4

0 4 5 1 4 - 0 4 5 4 9


0 4 6 5 5 - 0 4 6 7 9

U pr ati n g

0 4 6 8 0 U pr ati n g of S P C will n ot n or m all y r e q uir e a s u p er s e s si o n d e ci si o n. W h er e r at e s ar e

c h a n g e d o n u pr ati n g, t h e a m o u nt of b e n efit p a y a bl e a n d t h e a w ar d will b e t h e n e w

a m o u nt wit h o ut t h e n e e d f or a n y f urt h er d e ci si o n of t h e D M1 .

B ut s e e D M G 0 4 6 8 1 f or a n e x c e pti o n t o t hi s r ul e.

1 S S A A ct 9 2, s 1 5 9 B

0 4 6 8 1 T h er e i s a n e x c e pti o n 1 w h er e t h e a p pr o pri at e mi ni m u m g u ar a nt e e i n cl u d e s a n

a d diti o n al a m o u nt f or f or m er cl ai m a nt s of I S or J S A(I B) 2 ( k n o w n a s t h e tr a n siti o n al

a m o u nt - s e e D M G 7 8 1 2 0 et s e q f or g ui d a n c e o n w h e n t hi s a d diti o n al a m o u nt

a p pli e s).

1 S S C S ( D & A) R e g s, r e g 1 4( 5); 2 S P C R e g s, S c h I, p a r a 6

0 4 6 8 2 W h er e D M G 0 4 6 8 1 a p pli e s, u pr ati n g will n e e d t o b e c arri e d o ut b y m e a n s of

s u p er s e s si o n 1 .

1 S S C S ( D & A) R e g s, r e g 1 4( 6)

0 4 6 8 3 – 0 4 6 8 4

S u p er s e s si o n o n c h a n g e of el e cti o n - d ef err e d e ntitl e m e nt

0 4 6 8 5 T h e D M m a y s u p er s e d e 1 a d e ci si o n a w ar di n g S P C w h er e

1. t h e cl ai m a nt or p art n er m a k e s or i s tr e at e d a s h a vi n g m a d e a n el e cti o n f or a

l u m p s u m2 o r

2. a l u m p s u m i s r e p ai d aft er t h e p er s o n c h a n g e s t h eir el e cti o n t o a n i n cr e a s e of

C at A or C at B R P, S A P, G R B or S P 3 .

S e e D M G C h a pt er 7 5 f or g ui d a n c e a b o ut d ef erri n g e ntitl e m e nt a n d m a ki n g

el e cti o n s.

1 S S C S ( D & A) R e g s, r e g 6( 2)( o) o r r e g 6( 2)( o o); 2 S S C B A ct 9 2, S c h 5, p a r a A 1 o r 3 C; S c h 5 A, p a r a 1;

S S ( D ef R P, S A P & G R B) ( Mi s c Pr o v s) R e g s, S c h 1, p a r a 1 2 o r 1 7; P e n si o n s A ct 2 0 1 4, s 8( 2), s 8( 4) & s 1 0;

3 D ef R P R e gs 0 5, r e g 5; S S ( D ef R P, S A P & G R B) ( Mis c Pr o vs) R e gs, S c h 1, p ar a 2 0 D;

S P R e g s, r e g 4 4 & r e g 6; P e n si o n s A ct 2 0 1 4, s 1 0

0 4 6 8 6 W h er e D M G 0 4 6 8 5 a p pli e s, t h e n e w d e ci si o n i s eff e cti v e 1 fr o m

1. t h e d a y o n w hi c h t h e l u m p s u m or p a y m e nt o n a c c o u nt of a l u m p s u m i s p ai d

or r e p ai d w h er e t h at i s t h e p a y d a y or

2. t h e f oll o wi n g p a y d a y.

1 S S C S ( D & A) R e g s, r e g 7( 7 A)


Example

The claimant is a single woman who was 60 on 8.5.05 and who deferred her RP for twelve months. She has capital of £8,000. On 8.5.06 she claims RP and SPC but does not immediately make an election on her deferral option. SPC is awarded to the claimant, taking into account her RP and £4.00 deemed weekly income due to her capital. On 5.6.06 the claimant elects to receive increments. The decision awarding RP is revised to include increments. The decision awarding SPC is also revised to take into account the claimant’s increased RP. On 26.6.06 the claimant realises she would have been better off taking a lump sum so she changes her election. As she is liable for tax, the claimant receives a lump sum of £7,200 rather than the amount of £8,000 she would have received if she were not liable for tax. Of the claimant’s total capital of £15,200, the amount of £8,000 (the gross amount of the lump sum) is disregarded. The decision awarding SPC is superseded to reduce the amount of deemed weekly income to be taken into account to £3.00.


S p e ci al r ul e s - E m pl o y m e nt a n d S u p p ort All o w a n c e

0 4 6 9 6 T h e g e n er al r ul e i s t h at a n E S A s u p er s e s si o n d e ci si o n o n t h e gr o u n d s t h at t h er e

h a s b e e n a r el e v a nt c h a n g e of cir c u m st a n c e s t a k e s eff e ct fr o m t h e fir st d a y of t h e

b e n efit w e e k i n w hi c h t h e c h a n g e o c c ur s 1 .

1 S S C S ( D & A) R e g s, r e g 7( 1)( a); S c h 3 C, p a r a 1

0 4 6 9 7 “ B e n efit w e e k” m e a n s t h e p eri o d of s e v e n d a y s e n di n g o n

1. t h e d a y b ef or e t h e fir st d a y of t h e fir st b e n efit w e e k f oll o wi n g t h e d at e of cl ai m

or

2. t h e l a st d a y of E S A p a y m e nt w h ere it i s p ai d f or l e s s t h a n a w e e k 1

1 E S A R e g s, r e g 2( 1); S S C S ( D & A) R e g s, r e g 7( 3)( d)

0 4 6 9 8 Ot h er s u p er s e s si o n d e ci si o n s w h er e 1

1. t h e s u p er s e s si o n i s o n t h e gr o u n d s th at t h e d e ci si o n t o b e s u p er s e d e d

1. 1 i s a D M' s d e ci si o n w hi c h i s err o n e o u s i n l a w2

1. 2 i s a d e ci si o n a w ar di n g E S A w h er e t h e cl ai m a nt or a f a mil y m e m b er

b e c o m e s e ntitl e d t o a q u alif yi n g b e n efit 3

1. 3 i s a d e ci si o n a w ar di n g E S A w h er e t h e S D P c a n n ot b e i n cl u d e d i n t h e

a w ar d b e c a u s e t h er e i s a n o n- d e p e n d a nt, a n d t h e n o n- d e p e n d a nt i s

a w ar d e d a q u alif yi n g b e n efit 4

1. 4 i s a s i n D M G 0 4 2 9 2 (r ei nt er pr et ati o n of t h e l a w)5

al s o t a k e eff e ct fr o m t h e fir st d a y of t h e b e n efit w e e k.

1 S S C S ( D & A) R e g s, S c h 3 C, p a r a s 9 & 1 0; 2 r e g 6( 2)( b); 3 r e g 6( 2)( e); 4 r e g 6( 2)( e e); 5 r e g 7( 6);

E x c e pti o n s

0 4 6 9 9 T h e g e n er al r ul e i n D M G 0 4 6 9 6 d o e s n ot a p pl y

1. w h er e t h e c h a n g e i s t o t h e cl ai m a nt' s a d v a nt a g e, a n d w a s n otifi e d o ut si d e t h e

o n e m o nt h ti m e li mit 1 - s e e D M G 0 4 5 0 1 1. w hi c h al s o a p pli e s t o E S A

2. w h er e t h e c h a n g e i s b e c a u s e t h e cl ai m a nt i s t er mi n all y ill 2 - s e e D M G 0 4 7 1 0.

1 S S C S ( D & A) R e g s, r e g 7( 2)( b)(i); 2 r e g 7( 2)( b e)


Ot h er e x c e pti o n s

0 4 7 0 0 T h e g ui d a n c e at D M G 0 4 5 5 6 1 1 ., 3 2 ., 43 ., 54 . a n d 7. o n e x c e pti o n s t o t h e g e n er al

r ul e i n D M G 0 4 6 9 6 al s o a p pl y t o E S A. I n t h e se c a s e s t h e d e ci si o n i s eff e cti v e fr o m

t h e d at e of t h e c h a n g e5 .

1 W R A ct 0 7, S c h 1, p a r a 6( 1)( a); 2 E S A R e g s, r e g 1 5 6( 6)( d) o r ( h); 3 S c h 5, p a r a 1 2; 4 p a r a 3;

5 S S C S ( D & A) R e g s, S c h 3 C, p a r a 2 & 3

Ot h er eff e cti v e d at e r ul e s

0 4 7 0 1 G ui d a n c e o n eff e cti v e d at e r ul e s f or

1. s u p er s e s si o n i n i n c a p a cit y c a s e s 1 ( s e e D M G 0 4 2 3 1 - 0 4 2 4 5)

2. s u p er s e s si o n of a Ft T or U T f or err or of f a ct 2 ( s e e D M G 0 4 3 3 7 - 0 4 3 4 0)

3. c h a n g e b et w e e n b e n efit s i n cl u di n g w aiti n g d a y s 3 ( s e e D M G 0 4 5 1 1 - 0 4 5 1 3)

4. p a y m e nt of i n c o m e 4 ( s e e D M G 0 4 5 6 0)

5. r e d u cti o n of b e n efit f oll o wi n g s u p er s e s si o n 5 ( s e e D M G 0 4 5 6 1 - 0 4 5 6 2)

6. c h a n g e c e a s e s t o a p pl y 6 ( s e e D M G 0 4 5 5 7)

al s o a p pl y t o E S A.

1 S S C S ( D & A) R e g s, S c h 3 C, p a r a 7; 2 p a r a 8; 3 r e g 1 4 A ; W R A ct 0 7, S c h 2, p a r a 2; 4 E S A R e g s, r e g 9 3;

S S C S ( D & A) R e g s, S c h 3 C, p a r a 4; 5 p a r a 5; 6 p a r a 6;

N o n- d e p e n d a nt e ntitl e d t o E S A

0 4 7 0 2 W h er e t h e r el e v a nt c h a n g e i s t h at

1. t h e cl ai m a nt h a s a n o n- d e p e n d a nt a n d

2. t h e n o n- d e p e n d a nt b e c o m e s e ntitl e d t o m ai n p h a s e E S A

t h e s u p er s e s si o n d e ci si o n i s eff e cti v e fr o m t h e d at e t h e m ai n p h a s e E S A i s fir st p ai d

t o t h e n o n- d e p e n d a nt1 .

1 S S C S ( D & A) R e g s, r e g 7( 1 7 H)

F ail ur e d et er mi n ati o n

0 4 7 0 3 A d e ci si o n a w ar di n g E S A m a y b e s u p er s e d e d w h er e t h er e h a s b e e n a f ail ur e

d et er mi n ati o n 1 . A f ail ur e d et er mi n ati o n i s a d eter mi n ati o n b y t h e D M t h at t h e

cl ai m a nt h a s f ail e d wit h o ut g o o d c a u s e t o s ati sf y a r e q uir e m e nt t o t a k e p art i n a WfI

or u n d ert a k e W R A 2 . T h e s u p er s e s si o n d e ci si o n t a k e s eff e ct fr o m3

1. t h e fir st d a y of t h e b e n efit w e e k i n w hi c h t h e f ail ur e d et er mi n ati o n i s m a d e

w h er e, o n t h e d at e of t h e d et er mi n ati o n, t h e cl ai m a nt h a s n ot b e e n p ai d E S A

si n c e t h e f ail ur e t o w hi c h t h at d et er mi n ati o n r el at e s or


Documents

Department for Work and Pensions - gov.uk · 2019-04-11 · Department for Work and Pensions DECISION MAKING AND APPEALS D M G V 1 AP 58 – FU 2019 1. This letter provides details