Can ATOS Decision Affect Previous DLA Claims

[harvey111]

Child diagnosed with a disability at age 4, made a claim for DLA a few years later and has been receiving it to date, child now 16 and has made a claim for PIP after being invited to.

 

With an unrelated issue, contact was made to GP to ask proof of disability, GP's can't find medical notes so were unable to help, all records computerised, there are notes relating to his disability though not an actual diagonsis - child has very rarely seen GP and his difficulties have been dealt with by his family.

 

Fast forward with regards claim for PIP, child would not go to an assessment so Atos writing to GP. we understand its going to be very hard to get PIP, so are not holding out much hope - it's not a problem.

 

Now to my question, if GP can't provide confirmation of diagnosis, can Atos/ Decision maker ask that previous DLA awards by repaid? Forms have always been filled in correctly and child has never been asked to attend an appointment for assessment prior to this, we assumed DLA would have already contacted GP, especially given the amount of times the award has been issued.

[reallymadwoman]

Previous DLA cannot be affected by an future decision re PIP, though obviously the DLA award will end when the PIP decision is made.

 

DWP/ATOS in fact very very rarely contact GPs regarding claims. An actual diagnosis isn't necessary, any award is based upon care and mobility needs and it's not that unusual for conditions which are permanent but stable to produce very little in the form of medical records - there's often very little point going to the GP if no amount of medical intervention is going to change a condition.

 

It can be difficult to be awarded the correct level of PIP, but it isn't impossible. Assuming the forms regarding the effect of the child's disability were completed reasonably well, then there is a good chance that the correct award will be made, though that can of course be none. The very fact that ATOS have accepted that the child will not attend an assessment may be a positive - did they not consider a home visit? If they don't offer one and PIP is refused, I would consider that grounds to ask for reconsideration.

 

Whilst waiting for further progress it may pay for you to research thoroughly the criteria for PIP and the claims process. There are links to PIP resources in the Benefits forum stickies.

[harvey111]

Thank you, am now reassured. Atos called as they had cancellations but child refused to go. They asked about a home visit, and were told it needed to be discussed with child, was then asked to call back to confirm a home visit, which did happen but within a couple of days letter was received informing that they were writing to GP.

 

I am also wondering when payments will stop if they do stop, next payment due on 12th so I expect that will be received, but next one due on 9th February so unless paid in arrears that won't be received. How long do these procedures take?

[harvey111]

Will search this site this evening and try and get as much knowledge as I can, many thanks.

[Nystagmite]

DLA will only be asked to be repaid in cases of fraud.

 

You also have to remember that the criteria for DLA and PIP are different.

[reallymadwoman]

Thank you, am now reassured. Atos called as they had cancellations but child refused to go. They asked about a home visit, and were told it needed to be discussed with child, was then asked to call back to confirm a home visit, which did happen but within a couple of days letter was received informing that they were writing to GP.

ATOS do home visits only if they have absolutely no choice, so they're clearly trying to avoid it. Their handbook does say that for vulnerable claimants they should make every possible effort to obtain information elsewhere before doing a face to face assessment, but they're prone to sending out appointments first and then reconsidering if they really have to.

 

I am also wondering when payments will stop if they do stop, next payment due on 12th so I expect that will be received, but next one due on 9th February so unless paid in arrears that won't be received. How long do these procedures take?

 

Unfortunately if they have to wait a while for your GPs response, this may take weeks or even months. DLA will continue to be paid until 4 weeks after the PIP decision is made, so it won't stop without warning.

[harvey111]

DLA will only be asked to be repaid in cases of fraud.

 

You also have to remember that the criteria for DLA and PIP are different.

 

Apart of me is concerned that if the GP's correspondance with Atos , that the GP might say, as he has done with the other issue, that there is no longer anything showing as a complete diagnosis. The GP (apparently) has no remaining records of that time. When somebody called the receptionist referred it to a GP who said he couldn't find the original diagnosis and if the GP now gives the evidence to ATOS and they could request that all of the years of DLA will have to be paid back. With this childs disability he doesn't/hasn't needed to attend an appointment with relation to his disability, there is nothing they could do for hme really His records do have mentions of the disability, just not the actual first diagnosis.

 

So I asked if it was possible that ATOS/DWP look at historic claims and claim they were false. Obviously they weren't, all forms filled correctly and throughly, and I assume at some point during the yearly claims would have contacted GP for confirmation. So there must be some records. Surely DWP would not award such monies without the need to contact a GP?

[harvey111]

Unfortunately if they have to wait a while for your GPs response, this may take weeks or even months. DLA will continue to be paid until 4 weeks after the PIP decision is made, so it won't stop without warning.

 

Thank you, I don't think child would mind having a home visit. But it would have to be with a parent in tow. So the payments are in arrears so to speak?

[harvey111]

Unfortunately if they have to wait a while for your GPs response, this may take weeks or even months. DLA will continue to be paid until 4 weeks after the PIP decision is made, so it won't stop without warning.

 

Sorry to bother you again, but stated that DLA will continue to make payments until after the decision is made, so if payment on 12th is for the fours weeks previous and the one in February will again be paid in arrears (for monies owed in January, then he will still receive the payment in February as its 4 weeks after they made the decision

 

Sorry, should have said that the February payment is an important one. so would like it clarified that he will receive tthat payment

[reallymadwoman]

Nothing will change with the DLA payments until after a decision on entitlement to PIP is made, which will be notified to you by the DWP. This letter will include the date that DLA will stop and (hopefully) PIP start, with no break in between.

[harvey111]

Could someone please clarify for me that because the GP MAY not confirm that there has been a diagnosis, that the filling in of these forms does not constitute fraud by definition. All relevant information has been stated in this claim, as it was on previous year's claims for DLA.

 

How would proof be made available to DWP? After spending the last few hours scouring this site, I am led to believe that the onus would be on DWP to prove that the child does not meet the requirements for PIP, rather than the family proving that he does?

 

As stated before, there have been numerous awards for DLA, which I would presume have needed clarification from the GP, rather than the DWP just sending money to someone without first checking that the said person is entitled to receive DLA.

[Nystagmite]

DLA and PIP are based on needs and not the diagnosis. You have to prove that you meet the criteria.

 

DWP don't just saward DLA without proof from the claimant.

 

Not everyone who receives DLA / PIP has a diagnosis. But what they would have is a list of a symptoms. These would then be used to show that as a result of this symptom, they have these needs.

[harvey111]

If PIP not awarded, can ATOS/DWP look in to historic claims to see if they met the critera? And if previous claims do not, will that mean fraud? Quite concerned that all monies would need to be repaid.

 

Child and family have never been asked for proof of the symptons, so I am assuming that at some point they have contacted GP for claification? Though GP doesn't help with symptoms, everything is dealt with by family as there is nothing the GP could do to help.

[reallymadwoman]

If PIP not awarded, can ATOS/DWP look in to historic claims to see if they met the critera? And if previous claims do not, will that mean fraud? Quite concerned that all monies would need to be repaid.

No, they cannot. DLA would not have been awarded without evidence, particularly for a child that young. Just because it no longer exists, it doesn't mean the claims are possibly fraudulent.

Child and family have never been asked for proof of the symptons, so I am assuming that at some point they have contacted GP for claification? Though GP doesn't help with symptoms, everything is dealt with by family as there is nothing the GP could do to help.

 

They could also possibly have contacted the child's school, which is usually much better evidence than the GP anyway. Please try not to panic over this - DWP knows that many conditions don't change over long periods of time and that records are not kept forever. The lack of a diagnosis is no bar to making claims for DLA or PIP, just focus on the effects of the condition. Is the child still in education? If so, the school should easily be able to back you up if necessary.

[harvey111]

Thank you, yes child still in education so there is a strong possibility that school could help if needed for evidence.

[harvey111]

Child refused home visit after getting very distressed and embarrassed. Parents ok about DLA/PIP stopping. ATOS refused paper award. Parents informed ATOS that child would not have either a centre or home visit.

When ATOS informed they asked if parent wanted transferring to DWP, parent said no, not at the minute but was advised later by DWP that if no valid excuse then DLA payments would stop without notice, but parent understood that payments would be made at least 4 weeks in arrears then by a very rude member of staff. parent did not identify either child or themselves, is this not the case? Payment due on 8th March. One parent suffers from OCD, so would need to know payments expected.

 

How soon does it take for ATOS to inform DWP? ATOS were informed that parents realised that claim would end.

 

Also, please advise when to inform HMRC that child would not be receiving DLA?

 

Any advice would be most welcome.

Edited February 12, 2016 by harvey111
Missed ino