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PIP: a review of the

Assessment Guide

The Limbless Association

Unit 16

Waterhouse Business Centre

2 Cromar Way

Chelmsford

Essex CM1 2QE

Registered Charity Nos: 803533, SC042256 Company Registration No. 02487661

Contents

1. INTRODUCTION .................................................................................... 1

2. BACKGROUND ....................................................................................... 2

3. THE CLAIMANT JOURNEY ...................................................................... 3

Making a claim ........................................................................................ 3 Claimant questionnaire ............................................................................. 3 Supporting evidence ................................................................................ 3 Assessment by the provider ...................................................................... 4 Face-to-face consultation .......................................................................... 4 Decision ................................................................................................. 4 Reconsideration and appeal ....................................................................... 4

4. THE ASSESSMENT PROCESS .................................................................. 5

The role of the Health Professional ............................................................. 5 The basis for the assessment .................................................................... 5 Initial review ........................................................................................... 6 Further evidence ...................................................................................... 6 Paper-based review.................................................................................. 7 Face-to-face consultation .......................................................................... 7 Concluding the face-to-face consultation ................................................... 10 Advice produced for DWP ........................................................................ 11

APPENDICES ............................................................................................. 12

5. APPENDIX ONE – THE ASSESSMENT .................................................... 13

6. APPENDIX TWO – FURTHER EVIDENCE ............................................... 17

7. APPENDIX THREE – HOME CONSULTATIONS ....................................... 18

8. APPENDIX FOUR – ADVICE TO DWP .................................................... 19

Limbless Association

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1. INTRODUCTION

1.1 This note has been prepared to provide an overview of the 125 page Personal

Independence Payment (PIP) Assessment Guide produced by the Department for

Work and Pensions (DWP). The reason for this note is to help claimants understand

how PIP will be administered by the health professionals employed by the

assessment providers and how this relates to the PIP claim process.

1.2 In preparing this note we have sought to clarify the intention of the advice and

content in the DWP guidance document whilst highlighting relevant elements that

are likely to apply to the amputee and limb loss community.

1.3 In its guidance document, the DWP makes frequent use of the word ‘should’ in

terms of the role and actions the health professionals are to undertake. As such

there is the potential for the misreporting of health conditions or effects when

following this guidance. For that reason, this note has been produced to highlight

the assessment process and by doing so it is hoped that claimants will be aware of

the assessment process and its intended application.


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2. BACKGROUND

2.1 From 8 April 2013, for those of working age (16-64) PIP will replace Disability

Living Allowance (DLA). PIP is intended to help towards the extra costs arising from

ill health or disability and will be based on how an individual’s condition affects

them rather than on the condition itself.

2.2 There are two components of PIP: daily living and mobility. Each is payable at

either a standard or enhanced rate, based on the individual’s need. This will

assessed by a Health Professional (HP), on behalf of either Atos Healthcare or

Capita Health and Wellbeing who have been appointed by DWP, with most

individual’s having a face-to-face consultation as part of the claim process.

2.3 To that end, DWP has produced a guidance document for providers carrying out

assessments for PIP in order to ensure the quality of the assessments that are

undertaken by HPs on behalf of the providers. This guidance forms part of wider

training and other documentation and it should be noted that the guidance will be

updated as necessary in the run up to the implementation of PIP1.

1 We will update this note to reflect any changes made by DWP


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3. THE CLAIMANT JOURNEY

Making a claim

3.1 Claims for PIP will be made to DWP who will gather basic information about the

claimant and their health condition or disability and who will ensure that the

claimant meets certain criteria2 such as age and residency requirements.

Claimant questionnaire

3.2 If these criteria are met, DWP will issue individuals with a claimant questionnaire,

entitled ‘How your disability affects you’3. The questionnaire will ask the claimant to

explain how their health condition or impairment affects their day to day life and

their ability to carry out a series of daily living and mobility activities. This will

include asking whether the claimant needs to use an aid or appliance and whether

they are able to complete the activity reliably.

Commentary – For more information on how ‘reliably’ is defined, please

see Appendix One.

Supporting evidence

3.3 Claimants will also be encouraged to provide any supporting evidence that they

already have and that they feel should be considered, such as evidence from a

health or other professional who is involved in their care or treatment.

Commentary - The DWP stresses that claimants will only be encouraged

to provide evidence that they have readily available and to not delay their

claim in order to seek additional evidence or ask for evidence for which

they might be charged. It is the role of the provider to request any

further medical evidence.

The Limbless Association encourages its members to complete an

evidential diary that details how mobile they are from day to day (the

good day/bad day scenario) and the problems they encounter with their

prosthetic limbs such as socket fit, abrasions and irritation.

The Limbless Association recognises the concerns felt by amputees and

the limb loss community regarding the introduction of PIP, particularly

surrounding the mobility component, and believes that such a diary would

provide supporting evidence to help individuals in completing their PIP

2 For more information on the criteria please see the DWP website: www.dwp.gov.uk

3 A separate note regarding the claim process and the claimant questionnaire will be produced by the Limbless

Association. Please contact the office or see our website for more information.


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assessment as it will highlight the impact limb loss has on daily life and

how limbless people are able to routinely complete the PIP mobility

activities.

Assessment by the provider

3.4 The returned questionnaire will then be referred to the relevant provider, depending

on where the claimant resides, with any additional evidence provided. The provider

will then conduct an internal assessment and will gather any additional information

it considers necessary before providing an assessment report to DWP.

Face-to-face consultation

3.5 A face-to-face consultation is likely for the majority of cases. During the

consultation the claimant will have the opportunity to explain how their impairment

or health condition affects them.

Decision

3.6 A DWP decision maker, known as a Case Manager (CM) will review the assessment

report provided by the HP and all supporting and additional evidence and will make

a decision regarding benefit entitlement. The claimant will then be informed of the

decision in writing and if they are not awarded the benefit or if their benefit has

been reduced (for example, in DLA reassessment cases) the CM will also telephone

the claimant to explain their reasoning.

Reconsideration and appeal

3.7 At this point, the claimant will have the opportunity to present any new evidence. If

the claimant is not satisfied with the decision they can request a reconsideration,

which will usually be conducted by a different CM. If, after reconsideration, the

claimant is still not satisfied with the decision, they can submit an appeal. It should

be noted that a claimant can only submit an appeal after they have requested and

received reconsideration4.

4 A separate note regarding reconsideration will be produced by the Limbless Association. Please contact the

office or refer to our website for more information.


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4. THE ASSESSMENT PROCESS

The role of the Health Professional

4.1 A claimant’s ability to carry out a series of key activities in terms of the two

components (daily living and mobility) will be assessed by a HP employed by the

assessment provider.

4.2 The guidance states that providers will ensure that, before their HPs are approved

to carry out PIP assessments, they have demonstrated that they have appropriate

knowledge of the clinical aspects and likely functional effects of a wide range of

health conditions or disabilities and have the appropriate skills to assess individuals

with such health conditions or disabilities. HPs must also demonstrate that they are

able to critically evaluate and use logical reasoning to provide accurate evidence-

based advice. Providers are therefore required to put in place suitable training

programmes to ensure HPs meet these competency requirements.

The basis for the assessment

4.3 Each activity contains a series of descriptors that have numeric scores allocated to

them. Each activity ranges from the ability to fully complete the task to being

wholly unable to do so.

4.4 Claimants will be allocated a descriptor (and score) for each activity in the

assessment based on the HP recommendation of which of the assessment criteria

they believe applies to that individual. The total scores for all the activities related

to each component are then added together to determine entitlement for that

component. The entitlement threshold for each component is 8 points for the

standard rate and 12 points for the enhanced rate.

Commentary - For a list of the activities, the descriptors and their scores

please see ‘Personal Independent Payment – The Facts’.

For more information on choosing the descriptors please see Appendix

One.

4.5 The HP should take into account the individual’s level of ability, whether they need

to use aids or appliances to complete the activities and whether they need support

from another person or assistance.

4.6 Aids are devices that help a performance of a function such as a walking stick or

spectacles. Appliances are devices that provide or replace a missing function such

as prosthetic limbs, collecting devices (stomas) and wheelchairs.


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Commentary - Claimants who use or could reasonably be expected to use

aids to carry out an activity will generally receive a higher scoring

descriptor than those who carry out the activity unaided. It is important

to note that, the ability to perform an activity ‘unaided’ means without

either the use of an aid or appliance or help from another person.

Therefore an amputee who wears a prosthetic limb should not be

considered able to complete an activity ‘unaided’ and should be scored

accordingly.

For more information on aids and appliances and support and assistance

please see Appendix One.

Initial review

4.7 On receipt of a referral from DWP and following the completion of a claimant’s ‘How

your disability affects you’ questionnaire, the HP will conduct an initial review of the

case to determine the next steps and in doing so consider whether:

• Further evidence is needed;

• The claim can be assessed and advice can be given to DWP on the basis of a

paper-based review; or

• A face-to-face consultation will be required.

Further evidence

4.8 HPs should consider whether any additional evidence beyond that already provided

by the claimant is needed and should seek this from the professionals involved in

supporting claimants. Claimants will be asked to list the professional’s best placed

to advise on their circumstances and provide their contact details within the

claimant questionnaire.

Commentary - The Limbless Association would recommend that

individual’s include the contact details of their Prosthetist, Rehabilitation

Consultant, Physiotherapist or Occupational Therapist, for example.

4.9 Where necessary, HPs should also seek evidence from professionals by telephone, a

written record of which should be taken and included in the assessment report sent

to DWP.


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4.10 On the return of any further evidence requested5, the HP should review the case

again to see whether this evidence is sufficient to provide advice to the CM without

the need for a face-to-face consultation, whether more evidence is needed or

whether a face-to-face consultation is required.

Commentary - For examples of further evidence, please see Appendix

Two.

Paper-based review

4.11 Paper-based reviews will be conducted when the HP believes that there is sufficient

evidence, including supporting evidence, to provide robust advice to the CM on how

the assessment criteria relate to the claimant, on this basis, a face-to-face

consultation is therefore not required.

Commentary - For more information on the assessment criteria, see

Appendix One.

4.12 Examples of when a paper-based review may be appropriate include:

• Where evidence indicates that it is unlikely that the claimant’s condition has

any impact on any of the daily living and mobility activities; or

• Where evidence indicates that the claimant’s condition has a significant

impact on any of the daily living and mobility activities.

Commentary - This highlights the importance of being candid in the

claimant questionnaire and detailing exactly how living without a limb(s)

impacts on daily life and mobility and of sending in additional evidence,

such as a diary, which will provide a greater scope for detail.

Face-to-face consultation

4.13 A face-to-face consultation is likely to be necessary for the majority of cases and

will be carried out in a range of locations, including assessment centres, local

healthcare centres or at the claimants own home. Consultations may need to be

carried out at the claimant’s home when the claimant has a medical condition that

precludes them from travelling or where there is any accessibility issues related to

the planned location for the consultation.

5 We are currently in the process of trying to establish the timescales for the request, receipt and use of further

evidence.


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Commentary – For more information on home consultations please see

Appendix Three.

4.14 Providers should also consider whether other options may be acceptable. For

example, if travelling on public transport is an issue could a taxi be provided?

4.15 Claimants should be encouraged to bring another person with them to consultations

where they would find this helpful. The companion may play an active role in the

consultation; however this is at the discretion of the HP. The guidance states that

this is because the HPs advice must be based on the claimant’s actual

circumstances and not the companion’s views on these.

4.16 During the consultation the claimant will have the opportunity to explain how their

impairment or health condition affects them. To that end, the consultation should

be relaxed and unhurried to allow the claimant sufficient time to talk about

themselves and put across the impact of their health condition or disability in their

own words; the assessment should focus on their perception of how their condition

affects them.

Commentary - It is important to remember that the claimant should be

given the opportunity to state their perspective of how their health

condition or impairments affects their day-to-day life.

It should be noted at this point that, whilst this guidance documents the

standard structure for how HPs should carry out the face-to-face

consultations, it is not designed to be prescriptive. HPs should instead be

prepared to adapt their approach to the needs of the particular claim and

should ensure that claimants are able to put across the impact of their

health condition or impairment in their own words.

Informal observations

4.17 Informal observations, such as the claimant’s walking ability and their ability to

stand, sit and move around freely, will also be made throughout the consultation

whereby the HP will evaluate any functional limitations. Where relevant, the HP

may also carry out a focused examination in order to examine areas of function

relevant to the to the claimant’s health condition or disability.

4.18 The HP should also note any aids or appliances, such as a walking aid, and the

extent to which they are used during the consultation.


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Clinical history

4.19 HPs should record a history of all the disabling conditions and any treatment given

and how effective it has been and whether any further intervention has been

carried out or is planned.

4.20 All current medication, including frequency, dose and any side effects, should be

recorded and this includes “over-the-counter” medication as well as prescription

drugs. HPs should also include any other prescribed therapies, such as

physiotherapy, who prescribed them, how often they are carried out and how

effective they are.

Social and occupational history

4.21 The HP should record a concise and relevant social and occupational history which

should include details such as what type of dwelling the individual lives in, whether

they live alone, whether they can access all areas of their home and whether they

have had to make any modifications to their home.

Commentary – We would suggest that individual’s should, at this point,

clearly explain any modifications they have made to their homes. For

example; ramps, the widening of doors or installation of a wet room.

4.22 Occupational details include the nature of the individual’s job, including any

adjustments made by their employer and whether the individual has had to give up

or change their occupation, and whether it was it due to their health condition or

impairment.

Functional history and the “typical day”

4.23 HPs should invite claimants to discuss their “typical day” by asking them to talk

through all the activities they carry out on a normal day. HPs should also record the

claimant’s perspective of how their health condition or impairment affects their day-

to-day life and their ability to cope with every day activities and in particular any

functional limitations that occur as a result of this.

4.24 Within their assessment report HPs must describe the claimant’s function as

described on both good and bad days so that the CM can understand the claimant’s

circumstances and the consequences of their health condition or disability. HPs

should also record details of fluctuating conditions indicating how frequent the

fluctuations are, how long exacerbations last and on balance how many “good”

days or weeks and how many “bad” days or weeks the claimant experiences over


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time which will, in turn, highlight the claimant’s functional ability. In general, HPs

should record function over an average of a year for conditions that fluctuate over

months, per week for conditions that fluctuate by the day and by the day for

conditions that vary over a day.

Commentary - This again highlights the importance of keeping a diary; a

comprehensive diary will provide supporting evidence for the good/bad

day cycle experienced by many amputees. The Limbless Association

would also recommend that members make sure they bring this up at the

assessment so that the HPs are aware.

4.25 HPs should also ask about the typical day in relation to other activities such as

housework, shopping and carers responsibilities. This is because, whilst these

questions do not specifically determine a claimant’s entitlement to benefit, they do

provide supporting information regarding functional ability. Similarly, asking about

hobbies and pastimes provides useful additional information.

4.26 HPs should also explore all the PIP activities for the daily living and mobility

components, focusing on the activities most likely to be affected by the claimant’s

condition they should use open ended questions and should encourage the claimant

to expand their answer in order to explore how easy or difficult they find a task.

Commentary – It is important that individual’s are aware of this; they

should be given the opportunity to discuss how their disability affects

them.

Concluding the face-to-face consultation

4.27 Prior to the end of the consultation, HPs should give claimants an overview of their

findings. Claimants should then be given the opportunity to ask for clarification of

any points and ask any questions they may have regarding the assessment

process.

4.28 It should be noted that HPs cannot give claimants a copy of the report at the time

of the consultation; claimants must request a copy from the CM.

Commentary – As previously stated, CMs will write to claimants to inform

them of their entitlement to PIP and will phone them to explain their

decision if the claimant is not awarded PIP or if their benefit has been

reduced. The Limbless Association would suggest this would be an

opportunity to request a copy of the report.


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Advice produced for DWP

4.29 The assessment process, whether in the form of a paper-based review or a face-to-

face consultation, should provide the HP with sufficient factual information about

the claimant and the functional effects of their disability or impairment to be able to

provide a report advising DWP on the claimant’s circumstance, the impact of their

health condition or impairment on their everyday lives and how the assessment

criteria relate to the claimant.

4.30 Reports must be clear, fully reasoned and justified and the DWP CM should be

provided with all the evidence the HP has used to complete the assessment report.

All evidence must be interpreted and clearly evaluated using medical reasoning and

considering the circumstances of the case and the expected impact on the

claimant’s daily living and/or mobility. HPs should highlight key evidence in support

of their choice of descriptors and should document fact-based findings and/or well

supported opinion from all the evidence.

4.31 The HPs advice and justification should highlight key evidence in support of their

choice of descriptors; HPs should use evidence to choose the descriptor that best

reflects the claimant’s ability to carry out an activity, taking into account whether

they need to use aids or appliances and whether they need help from another

person or an assistance dog.

4.32 The HP should document fact based findings and/or well supported evidence from

all the evidence and in doing so must provide clear explanation as to why more

reliance has been placed on some evidence and not others.

4.33 The report should, where possible include specific examples to illustrate the

claimant’s difficultly with activities.

Commentary - For more information on the advice produced by the HP

please see Appendix Four.


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APPENDICES


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5. APPENDIX ONE – THE ASSESSMENT

5.1 This Appendix contains further information on the use of descriptors, aids and

appliances, support and assistance and time periods and fluctuations.

Choosing descriptors

5.2 It is important to note that, for a descriptor to apply the claimant must be able to

reliably complete the activity. If an individual cannot reliably complete an activity in

the way described, they should be considered unable to complete it. Therefore,

before selecting a descriptor, the HP must consider whether the claimant can

reliably complete the activity in the manner described in the descriptor.

5.3 Where the descriptor refers to the use of an aid or appliance, or support from

another person, reliability refers to the individual’s ability once the aid or support is

taken into account.

5.4 The fact that an individual can complete an activity is not sufficient evidence of

ability. Consideration must also be given to:

• Approach – what the individual needs to do; what assistance or aids are

required; how long it takes; and whether it is safe;

• Outcome – whether the activity can be successfully completed and the

standard that is achieved;

• Impact – what the effects of reaching the outcome has on the individual

and, where relevant, others. Whether the individual can repeat the activity

within a reasonable time period and to the same standard (this includes

consideration of symptoms such as pain, discomfort, breathlessness and

fatigue either during or after the activity); and

• Variability – how an individual’s approach and outcomes change over time

and the impact this has on them.

5.5 This has to be carried out for every activity within the assessment.

Commentary - It is important that individual’s are aware of this criterion

and should flag it up to the HP’s if they feel it is not being considered

during the assessment. With specific regard to the ‘Impact’ criteria, the

Limbless Association would recommend that members explain the impact

of wearing and walking on a prosthetic, for examples blisters and friction

sores which can then mean that they are unable to wear their prosthesis

again until these are healed and which highlights the good day/bad day

cycle experienced by many amputees.


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Reliably

5.6 In taking each activity into account the claimant should be able to complete it:

• Safely – being able to complete the activity in a fashion that is unlikely to

cause harm to themselves or to another person;

• To an acceptable standard – given the nature of the activity;

• Repeatedly – being able to repeat the activity as often as is reasonably

required; and

• In a timely manner – being able to complete the activity in a reasonable

time period.

Commentary - Notably, the guidance states that judgement and

experience will be required to determine whether something is

‘reasonable’ or ‘acceptable’.

Repeatedly

5.7 Where the act of completing the activity means the individual is unable to repeat

the activity again, within a period when they could reasonably be expected to do

so, they are likely to be considered as not completing the activity repeatedly.

Commentary - This is particularly important to remember and also

highlights the importance of keeping a diary which documents just how

often and how far an individual is able to walk without pain, discomfort

and fatigue.

5.8 An example of where an individual may be considered unable to repeatedly

complete a descriptor in the way described due to the impact that this would have

would be a person who is able to stand and move 20 m unaided, but is unable to

repeat it again that day.

Commentary - It is important to remember that an individual who uses or

could reasonably be expected to use an aid or appliance, i.e. a prosthetic

limb, should be considered unable to complete an activity ‘unaided’.

In a timely manner

5.9 When looking at whether the individual can complete the activity in a reasonable

time period, the HP should consider how long it is normally likely to take an

individual without a health condition or impairment to complete the activity.


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Time periods, fluctuations and descriptor choices

5.10 The HP must also take into account the fact that most health conditions or

impairments can fluctuate over time and should therefore consider ability over a

twelve month period and not on how the claimant was on the day of assessment.

Commentary - This is a key issue; feedback from the Work Capability

Assessments and Blue Badge assessments suggests that the very fact

that an individual is able to attend as assessment and walk from their car

to the assessment centre, means that they are assessed as not entitled.

5.11 This twelve month period should correlate with the Qualifying Period and

Prospective test; HPs must advise on and should consider the claimant’s ability to

complete an activity and therefore consider whether functional restrictions affecting

daily living and mobility activities are likely to have been present for 3 months (the

Qualifying Period) and will continue to be present for at least a further 9 months

(the Prospective Test)6.

5.12 For a scoring descriptor to apply, the claimant’s health condition or impairment

must affect their ability to complete the activity on more than 50% of days in a

twelve month period7.

5.13 The following rules apply:

• If 1 descriptor in an activity is likely to apply on more than 50% of the days

in the 12 month period then that descriptor should be chosen;

• If 2 or more descriptors in an activity is likely to apply on more than 50% of

the days in the 12 month period then the highest scoring descriptor should

be chosen; and

• Where 1 single descriptor in an activity is likely to not be satisfied on more

than 50% of days, but a number of different scoring descriptors in that

activity cumulatively are likely to be satisfied on more than 50% of days, the

descriptor likely to be satisfied for the highest proportion of the time should

be chosen. For example, if descriptor B is likely to be satisfied on 40% of

days and C on 30% of days then B should be chosen. Where 2 or more

descriptors are satisfied for the same proportion of days, the highest scoring

descriptor should be chosen.

Aids and appliances

5.14 The assessment must take into account the aids and appliances that individuals

normally use and which are low cost, commonly available and which someone with

6 For more information on these criterion please see the DWP website: www.dwp.gov.uk

7 For more information on this please see the DWP website: www.dwp.gov.uk


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their impairment might be reasonably expected to use, even if they are not

normally used.

Support

5.15 Support is defined as:

• Supervision: The need for the continuous presence of another person to

avoid a serious adverse event occurring to the claimant. The risk must be

likely to occur in the absence of such supervision;

• Prompting: Where another person has to remind or encourage a claimant to

undertake or complete a task or whether another person has to explain the

task to the claimant but does not physically help them. To apply, the

prompting needs to be required for part of the activity only; and

• Assistance: The need for another person to be present or to physically

intervene to help the claimant complete the activity, including doing some

but not all of the activity. To apply, the assistance only needs to be required

for part of the activity.


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6. APPENDIX TWO – FURTHER EVIDENCE

6.1 This Appendix provides information regarding the further evidence obtained by the

HP.

6.2 Examples of further evidence are dependent on the individual claimant but could

include:

• A factual report from a GP;

• A report from other HPs involved in the claimant’s care;

• A report from an NHS hospital;

• A report from a local authority funded clinic;

• Evidence from any other professionals involved in supporting the claimant,

such as social workers; and

• Contacting the claimant by telephone for further information


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7. APPENDIX THREE – HOME CONSULTATIONS

7.1 This Appendix provides further information on home consultations.

7.2 Some consultations will need to be carried out at the claimant’s home and should

be considered where a claimant indicates that they are unfit to travel to a

consultation in a location other than their home.

7.3 When considering whether an assessment should be carried out in the claimant’s

home, providers should take into account:

• Whether the claimant has a medical condition that precludes them from

travelling;

• Whether there has been medical verification of the severity of the condition

that precludes them from travelling;

• Whether there are any health and safety implications for a home

consultation, for example the claimant, or a person associated with them,

has had unacceptable client behaviour identified; and

• Whether there is any accessibility issues related to the planned location of

consultations.

7.4 Information that may help support a home consultation request may be:

• A diagnosis suggesting significant disability that may make travel extremely

difficult - for example incomplete quadriplegia; and

• Evidence that the claimant receives home visits or telephone consultations

with their GP.


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8. APPENDIX FOUR – ADVICE TO DWP

8.1 This Appendix provides further information on the advice provided to the DWP,

specifically prognosis and substantially the same condition.

Advice on prognosis

8.2 Entitlement to PIP is dependent on the functional effects of a health condition or

impairment having been determined as likely to have been present at the required

level for at least 3 months and being expected to last for at least a further 9

months (the Qualifying Period and Prospective Test respectively). CMs will be

required to decide whether these tests have been met based on advice from the HP

regarding prognosis (using their knowledge of health conditions and impairments).

If the CM determines that either test has not been met, the claim must be

disallowed.

8.3 HPs should also provide advice to the CM on when claims should be reviewed,

taking into account such issues as the likely progression of the condition and

whether it is likely to improve, stay the same or worsen. The CM will then use this

advice to inform their decision regarding the duration of the award and when to

review the claimant’s circumstances.

8.4 The advice should take into consideration that, even though for some conditions

there may be no expectation of improvement, it may be possible for the person to

adapt with sufficient time or with appropriate treatment and/or support, which in

turn reduces the effects on functions.

Commentary - This again highlights the importance of documenting the

long terms effects of wearing prosthetic limbs, including blisters and sores

and the additional strain placed on the individual and their remaining

limb, as well as issues to do with posture and balance and associated

conditions such as osteoarthritis. It is also important that amputees

reiterate the fact that a prosthetic limb will never and can never replace

an existing limb.

Advice on substantially the same condition

8.5 HPs may be asked to advice on whether a claim for PIP is being made for

‘substantially the same condition’ as an earlier claim.


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8.6 Re-claims for PIP by individuals who have developed a new condition or conditions

which are unconnected to the condition(s) that their original claim was based on,

will be treated as a new claim and the individual will therefore have to satisfy the 3

month Qualifying Period.

8.7 Some conditions, such as Multiple Sclerosis where individuals can have periods of

remission and deterioration, can subsequently deteriorate leading to a further

entitlement to PIP and as such, the legislation allows for a linked claim where the

individual is claiming for either:

• Substantially the same condition(s) for which the previous award was made;

or

• A new condition (or sequel) which developed as a result of a condition for

which a previous award was made.

8.8 If an individual re-claims PIP as a result of a deterioration in their condition, they

do not have to satisfy the 3 month Qualifying Period for any component(s) to which

they have previously been entitled to, providing they claim within two years, if they

are of working age (16-64) or within one year if they are aged 65 or over.

8.9 All claimants will need to satisfy the Prospective Test regardless of any previous

entitlement.

8.10 HPs may be asked by the CMs for advice if they have difficulty identifying a case

where a claim has been made for substantially the same condition(s).

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