DLA - Facts and claims. The basis for a decision Facts of the case Law which applies Apply Facts to Law for answer John Prosser.

DLA - Facts and claims

The basis for a decision

• Facts of the case• Law which applies• Apply Facts to Law for answer

John Prosser

DLA claim

• Facts– The claimant’s condition and disability– The care needs– The mobility needs

• Law– Acts; regulations– Interpretation of the law

• Application– Do the care needs

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Process – decision making

• Practical context• The Law


Facts

• Facts which are accepted• Facts which are unsure• Facts which are rejected


“Facts”• What are the facts in the claim• What are the relevant facts.• Most claimants assume that the DM will infer from the fact• Don’t do that – spell it out.• What can we infer from that fact• What will the DM accept• What will the DM need more evidence on?• How will the DM get that information?• Can we paint “ a picture”• Can we send them a picture!• How will they react when they get the picture!!


What trying to show

• The claimant is disabled. • The claimant has a need for care (or a mobility

problem) due to the way the disability affects the claimant


What have to show

• The claimant is disabled• That disability affects the claimant in a certain

way (problem/issue/factor)(p.i.f.)• That affect (p.i.f.)is severe* enough for the

claimant to need supervison/attention/watching over etc.

• It’s a scale – no effect; mild – medium - high


Facts

• I am “blind”– Define blind– Accept that claimant’s condition meets that– Reject that claimant’s condition meets it.

• Assertion – “the claimant is for all practical purposes blind”


Assertions and suspicions

• DM to accept what the claimant asserts– Unless there is contradictory evidence.– Or the assertion in itself can lead to doubt


Possible decisions for the DLA DMHigh care)

Middle (care)

Low (care)

Zero (care)

High (mobility)

1 4 7 10

Low (mobility)

2 5 8 11

Zero (mobility)

3 6 9 12


Possible decisions for the DLA DM – the main ones

High (care)

Middle (care)

Low (care)

Zero (care)

High (mobility)

1 4 7 10

Low (mobility)

2 5 8 11

Zero (mobility)

3 6 9 12


Likely decision made before your claim is read

• No award• Low care award• Middle care award


DLA – when is it best to claim?

• We know that your claim is to be read in 6 mins

• How do we react to that?• Do we think that it should be longer?• Do we work with it? Any alternative?• If we work with it – how?


Factors – relevant/irrelevant

• Where are the DMs• How old are they?• Do they work alone?• Do they supervise a team?• Who do they answer to?• Are they interrupted by phone calls?• Do they have an email address?


Working for the Friday go home early

• Assume that your claim is to be read last thing on a Friday before they have to go home

• Assume its first thing on a Thursday after a heavy night out

• Assume they have just had an argument with their kids or their husband or their boss

• Assume that they have passed 3 claims before yours and the pressure is on to fail one.


Choice

• The DM chooses what to award• How much choice do they have?• Entitlement (claim) • Law + facts• Amount • 11 different rates if they accept the claim• 1 rate – zero if they don’t accept


What attitude is the DM likely to have?

• It’s my money you can’t have it• People who live there shouldn’t get it• It’s not my money – here have it• I’m going nowhere in this job• I want to be head of the organisation – this

job is my first point on the scale• Rules what rules


How can we help you to help the client

• The decision maker’s judgement is the hole in the doughnut

• She is surrounded by guidance and rules – in the middle is their discretion (or power)

• Don’t tell them about the rules• Get them to apply it in your client’s favour.


Research into DLA

• A desk study into DLA claims with a small client group for qualatitive research into DLA claims in the London area – summer 2009.


Research

• Desk research into 100 claimants.• Qualitative research– 20 claimants– 16 were awarded DLA– 4 were unsuccessful– On appeal 1 was successful.


DLA research

• 1 in 5 claimant’s are unsuccessful when they claim with a professional adviser like a social worker

• 20% of claimant’s are unsuccessful when they claim on their own

• The study showed that nearly 4 in 20 claimant’s state that they are unsuccessful when a professional helps them


DLA research findings

• 80% of all claimants aged under 16 were successful.

• Only 20% of claimant’s aged over 16 were unsuccessful.

• Of those who were under 16 and unsuccessful nearly 4 out of 5 were successful when they appealed.

• process


• 2 in 10 claimants felt that the Decision Makers did not know the rules

• Nearly 8 out of 10 claimants had confidence with the claim



DLA - Facts and claims. The basis for a decision Facts of the case Law which applies Apply Facts to Law for answer John Prosser.

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