Terms & Conditions

[Anonymous]

I need some clarification on claims that are either defective or fail because of adverse inferences.
Example – clt makes a claim on May 1st which fails. If on a subsequent claim customer asks for current claim to be “backdated” to the previous one is it really backdating or is it a request for a revision of decision not to pay? You can only backdate where clt shows good cause for having failed to claim before but in this scenario he [i:4d89e4d6cd]has [/i:4d89e4d6cd]claimed before. If new claim is received after 1st June would you say he is “out of time” for a review, or can backdating be considered for any period in between – and if so what?

[Kevin D]

Hi Chris,

There is a CD (sorry, no ref for now) that somewhat sharply pointed out that “further info” in a claim form should have been treated as an appeal (or a request for a revision etc).

However, it will depend on the facts of each case and, in particular, the wording of the request. If there is any mention of the previous decision, I’d probably err on the side of caution and ask the clmt to provide reasons why he didn’t challenge the decision earlier. Then, go through the OOT routine and deal with the backdate as an alternative. Either way, you’ll get no thanks from TTS…. 😯

For what it’s worth, I agree with your analysis about the clmt having made an earlier claim. But, be aware that it is conceivable for it to be argued that the wording applies specifically to [b:10c6b19bbf]that[/b:10c6b19bbf] claim (i.e. the claim for backdating), even though the reg specifically refers to [b:10c6b19bbf]a[/b:10c6b19bbf] claim.

Regards

[Anonymous]

O.K., further scenario – if a clt doesn’t claim backdating until 2 months after a successful claim has been made you could argue that he doesn’t have good cause up to that point because his claim has been in payment for two months already. As good cause has to be continuous does that mean that backdating claims made after the event can never succeeed?
Anybody?

[Anonymous]

What if the situation was he has only just found out he could get backdating due to earlier getting bad advice, and, for one reason or another, had only just been able to access that good advice?
In my opinion – Good cause displayed throughout – backdating granted.

Don’t think you can be as proscriptive as that by a long way Chris. 8)

[emmadring]

A strict reading of the reg itself suggests that the claim for backdating cannot be succesful where it comes later in time than the intitial prospective claim for benefit, because continuous good cause for the failure to make a claim has not been shown from a day in the past period up to the date of the claim for backdating. The good cause is not continuous because the making of a claim for benefit inetervenes. But I take your point Jon, there could well be good cause for not requesting backdating even though a claim for benefit was made within the period for which backdating is requested.

If I understand Kevin’s post correctly, he is saying that it could be argued that the claimant need only show good cause for his failure to make a claim for backdating rather than a claim per se. So in the second scenario Chris has given, the request could be treated as a backdate because there was a continous failure to claim backdating, even though a claim for benefit was made within the period requested. The first sentence of the commentary in the CPAG guide does seem to support that interpretation, so I’ll go with it! The reg seems to use the word ‘claim’ to mean a claim for benefit and a claim for backdating within the same paragraph – confusing.

[Author]

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