Change of circs or new claim??

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  • #31652
    alijones5866
    Participant

    Scenario:
    Change of circs received early July stating claimant started work in May. Claim is suspended and requested details of new circumstances to reassess claim, allowing a month to reply.
    After the month, no response has been made and so the claim is cancelled back to May, leaving an overpayment from May to June.

    Two weeks later, the claimant responds and sends in the information to reassess their claim. Do we:
    a) reassess the period of the overpayment from May to June as underlying entitlement to offset against the overpayment, and then reopen the claim from the Monday following the receipt of the new information/form and assess it as a ‘new claim’, assuming they’ve not requested backdating
    b) Assuming they have requested backdating, do I reopen it as in a), but treat the period from the end of the overpayment to the start of the new claim as backdating, or do I reopen the claim as a ‘Change of Circs’ from May and treat as continuous claim?
    c) Reopen the claim as ‘entitlement’ back to May and treat as a change of circs and pay continuously irrespective of whether they’ve requested backdating or given good reasons why they didn’t respond earlier, just because they’ve responded within a calendar month of their claim being cancelled?

    We seem to have some conflicting interpretations of the regs in the office, so any help to resolve the confusion would be greatly appreciated. 😕

    #88517
    peterdelamothe
    Keymaster

    In my view, this all becomes a muddle because of a misunderstanding about what can or cannot be done under the legislation. “There is no provision for simply “cancelling”” is a quote from a decision I was reading yesterday – a common theme.

    I would suggest that you use your discretion to allow extra time under c). Plus perhaps ask if you and colleagues can go on the hbinfo “revisions” course in October – under the training tab.

    #88518
    alijones5866
    Participant

    Thanks for your response 🙂

    #88519
    chris harvey
    Participant

    I am assuming in May when you cancelled the claim back, you issued a decision notice giving reasons why the claim had been cancelled. They have a month to dispute that decision and as they responded within the time you have a duty to revise it if you can. They have supplied the info so you can and should revise it.
    It’s a revision not a new claim and I am going for ( c).

    #88520
    Anonymous
    Guest

    Agreed – your decision was based on the claimant’s income being too high to qualify for HB. You now have information showing that the decision “was made in ignorance of, or was based upon a mistake as to, some material fact” — this gives grounds to revise under D&A reg 4(1)(b).

    #88521
    alijones5866
    Participant

    Yes, when the claim was cancelled after giving them a month, they would have been notified and given a month to appeal.

    Am I right in thinking then, that after they’ve had the month to appeal, if they then provided the information, we would only offset the o/p period and then set up a new claim from the Monday following the receipt of the new claim, or should we still be making it continuous?

    #88522
    Anonymous
    Guest

    [quote:f046c21d8c]Revision of decisions
    4.—
    (1) Subject to the provisions in this regulation, a relevant decision (“the original decision”) may be revised or further revised by the relevant authority which made the decision where–
    (a) subject to regulation 10A(3), the person affected makes an application for a revision within– S.I. 2002/1379
    (i) one month of the date of notification of the original decision; or
    (ii) [b:f046c21d8c]such extended time as the relevant authority may allow under regulation 5;[/b:f046c21d8c]
    (b) within one month of the date of notification of the original decision that authority has information which is sufficient to show that the original decision was made in ignorance of, or was based upon a mistake as to, some material fact; or
    (c) [b:f046c21d8c]an appeal is made [/b:f046c21d8c]under paragraph 6 of Schedule 7 to the Act against the original decision within the time prescribed by Tribunal Procedure Rules but the appeal has not been determined.

    Late application for a revision
    5.—
    (1) The time limit for making an application for a revision specified in regulation 4 may be extended where the conditions specified in the following paragraphs of this regulation are satisfied.
    (2) An application for an extension of time (“the application”) shall be made in writing by the person affected by a relevant decision.
    (3) The application shall–
    (a) contain particulars of the grounds on which the extension of time is sought and shall contain sufficient details of the decision which it is sought to have revised to enable that decision to be identified;
    (b) subject to regulation 4(4), be made within 13 months of the date of notification of the decision which it is sought to have revised; and S.I. 2005/337
    (c) be delivered, by whatever means, to the relevant authority . S.I. 2002/1703
    (4) The application shall not be granted unless the person affected satisfies the relevant authority that–
    (a) it is reasonable to grant the application;
    (b) the application for revision has merit; and
    (c) special circumstances are relevant to the application and as a result of those special circumstances it was not practicable for the application to be made within the time limit specified in regulation 4.
    [/quote:f046c21d8c]

    #88523
    alijones5866
    Participant

    Great – thanks for your help, much appreciated 😀

    #88524
    Anonymous
    Guest

    Basically, if they include the magic word “appeal” with whatever information they provide, as long as its within 13 months, you may as well revise. 😉

    #88525
    alijones5866
    Participant

    Thanks, that’s worth remembering.

    I think what a lot of the assessors who’ve been here years are finding hard, is the idea of ending someone’s claim after giving them a month. Then at some point during the 13 months they can appeal and we just reopen the claim continuously and award them benefits again. Whereas previously we had offset the period of the overpayment, but then set up a ‘new claim’ from when they’d provided the information, leaving a gap inbetween. It just seems that there’s no incentive to respond by a given time and that they can just provide the information when they feel like it.

    #88526
    Anonymous
    Guest

    The incentive is that they get what they’re entitled to at the right time, instead of at a later date. 🙄

    I’m not quite sure about seting up a new claim from when they provide the information – what are you using as the claim? Is there a form completed when they provide the information or are you just treating the payslips as the claim?

    #88527
    alijones5866
    Participant

    When we cancel the claim, we send them out a form to complete if they wish to reapply now that claim has been ended.

    #88528
    peterdelamothe
    Keymaster

    The trouble is Alison, you cannot just “cancel” a claim because someone has started work. HB/CTB are in-work benefits and continue until the claimant is no longer entitled (for whatever reason). You can make an “adverse inference” and you can terminate the claim in some instances.
    Sending out huge claim forms following a “cancelling” of a claim harks back to the old days of benefit periods – abolished many years ago.

    In my experience the trouble with the decision-making process is that if it misunderstood or is incorrectly administered it ends up causing a lot of extra work and is very costly too. As you suggest “a lot of the assessors who’ve been here years” find the new process difficult. Trying to deny claimants benefit by various reasons (from “cancelling” to the defective claim saga to over zealous administration) is not really the idea and is widely blamed for the poor take-up of CTB for one.

    #88529
    alijones5866
    Participant

    Thanks for your response. 🙂

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