Terms & Conditions

[Anonymous]

Please could someone advise how the following would be treated:-

Claimant failed to reply to information requested following receipt of her review form.

Claim was then suspended and claimant advised that if information requested not supplied within 1 month entitlement to benefit would be ended.

Claimant failed to reply and therefore benefit entitlement ended and overpayment raised.

Claimant then sent in a new form 3 weeks later with all the information we required.

Do we consider underlying entitlement for the period of the overpayment and then commence new claim from monday following receipt if we refuse the claimants backdate request ?

Or do we not consider underlying entitlement and just commence new claim from monday after receipt ?

Or do we do something else ?

Thank you for any replies.

[Anonymous]

How can there be an overpayment if you suspended? The sequence of events in a suspension/termination case should mean that you simply don’t release the suspended payments. If you carried on paying, you didn’t suspend.

So your choices should be:

– don’t accept that the delay in providing the information was justified – new claim paid from Monday after receipt and the suspended payments remain, well, terminated and not issued

– do accept that the delay was justified and reinstate the suspended payments

But I cannot see where an overpayment comes into it?

[Anonymous]

Thanks for the reply – The overpayment arose because even though we received the review form the claim was not suspended at the time we requested further information.

When the information was not received after a month the claim was then suspended and after a further month the entitlement ended from the monday following receipt of the form.

The overpayment covered the period from receipt of form until claim was suspended.

[Anonymous]

Hmmmm … I don’t think you can do that. Termination only takes effect from the date of suspension, unless you feel that there are substantive grounds to make a superseding decision of nil entitlement from an earlier date. But that doesn’t seem to be the case here: it’s not as if you believed the claimant had had a change of circs that took her out of entitlement from the earlier date – all you were doing was applying a sanction for failure to respond to your enquiries. I would revise the overpayment decision to say there is no overpayment.

The termination and late evidence is a separate issue – depends whether you feel it would be reasonable to extend the time limit retrospectively, in which case the claim would be reinstated, but if not the new claim runs from the Monday after you got it.

[Anonymous]

Thank you very helpful.

[Author]

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