Terms & Conditions

[JamesPickering]

I thought I understood this until I started thinking about it and now have myself confused.

Scenario 1
Customer completes a claim form, does not supply all info. required. We request it, month passes and it’s not provided so claim refused under HB Reg 86.

Confusion 1
Does claimant have to submit a new claim form with evidence and request a backdate; or
Can claimant request a revision of decision to refuse claim i.e. I couldn’t provide evidence because I was in hospital…

Scenario 2
Customer claiming HB, we do a postal intervention on claim and as a result write for more information of wages or Capital etc. Does not supply info so claim suspended and then terminated under D&A Reg 14.

Confusion 2
Does claimant have to submit a new claim form with evidence and request a backdate; or
Can claimant request a revision of decision to terminate claim i.e. I couldn’t provide evidence because I was in hospital…

Some clarification would really be appreciated.

[Kevin D]

[b:fe83cf2e93][u:fe83cf2e93]Scenario 1[/u:fe83cf2e93][/b:fe83cf2e93]

Either option is, legally, correct. If the clmt asks for a revision (or appeals), it has to be dealt with in any case.

[b:fe83cf2e93][u:fe83cf2e93]Scenario 2[/u:fe83cf2e93][/b:fe83cf2e93]

On the basis that “interventions” are lawful, either option is again legally correct. And if a revision or appeal is requested, it has to be dealt with.

Obviously, if “interventions” are not lawful, there was no basis in the first place to suspend benefit. In turn, benefit could not have been terminated.

As to whether “interventions” are lawful, that’s been done to death in other threads :).

Regards

[JamesPickering]

That’s great, thanks although looking back picking Interventions in my example may have been a bad choice…

If in scenario 1 or 2 the claimant submits a new claim and requests backdating, and we decide that she had good cause for not supplying original info requested, can we choose to treat new claim as a reason for revising decision not to award/terminate and not actually as a new claim with a backdated period?

[Anonymous]

Unusually, I have to say I am not sure Kevin is entirely right here.

Scenario 1, Confusion 1 – if a claim was made, refused, and a later claim is made asking for the new claim to be backdated to the date of the original claim, how can that be reconciled with Reg 83(12) of the HBR 2006? I don’t see how you can backdate a claim to a time when a claim was actually made.

Scenario 2 – has the debate about whether or not a terminating decision carries the right of appeal been resolved?

[Kevin D]

James:

In short, yes.

Reasoning: A new claim form and/or the evidence in support of a claim may contain information such that it should be treated as a request for a revision – even an appeal, depending on the merits of the case. Such an approach is consistent with [b:463bfc0351]CH/3009/2002 (see para 21 onwards)[/b:463bfc0351].

Looking at Andy’s points, he raises an interesting issue re [b:463bfc0351]HBR 83(12)[/b:463bfc0351]. It depends on your interpretation of the wording “failure to make a claim” for a past period. I had overlooked that in my reply, but there has been plenty of argument on this forum about what it means. Does “[u:463bfc0351][b:463bfc0351]a[/b:463bfc0351][/u:463bfc0351] claim” mean ANY claim; or does it mean THAT (i.e. the backdating) claim? If it is ANY claim, the earlier defective claim may well bar backdating.

Regarding rights of appeal etc against termination under DAR 14, the DARs indicate there is a right of appeal, BUT, the CSPSSA suggests otherwise. As an Act trumps a regulation, that is what counts. So, er, that’s it then? Well, no. There is an increasingly wide view that any challenge under the HRA (Article 6) would be completely successful. Indeed, informally, Cmmr Jacobs has indicated that he cannot see how such a challenge would fail. But, until it is considered as a relevant issue in a case actually before a Cmmr, the arguments shall continue.

As an aside, in my experience, more LAs than not are accepting appeals against terminations (accepting that the HRA argument is correct).

Regards

[Author]

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