Terms & Conditions

[Karen]

looking to see what other authorities do with regards to the VF of adjudication claims.

when an adjudication is passed for processing do you ensure that all wages/income details are backed up with proof and especially do you ensure that relevant bank statements are included in the adjudications to cover the period of suspected fraud.

we have an ongoing battle between our fraud staff and the adjudications staff. The fraud staff don’t see the need to provide bank statements (if the clmt can’t obtain them) especially if the evidence they have supplied results in a ‘nil’ award, but the adjudications staff want to see the bank statements to show the wages/income being paid in, regardless of the outcome of the revision.

we are trying to come to some sort of procedure between the sections so any advice or guidance would be appreciated.

thanks

[markp]

I suppose it depends on the standard of the evidence itself. For example, do wageslips/ Social Security letters show payment vis BACS (as most generally do)? If so then you would alsmot certainly be entitled to ask for bank statements as this will also show the capital. It would also show whether there is more than one bank account (been stung by that before!) and so I would accept the adjudication staff recommendations over the fraud section since it is adjudications who will ultimately make any decision on the claim.

As an aside, can’t your fraud team get the bank statements under referral to NAFN and wouldn’t they have considered this with their investigation?

Do I know what I'm doing? The jury's out on that........................

[Chris Cook]

As Fraud investigators we try and obtain as much evidence as we can, however if in our judgement there is evidence that would result in potential changes, this is supplied to the Benefits Administration Team to consider/action.(By this time there would normally have been discussions/decision to suspend Claim).

The Benefits Administration Team are the decision makers, (fraud investigators are not) & if they feel the evidence is insufficient I would expect them to act appropriately. This would include writing/making contact with the claimant requesting them to provide reasonable information necessary to make an appropriate decision, giving the claimant all their rights/time limits etc as required by regulations.

This seems to work well in our LA.

The use of NAFN etc for pursuing information in respect of an investigation/evidence may take a considerable amount of time and there is no guarantee that we would get that information from that source. We mostly do but not always!

Chris Cook

[Karen]

thanks for responses

So, there is no conflict / or problem with the processing team requesting the appropriate information, especially if they then process the claim. this wouldn’t harm any future prosecution? 🙄

So what happens to the overpayment for fraud purposes? If you suspend a claim and request further info with regards to income/bank accounts etc, and they don’t respond, you can only terminate from the suspend date, you can’t create an overpayment because you can’t assume income for that period, therefore, the adjudication won’t create an overpayment.

We had a case like this go to appeal and the chair stated that if you suspend and request further info you cannot create an overpayment on failure to supply info on income details. Surely if this happens we can request that fraud staff visit the clmt to obtain the evidence,?

am I correct in this reasoning or I’m i just rambling ❓

[Anonymous]

You can request fraud staff do do anything, but the claimant is entitled to refuse them access to his home and to refuse to provide anything. The burden of proof is squarely on the Council

[david kearney]

If you have been provided with acceptable evidence of wages etc for a past period that you have already paid benefit for, revise entitlement on that basis. Why would you want further bank statements?, particularly if the result is nil-entitlement.

I’m with your fraud staff on this one.

[Anonymous]

I think all too often assessment staff see VF requirements as etched in stone (despite the fact that there is no longer such a thing as the VF, and it never had any status in law in the first place). A similar case arose yesterday, when I had quite a time trying to convince an assessor that it was OK to enter an occupational pension onto a claim that was already a nil qualifier, despite the fact that the occ pen had not been “VF’d”.

[Karen]

thanks

David – the point you raised [quote:1002c1d3ef]provided with acceptable evidence [/quote:1002c1d3ef] is the stumbling point here for our authority – the proof tends to be lacking eg the fraud staff give you the net figure for wages, but don’t supply details of the gross and all deductions, or supply a wage slip showing the actual tax, NI etc being calculated – surely we must enter correct details at that point – what if a deduction was for a savings account or some other item that needs to added to the net figure.

the BFI state that all cases must be accompanied with the correct level of evidence to back up any decision – and as we are under an investigation at this time with regards to the quality of all information – whether or not VF is not law – it is strictly adhered to by the BFI and at least a certain standard must be met.

and with regard to the ‘nil entitlement’ issue – what you may assume will result in a nil entitlement may not be the case, and some benefit may be payable, therefore a bank statement will be required, so to speed things up why not ask for it at the start ?

[david kearney]

Karen

Your assessment staff are presented with evidence by the investigation officers who want them to make a decision altering benefit.

VF in itself. doesn’t really come into it, but you can only supercede if you have sufficient evidence to do so Your assessment staff need to see all the evidence that has been obtained, not a fraud officer’s precis of the evidence.

They can then make a decision as to whether sufficient evidence is available to supercede the original decision. Would the evidence stand up at tribunal? If the only evidence of earnings that is available is a bank statement, then i dont see why you shouldnt make a decision on that basis (even if there may well be deductions you dont know about) That said it shouldnt be too difficult to obtain details directly from the employer

[chris harvey]

Just a quick thought on Karen’s second post, I think the appeal chair was right in that after suspension you would normally cancel from the date of suspension (or paid to point) and not create an overpayment. The only time you would cancel from a prior date and create an overpayment is if you had the evidence to support/justify that decision. If the claimant appeals the tribunal is likely to be unhappy that you have created an overpayment without the evidence to justify it.
I can think of all kinds of awkward decisions that are avoided if you cancel after suspension without creating an overpayment. For example if non dep income is not provided do you cancel after suspend or use adverse inference to apply the highest non dep charge. Or if someone tells you their private pension has been increased slightly but does not give the exact amount, do you cancel after suspend or use adverse inference (but what figure would you use?)
The regs provide us with a route to suspend and then cancel but is this the only route when dealing with minor changes that are not quantified by the claimant?

[Chris Cook]

Karen

As a fraud team we would try and obtain complete wage details, however you cannot always get them during the initial part of an investigation.
Full details could come from an employer (Admin/Fraud either could ask).
There are Powers open to Fraud investigators but we would only use them if employer was difficult/not provide info.

The same applies for bank statements (Admin/Fraud could ask).As pointed out Fraud could use NAFN or our own Authorised Officers to obtain the information.

While fraud can do this, there is no problem with the Admin Team requesting the information from an appropriate source.
If that source is the claimant the Admin Team can do the appropriate request with the necessary time restrictions etc.
Provided Admin Team do not discuss the details of the investigation with the claimant there is no problem.

Benefits Admin staff are the decision makers and they should make a decision on what is reasonable (balance of probabilities, rather than beyond all reasonable doubt is the guidance issued I believe).

If Benefits Admin staff make a decision that fraud have not provided enough evidence to make a decision fraud has 3 options to consider.

1 Ask decision maker to look again/ask for 2nd opinion to clarify what might be needed to make a decision.
2 Accept decision and close investigation as fraud are unable to obtain further evidence.
3 Try and obtain information to allow the decision maker to make a decision.

It does seem that you need to sit down and discuss what as a basic standard of evidence the Benefits Admin Team believe is reasonable and liase with the Fraud Team to explain this.

[Author]

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