Ombudsman finds ‘systemic maladministration’ following PIP investigation

The recommendations came following publication of an investigation report which found that repeated opportunities were missed to make the right payment as early as possible in the process. It found that a failure by both the Department for Communities and Capita to seek and use further evidence, including that from medical professionals, meant claimants had to continually challenge the decision, often all the way to Appeal, before the correct decision was made.

The repeated nature of the failures led the Ombudsman to conclude that it constituted ‘systemic maladministration’.

Ms Kelly said:

Too many people have had their claims for PIP unfairly rejected, and then found themselves having to challenge that decision, often ‘in the dark’, and on multiple occasions, while not knowing what evidence has been requested and relied upon to assess their entitlement.

Both Capita and the Department need to shift their focus to ensure that they get more of the PIP benefit decisions right the first time, so that the most vulnerable people in our society get access to the support that they need, when they need it. Furthermore, it will safeguard public resources by reducing both the time and costs associated with examining the same claim on multiple occasions.

Ms Kelly went on to say;

My investigation highlights that the system for dealing with further evidence, a critical part of how decisions on PIP are made, is characterised by confusion. Claimants face huge uncertainty throughout the process over who is responsible for providing further evidence, what evidence has been obtained and whether or not it has actually been considered as part of the decision to award benefit. In my investigation in only 35 of the 100 claims reviewed had further evidence actually been requested. The Department’s own figures, gathered over a 9 month period, put this even lower at 25% of all cases.

Overall the investigation found:
Of the 96 cases considered that were designated for a face to face assessment, in only 1 was further evidence requested after the initial review.

The most common reason for not requesting further evidence was that ‘it was unlikely evidence would be obtained within the timescale required’ – despite the fact that there were 6 weeks available within which to gain such evidence.

Face to face assessments of claimants was often the primary and in some cases the only source of evidence relied upon by Disability Assessors.

Capita used information on the number of assessment reports completed and submission times to decide on bonuses for Disability Assessors; these had the potential to inhibit the appropriate use of further evidence in making assessments.

In the high number of cases where claimants had their PIP decision overturned at the last stage of the Department’s internal process, the investigation found numerous examples of where the evidence relied upon at appeal was either already available to the Disability Assessor or the contact details of those who could provide it were already available.

Overall despite Capita and the Department’s contention that further evidence has a key role in the PIP process, it was often only at the last stage and following the submission of an appeal to the Tribunal that the role of further evidence was elevated.

Too many vulnerable claimants may not have been identified for additional support at the very start of the PIP process because of the Department’s narrow interpretation of its own guidance.

Many PIP claimants received correspondence from Capita that said all health professionals they had listed had been contacted, when in-fact this was not the case.

Opportunities for the Department and Capita to systematically improve the quality of assessments and decision making were lost due to an incomplete analysis of the reasons for the overturn of benefit decisions.

Ms Kelly concluded:

I accept that the delivery of PIP is a huge task and that there has been significant work by the Department and Capita on implementing PIP in a timely manner but it is my view there is more work to be done to improve both the experience and outcomes for claimants and public confidence in the system.

I welcome that the Department will be taking forward the many recommendations I have made, which I hope will fundamentally improve the PIP decision-making process and have a positive impact for those most vulnerable claimants for whom the support of PIP is critical in their day to day lives. My team will be continuing to work with the Department to monitor and evaluate the implementation of our recommendations and I will report on them at a later date.

For the full report and a summary of the findings, click here.