Personal Independence Payment, Disability Living Allowance and Attendance Allowance

From 8 April 2013, Personal Independence Payment (PIP) will replace Disability Living Allowance (DLA) for people aged 16-64, even if they have an indefinite or lifetime award of DLA. Only DLA claimants who are over the age of 16 and under the age of 65 on the 8 April 2013, or who reach the age of 16 after October 2013 will be asked to claim the new benefit.

If a claimant is aged 65 or over on 8 April 2013 they will not be able to claim PIP and will continue to receive DLA providing they meet the entitlement conditions. At the moment there are no plans to replace DLA for those under the age of 16.

Claimants who receive Attendance Allowance (AA) will not be affected by the introduction of PIP.

Personal Independence Payment, Disability Living Allowance (DLA) and Attendance Allowance (AA) are for people who have a disability and as a result need help with personal care (care component) or getting around (mobility component) or both.

Entitlement conditions

PIP, DLA and AA provide a non-contributory, non-means tested, tax-free contribution towards the extra costs of severely disabled people. Payment is not affected by income or whether a person is in employment.

To qualify for PIP, the person will have needed help with extra costs caused by a health condition or disability for three months or more (qualifying period) and be reasonably likely to need help for the next nine months (prospective test).

To qualify for DLA, the person must have needed help for three months (qualifying period) and will be expected to continue to need help for at least a further six months (prospective test).

To qualify for AA, the person must have needed help for six months (qualifying period).

Non-medical decision makers make decisions about entitlement taking all the evidence into account. This may include:

• information in the claim pack
• the statement at the end of the claim pack
• reports from healthcare professionals responsible for the clinical care of the person
• in some cases, a medical examination report from a healthcare professional working for Atos Healthcare.

Disability Living Allowance

DLA is for people who claim before age 65 and has both care and mobility components.

Care component

The care component is payable at one of three rates (highest, middle or lowest) for those who need help with personal care.

Lowest rate

For people who need attention with bodily functions, for example eating, washing, dressing and using the toilet for a significant portion of the day
Or unable to prepare a cooked main meal if over age 16.

Middle rate

For people who need:

• frequent attention with bodily functions throughout the day, or
• continual supervision throughout the day to avoid substantial danger to themselves or others, or
• prolonged and repeated attention at night in connection with bodily functions, or
• someone to be awake during the night for a prolonged period or at frequent intervals to avoid substantial danger to themselves or others.

Highest rate

For people who satisfy the middle rate criteria for both day and night.

Mobility component

The mobility component is paid at two rates – lower and higher.

Lower rate

For people who are able to walk but need someone with them to provide guidance and supervision for most of the time when they are outdoors on unfamiliar routes.

Higher rate

For people who are unable to or virtually unable to walk.

Attendance Allowance

Attendance Allowance is for people who claim after reaching 65 and only has a care component. It is paid at two rates:

Lower rate – equivalent to middle rate DLA
Higher rate – equivalent to higher rate DLA

Personal Independence Payment

PIP is for all new claimants aged 16 to 64 and existing DLA claimants who are aged 16 to 64 on 8 April 2013 or reach age 16 after that date.

PIP is being introduced in stages over a number of years so most people who receive DLA now will not be affected in the near future. But it is important to know how and when an existing DLA or potential new PIP claimants might be affected – you can find this out on the PIP introduction timetable.  Patients can check how PIP affects them at gov.uk/browse/benefits

PIP components and rates

PIP is made up of two parts (components), a Daily Living component and a Mobility component. Awards will be made up of one or both of these components.

Each can be paid at standard rate, or enhanced rate depending on the claimant’s needs. There are 12 activities that form the assessment criteria for PIP and these will consider the individuals’ ability to carry out a range of everyday activities.

Within each activity there are a number of descriptors, each representing a varying level of ability to carry out the activity.  The total score received for each activity under the Daily Living and Mobility components of PIP will determine the level of award a claimant might be entitled to.

Special rules

There are special rules which apply to PIP, DLA and AA for people who are not expected to live longer than six months due to a terminal illness. If a person qualifies for benefit under the special rules provision, they will qualify for personal care automatically even if no help is needed. They do not need to satisfy the three month qualifying period or prospective tests which are usually applied.

Children

Children under 16 may get DLA. The care component is usually payable from 3 months of age, but the mobility component can only be paid from the age of three years. In order to qualify for benefit the child’s needs must be substantially more than a non-disabled child of the same age.

The role of healthcare professionals

For DLA and AA

Healthcare professionals responsible for the clinical care of the person may be asked to complete the statement at the end of the claim form by their patient. If the decision maker is not able to make a decision about entitlement to benefit without further evidence, they may ask the healthcare professional to complete a medical report based on the medical records and their knowledge of the patient. If the person is claiming under the special rules, they or their representative may ask the healthcare professional to complete form DS1500.

For PIP

Claimants are only required to send in evidence they already hold, i.e. copies of clinic letters – they are not told to contact their GP or health professional to obtain further evidence.  There is also no requirement for a statement from a GP or other health professional on the PIP claim form.

It may be necessary to complete a factual report which will be used by the Assessment Provider to inform the PIP Assessment – they will contact you when that is necessary. It’s very important to the patient that you reply within the requested time.

Useful links

• Disability Living Allowance – information for patients (GOV.UK)
• Attendance Allowance – information for patients (GOV.UK)

• DLA/AA factual reports – one page desk aid –  (60KB)
• DLA/AA factual reports – 6 page version (48KB)
• A to Z of medical conditions – evidence-based guidance for DLA/AA decision makers
  Background information on the more common medical conditions in DLA/AA claims, their treatment, the likely disabling effects together with the likely impact on ability to self care and get around.