Carrying out management checks to ensure staff are processing claims accurately

Well-targeted management checks can ensure that staff are accurately and correctly processing claims.

This section includes good practice on:

• Quality checks
• Checks on new claims
• Checks on not entitled decisions
• Checks on change of circumstances
• Checks on overpayments

Quality checks

Management checking should involve a mixture of pre-payment and post-payment checks.

Management checking is resource intensive and if the checks are poorly targeted the activity may not represent value for money. The management checking regime should therefore be risk-based so that checks are carried out on cases when errors are most likely to occur. For example:

• cases assessed by inexperienced employees
• more complex claims such as persons from abroad and self-employed cases
• tax credit cases
• customers who frequently move home
• high value payments

However, some random checks across all staff and types of claims should also be included to guard against internal fraud.

The results of management and accuracy checks and any other activity, such as targeted reviews, which reveal error, should feed into the staff appraisal process and training plans to support continuous improvement.

Good practice includes:

• using the results of management checks to review existing policies and procedures
• analysing the results of management checks to identify the causes of error and any common error patterns so that appropriate remedial action can be taken. Such analysis can identify not only specific procedural areas where errors are being made but also pinpoint individual and team areas for improvement/training issues
• analysing the results of all management and accuracy checks across a full range of activities including counter-fraud and using its findings to identify the overall level of error in the caseload, inform training plans and the appraisal process and deliver continuous improvement in its performance and service delivery
• reporting performance to Members and senior officers to sustain accountability for performance to predetermined delivery and targets
• increasing the number of checks if a high number of inaccuracies are found
• including a second level check on a proportion of team leader checks
• ensuring that management checks confirm the correct processing of:
  • new claims
  • not entitled decisions
  • changes of circumstance
  • overpayments

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Checks on new claims

Good practice includes making sure:

• the claim form is complete
• all original evidence has been verified
• it is a new claim and not a change of circumstance
• there is documented evidence to confirm:
  • compliance with section 1(1A) and 1(1B) of the Social Security Administration Act (SSAA)1992
  • the identity of customer, and partner, when applicable
  • the liability to pay rent and/or Council Tax
  • residency
  • receipt of Income Support/Income-based Job Seekers Allowance IS/JSA(IB) or Pension Credit in applicable cases
  • for non IS/JSA(IB) or Pension Credit claims, full verification of all income
  • for non IS/JSA(IB) or Pension Credit claims, full verification of all capital
  • for Savings Credit only Pension Credit cases, any income which results in a modification of the assessed income figure provided by the DWP
  • income of non-dependants, when applicable
• the correct date of claim been used
• a payment on account (POA) considered when appropriate
• a Rent Officer referral was applicable. If so, was it referred to the Valuation Office Agency (VOA) within 3 days of receipt of the completed claim form or 2 days for a pre-tenancy determination?
• a valid Rent Officer determination exists when appropriate
• when a decision to pay the landlord direct has been made, the fit and proper person test has been considered and documented
• all foreseeable changes of circumstances have been taken into account and diarised
• details of income, capital and rent have been correctly recorded to ensure the benefit calculation is correct
• all details have been recorded correctly on the benefit information technology (IT) system, including personal details for customer and partner and landlord
• the appropriate payment terms have been applied
• any request for backdating has been considered and processed in a timely manner with supporting evidence
• the management check has looked for unnecessary delays

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Checks on not entitled decisions

Good practice includes making sure the:

• customer been asked to provide appropriate information to support their claim
• timescales given are appropriate
• 'not entitled' decision is correct
• decision has been correctly recorded on the benefits IT system
• appropriate decision notice has been sent to the customer

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Checks on change of circumstances

Good practice includes making sure:

• all original evidence has been verified to confirm the change
• benefit was suspended when appropriate to avoid an overpayment
• there is documented evidence, if it is relevant to the change of circumstances, to confirm:
  • compliance with section 1(1A) and 1(1B) of the SSAA 1992 if appropriate
  • the identity of customer, and partner, when applicable
  • the liability to pay rent and/or Council Tax
  • residency
  • receipt of IS/JSA(IB) or Pension Credit in applicable cases
  • for non IS/JSA(IB) or Pension Credit claims, full verification of all income
  • for non IS/JSA(IB) or Pension Credit claims, full verification of all capital
  • for Savings Credit only Pension Credit cases, any income which results in a modification of the assessed income figure provided by DWP
  • income of non-dependants, when applicable
• the correct effective date of change has been applied
• any other foreseeable changes of circumstance have been taken into account and diarised
• a valid Rent Officer determination exist, if appropriate
• the change of circumstances has been correctly recorded on the benefit IT system, if appropriate
• an overpayment has been raised, when appropriate
• if an overpayment was raised, check if:
  • the classification is correct and has been documented
  • recoverability has been considered correctly and has been documented
  • the person from whom to recover has been considered correctly and has been documented
  • the appropriate method of recovery is being sought
  • the overpayment could have been avoided by the LA

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Checks on overpayments

Good practice includes making sure:

• all original evidence has been verified to confirm the change of circumstance
• there is documented evidence, if it is relevant to the overpayment calculation, to confirm
  • compliance with section 1(1A) and 1(1B) of the SSAA 1992
  • the identity of customer, and partner, when applicable
  • the liability to pay rent and/or Council Tax?
  • residency
  • receipt of IS/JSA(IB) or Pension Credit in applicable cases
  • for non IS/JSA(IB) or Pension Credit claims, full verification of all income
  • for non IS/JSA(IB) or Pension Credit claims, full verification of all capital
  • for Savings Credit only Pension Credit cases, any income which results in a modification of the assessed income figure provided by DWP
  • the income of non-dependants, when applicable
• the correct effective date of change has been applied
• the change of circumstance has been correctly recorded on the benefit IT system, when appropriate
• any underlying entitlement has been established before issuing the overpayment decision notice
• returned or uncashed cheques have been taken into account
• the classification is correct and has been documented
• recoverability has been considered correctly and has been documented
• the person from whom to recover the overpayment has been considered correctly and has been documented
• the appropriate method of recovery is being sought
• if the overpayment could have been avoided by the LA

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