We've just had 2 cases back from our last audit that the LSC are threatening to disallow and we've been given 14 days to sort them out.
One is a DLA application and another is a DLA renewal. They are saying that there is no particular issue of law on either of them and that it breaches clause 10.78 SCC 2010 spec.
On the DLA review case the client had mental health problems and physical problems so would have been unable to complete the form herself. We looked into whether her condition had deteriorated and whether she would be entitled to an increase in DLA.
On the application it is just a physical thing but she had not claimed DLA before. We thought that these cases where it was a brand new application and we had to advise them on whether they would be entitled and what rate etc would be ok.
Has anyone got any tips for providing the LSC with points of law for these types of cases? We genuinely think that these clients could not have completed the forms on their own.
Any help would be great. If you need anymore information on the types of cases I'll keep checking back so I can answer queries.
Sorry, Heather, I won't be of much help, but thinking about your post reminds me how much more work we have to do since the disappearance of Level One. And your post persuades me to think about what we do within our own contract. In other words, here we ago, through the Looking Glass and back again. This one feels like Alice confronting the Sheep with the Knitting. I will have to start from Square One. So .... your DLA application breaches 10.78 SCC when this clause states "10.78 Legal Help should not be used to assist the Client in completing forms unless an issue of law arises and it is important that the form is completed in the appropriate legal terms, for example certain sections of the application form for Disability Living Allowance." Is there a definition of "issue of law" somewhere? It's not just Heather who needs to know - we ALL need to know! Any help will be gratefully received.
Hi folks We are experiencing problems as well. We have just received our Provider Assurance report after lengthy FS process. 3 cases nil assessed - 1 ESA application (which we expected) and 2 DLA applications (which we didn't expect). The report stated (in both instances of DLA apps) that "This file consists solely of helping the client to complete the DLA application forms. There was no specific issue of Law that arose in respect of the application and this matter should not have been opened. 16.3 of civil spec applies. See also PoP CLA51".
Just a quick update- we have contacted Provider Assurance and will be appealing. They will look again and if we can't agree they will pass to independent cost assessor
You have to focus on legal advice not the form. It could also be on overall caseload mix. At our last Stewardship several months ago the officer from the LSC reported that some providers (andI'm not for a minute suggesting yours) were going on fishing expeditions with DLA applications. Our DLA only cases were allowed because we identified the legal points of each case and its advised around these merits but these type of dLA only cases were only small part of the whole caseload. In other cases DLA were treated the same but as part of a larger matter and only seperated out if they became an appeal.
Thanks for your responses. ikbikb- it would be helpful to know what sort of points were noted on your casesheets. Having looked at the 2 DLA files in more detail, both of them discuss and explain the merits of the applications. One of the cases also discusses a housing and council tax benefit application with backdate and good cause. The client was turned down for DLA and the possibility of an appeal was discussed, which the cllient chose not to pursue.
I'll quote from the report 'use of matters to assist with DLa is well controlled. On all other files that involved assistance with this benefit the advice was clearly taoilored to the clients circumstances and the client provided with a guide as to their strength of argument and value of possible benefits to be received.'
I think the key is the first sentance. Since the PoP and even before if we had an appeal or other matter and DLA was also applied for then it was kept as one matter. I think only about 15% of the files were stand alone DLA's the rest are appeals and at least two of these Child Applications which are a specific area within DLA. We also if possible, though not always, also seek out further evidece to support applications. In the case of Supersession of existing DLA claims we will advice client of the risk to the existing award based on their inform,ation given in interview. We also then advice on the same information if they are making a claim for a higher award of DLA. We then always will seek evidenmce before such aplications are made and advice the client accordingly. This is repeated in new application but we do not seek medical reports via disbursements for new applications but try to get other existing evidence.
In the case of the DLA application and discussion of appeal and HB aplication with backdating with good cause. I would be arguing very strongly that this should be allowed. In the case record I would have tried to gather evidence medical or otherwise for the backdate good cause. I would have recorded and clearly given written advice to the client as to the merits of each case and espially the discussed appeal. Much of this can be done through proforma BUT with key areas tailoured to that cluient. I have no doubt this was done in your case. I also double check start and end points to ensure they are correct. So if a DLA application is initially reported WREA but by the close its an appeal then this is correctkly changed to WAPL.
That's really useful information- thanks very much. I have not had a chance to look at how many stand alone DLA apps we have done. I think it was unfortunate that the 2 files looked at were both DLA apps which did not result in appeals. In both cases, the strenght of the arguement was stated and the level (value) of possible benefit was provided. Interesting point about changing the opening code - this could be a reason for the LSC's stance (if our figures are showing codes that have not been ammended if applications go to appeal).
