NI PIP Handbook - Special Rules for terminal illness

Claims made under Special Rules follow a different process than the standard PIP claims.

People who meet the criteria for claiming under the Special Rules:

• will not have to complete the form 'How your disability affects you’;
• will not need an assessment
• will be entitled to an award of the enhanced rate of the Daily Living component of PIP without having to satisfy the normal qualifying period; and
• may also be entitled to the Mobility component of PIP depending on their mobility needs.

Claimants awarded PIP under Special Rules will receive payment on a weekly basis, one week in advance.

How to claim

To claim under Special Rules, a range of options is available to contact the PIP Centre.

The phone call can be made by someone supporting the claimant (such as a support organisation or family member) without the claimant needing to be present.

However, the claimant should be aware of the claim because we may need to contact them to verify their details, and we will send notifications and any payment to them.

The claimant does not need to know that the claim has been made under the Special Rules for end of life, and this will not be mentioned by us in any contact with the claimant.

Preparing for the phone call

It is important that the claimant or the person making the phone call has as much information ready before calling us.

In addition to an identity check, the caller will be asked for the following information:

• contact details and date of birth
• National Insurance number
• bank or building society details
• name and contact for their General Practitioner or other health professionals
• details of any time spent abroad or in a care home or hospital.

The claim can be taken even if the caller does not have all of the information but certain details are needed to register the claim. If the caller does not know the answer to some of the questions the claim may be delayed because PIP will need to get the detail before the claim can be put into payment.

As previously stated, the claimant will not be sent the form ‘How your disability affects you’ if they meet the criteria for an award under the Special Rules; instead they, or the person claiming on their behalf, will be asked some extra questions whilst they are on the phone about their condition and how it affects their ability to get around. These questions are:

• do you need someone else to plan any journey for you that you wish to take?
• do you have difficulties following the route of a familiar journey? For example do you need:
  • another person with you
  • an assistance dog, or
  • aids, such as a white stick?
• do you have difficulty walking short distances of up to 50 metres?
• do you have difficulty walking short distances of up to 20 metres?

The phone call – what to expect

At the beginning of the phone call the claimant will be asked a series of questions to verify their identity.

If a third party makes a claim on someone else’s behalf they will also be asked for their name and address.

The caller will be given an explanation of what the Special Rules for end of life mean and will be asked to confirm that they wish to claim under the Special Rules.

SR1 report

Claimants are encouraged to get a SR1 medical report to support the claim. The SR1 is a report about their medical condition, not their prognosis, and the claimant can obtain one from their General Practitioner, consultant, or certain other health professionals, including Macmillan nurses. The claimant will not have to pay for a SR1.

The SR1 report can be sent to us either by the healthcare professional or by the person requesting it but it is important that it is sent in quickly to support the PIP claim. The claimant (or the person making the claim on their behalf) will be given the following options for sending in the SR1:

Post it to the following address:

It’s important to use the full address to avoid unnecessary delay in processing the claim.

We cannot treat a SR1 as a claim to PIP. It is important that a claim to PIP is made in addition to providing the SR1.

Assessment process

The claim information and the SR1 will be sent to the Assessment Provider

• Capita Health and Wellbeing – who provide an assessment service for us.

A health professional working for them will be able to complete the assessment using the information provided during the claims process, the SR1 and any further evidence gathered.

Claimants who are deemed to qualify under the Special Rules will not need an assessment.