PIP: Six in 10 disability claimants win case on appeal

Six in every 10 people who appealed to have disability claim decisions overturned in Northern Ireland since 2019 succeeded, figures show.

Claimants won 60% of the 10,000 appeals between April 2019 and June 2021.

The Department for Communities, which oversees Personal Independence Payment (PIP) claims, said only 10% of all PIP benefit decisions resulted in appeals.

Citing a 2017-18 report, it added "PIP case managers were correct in 96.2% of cases".

The figures on the number of successful appeals by disability claimants were obtained by the BBC's Shared Data Unit.

It found out that in the UK as a whole, seven out of 10 people who appealed against a decision to deny them disability benefits were successful.

In Northern Ireland, appellants' success rate was slighter lower, with six in every 10 people overturning an initial decision to refuse their claim.

In total, there were 9,999 disability claims appeals lodged in Northern Ireland between April 2019 and June 2021, and of these 5,969 cases - or 60% - were won by the appellant.

In 3,591 of the appeal cases (36%) it was ruled that the original decision to refuse the disability benefits was the correct one.

In 58 cases, the appeal process resulted in the claimants' benefits being revised down.

When asked about appellants' high success rate, a spokesperson for the Department for Communities (DfC) explained this was often due to the submission of new information about claimants' health, and also suggested it sometimes simply came down to a difference of opinion.

"Decisions overturned at appeal are primarily because either additional evidence was presented at the tribunal which was not available to the officer who made the decision, or the tribunal took a different view of the evidence available to the department when the decision was made, with neither conclusion being unreasonable," they said.

The DfC spokesperson referred to the most recent report by the President of Appeal Tribunals John Duffy, who carried out a review of the standards of DfC's decision making on benefit claims in 2017-18.

DfC said the report showed that "of the PIP appeal cases monitored by the President of Appeal Tribunals, they found that decisions made by PIP case managers were correct in 96.2% of cases".

However, Mr Duffy's report also highlighted a number of problems with PIP assessments, some of which had been pointed out to the department previously.

He said the number of decisions overturned as a result of further medical evidence "suggests that the department really must consider what further steps can be taken prior to hearing in order to source additional medical information from or on behalf of appellants".

Mr Duffy also questioned whether some PIP assessors "have sufficient training to assess the medical conditions of some individual claimants".

He recommended that the DfC "should seriously consider obtaining a detailed report from a general practitioner in all cases prior to initial decision".

The PIP benefit was introduced in Northern Ireland in June 2016 and had gradually replaced its predecessor, the Disability Living Allowance.

In the five years from June 2016 to the end of May 2021, more than 245,700 decisions have been made on local PIP claims and 10% of those were the subject of appeals, DfC said.

The figures released to the BBC show a significant reduction in the number of PIP appeals which were able to proceed in Northern Ireland since the start of the coronavirus pandemic.

They show that a total of 7,455 were heard during the financial year 2019-20.

But from April 2020 to March 2021, a time period which included lengthy Covid-19 lockdowns, only 1,394 PIP appeals were heard.

The DfC confirmed that in response to tightening Covid restrictions, the President of the Appeals Tribunal suspended all face-to-face oral hearings "to protect the health and safety of appellants".

The department said face-to-face hearings "resumed on a gradual basis from Easter 2021" and the service is currently available at eight venues across Northern Ireland.

Overall, since 2015-2016, the number of successful benefits claims that have been appealed has been increasing in Northern Ireland.