[2025] UKUT 020 (AAC)

by telephone call to the telephone number specified by the Secretary of State; or

Regulation 11(1) confirms that a PIP claim can be made in writing or by telephone unless the Secretary of State decides only to accept one method.  Reg 11(1)(b) and (4) are clear that a telephone claim is completed rather than defective, and must be treated as such, so long as the information required to determine the claim is provided during the call, but if it is not, then further information must be provided as requested by the Respondent in order for the claim to be completed. Regulation 11(4) therefore makes the distinction between properly completed telephone claims (which I also refer to as “valid”) and defective claims.

Judge Hemingway sitting in the UT made obiter observations in GG v SSWP (PIP) [2019] UKUT 318 (AAC) (CPIP/ 2948/2018) (“GG”) at [19] as to how Regulation 11(4) might be interpreted broadly:

“…But while, speaking generally, the claim system set out in the above legislation appears coherent, it is odd, as the claimant picks up on, that regulation 11 of the PIP C and P Regs 2013 states that a claim made by telephone is properly completed if the Secretary of State is provided during that call with all the information required to determine the claim and that, otherwise, the claim is defective. But it is really very difficult to envisage a telephone conversation in which all of the information which might conceivably be required before a fair and informed decision can be made might be provided. That would certainly mean, in effect, the person receiving the call going through each and every question with the claimant which would be asked on the claimant questionnaire. Even then, very probably, there would need to be further medical information and opinion obtained from a health professional via a paper based report or (I think much more commonly) a face-to-face assessment with a report following that. That medical input cannot, of course, be obtained by way of a telephone conversation between the claimant and the call handler.

Further, the contention put forward by the claimant would mean, in effect, that a claim had not been properly completed until the point at which it was ready to be actually determined. The better way of looking at it, it seems to me, is to say, as the Secretary of State’s representative suggests, that notwithstanding the rather loose, misleading or unclear wording of regulation 11(4), the claim if made by telephone is actually made once the various questions concerning the “lay conditions” have been answered to the satisfaction of the Secretary of State such that she accepts the claim as having been made and as not being defective. What then follows is really the gathering of evidence relevant to the question of whether the claim, as made, should be allowed and if so on what terms. The phrase “all the information required to determine the claim” is not to be taken to mean all the information a diligent decision-maker might wish to have before making a fully informed decision but, rather, enough information to enable the making of a coherent decision on the claim in light of whatever evidence might or might not then be obtained in the process of considering that claim. There might though be some merit in consideration being given to rewording the regulation in order to aid clarity of understanding.”

Regulation 12(1)(b) defines the date of a PIP claim made by telephone as the date on which the claim is properly completed:

Regulation 8 of the Social Security (Personal Independence Payment) Regulations 2013 mandates the Secretary of State to make “a negative determination” on a claim for PIP in circumstances where, without good reason, a claimant has failed to provide information or evidence within one month of the date of its request or within such longer period as the Secretary of State may consider reasonable in the circumstances of the particular case. Further, section 80(5) of the Welfare Reform Act 2012 permits regulations to be made providing for a negative determination in such circumstances. The above clearly covers cases where a claimant questionnaire has been sent, after the making of a telephone call, but has not been completed and returned within the appropriate timescale.

Section 8(2)(b) of the Social Security Act 1998 provides that a claimant will not be entitled to the benefit on the basis of the circumstances not obtaining at the time the claim is decided by the Secretary of State:

Section 12(8)(b) of the Social Security Act 1998 provides that a tribunal deciding an appeal shall not take into account circumstances not obtaining at the time when the decision appealed against was made.

Section 17(1) of the same Act provides as follows: