“(4) For the purposes of this Part, a person has limited capability for work if– (a) his capability for work is limited by his physical or mental condition, and (b) the limitation is such that it is not reasonable to require him to work.”
“The matters to be taken into account in determining whether a claimant has good cause under regulation 22 (failure to provide information in relation to limited capability for work) or 23 (failure to attend a medical examination to determine limited capability for work) include— (a) whether the claimant was outside Great Britain at the relevant time; (b) the claimant's state of health at the relevant time; and (c) the nature of any disability the claimant has.”
“(1) A claimant who does not have limited capability for work as determined in accordance with the limited capability for work assessment is to be treated as having limited capability for work if paragraph (2) applies to the claimant. (2) … this paragraph applies if— … (b) the claimant suffers from some specific disease or bodily or mental disablement and, by reason of such disease or disablement, there would be a substantial risk to the mental or physical health of any person if the claimant were found not to have limited capability for work.”
“A claimant who does not have limited capability for work-related activity as determined in accordance with regulation 34(1) is to be treated as having limited capability for work-related activity if— (a) the claimant suffers from some specific disease or bodily or mental disablement; and (b) by reasons of such disease or disablement, there would be a substantial risk to the mental or physical health of any person if the claimant were found not to have limited capability for work-related activity.”
“Did Not Attend a WCA 5. When the claimant fails to attend a WCA assessment, MSRS produces an electronic outcome. MSRS holds all contact made between the claimant and HAAS. This includes all letters, telephone contacts including unsuccessful attempts, and appointment history. 6. HAAS will issue a letter, BF223 to the claimant asking for the reasons they did not attend. Claimants will be requested to return their response to BC within 15 calendar days. A reply envelope is enclosed with the BF223. Consequences: Failure to take prompt action will result in: • failing in your duty on behalf of DWP to safeguard vulnerable claimants by not checking the Mental Health flag • Failure to action, failure to return ESA50 or attend the WCA, means the claimant will not receive their correct entitlement and be overpaid • increase the value of any overpayment, adding to official error • rework to correct the claim. … 9. When an MSRS record shows a Mental Health flag, the DM should check if the claimants has attended or received any of the following: • Sanctions Safeguard Visits for non-attendance at mandatory interviews. • Telephone call from BC/JCP collecting good cause information for DNA WCA • Returned BF223 10. If the answer is yes to any of the above, the DM will consider Good Cause as normal as the claimant has already had their responsibilities explained, or responded to provide Good Cause reasons. See DMG42261 … and the DNA Toolkit for further instructions around good cause. 11. When considering Good Cause the DM may decide the claimant would benefit from a home visit. To do this they must engage the Assessment Provider to complete this. The DM does not have to get GP evidence and neither does the claimant. These cases should be treated as exceptions, DMG 42261 applies. 12. If the answer to all of the three bullet points above is no, and the DM is considering not accepting good cause, refer the case for a pre-disallowance Safeguard visit, see Core Visits .... Complete form MF37 …, ensuring all the appropriate boxes are complete, including: • The claimant’s condition • The claimant’s representative/third party • Details of action taken to contact the claimant/representative • If a previous safeguard visit has been undertaken • If Good Cause has been considered 13. All of the above must be completed or the Assessment Referral could be returned.”
“1. When ESA was introduced it was stressed how important it is to work with our claimants and move them closer to the labour market. 2. Decision Makers (DMs) have a crucial role to play in this and any rulings made by a DM must be made while considering the statement above. The actions of a DM can influence claimant behaviour and it is important DMs are aware of the consequences their actions may bring. 3. This toolkit highlights the basic things that should be considered when making DNA decisions, and as the preferred method of communicating with the claimant is by phone, also includes suggested questions to ask the claimant. There are extensive instructions for DMs. See DMG Chapter 42 … Note: Take care to safeguard vulnerable claimants. Evidence and Best Practise [sic] Always try to speak to the claimant on the phone 4. Any evidence collected over the phone is valid, but the DM must always ask for evidence of appointments, such as appointment cards or letters to be sent in. 5. The onus is on the claimant to provide any evidence required to make a fair and balanced decision. DMs must not make assumptions. However, it is also not appropriate for a DM to decide they are willing to accept good cause as it is the claimants first FTA, see DMG 01344 (link is external).”
“Always check Legacy notepad, LMS conversations and CAM 8. In all cases records must be checked for previous history of avoidance, similar explanations for non attendance in the past, or previous FTA markers or rearranged WCA and WFI appointments. This gives a better picture of claimant behaviour and builds evidence for your decision. Explain to the claimant the importance of attending their appointment and the consequences of not attending 9. This message is important if we are to ensure that claimants take responsibility for their actions. However, the claimant is advised at the point of claim, in the ESA40 and in the ESA35 that they might be called for an assessment and warned of the possible consequences, before they get the appointment letter.”
“42456 Before a claimant can be treated as not having LCW, the DM has to be satisfied that the prescribed conditions are met. These include the way in which the information or attendance was requested and the amount of notice given. … “Consideration of good cause 42500 When a claimant fails to return the questionnaire or fails to attend or submit to examination, consideration of good cause includes “42456 Before a claimant can be treated as not having LCW, the DM has to be satisfied that the prescribed conditions are met. These include the way in which the information or attendance was requested and the amount of notice given. … “Consideration of good cause 42500 When a claimant fails to return the questionnaire or fails to attend or submit to examination, consideration of good cause includes 1. whether the claimant was outside GB at the relevant time and 2. the claimant’s state of health at the relevant time and 3. the nature of any disability the claimant has. Note: The list is not exhaustive (see DMG 42501 - 42543 for further guidance on good cause). 42501 The claimant will have been asked to give the reasons for not complying with the Secretary of State’s request for information or to attend or submit for examination. The DM should bear in mind the guidance about evidence, including corroboration, in DMG Chapter 01. 42502 The list is not exhaustive; the regulations state “include”
“01405 A clear understanding of where the burden of proof lies helps the DM to weigh the evidence and decide whether further evidence should be sought. DMs should note that 1. initially the burden lies with the claimant to prove that the conditions for a claim or application are satisfied 1 but they should do as much as possible to ensure that the claimant has every opportunity to provide all relevant evidence and where the information is available to them rather than the claimant, then they must make the necessary steps to enable it to be traced 2. where they wish to show that an exception to a condition of entitlement is not satisfied, the burden of proof rests with them 2 3. there is no presumption in favour of the claimant though for IIDB the claimant is normally presumed to have the PD if he has worked in the prescribed occupation; for example, a cotton weaver with byssinosis (see DMG Chapter 67 for full guidance) 4. where an allegation is denied by the claimant it is generally for DMs to prove the facts. 5. the burden of proving that the conditions for revision or supersession are satisfied lies with the person who applies for revision or supersession 6. in overpayment cases the burden of proof for the purposes of determining the sum to be recovered falls on them 3 (see DMG Chapter 09). 7. where a criminal court convicts a person of an offence related to obtaining or receiving benefit, that conviction shifts the burden of proof relating to the same benefit and period at issue from them to the claimant 4. Note 1: An example of 2. is where there is a claim for a SF funeral payment, it is for the DM to show that the claimant is not entitled because a close relative is not in receipt of a qualifying benefit. Note 2: Where 5. applies the question of whether the conditions for revision or supersession are satisfied must be considered separately from the question of whether the decision should be revised or superseded.”
“I am unable to advise on the evidence held … Not been seen at the GP surgery since 2013 … the claimed level of disability is unclear. An assessment is needed to determine the level of function.”
“It is not possible for me to make a finding as to the reasons why Errol did not respond to the DWP at this time. There simply is not sufficient evidence as to how he was functioning, however, it is likely that his mental health was poor at this time - he does not appear to be having contact with other people, and he did not seek help from his GP or support agencies as he had done previously. … I have considered carefully the evidence available to the DWP at the time this decision was made. It is in my view a hugely important decision to take, particularly with the knowledge that this man had longterm illness that was unlikely to have improved significantly – also that he was reliant on this benefit as his sole income. Whilst I accept that there may have been no obvious ‘good cause’ for Errol not attending the WCA, there was other evidence of longterm depression and hypothyroidism from the recent GP information - I accept it was limited information, but more detail could have been sought from the GP. In addition I understand from Ms Hunt that currently there is no guidance for DWP staff following ‘failed safeguarding visits’ as occurred in this case. There is currently no requirement to seek more information before making a decision to cease benefit following failed safeguarding visits. Again I cannot say on a balance of probabilities that the cessation of Errol’s ESA led directly to his death, but I do think the sudden loss of all income, and the threat of eviction that followed from it, will have caused huge distress and worry, and significant financial hardship. I do not believe Errol had any other source of money to buy food or other provisions, nor to pay for utilities. He did not ask for help from family, NCH, his GP or other support agencies, or contact the DWP to explain his circumstances. Dr Thangavelu described in his evidence that Errol was vulnerable to life stressors. It is likely that this loss of income, and housing, were the final and devastating stressors, that had a significant effect on his mental health. … Conclusion In my findings I have identified a number of missed opportunities to better support Errol, a vulnerable man with long term depression. I cannot however say that there is a direct causal connection between any of these missed opportunities when considered alone, and Errol’s death. As is so common sadly with hindsight at an Inquest, a number of agencies had pointers suggesting his deteriorating health, but these were not put together into the full and very worrying picture until after his death. The safety net that should surround vulnerable people like Errol in our society had holes within it. Errol needed the GP to try harder to see him, certainly from 2015 onwards. He needed the DWP to obtain more evidence at the time his ESA was stopped, to make a more informed decision about him, particularly following the failed safeguarding visits. If anyone had known he was struggling, help could have been provided. We do not know why he did not seek it.”
“To mitigate the risk of hardship to claimants where we have safeguarding concerns, consideration should also be given to contacting (where relevant and appropriate): • the claimant’s appointee, Power of Attorney (POA) or next of kin • the claimant’s Community Psychiatric Nurse (CPN) • social services • the police.”
“… the claimant’s details must be referred to the HEO of the person who made the referral to discuss the case in more detail as part of the case conference. Pending the outcome of the case conference, the claimant’s award will not end and payments will not be stopped. Case conferencing will take place between the HEO and the referrer to determine all the facts of the case following two ineffective visits prior to making a decision on the claim. The case conference will review the information available to them and provide an assurance check. This will include reviewing, for example: • the circumstances prompting the referral for a visit to be made • previous interactions with the Department, including attendance at any interventions as part of the conditionality to receive ESA • any documentation or notes available regarding the claimant, for example a medical report following attendance at a WCA • any information we currently hold from third parties (this may include a next of kin or organisations such as social services) • whether a deferral of the original intervention/appointment is appropriate at this stage until safeguarding enquiries are made. The case conference will also consider whether to involve the local partnership manager who may be aware of local organisations who can offer support. The case conference participants must be satisfied that agreed actions have been taken and all relevant information has been adequately considered. The HEO must review the information and note on the relevant systems the actions considered/agreed.”
“1. The Defendant's current policy is unlawful for the following reasons: a. Firstly, it is well recognised that a substantial number of claimants will be prevented from responding to the DWP or putting forward evidence to show they had a good cause for not responding, because of mental illness. In such cases, placing the onus or burden on the claimant to prove why he or she had good cause is contrary to caselaw and inconsistent with the objectives of the legislation. Yet the policy places that onus of proving good cause on the claimant. The policy is therefore unlawful as it incorporates an error of law, provides a misleading impression of what the law is, and permits or encourages unlawful decision making. b. Secondly, in a case like this, where the claimant is vulnerable and has a long-term mental disability which may give him a good cause, regulation 24 of theEmployment Support Allowance Regulations 2008 ands.149 of the Equality Act 2010 imply a duty to inquire. The DWP must make all reasonable inquiries to obtain sufficient information to be able to properly assess whether the claimant has a good cause arising from his health or disability, including where necessary from external individuals and bodies. That is a rigorous duty in part because many such claimants will be at serious risk of harm or death if their benefits are terminated. c. The policy is unlawful because of a combination of these two factors: Firstly, it fails to identify the duty to make inquiries, indicating instead that there is merely discretion to make inquiries in respect of external sources. Secondly, it states that the onus to provide the evidence to prove good cause is on the claimant. That suggests the caseworker is not required to make further inquiries and therefore the policy permits or encourages unlawful action, namely failure by the DWP to comply with the legal duty to inquire. 2. The DWP’s decision to terminate Mr Graham’s benefits in October 2017 was also unlawful. a. That was firstly because the DWP failed to give due regard to the needs specified in s.149 EA 2010. b. Secondly, it failed to comply with the duties arising from reg.24 and/or s.149 EA 2010 to take all reasonable steps to obtain sufficient information to be able to properly assess whether Mr Graham had a good cause arising from his health or disability. c. Thirdly, the onus was placed on Mr Graham to prove he had a good cause, even though his mental illness may well have prevented him from doing so.”
“… the DWP has nonetheless always appreciated that a claimant’s health or disability may be preventing them from attending, and has measures in place to address that risk.”
“Sufficient information may be elicited by reference to the claimant’s completion of the initial questionnaire, questioning during his medical examination, or by any evidence he may choose to give on an appeal to the Tribunal. The process to be adopted by the decision-maker or Tribunal is to be regarded as inquisitorial and not adversarial. It is a process described by Diplock J in R v Medical Appeal Tribunal (North Midland Region ex-parte Hubble) 1958 2 QB 228 at 240 as a fact- 66. gathering exercise in which there is no formal burden of proof on either side. There should be no difficulty provided the decision-maker or Tribunal recall that the essential question is whether there is an adequate range of work which the claimant could undertake without creating a substantial risk to himself or to others.”
“62. What emerges from all this is a co-operative process of investigation in which both the claimant and the department play their part. The department is the one which knows what questions it needs to ask and what information it needs to have in order to determine whether the conditions of entitlement have been met. The claimant is the one who generally speaking can and must supply that information. But where the information is available to the department rather than the claimant, then the department must take the necessary steps to enable it to be traced. 63. If that sensible approach is taken, it will rarely be necessary to resort to concepts taken from adversarial litigation such as the burden of proof. The first question will be whether each partner in the process has played their part. If there is still ignorance about a relevant matter then generally speaking it should be determined against the one who has not done all they reasonably could to discover it. As Mr Commissioner Henty put it in decision CIS/5321/1998: “a claimant must to the best of his or her ability give such information to the AO as he reasonably can, in default of which a contrary inference can always be drawn.”
“(1) A public authority must, in the exercise of its functions, have due regard to the need to— (a) eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by or under this Act; (b) advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it; (c) foster good relations between persons who share a relevant protected characteristic and persons who do not share it. … (3) Having due regard to the need to advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it involves having due regard, in particular, to the need to— (a) remove or minimise disadvantages suffered by persons who share a relevant protected characteristic that are connected to that characteristic; (b) take steps to meet the needs of persons who share a relevant protected characteristic that are different from the needs of persons who do not share it; (c) encourage persons who share a relevant protected characteristic to participate in public life or in any other activity in which participation by such persons is disproportionately low. (4) The steps involved in meeting the needs of disabled persons that are different from the needs of persons who are not disabled include, in particular, steps to take account of disabled persons' disabilities.”
“… the public authority concerned will, in our view, have to have due regard to the need to take steps to gather relevant information in order that it can properly take steps to take into account disabled persons’ disabilities in the context of the particular function under consideration.”
“This argument … is in my opinion hopeless. Where, as here, the person concerned is ex-hypothesi disabled and the public authority is discharging its functions under statutes which expressly direct their attention to the needs of disabled persons, it may be entirely superfluous to make express reference to section 49A and absurd to infer from an omission to do so a failure on the authority’s part to have regard to their general duty under the section. That, I am satisfied, is the position here. The question is one of substance, not of form. This case is wholly unlike Pieretti v Enfield London Borough Council[2011] PTSR 565 (which held that the section 49A duty complements a housing authority’s duties to the homeless under Part 7 of theHousing Act 1996 ).”
“The classic situation where the Section 71 obligation bites is where some policy is in the course of being considered. The duty, to put it loosely, to have regard to race relations implications is very important. But where a policy has been adopted whose very purpose is designed to address these problems, compliance with Section 71 is, in my judgment, in general automatically achieved by the application or implementation of the very policies which are adopted to achieve that purpose.”
“To avoid any hardship to claimant’s [sic] in a vulnerable group every attempt must be made to ensure the claimant’s welfare. In the event of two ineffective visits, the HEO must attempt to contact the following sources to establish the claimant’s welfare: • Claimant’s Appointee/POA/next of kin, • Claimant’s Community Psychiatric Nurse, • Social Services, • Police.” • Claimant’s Appointee/POA/next of kin, • Claimant’s Community Psychiatric Nurse, • Social Services, • Police.”
“Note: The contact with these people/organisations is to ensure a claimant’s welfare (we have a moral obligation to make organisations aware of potential incidents around vulnerable claimants) and not to gather information to support the Labour Market process.”
“The general principles on the Tameside duty were summarised by Haddon-Cave J in R (Plantagenet Alliance Ltd) v Secretary of State for Justice[2014] EWHC 1662 (Admin) at paras. 99100. In that passage, having referred to the speech of Lord Diplock in Tameside , Haddon-Cave J summarised the relevant principles which are to be derived from authorities since Tameside itself as follows. First, the obligation on the decisionmaker is only to take such steps to inform himself as are reasonable. Secondly, subject to a Wednesbury challenge, it is for the public body and not the court to decide upon the manner and intensity of enquiry to be undertaken: see R (Khatun) v Newham LBC[2004] EWCA Civ 55 ,[2005] QB 37 , at para. 35 (Laws LJ). Thirdly, the court should not intervene merely because it considers that further enquiries would have been sensible or desirable. It should intervene only if no reasonable authority could have been satisfied on the basis of the enquiries made that it possessed the information necessary for its decision. Fourthly, the court should establish what material was before the authority and should only strike down a decision not to make further enquiries if no reasonable authority possessed of that material could suppose that the enquiries they had made were sufficient. Fifthly, the principle that the decision-maker must call his own attention to considerations relevant to his decision, a duty which in practice may require him to consult outside bodies with a particular knowledge or involvement in the case, does not spring from a duty of procedural fairness to the applicant but rather from the Secretary of State's duty so to inform himself as to arrive at a rational conclusion. Sixthly, the wider the discretion conferred on the Secretary of State, the more important it must be that he has all the relevant material to enable him properly to exercise it.”