Change of circumstances after an application is submitted and before a decision is made
An individual may experience a change of circumstance:
- after an application has been submitted
- before a determination has been made
A case manager should take any new information into account once they are made aware of it.
A further application is not necessary after a report of a change of circumstances. In this scenario, a case manager makes two determinations. This is if the change reported or new information provided affects the original award.
The first award takes into account the care and/or mobility needs of the individual based on the original information provided in the application.
The second award takes into account the care and/or mobility needs of the individual based on the changes reported or the new information.
This could result in two different rates of award, which is known as a split award.
The second award is effective for payment once the individual meets the backwards test for the new information.
Two separate determinations of entitlement should be sent to the individual to explain this.
Example: A change of circumstance is reported in advance of a determination
Federico has arthritis and a heart condition. They apply for Adult Disability Payment on 6 April stating their needs have existed for 2 years prior to applying. This means they satisfy the Backwards Test at the time of application. Information within the application suggests they are likely to be entitled to the standard rate of the daily living component and the enhanced rate of the mobility component from the date of application.
Before the case manager has made their determination, Federico’s spouse contacts Social Security Scotland on 27 May to say that Federico had a stroke on 21 May and now has increased needs. Supporting information leads the case manager to decide Federico will now be entitled to the enhanced rate of the daily living component as well as the enhanced rate of the mobility component.
As Federico’s increased needs began on 21 May, the date they had the stroke, they do not yet satisfy the Backwards Test for the enhanced rate of daily living. This will be satisfied on 19 August so this is the earliest date this rate can be paid.
The case manager therefore makes a determination that Federico is entitled to the standard rate of the daily living component and the enhanced rate of the mobility component from 6 April to 18 August, and the enhanced rate of both daily living and mobility components from 19 August.
Federico will be notified of the outcome in the Determination of Entitlement notification.
Example: A change of circumstance is reported in advance of a determination
Gurjit applies for Adult Disability Payment on 4 June due to having depression and anxiety. She advises her needs have existed for around 6 months prior to applying. The Backwards Test is therefore satisfied. Information suggests she is likely to be entitled to the standard rate of the daily living component and not entitled to either rate of the mobility component.
Before the case manager makes their determination, Gurjit writes to Social Security Scotland to say she was involved in a road accident on 23 July. She received severe injuries to her right leg requiring emergency surgery and intensive follow up physiotherapy. Supporting information from an orthopaedic surgeon confirms her injuries and the estimated recovery time is at least a year. The case manager decides an award of the enhanced rate of both the daily living and mobility components is now appropriate.
As Gurjit’s increased daily living needs and new mobility needs began on 23 July, the Backwards Test will be satisfied on 21 October so the higher rate of benefit can be paid from that date. As the needs are expected to last for at least 39 weeks following the start date of payment, the forwards test is also satisfied.
The case manager makes a determination that Gurjit is entitled to the standard rate of the daily living component from 4 June to 20 October, and the enhanced rate of both the daily living and mobility components from 21 October. A review is scheduled 1 year from the date the determination was made, to check whether her needs have changed.