Relationship with the date of entitlement
The backwards test must be met before the entitlement to ADP can begin.
The date an individual satisfies the backwards test might differ for the daily living component and the mobility component.
The case manager may need further information to determine that the backwards test has been met and the forwards test is to be met. This information should confirm that the individual is likely to meet the conditions of entitlement during both of the relevant periods.
For more information on the date of entitlement please refer to the Applying for ADP chapter.
Example 1 – an individual diagnosed with a progressive physical or mental health condition who does not meet the backwards test
Gillian is diagnosed with stage 1 kidney failure, however, currently has few symptoms. She has been advised that if her kidney failure advances to stage 3 or 4 her symptoms will impact on her daily life. Gillian applied for Adult Disability Payment on 1 September. Gillian’s needs have not yet progressed to the stage where she is eligible for Adult Disability Payment as they have not yet affected her ability to undertake the activities described under the daily living and mobility components. She does not initially meet the backwards test and is therefore not yet eligible to receive Adult Disability Payment.
She will be eligible once she’s met the conditions of entitlement for 13 weeks. As this will likely be more than 13 weeks in the future, she will need to make a new application when her needs meet the eligibility criteria.
Example 2 – an individual who initially was not thought to meet the backwards test however after investigation does in fact meet the backwards test
Graham has arthritis and he applies for Adult Disability Payment on 1 September. He notes on his application form that his mobility issues due to his condition began on the 25 August, which would suggest that the backwards test has not yet been met. However, the Case Manager identifies from supporting information received that Graham’s mobility issues may have been affected earlier by his condition.
There is a GP letter confirming he has been attending the practice over the last 6 months with bilateral hip and knee pain. This has been managed with pain control prescribed by the GP. Following worsening pain, a referral for x-rays and review by an Orthopaedic Consultant was made by the GP. Graham then received a diagnosis of generalised osteoarthritis at this appointment with the consultant on the 25 August, after the x-rays were reviewed.
The Case Manager is satisfied that although the condition was formally diagnosed on the 25 August, the symptoms and restrictions had actually been present for 6 months.
Example 3 – An individual who does not have a diagnosis however has needs linked to a condition and is eligible to meet the backwards test
Marian applies for Adult Disability Payment on 1 August and it is suspected that she has multiple sclerosis. She has not yet received a formal diagnosis, however she has blurred vision, feels uncoordinated and she is undergoing investigations for symptoms that commenced several months earlier. These investigations include an initial check of her movements, vision and reflexes which lead to a referral for an MRI scan. Following an MRI scan a lumbar puncture might be required. Waiting on the results of an MRI scan and for any further procedure to take place can delay a diagnosis. The Case Manager determines that Marian’s needs were affecting her ability to undertake the mobility components and that she met one of the qualifying criteria for an award for 13 weeks, prior to the application date.
Case managers use weeks to calculate the backwards test and forwards test.
Sometimes, individuals can only give the month and year when the required level of needs began. In these cases, The case manager should ask the individual to indicate a week in which the needs first arose. The case manager should then set the first day of the week as the day the needs began. The week runs from Monday to Sunday. This includes a part week.
Some individuals might only be able to give the week when the required level of needs began. In these cases, the case manager should assume that the needs began on the first day of the week in calculating the backwards test. The week runs from Monday to Sunday. This includes a part week.
Example: an individual gives the first week of the month as start date for their level of need
Eleanor is 55 years old. When she applied for ADP, she stated her condition began impacting her ability to carry out everyday activities in the first week of December. The first week of December starts on Monday 28 November. The case manager records this date as the first day of the backwards test.
Sometimes, an individual gives the last week of the month for when the required level of needs began. In these cases, it is assumed that the level of needs began on the first day of the final week of the month.
Example: an individual gives the last week of the month as start date for their condition
Martin is 61 years old. When he applied for ADP he stated his condition began impacting his ability to carry out every day activities from the last week of December. The last week of December starts on Monday 26 December. The case manager uses this day as the first day when calculating the period of weeks for the backwards test.