Conditions that might indicate a review is appropriate but additional factors suggest it might not (Pathway 3)

Some conditions might ordinarily suggest that a review of the individual’s entitlement to Adult Disability Payment is appropriate. These conditions will not normally be identified as part of Pathway 1 or Pathway 2.

However, sometimes the case manager will become aware of additional factors, that when taken together, suggest a review would be inappropriate. In that case they should consider making an indefinite award.

Example: an individual is eligible for an indefinite award due to the combined impact of their conditions on their life

Blair is 48 and works part-time as a volunteer for a charity but mostly from home. Blair completed an application where they report a primary generalised osteoarthritis condition, that they have had for the last 20 years.

This has been complicated by a diagnosis of obesity. They have been in receipt of surgical interventions, physiotherapy, occupational therapy, take multiple pain relieving medication, all of which has had minimal effect. In their application form Blair reports restrictions in activities 1, 2, 3, 4, 5 and 6 of the daily living component.

The case manager awards the following points for the daily living component:

1(e): 4 points

2(b): 2 points

3(b): 1 point

4(d): 2 points

5(b): 2 points

6(d): 2 points

Blair also has a diagnosis of anxiety disorder that does not significantly impact upon their level of need. For activity 12 they report that due to pain and breathlessness, caused by osteoarthritis and obesity they are unable to walk more than 20 meters.

The case manager awards the following points for the mobility component:

2(e): 12 points

The case manager thinks that an indefinite award might be right for Blair. They request a case discussion to discuss not setting a review period. During the case discussion, the practitioner confirms that Blair is experiencing a number of severe conditions that affect their ability to complete activities. It is clear that there is not likely to be a significant improvement in their condition. The complex effect of all of their conditions limits their ability to either lose weight or improve mobility, whilst symptom management is likely but there is limited chance of a substantial improvement. The case manager decides that it is reasonable to make an indefinite award and passes on their determination to a senior staff member for QA.