Requesting more additional supporting information

In some cases, you may not have enough information to understand the individual’s circumstances and entitlement based on:

• the application or review form
• available additional supporting information
• the balance of probabilities

This might be due to:

• gaps
• inconsistencies

in the information provided in the information you do have available.

Information provided by the individual or their source might not contain enough detail to make a determination if the information is:

• of low value (for example generic information about a condition, rather than about a person’s needs)
• not up to date i.e. information from a time when their needs were significantly different
• not provide the level of detail needed to understand an individual’s needs, particularly where the case is complex

You can ask for more information if:

• there’s not enough information to make a determination on the balance of probabilities
• you’ve considered other decision-making tools

You can contact an individual only where necessary to:

• clarify information already provided
• update or confirm details on a form
• ask for another source of information
• get more information to support what the individual told us
• request a consultation

This means that you must not request more additional supporting information because you:

• would find it interesting to find out more about the case in question
• would find it helpful, but not strictly necessary, to learn more
• do not feel confident enough to make a determination as you are new to the role
• need more general information on the individual’s condition when this information is also available in medical guidance or upon request through a case discussion with a practitioner
• need to have confirmation from a professional where an individual has good cause for not having this

Individuals can request help to gather supporting information at any time.

When requesting supporting information, you should limit the number of questions asked. You should also keep your questions general enough for the provider to give information on the individual’s condition and needs.

Who to ask for more additional supporting information

Depending on the details you need to make a determination, you should decide whether you should request this supporting information from:

• a professional
• the individual’s wider support network

Before asking for more information, you should consider whether information about a condition or disability can be gathered by using other decision-making tools, such as

• medical guidance
• a case discussion

You must also consider whether it can be established if the information you need is the confirmation from a professional.

As with all supporting information, anything additional should be:

• given equal consideration
• used to broadly support the information provided in an individual’s application or review form

You must never ask an individual to ‘prove’ or ‘disprove’ anything they have told us about any aspect of their:

• conditions
• disabilities
• needs

If the confirmation from a professional is unavailable

If after all efforts have been made, there’s still no confirmation from a professional, you can still make an award if:

• you can establish good cause for the missing information
• the individual has attended a consultation and it determines that they are entitled to an award

You should always try to establish good cause before you invite an individual for consultation.

You should:

• use the balance of probabilities, as always
• consider requesting a case discussion

A consultation may be able to provide enough information to make a determination, even where no good cause for missing information can be established.

Consultations should be able to establish:

• a clear picture of an individual’s conditions, disability or needs
• if the individual is not entitled to disability benefits

If no additional supporting information is available

Other decision-making tools may be necessary to establish the facts of a case in cases where all of the following apply:

• an individual has a confirmation from a professional, including good cause for not having the confirmation from a professional
• the application form does not contain enough detail for you to conclude whether it is more likely than not what their needs are
• there is no additional supporting information from any other source

One of those tools includes requesting more additional supporting information. You should ensure that this is the best tool for gathering the missing details before using this tool.

Other tools may be more appropriate, or produce results quicker, than gathering more additional supporting information. These include a consultation or a follow-up call with the individual.

You should always attempt a follow-up call, if it is appropriate to do so, to gather any information you need before requesting more additional supporting information.

Where you have utilised the available decision-making tools and you have still been unable to gather all the information you need, you should:

• continue to make a determination based on the facts they have been able to establish
• continue to use the balance of probabilities, as always, throughout this decision-making to establish what needs they are more likely than not to have
• recognise that this might lead to a lower award than the individual might have expected, or to no award

When it is appropriate to deny an application due to lack of supporting information

We’re required to make a determination on every application we receive. In instances where there is either

• no confirmation from a professional and no good cause
• not enough information to determine entitlement after using the relevant decision-making tools,

the determination might be that the individual is not entitled to assistance.

An individual’s application can be denied due to lack of confirmation from a professional if all of the following are met:

• there is no confirmation from a professional
• there is no good cause
• the consultation the individual was invited to did not go ahead because the individual declined the invitation or rescheduled the consultation more than three times OR a consultation does not confirm the conditions, disability or needs the individual told us about in their application.

A lack of confirmation from a professional and a lack of good cause is not the only basis for denying an application on grounds of supporting information.

Alternatively, an individual’s application can be denied if you are unable to determine the individual’s entitlement based on the information available. To deny an application on this basis, all of the following must be met:

• they have a confirmation from a professional or you have established good cause
• the information provided in their application form does not provide enough detail for you to establish their entitlement
• you have used other decision-making tools to resolve these gaps or inconsistencies but you are still unable to establish entitlement
• you tried to gather more additional supporting information and did not receive the detail you needed
• you invited the individual to a consultation to gain the insights needed to establish entitlement but the consultation did not take place
• due to inconsistencies or lack of detail, you were unable to establish their entitlement based on the balance of probabilities
• you have made every effort to support the individual to provide more additional supporting information, including offering to gather it on their behalf

Related reading

• how to send a supporting information request
• Good cause
• balance of probabilities
• establish the value of a piece of supporting information
• helping the individual to gather supporting information
• Equal consideration
• gaps and inconsistencies