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Writing a justification
A well-formed justification will:
- show a clear reason for the descriptor choice
- explain why the decision was reached
- clarify any inconsistencies and explain how you have understood and reached a decision on the inconsistencies
- allow an individual to understand the process used to get to a decision
- allow an individual to have the information they need to decide if they want to raise any issues they have with how the decision was made
- list any supporting information used in the decision-making process
Show a clear reason for the descriptor choice
The case manager must explain:
- which descriptor applies for each day of the required period for the client, based on the reliability criteria, and
- for the course of the required period based on the scoring rules
Example of reason recorded
The client has satisfied descriptors A in line with the reliability criteria 40% of days [explain reasons why, in terms of their needs and the reliability criteria], but B in line with the reliability criteria 60% of days [explain reasons why, in terms of their needs and the reliability criteria]. This means overall in terms of the scoring criteria the descriptor to be applied is B.
Explain why the decision was reached
If you make a deduction of the facts, based on the balance of probabilities to fill in the factual gaps in a client’s case, your judgements must be recorded.
In particular, this will include which pieces of information have been used to make a decision on the balance of probabilities. This should be included in the justification given. These judgments will then be applied to the eligibility criteria to determine which descriptor applies to the client.
If you consider the balance of probabilities to determine which descriptor the individual satisfies in line with the reliability criteria, you should also include this detail in your justification, and explain your conclusion.
Allow an individual to understand the process used to get to a decision
The justification should explain the process that has been applied to reach the determination for the client, including:
- eligibility criteria applied
- reliability criteria
- scoring criteria
You should provide a justification at the end of each descriptor and follow some basic rules when formulating the justification. These basic rules are:
- be clear on the descriptor chosen and information used to support a decision
- make sure any inconsistencies are clearly defined and state how the information will be used, in order to explain how the inconsistencies have been considered
- use clear and simple language, avoiding abbreviations and medical language where possible
- where there is more than one impact to be discussed, it may be worth splitting the justification into two paragraphs to avoid confusion
Where there is an inconsistency between the individual’s report of their functional ability and other sources of information, this should be stated and explained.
For example: “Although the individual reports that they ‘re unable to grip to cut their food up, supporting information from Dr Jones dated 21/03/2021 reports they are now fully recovered and have a full range of movement in their fingers and wrist.”
Examples of how to formulate parts of a justification
Example: agreeing with the impact experienced by an individual that is stated in the application form and when there are no inconsistencies present
In one sentence state the impact(s) the individual describes and why, for example:
- “Peter reports that they need assistance to dress due to reduced grip in both hands and limited movement in their shoulders due to their arthritis”.
- “Allegra reports that they need prompting to be able to engage with other people due to their depression and anxiety.”
Decisions on each area of need should be supported with the reasons, linking with any supporting information, if available, and how it has been applied to the eligibility criteria.
Example: supporting information is consistent with an individual’s diagnosis
“Peter’s requirement for assistance is consistent with his diagnosis of arthritis for which he is taking appropriate medication and has specialist support at home as confirmed in letter from his support worker (J Holmes dated 22/03/2021).”
It may be useful to state a list of the individual’s condition(s), and the impact that this has on them. It should be stated how these affect the individual’s ability to complete the activity and then complete a short justification.
Example: showing the impact of an individual’s condition(s) on their ability to complete an activity:
“Peter’s stated restriction, relating to his arthritis and difficulty gripping and moving his shoulders, are consistent with his diagnosis of arthritis for which he is taking appropriate medication, and has specialist support at home, as confirmed in letter from his support worker (J Holmes dated 22/03/2021).”
“Peter also reports that he lacks motivation to dress, due to low mood. There is a letter provided by his support worker which states that he visits him at home 4 mornings a week and he is usually still wearing nightwear when he arrives.”