Making a robust determination of entitlement

This section covers the cognitive aspect of the decision-making process. The process of making a determination consists of:

• finding of facts
• making conclusions of law

A robust determination of entitlement means that you have enough relevant information to, on the balance of probabilities, establish the facts of the case at hand and make a conclusion of law.

This information can come from:

• the application or review form
• supporting information, including confirmation from a professional
• any decision-making tools you used

What to consider when making a determination

You must consider all of the relevant information on the individual’s circumstances that is available to you in order to establish facts.

This could include:

• the application or review form
• supporting information, including confirmation from a professional
• information gathered through using decision-making tools, where necessary.

Decision-making tools include:

• any information recorded from follow-up phone calls with the individual
• additional supporting information from a professional and/ or the individual’s wider support network
• a consultation
• decision-making and medical guidance
• advice received through a case discussion
• colleague support

Establishing if information is relevant

During case familiarisation you might conclude that some information is not relevant.

You should not use the irrelevant information to establish the facts of that case.

Information might not be relevant if, for example:

• it describes the prognosis, symptoms or impact of a condition in relation to people in general when you’ve already established the individual experiences the condition differently
• it covers a period of time that is not relevant to the individual’s application or review
• it was provided by a person, or organisation, who is unlikely to be familiar with the individual, their conditions, disability or needs
• you’ve found inconsistencies in the information provided and established that it’s more likely than not that one or more pieces of information is inaccurate or untrue.

For example, the individual’s account could differ from the GP’s account of their symptoms. The individual could state that their symptoms have gotten worse recently. As their GP last saw them 6 months ago, you establish that it is more likely than not the GP is describing the individual’s symptoms before they got worse.

Read more about establishing relevance and quality of supporting information.