When new determinations take effect

If the individual has just been transferred from PIP because their PIP award was due to be reviewed, the case manager should follow guidance in the Adult Disability Payment Case Transfer chapter. For all other scheduled reviews, the rules set out in this chapter apply.

Individuals in receipt of disability benefits have the duty to report changes of circumstances to Social Security Scotland. People are expected to report a change of circumstance that is likely to impact on their level of entitlement as soon as reasonably practicable after that change happened. This then triggers an unscheduled review.

The rules on when entitlement starts in these scenarios are set out in the Change of circumstances: change in care and mobility needs DMG chapter.

However people might not proactively report a change of circumstance and might only tell us about that change in their next scheduled review.

For scheduled reviews an increase in their entitlement will normally take effect on the date the case manager makes the determination (ADP regs, reg. 45(1)(d)).

In a situation where the award is due to increase and an individual proactively tells us that there are clear reasons as to why they were unable to report a change sooner, you should consider whether it would be unjust not to set an earlier start date for their increase in entitlement (ADP regs, reg. 45(2)).

If the individual challenges the initial determination and gives a reason for why an earlier date should be considered the case manager must consider this and choose an earlier date if they feel it would be unjust not to do so. Where the scheduled review includes multiple changes, it is possible separate determinations may be needed. This will depend on the reason given (for an earlier date) and whether this affects all changes, or just one of them. 

If you’ve established that it would be unjust not to set an earlier date, you should refer to the section “Setting an earlier start date if it would be unjust not to do so” for a change resulting in increased entitlement or for more detail on when these changes will take effect.

It is possible that a review reveals a decrease in the individual’s level of needs which they should have reported earlier. Where the individual has knowingly failed to report such a change or failed to notify the change as soon as reasonably practical after that change occurring, the case manager would set the date of either:

• lower entitlement
• cessation of entitlement

to the date the individual should have notified the change (ADP regs, reg. 46(1)(b)(i))

See guidance at section “If the decrease should have been reported sooner”.

In any other case where the review reveals a decrease this change should take effect from the date of the determination (ADP regs reg 46(1)(b)(ii))

In a situation where the individual tells us that there are clear reasons why a later date would be more fair for a reduced award to commence from, you should consider whether it would be unjust not to set a later start date for their decrease in entitlement (ADP regs, reg. 46(2)).

If you’ve established that it would be unjust not to set a later date, you should refer to the section “If the decrease should have been reported sooner” for a change resulting in decreased entitlement or ceased entitlement for more detail on when these changes will take effect.

If there has been no change in level of entitlement

If the individual returns their review pack and reports that they have eitherL

• not experienced a change
• experienced a change in need that does not translate into a change in entitlement

the case manager should make a determination that the award will remain the same and set an appropriate review period. See the Choosing an Appropriate Review Period chapter for guidance on how to set an appropriate review period and to understand whether an indefinite award would be appropriate.

This new determination will take effect on the date the case manager makes the determination without application (ADP regs, reg. 45(1)(d)).

If there has been an increase in level of entitlement

This section covers scenarios where the individual reports a change of circumstances.

If the individual bothL

• returns their review pack and reports an increase in need that leads to an increase in entitlement,
• has already met the backwards test for this increase,

their change in entitlement will take effect on the date the case manager makes the determination without application (ADP regs, reg. 45(1)(d)).

Individuals must satisfy the backwards test before they can become entitled to an increased rate of ADP when their award is reviewed. For more information on the backwards test please refer to the Backwards and Forwards Tests chapter. Reference should also be made to the ‘Change of circumstances: change in mobility or care needs’ chapter for guidance on applying the backwards test appropriately.

Setting an earlier start date if it would be unjust not to do so

There are circumstances that would make it unjust not to set an earlier date for the increase in entitlement to take effect (ADP regs, reg. 45(2))

Case managers should make the decision

• whether it would be unjust not to set an earlier date
• what that earlier date should be

based on information already available to them. This could be, for example, through details provided on the client’s review form or further information provided later in a redetermination form.

One scenario where it would be unjust not to set an earlier start date would be where both:

• the award review has been delayed
• the delay was caused by Social Security Scotland

Examples of scenarios where Social Security Scotland is responsible for delays in reviewing a case include:

• forms or documents submitted by the individual as part of their review have got lost
• pre-review notifications or review packs were not sent out on time
• after completed review forms have been received, reviews are concluded more than 12 weeks after their review date

This list is not exhaustive.

The case manager must refer to the relevant operational guidance chapter where processing has been delayed and DMG chapter when deciding whether setting an earlier date would be appropriate.

Another scenario would be where the client reaches out to Social Security Scotland to explain that they didn’t notice the change, or have a good reason not to have reported it within a reasonable timeframe due to, for example:

• Impacts of their condition or overall health
• Bereavement
• A hospital stay

This list is not exhaustive.

If a case manager is uncertain about whether it would be unjust to not set an earlier date for a change of entitlement, they should seek advice from their decision team manager.

If there has been a decrease in level, or end, of entitlement

This section covers scenarios where

• the individual reports a change of circumstances leading to a decrease or end of entitlement, and
• the entitlement arising from this change continues throughout the review and beyond.

If during a scheduled review a case manager determines that both:

• there has been a change in the individual’s level of need
• this change leads to either a decrease or end of entitlement

this change will take effect on the date that it would have been reasonably practicable to expect the individual to have notified of the change. See guidance at section “If the decrease should have been reported sooner” (ADP regs, reg. 46(1)(b)(i)).

In any other case, this change should take effect from the date the case manager makes the determination without application (ADP regs, reg. 46(1)(b)(ii)).

However, the date when a change comes into effect can be different if it would be unjust not to set a later start date for the new entitlement (ADP regs, reg. 46(2)). See “Setting a later start date if it would be unjust not to do so”.

If the decrease should have been reported sooner

It is possible that a scheduled review reveals a change in the individual’s level of needs, resulting in a decrease of entitlement, which they should have reported sooner. To find out whether that is the case, refer to the Change of Circumstances: Change in mobility or care needs chapter.

If the individual either

• knowingly fails to report the change
• fails to report the change as soon as reasonably practicable after the change occurred,

the case manager would set the date of either:

• change
• end

of entitlement to the date the individual should have notified the change (ADP regs, reg. 46(1)(b)(i)).

In all other cases, the decrease or end of, entitlement should take effect when the case manager makes the determination.

The case manager should use the timeframes set out in the Change of circumstances: change in mobility or care needs chapter to establish whether the individual could reasonably have been expected to report this change sooner. This is to establish when the individual’s change of entitlement begins.

If the individual should have reported their change sooner, but informs the case manager of circumstances which meant they could not report the change sooner, the case manager can set a later start date for the change in entitlement, if it would be unjust not to do so. See the ‘Setting an later start date if it would be unjust not to do so’ section for more information.

Setting a later start date if it would be unjust not to do so

When completing the change of circumstances form as part of their review pack, clients might tell us that they have circumstances which meant they could not report their change sooner or give a reason why they think a reduction in their award should happen from a later date.

The case manager can set a later start date (than the date they should have notified us) if the entitlement has decreased or ended following the determination. This is only possible if it would be unjust not to do so (ADP regs, reg. 46(2)). One example would be where the individual’s condition has improved slowly and the decrease in needs was therefore not noticed for a while, however they should still have reported it before they reached scheduled review.

The case manager must refer to the relevant DMG chapter when deciding whether setting an later start date would be appropriate.

If a case manager is uncertain about whether it would be unjust to not set an later date for a change of entitlement, they should seek advice from their decision team manager.