What a determination of entitlement is

Case managers are responsible for determining whether or not an individual is entitled to PADP.

PADP can be paid at two different rates, the lower or higher rate. More information on the rates of PADP can be found in the Rates and Criteria chapter.

Case managers must determine whether an individual meets the criteria of entitlement to PADP. The criteria of entitlement refer to:

• the residence and presence conditions, which are set out in the Residence and Presence chapter
• the age criteria, which are set out in the Rates and Criteria chapter
• The daytime and/or night-time conditions for are which are set out in the Rates and Criteria chapter.

Individuals entitled to any of the following benefits are not entitled to PADP (PADP regs, reg 4):

• Armed Forces Independence Payment
• Attendance Allowance • Adult Disability Payment
• Disability Living Allowance
• Personal Independence Payment

Individuals must meet the residence and presence conditions and the age criteria to be entitled to PADP.

A determination of entitlement to PADP consists of:

• a decision about whether or not the individual is entitled to PADP
• if the individual is entitled to PADP, a decision about:
  • if they are entitled to the lower or higher rate of PADP
  • when they will become entitled to PADP
  • reducing the payment of the weekly rate of PADP to zero when the individual is resident in alternative accommodation for more than 28 days.
  • reducing the payment of the weekly rate of PADP because of entitlement to other benefits, such as Constant Attendance Allowance.

This chapter provides an overview of how and when case managers make determinations of entitlement to PADP. More detailed information on the specific aspects of making determinations are provided in linked chapters.

Case managers are required to make determinations of entitlement when they:

• receive an application for PADP
• are required to make a determination without application as part of a scheduled or unscheduled review
• an individual requests a re-determination

The rules also require a court or tribunal to make determinations of entitlement if an individual makes an appeal regarding a determination of entitlement (SS Act 2018, s25). This chapter will focus on determinations of entitlement made by case managers.