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
• any supporting information available
• any decision-making tools you used

It also means that you have made the determination based on the standards for good decisions set out in this chapter.

Related reading

• The balance of probabilities
• Finding of fact and conclusions of law
• Decision-making tools
• Getting determinations right
• Making robust decisions – example section

What to consider when making a determination of entitlement

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
• any supporting information, if available, including confirmation from a professional and the statement of support
• 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
• decision-making and medical guidance
• advice received through a case discussion

Related reading

• Decision-making tools
• Establishing if information is relevant
• Types of information not to consider
• Supporting Information chapter

Applications without relevant confirmation from a professional

For applications that have been submitted without any, or without relevant, confirmation from a professional (including the statement of support completed by a professional) you will have to establish whether you’re able to broadly establish a holistic picture of the client’s circumstances based on the information you have and can make a robust decision on the balance of probabilities.

Refer to the decision tree in the Supporting Information to understand what steps to take. You should only request, or gather, confirmation from a professional if there are significant inconsistencies that prevent you from being able to make a robust determination.

If you are unsure whether you can make a robust decision, you should

• Use decision-making tools
• Refer to the Making robust decisions – example section in this chapter

Once you have either

• Established good cause for the confirmation from a professional not being available
• Received confirmation from a professional

you should move on to establishing the individual’s entitlement