Denying an application due to lack of supporting information

We’re required to make a determination on every application we receive. In instances where there is either

• no confirmation from a professional and no good cause when you have determined that a confirmation from a professional is required
• not enough information to determine entitlement after using the relevant decision-making tools,

you can make a determination that the individual is not entitled to assistance.

An individual’s application can be denied due to lack of confirmation from a professional if all of the following are met:

• you have determined that in order to make a robust decision, the application does require a confirmation from a professional
• you try, unsuccessfully, to gather the confirmation from a professional
• there is no good cause for why there was no confirmation from a professional

A lack of confirmation from a professional or good cause is not the only basis for denying an application on grounds of supporting information.

Alternatively, an individual’s application can be denied if you are unable to determine the individual’s entitlement based on the information available. To deny an application on this basis, all of the following must be met:

• they have a confirmation from a professional or you have established good cause, or you have determined that they do not require a confirmation from a professional
• the information provided in their application form does not provide enough detail for you to establish their entitlement
• you have used other decision-making tools to resolve these gaps or inconsistencies, but you are still unable to establish entitlement
• you tried to gather more additional supporting information and did not receive the detail you needed
• due to inconsistencies or lack of detail, you were unable to establish their entitlement based on the balance of probabilities
• you have made every effort to support the individual to provide more additional supporting information, including offering to gather it on their behalf.

Disengagement

You must use discretion and judgment where an individual:

• is uncooperative about providing supporting information
• has not responded to us

If the individual has disengaged, you should use discretion to make a person-centred decision based on the individual’s situation, and consider:

• good cause
• the balance of probabilities
• a case discussion

Every effort must be made to:

• contact the individual to explain that a lack of information may cause delays and impact their determination
• understand or explain gaps or inconsistencies using decision-making tools

When carrying out a review, the individual might fail to supply requested supporting information. You must use judgement and discretion to consider whether their assistance should be suspended.

Deadlines

You should set a deadline for the individual to respond to a request for information only if:

• you’ve made every effort to contact the individual by other means
• more additional supporting information is strictly necessary to determine an individual’s eligibility to PADP

Suspensions

You may need to suspend an individual’s entitlement to Pension Age Disability Payment.

Suspensions can happen as part of any determination where:

• the individual has ongoing entitlement (the individual is a client, and you are carrying out a review)
• a decision must be made without an application or review form (known as an ‘unscheduled review')
• the individual has failed to provide requested information by the end of the period you set

Before suspending an individual’s award, you should

• consult and follow the guidance on suspensions.

In suspending payment of Pension Age Disability Payment, you should make a further request for the information. The request should note that, if the individual fails to supply the information by the new deadline, you may then determine that the individual is no longer entitled to Pension Age Disability Payment.

Where an individual has an existing entitlement to Pension Age Disability Payment, you may need to make a nil award as a result of the individual failing to supply the necessary supporting information.

Related Reading

• local delivery
• principles of decision-making
• suspension of assistance
• how to send a supporting information request
• good cause
• balance of probabilities
• establish the value of a piece of supporting information
• helping the individual to gather supporting information
• equal consideration
• Gaps and inconsistencies