Lack of confirmation from a professional and good cause

Individuals are encouraged to provide confirmation from a professional when they apply.

If confirmation from a professional has not been provided with the application, you must decide whether either

• good cause can be established
• confirmation from a professional should be requested. Despite not initially establishing good cause, the following sections explain how it can be established after going out for a confirmation from a professional.

Refer to the decision tree to guide your next steps.

There are many reasons an individual may not be able to provide confirmation from a professional.

Good cause

Establishing ‘good cause’ allows you to make a positive determination despite not having confirmation from a professional. It refers to there being a reasonable explanation as to why the individual has not provided this supporting information.

In the PADP context, ‘good cause’ can be established at two points.

1. Good cause for not having a confirmation from a professional at the application stage. If confirmation from a professional is not provided with the application, you have to establish whether confirmation from a professional is required for you to make a robust determination. Use the decision tree for this decision. If confirmation is not needed, you can establish good cause and move on to making a determination.
2. Good cause for not having a confirmation from a professional when requested. If you have established that good cause does not apply at point 1 above and confirmation is needed, it might turn out that confirmation from a professional is unavailable or delayed. You can establish this either before going out for a request (i.e. the individual informs you of the reasonable explanation) or after your request has gone out (i.e., you or the individual has been unable to gather it). If there is a reasonable explanation for why it is unavailable or delayed, you can establish good cause and move on to making a determination without confirmation from a professional.

Good cause for not having a confirmation from a professional at the application stage

We are encouraging everyone applying for PADP to provide confirmation from a professional.

However, it can be assumed that there is an explanation for whythe confirmation from a professional might be available less frequently for PADP applicants.

If an individual has not provided confirmation from a professional with their application, it might therefore be appropriate for you to establish good cause based on that explanation, rather than for you to – potentially unsuccessfully – automatically request confirmation from a professional in every case where it has not been provided with the application.

At this stage, you do not need to determine a specific reason for establishing good cause. The general explanation above can be used to establish good cause for most applications that are submitted without a confirmation from a professional. You may be able to determine a specific reason, for example one of the reasons listed in the next section, but it is not required at this stage in order to establish good cause. The key reason you would not establish good cause here would be if the information provided had an significant inconsistency that needed resolving.

Where there is a lack of a confirmation from a professional, you should always consider if there is good cause before requesting or gathering a confirmation from a professional.

For reviews, it is not a requirement for the individual to provide supporting information, including a confirmation from a professional, when reporting a change of circumstances. You should only request it, when, following the guidance set out in the reviews chapter, you determine that supporting information is needed. The guidance in this chapter regarding good cause for not having a confirmation from a professional when requested also applies to reviews.

When it is appropriate to establish good cause for not having a confirmation from a professional at the application stage

If confirmation from a professional is not provided with the application, you should refer to the section Can I make a robust determination with the information available? to establish whether it is required for the decision. If you decide that it is not required, you can establish good cause and establish the individual’s entitlement.

You can still establish good cause if a confirmation has not been provided but, using the decision tree, you establish that it is required to make a robust decision. The section ‘Good cause for not having a confirmation from a professional when requested’ will help you when you do not get the necessary confirmation from a professional when requested.

Good cause for not having a confirmation from a professional when requested

If confirmation has not been provided but you have established that it is required to make a robust decision, you might still not be successful in gathering it or requesting it from the individual.

The following guidance in this section also applies to being unsuccessful when gathering confirmation from a professional, where needed, at review stage.

You should then establish whether the individual might have a reasonable explanation for:

• a delay in providing information
• not providing information
• disengaging from the supporting information gathering process

These reasonable explanations will be the foundation for establishing good cause where a confirmation from a professional has been requested but it has not been provided. At this stage, the individual will need a specific explanation as to why you have been unable to gather a confirmation from a professional. Examples of these reasons are below. You cannot retrospectively apply the broad explanation for good cause that is described in earlier sections because you determined a confirmation from a professional was needed.

Reasonable explanations might relate to:

• lack of access to or contact with professionals
• their health or disabilities
• a hospital stay
• being placed in local authority care or legal detention
• lack of support needed from an advocate or support worker, including in relation to providing support to fill out the application or review form
• dealing with an unexpected life event, like a death in the family
• having difficult lives due to their disabilities or conditions
• how their condition/s are managed i.e. when older people are in receipt of services, they may be more likely to receive input from multiple care providers and there can be a lack of any one professional who has the oversight necessary to provide the confirmation from a professional
• the level of input by professionals i.e., their condition is managed by their family and wider support network with minimal professional input. This has historically been the case with learning difficulties and disabilities, and mental health conditions.
• Unresponsiveness to, or lack of engagement with, supporting information requests.

This list is not exhaustive.

Good cause due to unsuccessful supporting information requests

Good cause for supporting information being unavailable does not just apply to the individual’s personal circumstances. It also applies where the response from a professional to your, or the individual’s, supporting information request does not deliver the outcome you were hoping for.

Where a professional:

• is unresponsive to a supporting information request
• responds declining to answer your questions
• provides a response that is of low value
• does not provide information relevant to the individual or the application (e.g. sending a leaflet on a condition, rather than confirming that the individual has the condition or how they are impacted by the condition)

you can establish good cause for why you did not receive the confirmation from a professional you requested. This guidance also applies to reviews.

Lack of confirmation from a professional when it is requested and no good cause

This scenario is where you:

• determined that a confirmation from a professional was needed to make a robust determination
• were unsuccessful in gathering the confirmation from a professional
• could not establish a reasonable explanation as to why a confirmation from a professional was not available.

Where this is likely the case, before you establish whether or not there is good cause, you should ensure that the individual understands

• what confirmation from a professional is
• how to find and submit it
• that we can gather it on their behalf.

If confirmation from a professional still doesn’t become available after this engagement, you should go on to make a negative determination.

Refer to the decision tree for an overview of the steps outlined in this section.

After you have established good cause

If you have established good cause, you should move on to establishing the individual’s level of need and their entitlement. You should use the information you have available to you to do so, such as the information provided by the individual in the application form.

Lack of supporting information where the individual is unlikely to meet the PADP eligibility criteria

The information an individual provides on their application or review form can suggest they’re unlikely to meet the eligibility criteria, for example, because it is unlikely that their needs are significant enough to qualify for the benefit.

If the individual has asked you to gather supporting information on their behalf, you should take the steps necessary to do so.

If the individual has both:

• not provided supporting information
• not asked Social Security Scotland to gather it on their behalf

you must request a case discussion to understand whether it is more likely than not that supporting information would change the outcome of the application from a likely deny to a likely award. This includes both the confirmation from a professional and additional supporting information. As case managers are not health and social care professionals, you are not able to determine whether supporting information could potentially provide crucial details that might lead to an award.

This is because individuals with certain conditions are likely to under-report their needs. In order to ensure we are making fair and balanced decisions; you should make every effort to understand the individual’s condition to ensure they can access the support they are entitled to.

If the outcome of the case discussion helps you to conclude that supporting information would change the outcome of the application from a likely deny to a likely award, you should refer to earlier guidance on good cause as the issue of no confirmation from professional remains.

If the outcome of the case discussion helps you to conclude that supporting information would not change the outcome of the application from a likely deny to a likely award, you should refer to the guidance in this chapter on denials.

Related reading

• case discussions
• client-led route
• Agency led route
• follow-up calls with the client
• good cause
• local delivery
• Denials