What a determination of entitlement is

Case managers are responsible for determining whether or not an individual is entitled to Scottish Adult DLA.

Scottish Adult DLA has two components – the care component, which relates to the assistance that a person needs with daily personal care; and the mobility component, which relates to the assistance a person needs moving around. The care component has three rates: lowest, middle and highest. The mobility component has two rates: lower and higher.

More information on the rates of Scottish Adult DLA can be found in the Rates and Payment chapter.

Case managers must determine whether an individual meets the criteria of entitlement to Scottish Adult DLA. The criteria of entitlement include:

• 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 Payment chapter
• the daytime and/or night-time conditions for are which are set out in the Rates and Criteria chapter.

For information about what assumptions are made for the purpose of the case transfer determination, please see the Case Transfer chapter.

Individuals entitled to any of the following benefits are not entitled to Scottish Adult DLA (Scottish Adult DLA regs, reg 5 7) :

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

The care component of Scottish Adult DLA also overlaps with Constant Attendance Allowance (CAA) (Scottish Adult DLA regs, reg 28(4), (5) ). Individuals in receipt of the War Pensions Mobility Supplement (WPMS) will have their mobility supplement reduced to £0. It is possible that someone could receive both Scottish Adult DLA and one of these benefits, e.g. WPMS and Scottish Adult DLA care component only. (Scottish Adult DLA regs, reg 28(6))

Individuals must meet the residence and presence conditions, the age criteria, and have been in receipt of Disability Living Allowance (DLA) administered by the Department for Work and Pensions to be entitled to Scottish Adult DLA.

A determination of entitlement to Scottish Adult DLA consists of:

• a decision about whether or not the individual is entitled to Scottish Adult DLA 
• if the individual is entitled to Scottish Adult DLA, a decision about:
  • the rates and components of Scottish Adult DLA which they are entitled to
  • when their entitlement to Scottish Adult DLA begins or ends
  • reducing the payment of the weekly rate of Scottish Adult DLA when the individual is resident in alternative accommodation, e.g. hospital, care home, legal detention
  • reducing the payment of the weekly rate of Scottish Adult DLA because of entitlement to other benefits, such as Constant Attendance Allowance.

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

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

A court or tribunal is required 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.