Not making changes to the level of entitlement due to lack of supporting information

We’re required to make a determination on every review 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 the changes in an individual’s needs after using the relevant decision-making tools

you may conclude that the individual is not eligible for a change in entitlement.

A lack of confirmation from a professional can be a reason for this if all of the following are met:

• you have determined that in order to make a robust decision, the review 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 not making changes to an individual’s entitlement.

Alternatively, the outcome of a review may result in an entitlement lower than the individual was expecting if you are unable to determine the individual’s entitlement based on the information available. This happens only when all of the following are met:

• the confirmation from a professional is not the basis for not increasing entitlement i.e. 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 review form does not provide enough detail for you to increase their entitlement
• you have used other decision-making tools to resolve gaps or inconsistencies but you are still unable to establish an increased 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 needs that would increase 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 entitlement to Scottish Adult DLA

Suspensions

You may need to suspend an individual’s entitlement to Scottish Adult DLA.

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 Scottish Adult DLA , 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 Scottish Adult DLA.

Where an individual has an existing entitlement to Scottish Adult DLA , 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