Requesting more supporting information

In some cases, you may not have enough information to understand the individual’s circumstances and entitlement based on:

• the review form
• available additional supporting information
• the balance of probabilities

This might be due to

• gaps
• inconsistencies

in the information you do have available.

Information provided by the individual or their source might not contain enough detail to make a determination if the information is:

• of low value i.e. generic information about a condition, rather than about a person’s needs
• not up to date i.e. information from a time when their needs were significantly different
• not provide the level of detail needed to understand an individual’s needs, particularly where the case is complex

You can ask for more information if:

• there’s not enough information to make a determination on the balance of probabilities
• you’ve considered other decision-making tools, such as medical guidance and case discussions, and it is more likely than not that these tools will not help you move to making a determination.

You can contact an individual only where necessary to:

• clarify information already provided
• update or confirm details on a form
• ask for another source of information
• get more information to support what the individual told us

This means that you must not request more additional supporting information because you:

• would find it interesting to find out more about the case in question
• would find it helpful, but not strictly necessary, to learn more
• do not feel confident enough to make a determination as you are new to the role
• need more general information on the individual’s condition when this information is also available in medical guidance or upon request through a case discussion with a practitioner
• need to have confirmation from a professional where you have concluded they do not need one. For example where an individual has good cause for not having this.

Individuals can request help to gather supporting information at any time.

When requesting supporting information, you should limit the number of questions asked. You should also keep the questions general enough for the provider to give information on the individual’s condition and needs.

Who to ask for more additional supporting information

Depending on the details you need to make a determination, you should decide whether you should request this supporting information from:

• a professional
• the individual’s wider support network

Before asking for more information, you should consider whether information about a condition or disability can be gathered by using other decision-making tools, such as

• medical guidance
• a case discussion

As with all supporting information, anything additional should be:

• given equal consideration
• used to broadly support the information provided in an individual’s application or review form

You must never ask an individual to ‘prove’ or ‘disprove’ anything they have told us about any aspect of their:

• conditions
• disabilities
• needs

If no additional supporting information is available

Other decision-making tools may be necessary to establish the facts of a case in cases where all of the following apply:

• you do not need to gather a confirmation from a professional. It may have already been provided OR you have established good cause OR you have concluded that it is not needed
• the review form does not contain enough detail for you to conclude whether it is more likely than not what their current needs are
• there is no additional supporting information from any other source

One of those tools includes requesting more additional supporting information. You should ensure that this is the best tool for gathering the missing details before using this tool.

Other tools may be more appropriate, or produce results quicker, than gathering more additional supporting information. These include a follow-up call with the individual and case discussions.

Before requesting further additional supporting information, you should always attempt a follow-up call and/or a case discussion, if it is appropriate to do so.

Where you have utilised the available decision-making tools and you have still been unable to gather all the information you need, you should:

• continue to make a determination based on the facts ypu have been able to establish
• continue to use the balance of probabilities, as always, throughout this decision-making to establish what needs they are more likely than not to have
• recognise that this might lead to a lower award than the individual might have expected