ANNEX A
DLA RULES AND PROCEDURES
ENTITLEMENT
1. DLA is designed to help severely disabled people under
the age of 65 with extra costs incurred because they need help
with personal care and/ or have mobility needs. It provides extra
help for those disabled early in life who have lost the opportunity
to earn and save. Once awarded, DLA may continue in payment after
the age of 65, if the recipient continues to satisfy the conditions
of entitlement. A similar scheme exists in Northern Ireland.
2. Entitlement is based on the effect of disability
on a person's need for help with personal care and/or mobility
needs. It does not depend on specific disabilities. Claimants
must have needed help for three months and be likely to continue
to need help for at least a further six months. People who are
terminally ill and not expected to live for longer than six months
do not have to wait three months in order to receive help. In
addition these cases are given high priority with the BA aiming
to achieve a 10 working day turnaround between claim and notice
of award.
3. DLA has two components, care and mobility, and a claimant
may be awarded both. The care component has three rates and the
mobility component two. The amount payable depends on the claimant's
care and mobility needs. The mobility component is payable only
to those aged five or over.
4. To qualify for the lowest rate of the care component,
claimants must be so severely disabled physically or mentally
that they require attention in connection with their bodily functions,
such as washing, toiletting or dressing, for a significant portion
of the day (whether during a single period or a number of periods)
or are over 16 and would be unable to prepare a cooked
main meal for themselves even if they have the ingredients (the
main meal test).
5. The main meal test is a hypothetical examination of ability
to prepare and cook a meal, which is seen as a proxy of ability
to perform a wide range of household tasks. These include both
physical and mental activities, such as manual dexterity, ability
to stand, bend and reach, and ability to plan and execute activities.
The test is independent of the household appliances which are
available to the claimant.
6. To qualify for the middle rate of the care component,
claimants must be so severely disabled physically or mentally
that throughout the day they require frequent attention in connection
with bodily functions or continual supervision in order to avoid
substantial danger to themselves or others or at night
they require prolonged or repeated attention in connection with
bodily functions or that in order to avoid substantial
danger to themselves or others they need another person to be
awake for a prolonged period or at frequent intervals for the
purpose of watching over them.
7. To qualify for the highest rate of the care component
claimants must be so severely disabled physically or mentally
that they require attention day and night as referred to
above for the middle rate.
8. Children have two additional tests to satisfy in order
to qualify for the care component, designed to take account of
the fact that all children have care needs to some degree. These
are that they have care needs substantially in excess of those
of a non disabled child of the same age or have substantial
requirements that younger children in normal physical and mental
health might have but that children of the same age in normal
physical and mental health would not have.
9. The condition of someone qualifying for the mobility component
must be such that they can "from time to time benefit from
enhanced facilities for locomotion". To qualify for the higher
rate claimants must be so physically disabled that they are unable
or virtually unable to walk, or be both deaf and blind,
or be severely mentally impaired, display severe behavioural
problems, and satisfy the conditions for the higher rate of care
component. Invalid vehicle (trike) users can transfer their benefit
automatically to the higher rate mobility component and are not
subject to any age restrictions.
10. Satisfying the unable/virtually unable to walk condition
is independent of where a claimant lives or the place or nature
of their employment. Claimants will fail the unable/virtually
unable to walk condition if by wearing or using a prothesis or
artificial aid they would no longer be unable/virtually unable
to walk, but those who have lost both legs qualify automatically.
Factors in deciding whether someone may be virtually unable to
walk relate to how far their ability to walk out of doors without
severe discomfort is limited by the distance they can walk, the
speed at which they can walk, how long they can walk and in what
manner they can walk. The condition is satisfied if the exertion
required to walk would constitute a danger to the claimant's life
or would be likely to lead to a significant deterioration in health.
11. The severe behavioural disorder condition applies where
the claimant exhibits disruptive behaviour which is extreme, regularly
requires someone to intervene to impose physical restraint in
order to prevent physical injury to the claimant or others or
damage to property, and is so unpredictable that someone
must be present and watching over the claimant whenever the claimant
is awake.
12. The severe mental impairment condition applies where
a claimant suffers from a state of arrested development or incomplete
physical development of the brain, which results in severe impairment
of intelligence and social functioning. This was originally intended
for people with congenital disability, but has been extended by
a recent Commissioner's decision, which has stated that the brain
can continue to develop up to the age of 30.
13. For claimants to qualify for the lower rate of mobility
component a person must be so severely physically or mentally
disabled that, although able to walk, they cannot make use of
the faculty outdoors without guidance or supervision from another
person. In addition, those under age 16 must also show that they
require substantially more guidance or supervision than their
able bodied counterparts.
FORMS OF
MEDICAL EVIDENCE
14. Claimants have a choice of completing an extensive questionnaire
to identify care and/or mobility needs or a medical examination.
15. Once the claim has been passed to the adjudication officer
he can request a medical examination report from a doctor employed
by the Benefits Agency Medical Service (an "Examining Medical
Practitioner Report"), or a factual report from a doctor
who has treated the claimant. There are approved reports for certain
conditions and an approved list of questions from which a report
can be constructed. Reports can also be obtained from community
psychiatric nurses, physiotherapists or occupational therapists.
In addition, medical advisors employed by the Benefits Agency
Medical Service can be asked to construct a report if the approved
reports or questions do not cover a particular case. They also
advise the adjudication officer on medical matters.
DURATION OF
PAYMENT
16. Awards may be for a fixed period of six months or more,
or for an indefinite period ("for life" awards). Benefit
is paid four weekly (three in arrears, one in advance) by order
book or by automated credit transfer (ACT) paid four weekly in
arrears.
AMOUNT OF
PAYMENT
17. Weekly amount from April 1997. April 1998 rates given
in brackets.
| Care component |
| Highest | £49.50 | (£51.30)
|
| Middle | £33.10 | (£34.30)
|
| Lowest | £13.15 | (£13.60)
|
| | |
| Mobility component |
| | |
| Higher | £34.60 | (£35.85)
|
| Lower | £13.15 | (£13.60)
|
"LIFE" AWARDS
18. Awards of DLA are made "for life" where a disabled
person is considered likely to continue to satisfy the qualifying
criteria. Correctly speaking, they are made for an indefinite
period for as long as the person satisfies the criteria. People's
needs may increase if their condition deteriorates or decrease
as they adapt to a disability or their condition improves.
19. It is a general feature of the social security scheme
that changes in claimants' circumstances may affect their entitlement
to benefit. Evidence of a change of circumstances in DLA cases
results in a "life" award being reviewed in the normal
way and benefit may increase or decrease. As with any change made
to an award, the claimant has full rights of review and appeal.
In certain circumstances legislation provides that life awards
may be protected from unnecessary review.
FIXED PERIOD
AWARD EXAMPLES
20. In cases where a "life" award is not appropriate,
an award will be made for a fixed period. All the individual circumstances
of the case will be taken into account. The two following examples
give a flavour of the type of circumstances leading to fixed awards.
Example 1
21. A man suffers from agoraphobia causing panic attacks
when walking outdoors. He attends support groups and received
therapy for his condition, which may reduce his need for guidance
or supervision. The Adjudication Officer awards the lower rate
mobility component for three years.
Example 2
22. A 58 year old woman makes a claim after suffering a stroke.
There are no other disabling conditions. She satisfied the day
attention conditions. Guidance suggests that any improvements
may continue for a year. The Adjudication Officer awards the middle
rate, care for one year.
RENEWAL CLAIM
PROCEDURE
23. Claimants are invited to make a renewal claim six months
before the expiry of their existing awards. A simplified version
of the initial claim form is used.
PASSPORTING FROM
DLA
24. Annex E gives details of the inter-relationship of the
various disability benefits and help.
| 
