The 3 steps you must take if your PIP claim is rejected - including taking DWP to court

-Credit: (Image: Getty Images/iStockphoto)
-Credit: (Image: Getty Images/iStockphoto)


Every year, thousands of Personal Independence Payments (PIP) claims are rejected. So, what should you do if your claim isn't successful?

PIP is the primary disability benefit for working-age individuals in England and Wales, with approximately three million people currently receiving it. The benefit is not awarded based on your condition, but rather how your condition impacts your daily life.

This means a wide range of disabilities or medical conditions could potentially qualify. The amount received depends on how challenging everyday tasks and mobility are for the individual. There are two components - daily living and mobility - each divided into a standard rate and an enhanced one.

Read more Venice introduces new rules as city limits number of people you can travel with

The maximum weekly payment currently stands at £184.30, reports the Mirror. However, this does mean that the claiming process can be quite complex. According to data from the Department for Work and Pensions ( DWP ), only about 52% of PIP claims are successful on average.

However, success rates can vary depending on the main disabling condition. For instance, PIP claims for Rheumatoid Arthritis have a success rate of 74.7%, while those for Type 1 Diabetes are as low as 28%.

If your PIP claim is unsuccessful, there are steps you can take, starting with the Mandatory Reconsideration process. Recent figures reveal that during 2022/23, around 5,300 people successfully challenged the DWP's initial PIP award decision.

Of those, 1,500 individuals were granted at least one enhanced rate for either the daily living or mobility component of the disability benefit through the process. Around 28% of claimants who were awarded PIP at the Mandatory Reconsideration stage, after initially being denied, received at least one enhanced component.

Citizens Advice suggests that if you're unhappy with a DWP decision on PIP, whether it's because you didn't receive it, the rate was lower than expected, or the duration of the award seems insufficient, you can challenge it. Below are the steps to take when disputing a DWP decision.

Contact the DWP

Firstly, if the PIP decision is unclear, contact the DWP for clarification. You'll typically get the outcome in a letter, which, according to Citizens Advice, will have information on whom to reach out to for an explanation.

If you disagree with their reasoning, the next step is to request a "Mandatory Reconsideration". To initiate a Mandatory Reconsideration, you must ask the DWP to review their initial decision. Remember, there's a one-month deadline from the date on your decision letter to request this.

Citizens Advice recommends the "best way" to apply for reconsideration is by downloading the CRMR1 mandatory reconsideration request form from GOV. UK, filling it out, printing it, and then posting it to the DWP, as the form cannot be submitted online.

If you're unable to utilise the form, you can write a letter to the DWP detailing your disagreement with their decision. Citizen's Advice suggests that while you can ring the DWP, it's more beneficial to have everything documented in writing.

After the DWP has revisited its decision, they'll dispatch a Mandatory Reconsideration Notice to you. This will inform you whether the decision has been altered or remains the same.

Appeal to a Tribunal

If the DWP's verdict isn't modified through Mandatory Reconsideration, you have the option to appeal to an independent panel known as a tribunal. The tribunal examines evidence from both parties before reaching a final decision.

Specifically, the appeal will scrutinise whether the decision was correct at the time it was made - they won't take into account if your condition has deteriorated since then. To be permitted to appeal to the tribunal, you'll need to complete an appeal form, which is available online at GOV. UK for you to fill out, or you can lodge your appeal online.

To appeal, you'll require your letter from the DWP bearing the words Mandatory Reconsideration Notice at the top - if you've misplaced it, you'll need to request a new one from the DWP. You'll also need to submit your appeal form within one month of the date displayed on the mandatory reconsideration notice.

Citizens Advice highlights that the "most important" segment of the application is the "Grounds for appeal" section. This bit requires specific reasons pointing out why you disagree with the decision.

While writing this part, your decision letter, statement of reasons and medical assessment report should be utilised to reference each of the statements you disagree with and provide reasons. Citizens Advice suggests furnishing facts, instances and medical proof (if available) backing your assertions.

When dispatching your appeal form, Citizens Advice states it would be "better" to request an "oral hearing", meaning you'd be present at the hearing in person. The benefit being: "Having an oral hearing gives you more opportunities to put your case forward and a better chance of winning."

Take down dates when you're unavailable. If a hearing is planned for a day you can't make it, altering it might become impossible.

As you mail your appeal documentation, remember to do so by recorded delivery or acquire proof of postage. This nugget from Citizen's Advice could prove useful if the tribunal service accuses you of missing the deadline or in instances where the letter goes astray in the post.

At the tribunal

Once the HM Courts and Tribunal service receives your form, they'll check it and request a response from the DWP within 28 days. The hearing itself is set to be more "informal" than a traditional court setting, taking place outside of a formal courtroom.

A legally qualified judge will preside over the panel, which may include up to two other independent individuals, such as a doctor. During the hearing, you'll face questions, and a DWP representative might also attend to present their side.

If your appeal turns out successful, expect an official notice in your letterbox within a fortnight. The DWP will then be obliged to back-pay you all that you're owed from the initial claim date, typically taking four to six weeks to process.

Should the appeal not go your way, you'll receive a guide alongside the official notice detailing further steps. In some cases, there's the option to escalate the matter to the Upper Tribunal if you believe there was a legal error, though disagreement with the outcome alone isn't grounds for this.

Citizens Advice has issued a caution that the tribunal journey can be lengthy, with their website stating: "The process can be draining but it's worth remembering that more than half of people who appeal their PIP decision win at a tribunal. If you feel the decision is wrong, don't be put off appealing."