Full list of conditions that qualify for DWP’s new ‘fast-track’ criteria for PIP
THOUSANDS of households eligible for Universal Credit and PIP will be able to receive payments faster under the new rules.
The Department for Work and Pensions (DWP) has now revealed exactly who can use a new, fast-track application process.
The Severe Disability Group (SDG) is being established to help identify applicants with the most severe and permanently disabling conditions.
If you are found to be eligible and selected for the group, you can go through an accelerated application process for Universal Credit, PIP and Employment and Support Allowances (ESA).
You will receive the highest disability benefit available to you without having to go through the usual application and assessment process.
To meet the SDG criteria, the Department for Work and Pensions says applicants must:
- If you have an irreversible or progressive condition, confirmed or managed by a secondary care specialist, with no realistic prospect of improvement
- Has not had a significant response to treatment, or treatment will not improve functioning, or no further treatment is planned
- Have severe impairment of physical or mental function (or are likely to develop within six months) such that they require assistance from another person to complete two or more activities of daily living
The DWP has also released a full list of the medical conditions that qualify for the new group.
Cardiorespiratory disorders
- Three-vessel coronary artery disease
- Heart failure scores three or four on the New York Heart Association (NYHA) and does not qualify for a heart transplant
- Pulmonary arterial hypertension
- Severe chronic respiratory disease (e.g. chronic obstructive pulmonary disease (COPD), fibrotic interstitial lung disease, diffuse pleural thickening) with grade five MRC dyspnea
Neurological disorders
- Severe spinal cord injury with irreversible disability leading to significantly reduced mobility, bladder dysfunction and deterioration of upper limb function
- Severe acquired brain injury, advanced dementia, or other condition causing cognitive impairment where the person is in residential or long-term hospital care or lives at home and is assessed as requiring 12 to 24 hours of supervision
- Motor neuron disease
- Advanced Parkinson’s disease with bilateral symptoms of tremor, rigidity and bradykinesia and balance disorders, plus a Unified Parkinson’s Disease Rating Scale (UPDRS) score of 21 to 30
- Advanced multiple sclerosis scores more than six on the Expanded Disability Status Scale (EDSS)
- Myasthenia gravis, which is refractory to immunosuppressive therapy, with frequent recurrences requiring hospital treatment
- Intractable epilepsy
- Heart attack
Musculoskeletal or rheumatological disorders
- Late or poorly controlled systemic connective tissue diseases
- Late or poorly controlled inflammatory arthritis
Cancer
- Incurable cancer diagnosis, highly symptomatic where the patient’s Eastern Cooperative Oncology Group (ECOG) performance status is greater than or equal to two
- Incurable cancer diagnosis where no suitable active treatment options exist or remain
Gastrointestinal or liver disorders
- Treatment-resistant inflammatory bowel disease
- End-stage liver disease with complications, highly symptomatic, reduced functional status and unsuitable for transplantation
Kidney disorders
- Stage four or five chronic kidney disease (CKD), highly symptomatic and reduced functional status despite or unsuitable for renal replacement therapy and unsuitable for transplantation
Immune or hematological disorders
- Immunodeficiency, highly symptomatic despite therapy, reduced functional status
- Aplastic anemia unsuitable for transplantation
Skin conditions
- Severe treatment-resistant inflammatory skin disease
- Genetic skin disease such as xeroderma pigmentosa or epidermolysis bullosa dystrofica
Chronic pain and fatigue
- Syndromes characterized by chronic pain and fatigue in which symptoms persist for long periods of time and affect multiple activities of daily living (ADLs)
Sensory conditions
- Presence of combined severe hearing loss (greater than 71 decibels loss) and certified as severely visually impaired (deafblind)
Multiple physical conditions
- Multiple disorders, for example combinations of COPD, coronary artery disease, diabetes and obesity that would not meet the criteria as a single condition, but may do so if present in combination
Mental, cognitive and intellectual disability
- An intellectual disability and meeting the five criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM) for a severe or severe intellectual disability
- Autism spectrum disorders and meet the criteria of DSM five level two or level three
- Long-term schizophrenia, not responding significantly to all treatment or rehabilitation options, under the care of specialist psychiatric or support services
- Long-term major depression or bipolar disorder that does not respond significantly to treatment, under the care of specialist psychiatric services
- Long-term alcohol or drug dependence, despite repeated failed withdrawal attempts and treatment by specialist alcohol or substance abuse services
- Borderline or severe personality disorder with long-term and ongoing involvement with psychiatric or support services and inability to respond significantly to all treatment options
- Long-term obsessive-compulsive disorder (OCD), unresponsive to treatment by intensive specialized treatment services, with severe persistent symptoms resulting in significant difficulty with ADLs
How does the group of severely disabled people work?
The SDG was first introduced in the 2021 Green Paper on Health and Disability.
The resulting Health and Disability White Paper published in 2023 found that design and testing of the Severe Disability Group had already begun in autumn 2022.
Now the DWP has confirmed that it is expanding the testing phase to a wider number of claimants for PIP.
It asks a select group of physicians to identify patients they believe are eligible, or contact claimants they believe are directly eligible to participate in the testing phase.
Under the SDG process, when a doctor or nurse determines that a patient meets the criteria, they must complete a short form to confirm the patient’s eligibility.
Forms must be completed and returned to pip.severedisabilitygroup@dwp.gov.uk within 15 working days.
While the focus of the SDG testing is on PIP for now, the DWP will roll this out to those eligible for Universal Credit and Employment and Support Allowances (ESA) in the future.
What is PIP?
HOUSEHOLDS suffering from long-term illness, disability or mental illness can receive extra help through Personal Independence Payments (PIP).
The maximum you can receive from the government benefit is €172.75 per week.
PIP is for people over 16 years old and under the state pension age, currently 66.
Crucially, you also have a health condition or disability where you have had difficulties with daily living or getting around (or both) for three months, and you expect these difficulties to last for at least nine months (unless you have a terminal illness are). with less than 12 months to live).
You can also claim PIP if you are in or out of work and you already have limited options for payments for work and work-related activities (LCWRA) when you claim Universal Credit.
PIP consists of two parts and whether you receive one or both parts depends on the severity of your condition.
You can get the mobility part of PIP if you need help getting out or moving. The weekly rate for this is £26.90 or £71.
For the daily living part of PIP, the weekly rate is €68.10 or €101.75 – and you can get both elements, for a maximum of €172.75 in total.
You can apply for PIP at the same time as other benefits, except the Armed Forces Independence Allowance.
Make a claim by calling the Department for Work and Pensions (DWP) on 0800 917 2222.
It comes after a High Court decision in July 2019 changed the way the DWP defines ‘social support’ in one of the PIP categories assessed.
Dubbed the ‘MM’ judgment, the DWP realized that hundreds of thousands could now be entitled to additional support.
It means that people may not have received one of the two elements of PIP even though they were actually entitled to it.
Others may have received the standard rate but should have received the increased rate, which is a higher amount.
In response, the DWP launched an administrative exercise in 2021, looking at PIP claims since 6 April 2016 to determine whether claimants may be eligible for more support.
In its latest update, the DWP says it has identified around 326,000 cases requiring assessment.
To date, around 79,000 cases reflecting MM’s judgment have been assessed and arrears totaling around £74 million have been paid out to 14,000 people.
The exact amount of retroactive PIP payments you might qualify for will depend on your own circumstances, but the average payout is around £5,285 per claim.
Check if you are affected.