Social Security Experience Panels - re-determinations and appeals, fraud and special measures for COVID-19: main report

Special measures for late re-determinations, appeals and applications

Views on measures introduced during COVID-19 for late re-determinations and appeals

Special measures were implemented during the pandemic which allowed clients to submit a re-determination or appeal request beyond one year of the determination or re-determination if the reason for the lateness was COVID-19^[5]. Participants from the focus groups and interviews were asked if they agreed that now is the right time to stop these measures for COVID-19. Mixed views were provided.

Many participants who agreed that it is right to stop COVID-19 measures said that the pandemic does not represent as high a risk as it was when it started. Some felt that the pandemic is now over, so COVID-19 cannot be a reason for any lateness in requesting a re-determination or an appeal.

"I agree to stop measures. I know it is wrong to say that COVID-19 is on [the] way out, but it is not necessarily as bad it was when everything was shut down. Maybe the time is right [for] everything to move forward. You can't use COVID as an excuse now." (Interview participant)

Other participants noted that although the pandemic is continuing it has become normalised and is no longer an exceptional event and can no longer be regarded as a sufficient excuse for any delays.

"I think that what we know is that COVID-19 is going to be around for many years to come and we're going to have to live with it. If that's going to be the norm, then the rules should go back to the norm. How can you wait a year then suddenly decide, nope I've got COVID […] using COVID as a reason now, it's not a good enough reason for people not putting in paper work." (Interview participant)

Other participants who agreed that it is the right time to stop COVID-19 measures noted that the public are now better protected through vaccinations and safety measures and that public services are largely back to normal; hence the rules about late re-determinations and appeals should also go back to their pre-pandemic state.

"Yes, I think it is the right time to stop them now. I think the majority of things are pretty much getting back to normal now. I don't think it's necessary to continue. A year is more than enough time to do these things, even if you have problems getting hold of somebody, I think it's a good idea just to let it go now." (Interview participant)

"We are all more and less vaccinated now so we don't have it as bad now." (Interview participant)

Some participants who disagreed or were not sure if it is the right time to stop the COVID-19 measures mentioned that some people experience long covid and due to its health effects, they should be allowed a longer period of time for their re-determination and appeal requests.

"…basically they've already said that COVID will flare back up and if we are going to go through anything like we've been through in the past, it's not the right time. Taking it away too quick could be to the detriment of people. People could be lying ill in bed for a year with long COVID, the effects of that could be horrendous. If that person is the only one doing their application, they might need longer still." (Focus group participant)

Some participants disagreed with stopping the COVID-19 measures because they noted that levels of infections are still high, and the health effects of COVID-19 can still be very serious.

"There's still a lot of infections, but it's not as present in the media. There are still millions of people infected. It's being a little bit premature. […] I think still allow for COVID because we don't know the full extent of the after effects of COVID. Some people have been floored and have long COVID and cannot work. This could have an effect on their benefits and their claims and how they claim. I wouldn't drop it yet, maybe revisit it. It may be an overreaction, but you need to know that you are still thinking about it and care about it." (Interview participant)

Others who disagreed with stopping the COVID-19 measures noted that there are some vulnerable and disabled people who cannot have the vaccine, meaning that they can still get seriously ill and that this could consequently result in delays to their re-determination and appeal requests.

"…some people on ADP can't have the vaccine, some are still vulnerable, so some people are still very affected. If COVID is the reason, they should still have that option." (Focus group participant)

The timescale for late re-determination and appeal requests

When asked about their views on stopping the COVID measures some participants highlighted that one year is a fair and long enough timeframe for late requests, and that there are no justifiable reasons to delay a request beyond one year.

"No conceivable justification for that kind of leeway anymore as COVID pandemic largely over. No reason to extend beyond a year for any reason. That is more than a reasonable amount of time for someone to appeal a decision." (Interview participant)

Two participants who acknowledged the health effects of experiencing long COVID suggested that one year is still a sufficient period for submitting re-determination and appeal requests.

"I think you have to allow for long COVID. If someone says they have long COVID they should be allowed a longer period. I think one year is a fair cut off." (Interview participant)

Special measures for late applications

Special measures are also in place for late benefit applications if the delay is due to a reason related to COVID-19. For some benefits there is already legislation that allows an application to be treated as made 'on time' if there is good reason for the delay, but for other forms of assistance there is no flexibility for late applications other than the COVID-19 reason.

Views on COVID-19 as a valid reason for late applications

Research participants were asked if they agreed or disagreed that applications for assistance to Social Security Scotland should no longer be able to be treated as valid where they are made late and the reason for that delay is related to COVID-19. Similar views to the ones conveyed for late re-determination and appeals requests and COVID-19 were highlighted by participants

Participants who agreed that COVID-19 should not be a valid reason for late applications noted that people are now used to living with the pandemic, and are also better protected because of the vaccines. Hence, the COVID-19 measures are no longer relevant.

"Yes, take it away we are all getting used to COVID now [...] we have to learn to live with it and that's why the vaccines are there to help." (Interview participant)

One participant noted that having COVID-19 alone is not a good enough reason to postpone administrative tasks such as completing applications.

"You set lots of timeframes and people will apply within that time, I think the slippage is on the other side and there should be penalties for that. Using COVID as a reason now, it's not a good enough reason for people not putting in paper work." (Interview participant)

Some participants who disagreed with removing the special measures for late benefit applications highlighted that COVID-19 still affects people's health, particularly vulnerable people.

"I disagree. I think COVID should still be considered as a reason for being late. People are still catching it and becoming ill from it […] I know far too many vulnerable people and I wouldn't want to put them at risk. I think it's the same as any infectious illness." (Interview participant)

A few participants mentioned that some people can experience long COVID or that there is still a risk of hospitalisation because of COVID, both of which could delay submitting applications.

"If they are hospitalised because of COVID then that's a valid reason. There has to be some flexibility and common sense." (Interview participant)

Others noted that some people cannot work on the application process when infected with COVID, especially when they do not have any support to help them with completing application forms or requests.

"COVID-19 is still a valid condition. If it's a single person who doesn't have assistance, that would be a valid reason for a delay. Trying to get medical information can take 6 weeks so applications can be late because of this." (Interview participant)

Reasons for late applications

Participants were asked if they agreed or disagreed that the ability to apply late with a 'good reason' should be extended to reasons other than COVID-19. Participants agreed with this proposal. They gave various 'good reasons' that can be valid for late applications.

Client or family member being ill

Some participants stated that a client or their family member being ill is a good reason for an application being delayed. They mentioned that a range of illnesses may include long-term health conditions which can become worse, or which may have a long-term effect. Mental health conditions were also noted as good reasons. Many participants mentioned stays in hospitals as a valid reason.

"Yes, you can apply late with a reasonable excuse at the moment. I consider a good reason to be hospitalised, for example." (Interview participant)

Some participants had contrasting ideas about which illnesses should be considered as valid reasons for late applications. Whereas a few mentioned that all illnesses should be considered, others noted that 'your everyday illnesses' (for example, flu or chicken pox) should not be considered as good reasons for delaying submitting applications.

"Application might be late because a family member was ill, not COVID; but might have broken a hip and been in hospital or just come out of hospital and haven't filled in a form or forgotten to fill in a form. The other reasons would have to be quite strong, not I had the flu, I forgot, my child had chicken pox. It would have to be a strong reason. Otherwise, there would be too many loose ends." (Interview participant)

"I'm not being funny, but I think it should be for everything, if it's a health-related issue it could be that you've had to go to the hospital to get tests or anything, or it could be that you've had a bad flu, if you've had a bad flu, you don't want to be dealing with applications and that. I think any reason could be a good reason." (Interview participant)

Supporting evidence

Some participants said that getting supporting information/evidence from health professionals can take longer than the timeframe for applications, and these delays could be a good reason for late applications.

"A lot of the time when you are putting stuff together it takes time. If you are trying to get information from the GP, it takes time." (Interview participant)

"If you were waiting on some supporting evidence, that should be taken into consideration." (Focus group participant)

External support

Some participants highlighted that a client may need external support from third sector/advocacy organisations to complete applications, however the waiting period for that support may be longer than the timescales to complete and submit applications.

"We had a deadline but by the time we got involved with the financial inclusion team this brought us over the deadline …" (Interview participant)

Family reasons

A few participants noted some family circumstances such as caring responsibilities or having a baby as good reasons for late applications.

"Should be extended to other reasons, for example if someone has just had a new baby or young children they might forget. Some people are sick for a very long time and struggle to function. You should be able to have a year to do a re-determination if you have a new baby, you can't get out of bed because of illness and you had no mental facility to deal with it at that time." (Interview participant)

Unexpected life events

A few participants mentioned accidents, family bereavement, breakdown of a relationship or moving house as good reasons for late applications.

"Illness, bereavement, trauma and unexpected accidents, relationship breakdown, moving house." (Interview participant)

Other reasons

Some participants mentioned other circumstances such as delays in receiving forms, having no support to complete forms, or coming out of prison as reasons that could impact on whether an application was submitted on time. Others also mentioned that the reasons for late applications should be assessed on case-by-case basis.

"Can't have a definitive list of reasons, but a client would give a reason and it would have to be assessed. A case-by-case basis. Need to say that you reserve the right not to accept their reason." (Interview participant)