DWP complaint
15. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.
16. Miss M complains that DWP did not tell her she needed to provide a fit note to support her LCWRA claim when it should have done.
17. Miss M says that DWP’s lack of appropriate advice regarding the fit note meant she was only awarded LCWRA from May 2022 (starting February but with a three-month period before payment starts as DWP’s ‘Universal Credit: Health conditions and disability guide’(the Guidance) states). She believes this should have been paid from January 2020 or, at the very latest, August 2021. She says that as she provided this in February 2022 as soon it was asked for, she would also have done this sooner if DWP had told her earlier that she needed to do this. Miss M also says it would, or should, have been obvious to DWP that she was not able to work or undertake work-related activities.
18. DWP’s Customer Charter says it will follow processes correctly and give its users correct information. It also says that, in return, it needs its users to give it the correct information at the right time and tell it when something changes.
19. The Guidance explains that where there is an existing claim for UC, any new health condition or disability needs to be reported to it as a ‘change of circumstances’. The Guidance tells the claimant that if the medical condition goes on for longer than seven days, they will need to submit medical evidence. It says ‘this will normally be a Statement of Fitness for Work (SoFFW). This is often referred to as a fit note, sick note, med cert or doctor’s note. This can be provided by a doctor or General Practitioner.’
20. This requirement was the same in each of the different versions of the Guidance that applied during the January 2020 to February 2022 period. It shows it is the claimant’s responsibility both to notify DWP of any issues and to provide evidence in support of these.
21. Because Miss M did not report the change and provide evidence of her condition until February 2022, DWP did not consider her entitlement to the LCWRA element until this time. As there was a three-month exclusion period between a claim being made and it being paid, this meant she started to receive the additional payment from May 2022 onwards. DWP’s decision to only pay Miss M from this point is in line with its Guidance.
22. Miss M says that DWP should have told her that she needed to take this action much sooner than it did. She explains that she started to experience health problems at the beginning of 2020 and says she made this clear to DWP when she visited her Work Coach at her local Jobcentre.
23. Miss M says she started to have chest pains, which she sought medical help with and told her Work Coach about. She says she was clear that she was no longer able to undertake work-related activities but was told she had to continue with these, which she did. DWP’s records reflected Miss M’s continued attendance at the Jobcentre and demonstration of actively looking for work. We have reviewed these records and see no reference to her disclosing her health problems during this time.
24. We have no reason to doubt that Miss M was experiencing health problems in 2020. Based on what we have seen, we cannot say this was discussed with her Work Coach or, if it was, how that conversation went. We were not present during these appointments, and there is limited documented information so we cannot say with any degree of certainty what was discussed within them.
25. Miss M says that she also discussed her ongoing health problems with her Work Coach in May, June and July 2021. Although DWP’s records reflect that she talked about her health, this was not in a capacity of it impacting her ability to work or look for work. Again, given the differing accounts provided and the lack of there being any evidence other than each party’s recollection of these conversations, we cannot conclude which was more likely to be an accurate representation.
26. DWP’s records reflect that Miss M told it her health issues were affecting her ability for work-related activities in August. They also note that Miss M’s Work Coach explained she would need to provide medical evidence to support this being the case, something which Miss M disputes. We know that Miss M discussed her concerns at this time and knew she needed to report the change via her UC journal because we can see she told DWP she was having difficulty doing this. We can also see that she asked her Work Coach for help with this.
27. Miss M says her Work Coach told her they would help her but failed to do that until February 2022. We note that the response she received to her August 2021 request was that they would discuss the way forward at her next appointment. We do not think this necessarily meant the Work Coach agreed to help her with the reporting but that it would speak to her about it.
28. There is no record of this issue being raised during Miss M’s September appointment with her Work Coach although DWP notes that she did report being worried about her health. If Miss M was expecting to obtain assistance reporting the change she had tried to make the previous month, we would have expected her to have raised this with her Work Coach.
29. This also applied to Miss M’s October visit to the Jobcentre, although we can she did leave a message for her Work Coach a few days after her appointment to ask for support when she next visited.
30. Miss M missed the November appointment as her mother had sadly died. DWP recorded during her December and January 2022 visits that she was grieving still. Miss M explains that she was very visibly upset when she attended these appointments and feels that her Work Coach should have told her then that she needed a FIT note as it would have been clear she was struggling. We have no doubt that Miss M would indeed have been very upset given the short time that had passed since her mother died. Bereavements are understandably devastating. While this is the case, it is not something we would expect DWP to have considered as likely to affect someone’s longer term capacity to look for work. Dealing with grief does not always mean the claimant is not capable of work or undertaking work-related activities. Plus, there is a responsibility on the claimant to notify DWP of a change.
31. Miss M says her Work Coach helped her to report the change to her health during her February appointment. She also says this was when DWP also told her that she needed to provide a fit note from her doctor. As explained above, we see Miss M was aware of the need for a fit note in August 2021. Miss M provided this, with the note starting from later that month. She continued to provide fit notes after this time and was referred for a Work Capability Assessment (WCA) in April.
32. DWP provides Guidance about medical issues and disabilities in conjunction with UC claims. This is publicly available online and the information would be well known to its employees, both via phone and in person. DWP’s Customer Charter and the Guidance are clear that there is an expectation that any changes of this nature must be reported to it by the UC claimant. In addition to this, the claimant must provide evidence to support their claim of being unable to work or undertake work-related activities. Both things must be done.
33. We have not been able to conclude that Miss M raised the issue of reporting the change before August 2021. That is not to say we do not believe her when she says she did this, but that we have not seen sufficient evidence to allow us to reach a robust decision that she did. We know she tried to report the change in August but this was not done until February 2022. We understand that she experienced a bereavement part way through this period and acknowledge that her focus would likely have been elsewhere.
34. In line with the Guidance, it was Miss M’s responsibility to ensure she reported the change and to obtain any help she needed to do this. While we accept that she asked for help in August 2021, we cannot see that she took steps to obtain this until February 2022. Miss M was aware of the need for a fit note, and she was responsible for following up on her initial request as she is the claimant and the responsible party.
35. Additionally, we have the issue of the fit note or other medical evidence required. Miss M says DWP did not mention this to her until February 2022. DWP says it told her about this in August 2021 and this is supported by its records. Despite the disagreement here, it remains that the Guidance makes it clear that this is something Miss M would have to provide.
36. When ICE considered Miss M’s complaint, it noted that she had told DWP in a piece of correspondence that it had told her she needed to provide this in September 2021. While we are mindful of this, we do not consider it has any material impact on the overall outcome. Even if Miss M had provided evidence sooner than February 2022, she would not have been able to be considered for the LCWRA element until she reported the change to her circumstances, which did not happen until February 2022.
37. While we realise it will be disappointing for Miss M, we do not think that DWP has demonstrated any failing in its actions in this respect. We are satisfied that its decision to record the date of the change being communicated and evidenced as February 2022, in in line with Guidance. We will therefore not consider this aspect of the complaint further.
ICE complaint
38. Our Principles explain that public bodies should do what they say they are going to, be open and clear about their policies and procedures and provide clear reasons for their decisions.
39. ICE’s Guidance ‘How to bring a complaint to the Independent Case Examiner’ (ICE’s Guidance) sets out how it will deal with a complaint. It explains that if ICE decides to investigate the complaint, it will ask the organisation being complained about for the relevant ‘case papers’ before being allocated to an investigator. The investigator’s role is to ‘examine the facts’ of the case and ‘report the detail of their investigation to the Independent Case Examiner’. The ICE will reach a finding and provide a report detailing this.
40. Miss M referred her complaint to ICE in May 2024. It discussed this with her by phone in July and followed this with a letter a few days later. ICE’s letter contained a summary of the complaint it was going to look at and explained that it was awaiting records from DWP. ICE told Miss M that it was going to ‘fast track’ her case and that she would hear from it again when this had been allocated to an investigator.
41. Within her complaint to us, Miss M says the scope of the complaint was not sent to her for consideration before ICE reached its decision. We see the July letter clearly sets out what ICE is going to be looking at. We find this shows ICE made Miss M aware of what it would consider. The scope was that a ‘DWP work coach failed to start [her] health journey at the earliest opportunity between January 2020 and February 2022.’
42. We know that an ICE investigator spoke to Miss M by phone in August 2024 as it sent a letter confirming this later that day. The letter explained that the investigator had called to discuss a separate complaint Miss M had asked it to look at (which was one of several others she had referred to it prior to this case). During that call, Miss M asked for an update on this specific case.
43. The investigator told Miss M that ICE had just received the information it had asked DWP for. The investigator also told Miss M that they would consider this complaint, alongside another three they were already looking at. The letter contained the scope of this complaint which was as we have detailed above. It also explained that the investigator would prepare a case history for the ICE themselves, with this including details of what had happened, what should have happened, and the impact of the complaint on Miss M.
44. The investigator did this, and in October, ICE provided Miss M with its decision about her complaint. While it did not uphold her complaint as it did not identify any maladministration in DWP’s actions, it felt DWP could have provided more support for other matters in August and November 2021. Because of this, ICE explained that DWP had agreed to make a payment of £150 to Miss M by way of apology.
45. ICE notes that Miss M sent it four emails and made two phone calls in the two weeks following its decision. She expressed concern that she had not seen the information the investigator had compiled.
46. ICE’s Guidance is clear that the investigator will obtain information about the case and present this to the ICE themself and that the ICE then reaches a decision about the matter. There is no disclosure of evidence to each party as would be the case if, for example, Miss M was taking legal action. We therefore find no failing on ICE’s part in not providing this information. While we acknowledge Miss M wanted to see this to check its validity and raise any concerns, this is not part of its process.
47. ICE’s Guidance also explains if someone is unhappy with its decision about their complaint they should contact it within three months. Importantly, ICE Guidance says that as well as being unhappy, they must ‘have new evidence that [they] think would materially affect it or which shows that it contained a factual error’. ICE says it will consider this and review its findings ‘if appropriate’.
48. We note that Miss M contacted ICE because she was unhappy with the outcome. We recognise that this may have been time consuming and upsetting. ICE considered Miss M’s contact and wrote to her in November 2024 explaining that it would not be reviewing her complaint further. This was because she had not provided any new evidence or demonstrated any factual error.
49. As ICE’s Guidance sets out, it did not review its findings because Miss M did not provide new evidence. While we understand this was disappointing for Miss M, as she did not meet the criteria for it to undertake a review, we do not find any failing on ICE’s part.
50. Miss M says that, when she contacted ICE after its decision, its staff were rude to her and hung up on her. We have asked ICE for copies of call recordings to consider this, but it does not record calls made and received within its office.
51. We note that the contemporaneous records made about telephone calls with Miss M do not reflect ICE employees terminating these. Unfortunately, with differing accounts and no other evidence to support either party’s side, it is not possible for us to reach a decision about this with any degree of certainty. We understand this will be frustrating for Miss M.
52. Having considered Miss M’s complaint about ICE, we have concluded that it has acted as we would expect. It has been clear about what Miss M could expect from it and has provided reasons for the decisions it has made. While we acknowledge that she remains unhappy with the decision itself and ICE’s refusal to review her complaint, ICE acted in line with its Guidance and has not demonstrated any failing. Because of this, we will not consider this aspect of her complaint further.