Advice on PIP in Northern Ireland

Lower Limit (16)

In order to be entitled to PIP a claimant must be aged at least 16 years of age. Those with care or mobility needs under the age of 16 should make a claim for Disability Living Allowance.

Upper Limit (State Pension age)

With some exceptions as outlined below, you cannot normally make a claim for PIP after you reach State Pension age. Attendance Allowance may be the appropriate benefit for those who have reached State Pension age and have previously received PIP.

Upper Limit Exceptions

If you already have a claim for PIP prior to reaching State Pension age you can continue to claim this benefit. If your award of PIP comes to an end after you reach State Pension age it is possible to renew your claim.

It is also possible to make a fresh claim for PIP after you reach state pension age provided you were in receipt of PIP in the previous year. [See Linking Rules]

Unless there is already an award of the mobility component it is not possible to establish entitlement to the mobility component after State Pension age. If there is already an award of the mobility component at State Pension age it is possible to renew this award but not to increase it even if the condition becomes worse.

(Residence and Presence can be complex. This guide provides a summarised overview and is not designed to be comprehensive on this topic. Should you require further advice and assistance please contact the specialist team within Law Centre NI)

In order to receive PIP, the claimant must satisfy the residence and presence in Northern Ireland conditions:^[1]

Present in Northern Ireland

This means physically present or treated as present in Northern Ireland. You can continue to receive PIP after you leave NI if it is unlikely your temporary absence will exceed 52 weeks. In these circumstances you can receive PIP for:

• The first 13 weeks; or
• The first 26 weeks if you go abroad to receive medical treatment for your current condition;

Past Presence Test

In normal circumstances you must be present in Northern Ireland for 104 weeks out of the last 156 weeks prior to establishing entitlement to PIP.

The past presence test does not apply to:

• Terminally ill claimants;
• A claimant, or family member of a claimant, granted refugee status or humanitarian protection;
• Claimants who are resident in an EEA state and satisfy the EEA co-ordination rules and can demonstrate a genuine and sufficient link to the UK; or
• Claimants who are habitually resident in the Common Travel Area and can demonstrate a genuine and sufficient link to the UK.

The Common Travel Area consists of the United Kingdom (England; Scotland; Wales and Northern Ireland); the Republic of Ireland; the Channel Islands and the Isle of Man.

Habitually Resident

 There is no specific definition of habitual residence, but you generally must show a settled intention to remain and may need to be actually resident for an appreciable period of time. This can be a shorter period of time if you are returning to the Common Travel Area having previously been resident there.

[1] Reg 16 PIP Regs (NI) 2016

The country responsible for paying an individual’s benefits is known as the ‘competent state’. Recent tribunal decisions have led to a change in the Department’s approach to determining which country is competent to pay disability related benefits. This means that some claimants who are resident here who were previously told they were not entitled, should now be treated as entitled.

This applies even if the person receives a “pension” from another EEA country.

Previously, DfC refused payment if claimants received a “pension” from another EEA state. However, case law has clarified that this is not determinative. Article 11 of EU Regulation 883/2004 sets out that:

• Employment, civil service, or unemployment benefits usually dictate competence.
• If none apply, the state of residenceis responsible.

Recent cases[1] confirm that receiving a pension from another EEA country does not stop someone from qualifying for relevant UK benefits.

Benefits affected

This applies to the following cash-sickness benefits:

• Attendance Allowance
• Carer’s Allowance
• Disability Living Allowance (care component)
• Personal Independence Payment (daily living component)

What advisers should do

Advisers may want to review cases where a client:

• Lives in the UK
• Is not working or self-employed
• Is not receiving unemployment benefits
• Receives a pension from another EEA country

Some clients in this situation may have been wrongly refused benefits or told another country is responsible.  For more detail, see our Legal Briefing or contact the Law Centre NI Social Security Advice Line: 028 90 244401

[1] SP-v-Department for Communities (PIP) [2023] NICom 23; and SE v Secretary of State for Work and Pensions: [2024] UKUT 405 (AAC) – GOV.UK

If the claimant is a person subject to immigration control (PSIC) they will not be entitled to claim PIP.

A person subject to immigration control is someone:

• Who lacks leave to enter or remain in the UK; or
• That has leave to enter or remain but with the condition that they will not have recourse to public funds; or
• The person’s leave is dependent on a maintenance undertaking; or
• Cannot satisfy a right to reside under EU law (e.g. family member of an EEA worker).

Claimants with refugee status or humanitarian protection are not excluded from entitlement under this provision.

EU Settlement Scheme (EUSS)

 A claimant with pre-settled status or settled status is not subject to immigration control whilst they have this status. Claimants with settled and pre-settled status can claim PIP if they meet the above criteria.

In order to qualify for PIP, the claimant must satisfy the disability criteria for 3 months prior to their claim and be likely to continue to satisfy the criteria for the next 9 months. This is sometimes referred to as a 3 months backwards test and 9 months forwards test.^[1]

It is possible to make the claim in advance of the completion of the 3 months backwards period, but entitlement cannot be established unless this 3 month period has expired. In other words no payment before the 3 months is expired.

There is no 3 month backward test if you reclaim on the basis of the same condition for which a previous award was made. [See Linking Rules]

There is no required period condition for claimants awarded PIP on the basis of a terminal illness.

[1] Reg 7(3) PIP Regs (NI) 2016

If a claimant aged under retirement age previously had an award of PIP or DLA within the previous 2 years, and a new PIP claim is made for the same condition (or something that has arisen from the original condition), there is no requirement to satisfy the 3 months backwards condition.

If a claimant over retirement age previously had an award of PIP or DLA within the previous 1 year, and a new PIP claim is made for the same condition (or something that has arisen from the original condition), there is no requirement to satisfy the 3 months backwards condition.

It is still necessary to satisfy the 9 months forwards test.

A claimant is entitled to PIP if their ability to complete specified activities of daily living and/or mobility is severely limited by a physical or mental health condition. Diagnosis may not be necessary, so long as it can be said that the inability to complete the activity is as a result of a physical or mental health condition.[1] This includes circumstances where symptoms are not readily explained.[2]

The specific daily living and mobility activities and the way they are to be assessed is outlined in the Personal Independence Regulations (NI) 2016. The guide will address the various factors in determining functional ability according to the regulations below.

[1] PR-v-Department for Communities (PIP) [2019] NICom 75

[2] NK v SSWP [2016] UKUT 146 Somatic symptoms can lead to a claimant scoring points from Activity 2 of the Mobility Component: Moving Around.

When assessing entitlement to PIP, the ability to complete each activity should be considered in light of any aid or appliance the claimant will normally or could reasonably use.^[1]

Aids do not specifically need to be prescribed but they must be something that is needed to improve, provide or replace a mental or physical function.^[2]

Aids might include: Raised toilet seat; shower seat; perching stool; modified cutlery; grab rail; kettle tipper; long arm leaver taps; chair to aid dressing; walking stick; wheelchair etc.

[1] Reg 4(2) PIP Regs (NI) 2016

[2] CW v SSWP (PIP): [2016] UKUT 197 (AAC); [2016] AACR 44 – an aid need not be designed, manufactured or sold for purpose of overcoming a limitation or function – but must be needed to carry out the activity, not merely to carry it out in a particular manner

“Safely” means in a manner unlikely to cause harm to [the Claimant] or to another person, either during or after completion of the activity.[1]

Both the likelihood of the harm occurring and the severity, are relevant considerations of whether the claimant is capable of completing an activity safely. Is there a possibility that cannot be ignored of harm occurring, having regard to the nature and gravity of the feared harm in the particular case?

It can still be unsafe to complete an activity even if the harmful event does not actually occur more than 50% of the time.

For example, someone with epilepsy may have seizures without warning creating risk of injury. Although these seizures occur less than 50% of the time, it may be unsafe to complete an activity most of the time or require supervision as the person does not know when the seizures are going to occur.

Similarly, if someone experiences episodes of losing consciousness, the important issue is the risk created by those episodes, not their medical cause. The possibility of serious harm is what matters when deciding whether the activity can be done safely.[2]

Ability to complete the activity safely should also be applied to the requirement for supervision in the descriptors. [2017] AACR 32[3]

[1] Reg 4(5) PIP Regs (NI) 2016

[2] SP-v-Department for Communities (PIP) [2025] NICom 21

[3] Endorsed in AG V DfC (PIP) [2018] NICom51

Acceptable Standard is not specifically defined in legislation but is likely to have an everyday meaning. If it is possible to complete the activity, is it to a poor standard or does it cause unreasonable discomfort?

Case law has also suggested that pain and its severity and frequency is relevant to the ability to complete an activity to an acceptable standard. It is also likely to factor in consideration of ability to complete the task repeatedly and in a reasonable time period.

CPIP/2377/2015

“Repeatedly” means as often as the activity being assessed is reasonably required to be completed.[1]

It is important that more than a snapshot view is taken of the ability to complete the activity. The legislative basis of the ability to complete the activity repeatedly reflect social security case law considerations of the ability to complete an activity with reasonable regularity or some degree of repetition.

If there is any time in the day that the claimant would reasonably wish or need to complete an activity and is unable to do so, then they cannot do so as often as is reasonably required and should score points. CE v SSWP (PIP) [2015] UKUT 643; para. 34

[1] Reg 4(5) PIP Regs (NI) 2016

 “Reasonable time period” means no more than twice as long as the maximum period that a person without a physical or mental condition which limits that person’s ability to carry out the activity in question would normally take to complete that activity. [1]

 [1] Ibid

[2] GP v Secretary of State for Work and Pensions (PIP) [2016] UKUT 0444 (AAC)

[3] MS v SSWP (PIP) [2024] UKUT 185 (AAC)

Points will only be awarded if the claimant satisfies the descriptor more than 50% of the qualifying period.[1]

If two or more descriptors are satisfied more than 50% of relevant days then the highest scoring descriptor applies.[2]

If two are satisfied for less than 50% of the time but more than 50% together the one that the person suffers from for greater period may be awarded points. If they are both equal the highest scoring descriptor applies.[3]

If there is any time in the day that the claimant would be unable to do an activity in a particular day, then the descriptor is satisfied for that day. The question is then whether the descriptor would be satisfied in 50% of the days in the qualifying period.[4]

It is sufficient that the claimant is unable to perform the relevant task at some point in a day, for a period which was more than trifling and which has some degree of impact. [2016] AACR 23 – para. 34

[1] Reg 7(1)(a) PIP Regs (NI) 2016

[2] Reg 7(1)(b) PIP Regs (NI) 2016

[3] Reg 7(1)(c) PIP Regs (NI) 2016

[4] Reg 7(2) PIP Regs (NI) 2016

There are two components of PIP called the Daily Living Component and Mobility Component. Each is paid at a standard and enhanced rate.

PIP relies on a points-based assessment process to determine entitlement to the components and rates.

Claimants can combine points within the Activities of a Component to demonstrate entitlement.

There are ten Activities within the Daily Living Component and two Activities within the Mobility Component

Points are awarded based on the claimant’s ability to do these predefined tasks – not because of the conditions they may have. It is important that advisers remember that the ability to complete each activity should be considered with reference to ‘safely’; ‘acceptable standard’; ‘repeatedly’ and ‘reasonable time period’ as outlined above.

Descriptors differentiate between the points available within each activity.

 Detailed information about the Activities including the legislative definitions and case law can be found here.

Those who are considered terminally ill will automatically qualify for the Enhanced Rate of the Daily Living Component of PIP without the need to satisfy the 3 months backwards test.

Entitlement to the Mobility Component is not automatic. Terminally ill claimants who are seeking the Mobility Component will have to satisfy the functional restriction criteria of the Mobility Component.

Terminal illness is defined as a progressive disease and the person’s death in consequence of that disease can reasonably be expected within 12 months.[1]

Claims under the terminal illness criteria are sometimes referred to as ‘special rules’ claims. In order to make a special rules claim you will have to phone the PIP Centre. Claimants will not normally have to complete a PIP 2 form or require a face to face assessment but they will be asked some additional questions about their mobility during the initial call and will be asked to forward a SR1 form.

A SR1 form can be completed by a medical practitioner that can confirm the terminal illness diagnosis such as a GP; hospital or hospice doctor or a registered nurse.

Under the special rules it is possible for someone else to make a claim on behalf of the claimant and without their knowledge or authority.[2]

[1] Article 87(4), The Welfare Reform (NI) Order 2015 (as amended 4/4/22 following a sustained campaign for change)

[2] Article 87(5), The Welfare Reform (NI) Order 2015

Hospital

If a claimant is aged under 18 when admitted to hospital, the payment of PIP will continue regardless of the length of hospital stay.[1]

If the claimant is aged 18 or over the PIP payments will continue for up to 28 days. After 28 days the payments will cease.

The entitlement will continue even though the payments cease. It should therefore restart once the claimant is discharged from hospital.

The day of admission and day of discharge do not count toward the 28 days total.[2]

Care Home

 The daily living component of PIP will normally stop for a claimant who resides in a care home for more than 28 days in which any of the costs are met by the public authority or Trust under specified legislation.

The entitlement will continue even though the payments cease. It should therefore restart if the claimant leaves the care home.

If the claimant is completely self-funding, payment of PIP will not cease.

Payment can be made for each part day in which the claimant is no longer staying in the care home. For example, if the claimant stays with relatives.

The mobility component will not normally stop as a result of someone residing in a care home.

If the claimant has notified the Department for Communities that they are terminally ill, they can continue to receive both components of PIP whilst in a care home or hospice.[3]

Prison

If a claimant is in receipt of PIP before going into prison, they will continue to receive payment for up to 28 days. After 28 days the payments are suspended. This is the position regardless if the claimant is convicted or on remand.[4]

If a claimant first qualifies for PIP when in prison, payment is suspended and no payment will be made until release.

Any suspended PIP payments cannot be reclaimed by the claimant, regardless of the outcome of proceedings.

Hospital/Care Home/Prison Linking Rules

 The 28 day period of payment outlined above for Hospital/Care Home/Prison can be linked together if the claimant enters any of the above institutions funded by the state within a one year period.[5]

If the claimant was in either a Hospital/Care Home/Prison for less than 28 days and enters a Hospital/Care Home/Prison within a year, then the PIP payments are only made for the remainder of the total 28 days.

[1] Reg 29(3) PIP Regs (NI) 2016

[2] Reg 32(2) PIP Regs (NI) 2016

[3] Reg 30(3) & (4) PIP Regs (NI) 2016

[4] Reg 31 PIP Regs (NI) 2016

[5] Reg 32 PIP Regs (NI) 2016

Should the claimant be unhappy with the assessment process they can raise a complaint by contacting Capita. The complaint can be raised directly with Capita’s Customer Complaints team or by writing to the PIP Centre and asking that the complaint is forwarded to Capita for a response. If the claimant has an active appeal it is recommended that a copy is also sent to The Appeals Service.

If the complainant is unhappy with the response received from Capita/DfC they can escalate their complain to the NI Public Services Ombudsman (NIPSO) or the Independent Case Examiner (ICE).[1]

Following a 2021 NI Public Services Ombudsman investigative report which found systematic maladministration DfC have engaged with NIPSO in relation to 33 recommendations for change.

Department for Communities Case Managers make decisions on entitlement to PIP. They will normally consider the claimant’s PIP 2 form; the Capita disability assessor’s report and any other evidence provided to determine entitlement.

The Case Manager will decide what component and rates of PIP to award, if any, as well as determining the length of the award.

The claimant is issued with a decision and if they are unhappy with the outcome they can seek a mandatory reconsideration within one month. If they are unhappy with the mandatory reconsideration decision, they can seek an appeal within 1 month of the mandatory reconsideration notice.

In PIP cases the award should be for a limited period unless reasons are given for an indefinite award.[2] Guidance has been provided to help Decision Makers decide on award length and this can be found here. At the time of writing of this guide, Central Government has outlined an intention in most cases to move to standardised 3 year awards for new claims and 10 awards for review claims where the claimant is 25 years and over.[3] Tribunals however are not bound by award length guidance.[4] Awards can be reviewed at any time.

Claimants who are in receipt of PIP after state retirement age will receive an ‘ongoing award’ (with a light touch review after 10 years).

Claimants can also dispute this element of the decision via mandatory reconsideration and appeal.[5]

If the claimant has a fixed period award with a review date, the Department will normally contact the claimant approximately 8 months before it is due to end with a view to collecting up to date information for the purposes of a renewal. The claimant is not required to make a fresh claim to PIP.

If the award was made for 18 months or less, the Department will advise the claimant that the award is coming to an end, but it is up to the claimant to make a fresh claim. The Department will not conduct a renewal.

If a claimant is unhappy with a decision, they can ask the Department for Communities

to look at the decision again and review if it was correct. This is called a Mandatory Reconsideration. This can be requested by telephoning or writing to the PIP Centre within one month of the decision. It may be possible to seek a late mandatory reconsideration if it is reasonable to grant the application and there were special reasons for the delay. The claimant can apply up to a maximum of 13 months after the decision but the longer the delay the more compelling circumstances are necessary.

If the claimant has an existing award of PIP, there may be risk from seeking a Mandatory Reconsideration and it is important that advisers make clients aware of this (see below).

If the claimant was previously in receipt of DLA and did not receive any award of PIP on reassessment, they received a supplementary payment provided they lodged a valid appeal against the decision. Once the valid appeal was lodged, they would have automatically received a Welfare Supplementary Payment (WSP) which would have been the same value of the DLA which was previously in payment.

[1] Part 2; The Welfare Supplementary Payment (Loss of Disability Living Allowance) Regulations (NI) 2016

This is the only PIP WSP that was not automatically limited to a year.

If the decision under appeal was revised or the appeal was successful, then the ‘pending appeal WSP’ would cease.

The claimant would not receive arrears of PIP unless the appeal decision awarded a higher amount of PIP than was previously paid under DLA.

If the appeal was withdrawn or the appeal is unsuccessful the WSP ceased but did not need to be repaid.

DfC had previously been misapplying the legislation about the payment of pending appeal WSPs whilst a claimant appealed to the Commissioner. Following a Law Centre NI test case[1] this error was identified and DfC committed to reviewing impacted claimants.[2]

[1] LA v DfC (PIP) [2024] NICom 42

[2] Policy change to Welfare Supplementary Payments | Law Centre Northern Ireland

If the claimant was previously in receipt of DLA and received any award of PIP on reassessment which is at least £10 per week less than the DLA, they received a WSP equivalent to 75% of their loss for up to one year.

If the claimant was previously in receipt of DLA, did not receive an award of PIP but scored at least 4 points on assessment they would have received this WSP for up to one year if they had a conflict related injury.

What is a Conflict Related Injury?

A conflict related injury[3] is a physical or psychological injury as a result of, or in consequence of a violent incident in connection with the “affairs of Northern Ireland” in or after 1966 and before the end of the DLA award.

A psychological injury may include a result or consequence of:

• Witnessing a violent incident or consequences of such an incident; or
• Providing medical or emergency assistance to someone in connection with a violent incident.

Accepted evidence included a report from the PSNI; a recognised healthcare professional;[4] or an appropriate body providing services and support to victims and survivors.[5]

Where a WSP was overpaid the Department for Communities could recover this even in circumstances where the overpayment has arisen out of official error.

Law Centre NI had raised concerns about the recovery of overpayments caused by official error, and this culminated in a change of policy to ensure better awareness that the Department can use its discretion not to recovery overpaid amounts of benefit.[6]

A discretionary waiver is a mechanism, whereby in exceptional circumstances, DFC can exercise its discretion to ‘waive’ recovery of all or part of an overpaid benefit. This has become more important following a change in the law which, for the first time, allowed recovery of some overpaid benefits even in cases when the overpayment was caused by official error. As a result, a significant number of claimants are now unable to challenge the recovery of an overpayment even if they had not been responsible for it occurring. Claimants in these circumstances would have to ask for a discretionary waiver if repayment would cause them significant detriment.

Law Centre NI has produced helpful guidance to assist in the application for the discretionary waiver of an overpayment which can be found here.

[1] Part 3; The Welfare Supplementary Payment (Loss of Disability Living Allowance) Regulations (NI) 2016

[2] Part 4; The Welfare Supplementary Payment (Loss of Disability Living Allowance) Regulations (NI) 2016

[3] Reg 15, The Welfare Supplementary Payment (Loss of Disability Living Allowance) Regulations (NI) 2016

[4] Section 11C (6) Welfare Reform Act (NI) 2007

[5] Article 10 Victims and Survivors (NI) Order 2006

[6] Amendments-to-Discretionary-Waiver-Guidance.pdf (lawcentreni.org)