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Chapter P4: Exceptions to normal payability rules

Contents
Hospitals and Similar Institutions and Prisons
P4001:Introduction
P4002:Effect of imprisonment or detention on PIP
P4016:Exceptions to payability whilst in hospital, a care home or prison
P4018:Meaning of period of residence
P4020:Linking rules for prisoners
P4021:Linking rules for hospital in-patients and care home residents
P4031:Payment at daily rate
P4051:Payability of the mobility component
P4053:Payment of PIP on behalf of a claimant with a motability agreement

Effect of hospitalisation on the Motability agreement
P4055:Hire of vehicles
P4057:Purchase of vehicles
P4058:Powers of DM to terminate a Motability agreement
New claim and entitlement to PIP when reaching the relevant age
P4076:Meaning of relevant age
Further claims when claimant has reached the relevant age
P4080:General
P4082:12 month linking rule
P4083:Mobility component
P4084:Daily living component
Revision and supersession when claimant has reached the
relevant age
P4085:Mobility component
P4097:Residence and Presence conditions

Chapter P4: Exceptions to normal payability rules

Hospitals and Similar Institutions and Prisons

P4001 Introduction

This chapter is about payability of PIP and also the exceptions to payability and
entitlement.

P4002 Effect of imprisonment or detention on PIP

When a person is in prison or detained in legal custody, for either criminal or civil
offences, PIP is affected. Unless P4003 - P4007 applies, no amount in respect of
PIP daily living component and mobility component is payable in respect of a
claimant whilst they are undergoing imprisonment or detention in legal custody (1) (see
ADM Chapter E3 for more detail).

1 WR Act 12, s 87

P4003 P4002

PIP is payable for the first 28 days of imprisonment or detention in legal custody (1).
However, the 28 days is not payable if entitlement does not begin until
1. the day of entry to prison or detention in legal custody or
2. after they have entered prison or detention in legal custody (2).

1 SS (PIP) Regs, reg 31(1); 2 reg 31(2)

P4004 P4006 P4007 P4008

If at the end of criminal proceedings (1) the claimant is detained in a hospital or similar
institution and the conditions in P4006 do not apply, payment of benefit may be
restricted under the normal hospital payability conditions (see ADM Chapter P3).
Note: PIP will only be payable for the first 28 days.
1 SS (PIP) Regs, reg 31(3)

P4005

P4006 P4004

P4004 does not apply where
1. the claimant is detained under Mental Health legislation (1) and directed by the
higher courts to be detained in a hospital and
2. that person is being detained on or before the day which the Secretary of
State has certified to be that release date (2) or
3. the claimant is detained under the
3.1 criminal procedure legislation in Scotland (3) or
3.2 Mental Health legislation in Scotland (4).
1 SS (PIP) Regs, reg 31(4)(a)(i); MH Act 83, s 45A & s.47; 2 s 50(3);

SS (PIP) Regs, reg 31(4)(a)(ii); 3 reg 31(4)(b)(i); 4 reg 31(4)(b)(ii)

P4007 P4002

For the purposes of P4004 `hospital or similar institution' means any place (1) not
being a
1. prison
2. detention centre
3. young offenders institution or
4. remand centre
in which persons suffering from mental disorder are or may be received for care or
treatment.

1 SS (PIP) Regs, reg 31(5)(a)

P4008

For the purposes of P4004 criminal proceedings against any person are deemed to
be concluded upon that person being found insane in those proceedings with the
effect that
1. that person cannot be tried or
2. the trial of that person cannot proceed (1).

1 SS (PIP) Regs, reg 31(5)(b)

P4009

Periods of imprisonment or detention in legal custody outside GB should be treated
the same as imprisonment or detention in GB (1). This is subject to all other conditions
of entitlement being met.
1 SS (PIP) Regs, reg 31(6)

[P4010-P4015]

P4016 Exceptions to payability whilst in hospital, a care home or prison P3027 P3050

When a person enters
1. a care home or
2. hospital (1) or
3. prison (2)
for the first time, provided they are not in the hospital, care home or prison on the
first date of entitlement, PIP is payable for the first 28 days (1) they are there. See P4019 for conditions for the mobility component when in a care home.

1 SS (PIP) Regs, reg 30(1); 2 reg 31(1)

P4017

For the purposes of calculating the 28 days
1. the day they enter the hospital, care home or prison is treated as a day out of
such residence and
2. the day they leave the hospital, care home or prison is a day out of the
residence (1).
However, the day the claimant leaves one residence and immediately enters
another residence, the earlier period of residence ends on the day the claimant
leaves the first residence (2). This has the effect that if a claimant leaves hospital or
prison, but enters a care home immediately, then the mobility component will be
payable from the following day.
1 SS (PIP) Regs, reg 32(1); 2 reg 32(3)

P4018 Meaning of period of residence

A period of residence (1) is a period during which the claimant
1. is
1.1 resident in a care home or
1.2 an in-patient in a hospital or similar institution or
1.3 undergoing imprisonment or detention in legal custody and
2. is prevented from receiving PIP unless the provision for the first 28 days
applies.

1 SS (PIP) Regs, reg (32)(1)

P4019 P4016

The mobility component only will continue to be paid to any claimant who is in a
care home, but not when in hospital or prison. However, see P4051 for rules when
in hospital.

P4020 Linking rules for prisoners

Where there are two or more distinct periods of residence in prison or legal
detention which are separated by not more than 1 year, then the claimant will not
receive a further payment of PIP for the first 28 days (1). If the claimant is in prison, for
example on remand, for less than 28 days, and then is released, they will be entitled
to the remainder of the 28 days should they re-enter custody within one year.
1 SS (PIP) Regs, reg 32(5)

Example 1

Maurice is entitled to PIP daily living component at the standard rate. He is taken
into legal custody on 7.4.14, but continues to receive payment of PIP for the first 28
days, until 5.5.14. If Maurice is then discharged from prison on 16.9.14 and within
12 months is again taken into legal custody, he will not receive a further 28 days
paid benefit.

Example 2

Janet enters prison on remand on 3.5.13 and is entitled to PIP mobility component
at the standard rate. She continues to receive the benefit for the first 28 days, until
31.5.13. She is then discharged from prison on bail on 19.9.13, and her benefit is
put back into payment from 19.9.13. Following trial she is then imprisoned again
from 28.11.13, and as this is within 1 year of her previous detention, the 28 days
period before impacting on entitlement does not apply and benefit is stopped
immediately.

Example 3

Gary enters prison on remand on 3.4.14 and is entitled to PIP at the standard rate of
the daily living component. His case is then heard on 23.4.14 and he is acquitted.
Payment of his benefit continues as he has only had 19 days in prison. He is again
taken into legal custody on 3.10.14. As this is within 12 months it links with his
previous period on remand. He is therefore only entitled to a further 9 days paid
benefit, until 12.10.14, before it becomes not payable. On this occasion Gary is
found to be guilty and remains in prison for a further 18 months.

P4021 Linking Rules for hospital in-patients and care home residents

Where there are two or more distinct periods of residence in a hospital or care home
which are separated by not more than 28 days, these periods will link (1). This results
in the DM awarding the remainder of any of the 28 days payment remaining, or
ceasing payment of the benefit immediately.
Note: If the claimant has been in a care home, and payment of the mobility
component is still in payment, then there will be a full 28 days entitlement for the
mobility component if the claimant is admitted to hospital or prison.
1 SS (PIP) Regs, reg 32(4)

Example

Gordon enters hospital on 6.9.13 and is entitled to PIP at the enhanced daily living
component rate. He receives payment of PIP for up to the first 28 days from 7.9.13.
However, he is discharged on 15.9.13, so he has only received payment from 7.9.13
to 14.9.13 as an in-patient, amounting to 8 days. He then re-enters hospital on
1.10.13, which is within 28 days of the previous discharge. Therefore he is paid the
remainder of the 28 days benefit from 2.10.13 to 21.10.13. Benefit then ceases
being paid until he is again discharged from hospital.

[P4022-P4030]

P4031 Payment at daily rate

When a claimant
1. leaves a hospital or care home for a short period after receiving the first 28
days of benefit payment and
2. is expected to re-enter that residence within a further period of 28 days
that claimant may be paid PIP at the daily rate of 1/7th of the weekly rate. This is
payable on a weekly basis for all days they are out of the relevant residence (1) (see
ADM chapter B1).

1 UC, PIP, JSA & ESA (C&P) Regs, reg 50

P4032

The DM may arrange to pay PIP on any day of the week, and part weeks may be
paid at the daily rate of 1/7th of the weekly rate. Where there are any changes that
are not on the normal pay day, the DM can arrange to pay the remaining days at the
daily rate (1).

1 UC, PIP, JSA & ESA (C&P) Regs, reg 50(2), (3) & (4)

P4033

The claimant will continue to receive PIP at the daily rate whenever the periods out
of the residence are linked by periods not exceeding 28 days (1). Once the claimant
leaves the relevant residence for longer periods than 28 days, their PIP will be paid
at the normal 4 weekly rate.
Note: If the claimant is in a care home the mobility component will continue to be
paid throughout.
1 UC, PIP, JSA & ESA (C&P) Regs, reg 50

Example 1

Gillian has had a stroke and has been in hospital for several months. To be able to
assess her ability to cope at home she is allowed home at weekends for a period of
time. She has put in a claim for PIP and has been awarded the enhanced rate of the
mobility component and the standard rate of the daily living component. She goes
home on a Friday and comes back into hospital on a Monday, so she is entitled to
payment of PIP for 4 days. She is also entitled to PIP for the first 28 days on her first
return to hospital. After her 28 days entitlement has been paid, she then stays in
hospital for a further two weeks and comes home at the weekend again. This
pattern continues for some time, and each time she goes on home leave she is
entitled to be paid PIP for the days she stays at home, until such time she is
discharged from hospital.

Example 2

Clifford has had a heart attack and has spent several weeks in hospital. Before his
hospitalisation he had been assessed as being entitled to the standard rate of the
mobility component and the standard rate of the daily living component. His heart
attack requires him to undergo surgery and there are complications which means he
has to stay in hospital for several weeks. As Clifford lives at home on his own it is
necessary for him to learn how to cope with his own care needs. After being in
hospital for 28 days, benefit is no longer paid until he is allowed to go home at
weekends to help him adjust to living again in his own home. He goes home on a
Friday and comes back on a Monday, and is therefore paid PIP for 4 days. He stays
in hospital during the week and then goes home again. This pattern continues for 6
weeks, with only a few days before each visit home. He then returns home
permanently after the 6 weeks and his benefit is put back into payment. He may
also undergo a reassessment of his PIP to see if he requires more help than
previously.

[P4034-P4050]

P4051 Payability of the mobility component P4019 P4052

In certain circumstances the mobility component of PIP is not payable. These are
when the claimant has received or is receiving any payment
1. by way of a grant under specified legislation (1) towards the costs of running a
private car or
2. of mobility supplement under specified legislation (2) or
3. out of public funds which the Secretary of State is satisfied is similar to a
payment (3) under 1. or 2.
1 UC, PIP & WaB (C&P) Regs, reg 61; NHS Act 06, s 5 & Sch (1), para 10; NHS (Wales) Act 06,s 5 & Sch 1,
para 10; NHS (Scot) Act 78, s 46; 2 UC, PIP & WaB (C&P) Regs, reg 56(1)(b); NMAF (Dis & Death)
SPO 06; PI (Civ) Sch 83; WP (NAP) Sch 64; Pen (PF) Sch 64; WP (MM) Sch 64;
Order of Her Majesty in relation to the Home Guard 22.12.64;
Ulster Defence Regiment 4.1.71; 3 UC, PIP, JSA & ESA (C&P) Regs, reg 61(3)

P4052

Payments made under any of the legislation specified in P4051 are an overlapping
benefit (1) for the purposes of PIP.
1 UC, PIP, JSA & ESA (C&P) Regs, reg 61(3)

P4053 Payment of PIP on behalf of a claimant with a motability agreement

Motability (1) is the company that has been set up under that name as a charity and
incorporated by Royal Charter. A claimant may use their mobility component, if paid
at the enhanced rate only, to hire a car or wheelchair or buy a car or wheelchair on
hire-purchase from Motability.

1 UC, PIP, JSA & ESA (C&P) Regs, reg 62(5)

P4054 P4058

The DM may arrange that any award of the enhanced rate mobility component of
PIP may be made in whole or in part, on behalf of the claimant, in settlement of any
agreement made between the claimant and Motability for the purchase or hire of a
vehicle (1).
1 UC, PIP,JSA & ESA (C&P) Regs, reg 62(2)
Effect of hospitalisation on the Motability agreement

P4055 Hire of vehicles P4058

In the case of a claimant who has hired a vehicle (which includes wheelchairs) from
Motability when they enter hospital, after 28 days the mobility payment will cease.
Motability will be informed by the DM and contact will be made with the claimant
within 28 days to discuss the return of the vehicle.

P4056 P4058

Any agreement with Motability will be terminated by the DM where the vehicle is
1. returned to the owner (Motability) at or before the end of the term of hire or
any agreed extension of the term of hire, on expiry of the term or extended
term or
2. retained by or on behalf of the claimant, with the owner's consent after the
end of the term of hire or any agreed extension, on expiry of the period of the
term or extended term or
3. retained by or on behalf of the claimant, with the owner's consent, after the
end of the term of hire or any agreed extension, or its earlier termination, on
expiry of whichever is the longer of the following periods
3.1 the period ending the return of the vehicle to the owner or
3.2 the period of the term of hire or any agreed extension of the term of
hire (2).
1 PIP Regs, reg 28(1); 2 UC, PIP, JSA & ESA (C&P) Regs, reg 62(3)

P4057 Purchase of vehicles

Subject to the claimant being in hospital for more than 28 days, and the payment of
the mobility component ceasing, after the DM informing Motability, the claimant will
be contacted within the next 28 days to discuss the hire-purchase agreement (1)
(which may include wheelchairs) which will be terminated
1. on the purchase of the vehicle or
2. where the vehicle is returned to, or is repossessed by, the owner under the
terms of the agreement, before the completion of the purchase, at the end of
the original period of the agreement.
1 UC, PIP, JSA & ESA (C&P) Regs, reg 62(4)

P4058 Powers of DM to terminate a Motability agreement

The DM may terminate an arrangement (1) under P4054 if
1. requested to do so by the owner of the vehicle or
2. it appears to the DM that the arrangement is causing undue hardship to the
claimant and that it should be terminated earlier than provided for by
regulations as in P4055 and P4056.

1 UC, PIP, JSA & ESA (C&P) Regs, reg 63

P4059

The
DM
must terminate an arrangement (1) made under the terms of P5054 if the DM
is satisfied that the
1. vehicle has been returned to the owner and
2. the expenses of the owner arising out of the hire or hire-purchase agreement
have been recovered following the return of the vehicle.
1 UC, PIP, JSA & ESA (C&P) Regs, reg 64.

[P4060-P4075]

New claims and entitlement to PIP when reaching the relevant age

P4076 Meaning of relevant age

The relevant age means
1. age 65 or
2. if higher pensionable age (1).

1 WR Act 12, s 83(1); Pensions Act 19 95, Sch 4, para 1

P4077

A claimant will continue to be entitled to PIP if they are entitled to an award of
1. the daily living component or
2. the mobility component or
3. both on the day preceding the day on which they reached the relevant age.

1 SS (PIP) Regs, reg 25(a)

P4078

A claimant is entitled to PIP if
1. they make a claim for PIP before reaching the relevant age and
2. although that claim is not determined before they reached the relevant age (1)
an award of
2.1
the daily living component or
2.2
the mobility component or
2.3
both is subsequently made in respect of them.

1 SS (PIP) Regs, reg 25(b)

P4079

Rules for those claimants approaching the age of 16 are dealt with in chapter 5.
Further claims when claimant has reached the relevant age

P4080 General P4083 P4088

Where the previous award is in respect of only the daily living component (1) then the
DM cannot additionally award any rate of the mobility component on a further claim.

1 SS (PIP) Regs, reg 15(2)(c)

P4081

Where a decision is made on entitlement on the further claim and the conditions are
substantially the same mental or physical condition, the required period condition (1)
does not have to be satisfied (see ADM Chapter P1 for required period condition)2.
1 SS (PIP) Regs, reg 15(3); 2 reg 12 & 13

P4082 12 month linking rule

If the claimant makes a new claim for PIP
1. after the age of 651 and
2. within 12 months of the previous award ending (2) and
3. was previously entitled to an award of PIP for
3.1 substantially the same condition or conditions for which the previous
award was made or
3.2 a new condition which developed as a result of a condition for which
the previous award was made
a new award for the same rate of PIP can be made (3).
1 SS (PIP) Regs, reg 26(2)(a); 2 reg 26(2)(b); 3 reg 15(2)

Example

Sharon, who was aged 64, had been in receipt of PIP at the standard rate for both
the daily living and the mobility component for 12 months following a stroke. She
had then improved and been reassessed and the PIP entitlement was removed. 9
months after PIP ceased, but after reaching the age of 65, Sharon had a further
stroke. The condition was the same as before but her needs had increased, and as
the period between claims was less than 12 months, she did not have to serve the
QP again for the standard rate to be paid. After the QP had been served for the
enhanced rate the benefit would be increased. Although her needs were
substantially worse, she could only receive the standard rate of the mobility
component due to the PIP rules (see P4083 for mobility component rules).

P4083 Mobility component P4082 P4084

When the claimant makes a further claim and entitlement on that claim and the
previous award result from substantially the same conditions in P4080 3.1 or 3.2
then the DM can only make an award of
1. the enhanced rate if the claimant was entitled to that rate on the previous
award (1) or
2. the standard rate (2) equal to the previous award or at a lower rate if they no
longer satisfy the conditions for the enhanced rate.
The new award cannot be greater than the previous award even if the conditions for
that rate are met.
1 SS (PIP) Regs, reg 26(2)(c)(i); 2 reg 26(2)(b); 3 reg 26(3)

P4084 Daily living component

Where the DM makes an award of the mobility component under P4083, then an
award of the daily living component may additionally be made irrespective of
whether the claimant had previously had an award for daily living component.
1 SS (PIP) Regs, reg 15(3)

Example

Richard's date of birth is 21.6.49 and he was awarded DLA and then re-assessed
and awarded PIP until 17.8.14. His PIP award was for enhanced rate mobility only.
His award then stops and he fails to make a new claim, as he is taken ill and in
hospital from July 2014 until September 2014 and then recuperating at home. On
15.2.15 Richard claims PIP again. This is within 12 months of his previous award
ceasing. His condition has deteriorated with the same disability as before. He is
assessed by the DM as being entitled to the enhanced rate of mobility component
and the standard rate of daily living component. He is subsequently paid PIP at
these rates due to the linking provision, from the date of his new claim. This is
because he has claimed within 1 year of his previous claim, his required period
condition is satisfied for the mobility component and his daily living component is
satisfied as it is more than 6 months since his hospitalisation and deterioration.
Revision and supersession when claimant has reached the relevant age

P4085 Mobility component P4089

Where the original award
1. is superseded for a relevant a change of circumstances which occurred after
the claimant attained the relevant age and
2. the award includes an award of the mobility component
restrictions apply (1).

1 SS (PIP) Regs, reg 27(2)

P4086 P4089

Where the current award is in respect of the standard rate (1) of the mobility
component the DM may make an award of the standard rate
1. if the relevant conditions are satisfied (2) and
2. where the conditions of entitlement are a result of the same mental or
physical condition as for the current award (3).
Note: This applies even where the claimant meets the criteria for the enhanced rate
of the mobility component.
1 SS (PIP) Regs, reg 27(2); 2 reg 27(3)(a)(i); 3 reg 27(3)(a)(ii)

Example

Rita is entitled to the standard rate of the mobility component but no rate of the daily
living component of PIP, and is now aged 66. She has rheumatoid arthritis, which
has recently become more severe, and she has reported a change in her mobility
and daily living condition, stating that she can hardly walk, needs a wheelchair
whenever she goes out, and requires help from another person with some dressing
and bathing. The DM makes all the required enquiries, and consultations with the
HP. Although the DM decides that the conditions for the enhanced rate of the
mobility component are satisfied, as well as the standard rate of the daily living
component, the DM can only award both the daily living and mobility components at
the standard rate.

P4087

Where the current award is for the enhanced rate of the mobility component (1), the
claimant can only retain that rate providing their entitlement results from
substantially the same mental or physical condition for which the current award was
made.

1 SS (PIP) Regs, reg 27(3)(b)

P4088

Where the award does not include an award of the mobility component but the
claimant had a previous award of that component, then entitlement can be
considered under the linking rules (1) (see P4080).

1 SS (PIP) Regs, reg 27(4)

P4089

Where an award for the mobility component is made under P4085 or P4086 the
daily living component (1) may additionally be awarded provided the conditions of
entitlement are met.
1 SS (PIP) Regs, reg 14(2)(c)

[P4090-P4096]

P4097 Residence and Presence conditions

Conditions for the residence, presence and exportability for PIP claimants are in
ADM Chapter C2.

[P4098-P4999]