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Chapter P6: Good Reason

Contents
P6001:Introduction
P6011:Time to show good reason
P6015:Reconsideration
P6021:The `reasonable' test
P6031:Evidence
P6041:Previous failures
P6051:Specific examples which may be good reason
P6071:Mental health
P6091:Disadvantage
P6091:Homelessness
P6111:Domestic situations

Chapter P6: Good Reason

P6001 Introduction

This Chapter contains guidance on good reason (1) where the claimant fails to supply
information or attend for a consultation requested on behalf of the Secretary of State
after a valid claim has been accepted. For guidance on the provision of
information/evidence for making a claim, see ADM Chapter A2.

1 WR Act 12, s 80(5); SS (PIP) Regs, reg 10

P6002

Good reason is not defined in legislation. DMs should take into account all relevant
information about the claimant's individual circumstances; their reasons for any
failures, actions or omissions when considering whether any failure, act or omission
results in a negative determination being given for PIP. Matters to be taken into
account should include the claimant's health at the relevant time and the nature of
any disability (1).

1 SS (PIP) Regs, reg 10

P6003

Claimants have the opportunity to explain why they have not complied with
requirements but it will remain the responsibility of the claimant to show good reason
for any failure, act or omission and provide information and evidence as appropriate
to explain why they have not complied.

P6004

ADM A1380 refers to the DM not accepting claimant's evidence uncritically, and this
should be taken into account. Also P6041 should be taken into consideration when
looking at the claimant's credibility. The DM should look at the claimant's actions and
decide if they could reasonably be expected to contact the Department when failing
to comply.

P6005

The following guidance in this Chapter is to provide a framework for DMs to use
when considering whether or not good reason is demonstrated and is not an
exhaustive list of individual circumstances. In every case the DM should take into
account all the individual facts and circumstances and consider the case on its own
merits.

[P6006-P6010]

P6011 Time to show good reason

There is no specified time constraints for a claimant to show good reason for a
failure, act or omission.

P6012

DMs should give the claimant sufficient time to comment and to provide evidence
appropriate to the particular circumstances of the failure, act or omission. This
should be flexible to reflect an individual's circumstances. A shorter time may be
required where the claimant can be contacted by phone. A longer time may be
needed if the claimant
1. needs to seek information or evidence from a third party or
2. has an agent or representative or
3. has a health condition or other temporary circumstances that prevents them
from replying (e.g. a pre-existing health condition that is relevant or existing
caring or parental responsibilities that may be relevant).
Note
1: Allowance must be made for posting where a notification is made by post (1).
Note
2: If the claimant agrees to provide evidence face-to-face, by telephone or by
electronic means the claimant must be informed of the consequences of not
providing good reason.

1 Inte Act 78, s 7

[P6013]

P6014

The DM will then consider whether the evidence constitutes good reason taking into
consideration all the facts and evidence particular to the individual circumstances
and make rational decisions when considering a negative determination (1).
1 WR Act 12, s 80(5); SS (PIP) Regs, reg 8

P6015 Reconsideration

If the claimant provides information or evidence giving good reason after a negative
determination decision has been made then the claimant can request a
reconsideration of the decision. Any new facts and evidence received within the
normal time limits for revision should not stop the normal revision rules coming into
play which would alter the original decision (1) (see guidance in ADM Chapter A3
(Revision)).
1 UC, PIP, JSA & ESA (D&A) Regs, reg 18(3)

P6016

- P6020

P6021 The `reasonable' test. P6112

Good reason is not defined in the law, but `good cause' has been considered in case
law. It includes facts which would probably have caused a reasonable person to act
as the claimant did (1) and could equally apply to good reason.

1 R(SB) 6/83

P6022

DMs should establish facts which would probably have caused a reasonable person
to act as the claimant did by establishing three key points
1. what would be reasonable to expect someone to do in the particular
circumstance, i.e., was the action or failure to act preventable
2. what did the claimant do or fail to do that was different to what was the
expected action and
3. what were the claimant's reasons for their action or failure to act.

P6023

The general rule for taking each incidence on its own merits and considering all the
facts and evidence should be applied. Consideration of all the evidence should be
made and the DM should decide on
1. the balance of probabilities that it is more likely than not that something
happened or something is correct and
2. whether the evidence is inherently improbable in the circumstances.
Note: See ADM Chapter A1 - Principles of decision making and evidence.

[P6024-P6030]

P6031 Evidence

The DM should seek further evidence where it is considered necessary in order to
1. clarify reasons
or
2. seek further evidence
as sufficient proof to justify good reason.

P6032

This could involve either writing to or telephoning the claimant.

P6033

However, it is the responsibility of the claimant to provide evidence to demonstrate
good reason. Although it is not necessary for claimants to corroborate their own
evidence, the DM should not accept evidence from the claimant, or anyone else,
uncritically (see ADM Chapter A1 - Principles of Decision Making and Evidence).

P6034

The DM needs to be satisfied, on balance, that there is good reason. Whatever the
DM decides, it should be reasonable and without bias or discrimination (see ADM
Chapter A1 - Principles of Decision Making and Evidence).

[P6035-P6040]

P6041 Previous failures P6004

Each case should be looked at on its individual merits though past behaviour can be
taken into account. If the claimant has a record of previous failures the DM should
consider those failures as evidence of credibility of the evidence presented to
support the claimant's reasons for a current failure. The DM should consider how
likely is it that
1. a claimant happens to have a problem coinciding with when they are required
to participate with some activity (e.g. attend for a consultation or provide
further information) and
2. it would happen twice or more than that.
Note: It is for the DM to identify patterns and trends in a claimant's behaviour when
considering a claimant's reasons for a failure in consideration of all the facts of the
individual case.

P6042

The DM should not automatically accept good reason even if the reasons given for
the failure would in isolation normally support good reason. The DM should be
satisfied that the good reason is valid by seeking supporting evidence. It is not
unreasonable for the DM to ask the claimant to provide written evidence to support
their reasons for a failure, for example, medical evidence from a doctor or a letter to
provide evidence of another appointment.

Example 1

Eric was asked to send his completed PIP (2) back by 12.3.15. Despite being sent a
reminder, he did not respond. Eric had been given an extension of time to comply
with the request and, as he had been given reasonable time to respond, a negative
determination was made on his claim.

Example 2

Janine had previously been asked to attend for a face-to-face consultation but had
failed to attend. She had not given any reason for her non-compliance. She was
contacted and stated the reason for her not attending was that she had lost her letter
and could not remember the date of the appointment. This was accepted and a new
appointment was made for her. She did not attend this further appointment and,
again, gave her reason as losing her letter. As this was the second time she had lost
her appointment letter, it was not accepted as reasonable and a negative
determination was made.

[P6043-P6050]

P6051 Specific examples which may be good reason

Examples of a claimant's circumstances which may be treated as contributing to
good reason for an action, omission or failure include those who
1. have mental health conditions or disorders (see P6071)
2. are disadvantaged, e.g. the claimant
2.1
is homeless (see P6091)
2.2
has a disability
2.3
has learning difficulties
3. have domestic emergencies (see P6111)
4. there will be
4.1
a significant harm to health (see K2116) or
4.2
unreasonable physical or mental stress or
4.3
a risk to the health and safety of the claimant or that of others
5. have certain temporary circumstances (see K2146)
Note: This list is not exhaustive and each case should be considered on the
individual circumstances and merits.

P6052

In all cases the DM should consider all the individual circumstances of the case
when considering whether the claimant can show good reason.

[P6053-P6070]

P6071 Mental health P6051

Claimants may have good reason if they fail to carry out tasks or participate in
relevant consultations if they were experiencing poor mental health which meant that
1. they were not able to comply with a reasonable request or
2. complying with the request in question would put their mental health at risk or
3. complying with the request would have put the health of other people at risk.
Note: The consideration at 3. would apply to any situation where the claimant was
involved with others, for example their mental health may involve unprovoked violent
episodes or may mean they cannot concentrate fully.

P6072

The DM should consider each individual case on its own merits taking into
consideration all the facts and evidence and whether the claimant understood what
was required of them and their reasons for the failure taking into account in
particular their mental health.

Example

Barbara has a long term mental health issue and was invited to a consultation with
the HP after she made a claim to PIP. She did not attend for the consultation so
enquiries were made as to the reason for this. Barbara explained that she needed
her support worker with her, and at the last minute the support worker was unable to
attend. Due to the nature of Barbara's illness the DM decided that the support
worker would be key to providing insight into how her disability affects her day-to-day
living. The DM decides that Barbara has shown good cause as to why she did not
attend the consultation, and a new appointment was made for her at a time that was
suitable for the support worker.

P6073

As well as giving consideration to those claimants who have a clinically diagnosable
mental health condition, the DM should consider whether a claimant who has no
diagnosed condition may be temporarily distressed by particular circumstances that
could worsen or precipitate mental ill health.

P6074

In particular where a claimant has no previous history of mental ill health, the DM
should seek supporting medical evidence or other information via the claimant. The
DM should ask the claimant to supply evidence from additional sources which may include
1. health or support services
2. housing support services or
3. hostel keyworkers
where the DM can establish that the claimant is in contact with these services

[P6075-P6090]

Disadvantage

P6091 Homelessness P6051 P6111

Many homeless people face multiple issues that can add up to form complex
barriers to compliance, for example: mental health issues, significant medical health
problems, substance abuse, exclusion and trauma.
Note: Each case should be considered on the individual merits and circumstances.

P6092

Homelessness in itself is not provided for in legislation but a DM may consider the
claimant can be treated as dealing with a domestic emergency when they are
homeless if a DM considers the accommodation status impacts on the claimant's
capacity to comply with requirements.

[P6093-P6110]

P6111 Domestic situations P6051

Where crises arise unexpectedly which limit a claimant's ability to meet the required
conditions the DM should give careful consideration when deciding whether a
claimant can show good reason and take into account in particular the nature of the
crises and what is reasonable in the individual's circumstances. For example
1. short notice caring commitments of the elderly, sick or young children
2. a domestic emergency
3. a family bereavement
4. homelessness (see P6091).
Note
1: This list is not exhaustive. The DM should consider each case on the
individual facts and circumstances of the case.
Note
2: The DM should in particular consider what is reasonable behaviour
expected by a reasonable person in a similar situation.

P6112

The DM should consider
1. the nature of the emergency and
2. when the emergency arose and
3. any alternative arrangements the claimant has made and
4. any alternative arrangements the claimant could reasonably have made.
Note:
There is no automatic good reason, the DM should consider all cases on the
individual merits and circumstances of the case applying the `reasonableness' test
(see P6021).

[P6113-P6999]