Claim Maintenance Policy
and Strategy
WEALDEN DISTRICT COUNCIL
Benefits Service
May 2017
CLAIM MAINTENANCE POLICY and STRATEGY
POLICY OBJECTIVES
1 To ensure
compliance with The Housing Benefit Regulations (2006), the Housing Benefit (State Pension Credit)
Regulations 2006 and best practice in the maintenance of Housing Benefit (HB)/Council Tax Reduction
(CTR) claims
that the Claim Form requests comprehensive information, and relevant documentary evidence to
support benefit and/or reduction claims
that appropriate guidance on risk based verification is applied to documents provided in support of
benefit and/or reduction claims
that decision makers accurately update computer records with data provided in support of benefit and/or
reduction claims
that the Benefits IT system (Academy Benefits) accurately calculates benefit in accordance with the
latest HB/CTR Regulations
that the correct subsidy classifications are applied to each housing benefit payment made
that customers are notified about decisions in the prescribed manner
that customers know their rights to request a revision or appeal against claim maintenance decisions
that operational procedures satisfy internal and external audit considerations as well as regulations, and
are being followed accurately
that performance targets seek continuous improvement
support for the Council’s mission, corporate objectives and values
POLICY STATEMENT
2.1 The Council is committed to operating a policy for claim maintenance which is fair and equitable, and
which complies with the HB/CTR Regulations and best practice. The Council recognises that effective claim
maintenance is achieved if claimants have confidence in operational procedures being accurately followed,
and they have been given the opportunity to make representations about their circumstances.
2.2 The Council ensures that the Claim Form asks every relevant question, and requests all relevant
documentary evidence from claimants in support of their claim. Unless all questions are asked, and all
documents are verified according to risk, it cannot be claimed that each claimant receives their correct
entitlement to benefit.
2.3 The Council is committed to ensuring compliance with the guidance on risk based verification, which
provide practical advice on obtaining the best most suitable evidence for benefit claim maintenance
purposes.
2.4 The Council provides for internal checks and quality control mechanisms to ensure the correct
application of this policy. The Council also ensures that claim maintenance operational procedures satisfy
internal and external audit considerations, as well as regulations. Policies and strategies are adopted by the
Council, which requires their decisions to be applied consistently on behalf of the community.
2.5 The Council demands that Academy Benefits is regularly tested for accuracy and relevance in relation
to HB/CTR Regulations. Academy Benefits is tested after every new release of software, or release of
patch and bug-fix software, to ensure that changes to program coding have not detrimentally interfered with
previously accurate software.
2.6 The Council applies the correct subsidy classification to each housing benefit payment made. The
Council is reimbursed by the government depending on the type of expenditure but in most cases, this is
100%. The subsidy claim procedure demands that benefit payments are allocated for subsidy purposes
depending on the type of benefit payment made. Incorrect allocations can result in the Council submitting
an inaccurate annual claim and this can lead to the Council being financially penalised by the Government.
2.7 The Council pays CTR and Rent Rebate for Council tenants in the prescribed manner, as a rebate to
their Council Tax and Rent accounts held by the Council. The Council pays Rent Allowance to private
tenants and Registered Social Landlords (RSLs) either by cheque or BACS, to the claimant or landlord.
2.8 The Council ensures that claim maintenance decisions are notified to claimants and landlords in
accordance with the HB Regulations Schedule 9 (Schedule 8 of the State Pension Credit regulations). This
Schedule prescribes the minimum information contained in Decision Notices to enable claimants and
landlords check that the data they provided has been used correctly to decide HB/CTR entitlement.
2.9 The Council ensures that claimants and landlords know their rights to request a revision or appeal
against claim maintenance decisions, within the HB (Decision-Making and Appeals) Regulations 2001
(DMA Regulations). Where revision and appeal rights are available the Council actively promotes their use
as an effective way to resolve disputes.
2.10 These statutory instruments set out the rules under which we and the council have to deal with any
council tax reduction appeals:Council Tax Reduction Schemes (Prescribed Requirements) (England) Regulations 2012, Statutory
Instrument 2012 No 2885 Council Tax Reduction Schemes (Default Scheme) (England) Regulations 2012,
Statutory Instrument 2012 No 2886 Council Tax Reduction Schemes (Prescribed Requirements and
Default Scheme) (England) (Amendment) Regulations 2012, Statutory Instrument 2012 No 3085 Council
Tax Reduction Schemes (Detection of Fraud and Enforcement) (England) Regulations 2013 (SI 2013 No.
501) Valuation Tribunal for England (Council Tax and Rating Appeals) (Procedure) (Amendment)
Regulations 2013 Valuation Tribunal for England (Council Tax and Rating Appeals) (Procedure)
Regulations
2009, Statutory Instrument 2009 No 2269 Council Tax (Alteration of Lists and Appeals) (England)
Regulations 2009, Statutory Instrument 2009 No 2270.
2.11 The Council supports speedy decision making operational procedures, taking into account the
guidance provided by the Department for Work and Pensions (DWP) and for Council Tax Reduction the
Department for Local Government and Communities (CLG). The Council recognises that benefit and
Council Tax Reduction claimants are often vulnerable members of the community who need quick
decisions about their entitlement in order to secure their housing requirements.
2.12 All targets are reviewed every year with a view to improving performance across the Benefits Service.
2.13 The Council will review this policy every year.
Last reviewed and published May 2017
STRATEGY
3 Background to claim maintenance
3.1 Benefit and Council Tax Reduction regulations are complex and dynamic, changing several times each
year. Maintaining benefit claims effectively requires that decision makers follow operational procedures
closely; and that the Benefits Management Team anticipate and plan for the impact of HB/CTR Regulations
changes on service delivery.
3.2 The correct maintenance of a claim depends on claimants providing all relevant information at the time
they claim, and then keeping the Council up-to-date about changes to their income, savings and household
circumstances. It also requires the Council to accurately and quickly apply changes in HB/CTR Regulations
to relevant claims as they occur.
3.3 Decision makers contact claimants who do not provide requested information and documentary
evidence with their application, in order to assess their benefit entitlement. All evidence is verified to the
standards set out in the guidance on risk based verification in order to reduce the potential for fraud or error
to enter the benefits system.
3.4 Payments are made in accordance with the claimant’s instructions except where prescriptions apply.
HB Regulations prescribe that payments are made at certain intervals depending on the benefit-type of the
claimant.
3.5 Not maintaining claims accurately and promptly can result in claimants jeopardising their security of
tenure, paying more in rent than they should, and the Council paying incorrect amounts of benefit. This
could lead to the Council being financially penalised.
4 Summary of strategic elements
4.1 The policy objectives above cover the process of receiving, assessing, paying and maintaining benefit
and council tax reduction claims, which can result in some conflicting priorities. The following sections set
out the elements of the strategy to achieve the policy objectives without compromise, specifically covering
the following issues
Section 5 – Legal duties – apply the HB/CTR Regulations to maintain claims
Section 6 – The Claim Form – provide a comprehensive Claim Form to request all relevant information
and documentary evidence to support claims
Section 7 – Risked Based Verification – correctly seek evidence as appropriate to the risk
Section 8 – IT system – correctly record claim data into Academy Benefits
Section 8 – IT system – accurately assess benefit entitlement using Academy Benefits
Section 9 – Financial responsibilities – allocate the correct subsidy classification to each benefit
payment
Section 9 – Financial responsibilities – pay the right claimants the right amount, in the right manner, at
the right time
Section 10 – Decision notices – notify claimants and landlords about benefit decisions, in accordance
with HB/CTR Regulations
Section 11 – Claimant and landlord rights – make claimants aware of their rights to request a review or
appeal against decisions
Section 12 – Quality Control – ensure decision-makers make accurate decisions
Section 13 – Performance Targets and Monitoring
STRATEGIC ELEMENTS
5 Legal Duties
Apply all legislation relating to HB/CTR
5.1 The following main primary and secondary legislation govern the maintenance of benefit claims
Social Security Contributions and Benefits Act 1992
Social Security Administration Act 1992
Housing Benefit Regulations 2006
Housing Benefit (State Pension Credit) Regulations 2006
Local Government Finance Act 2012
Local Government Act 1992
5.2 Council Tax Reduction is a discount from Council Tax available to all residents within the District on a
low income including those in receipt of benefits. Full details of the scheme for the 2016/2017 financial year
are at
http://www.wealden.gov.uk/Wealden/Residents/Benefits_and_Council_Tax/Council_Tax/CouncilTax2017/B
enefits_Council_Tax_Reduction_Scheme_2017_to_2018.aspx. The details of the scheme are contained
in:The Council Tax Reduction Schemes (Prescribed Requirements) (England) Regulations 2012 (SI
2012/2885) and The Council Tax Reduction Schemes (Default Scheme) (England) Regulations 2012 (SI
2012/2886) were made on 16 November 2012, and laid before Parliament on 22 and 23 of November 2012
respectively.
This instrument, the Council Tax Reduction Schemes (Prescribed Requirements and Default Scheme)
(England) (Amendment) Regulations 2012 (SI 2012:3085) has now been laid before Parliament. This
follows through on the government’s stated intention to increase some of the allowances in the Prescribed
Requirements and Default Scheme in line with the Department for Work and Pensions’ up-rating of
Housing Benefit following the Autumn Statement.
The Prescribed Requirements regulations prescribe requirements for all local Council Tax reduction
schemes and came into force on 27 November 2012.
Please note for Prescribed Requirements:
Schedules 1 to 6 apply to pensioners (as defined) only
Schedules 7 to 8 apply to all applicants (ie working age and pensioners)
The Default Scheme Regulations contain provisions about applicants in receipt of an award of universal
credit, and we will be publishing a further guidance note on this approach, with worked examples.
5.3 The HB/CTR Regulations cover the following specific aspects of maintaining claims
General
Provisions affecting entitlement to HB/CTR
Payments in respect of a dwelling
Membership of a family
Applicable Amounts
Assessment of income and capital
Students
Amount of benefit
Calculation of Weekly Amounts and changes in circumstances
Claims
Decisions on questions
Payments
Overpayments
Information
5.4 In summary, LA’s maintaining claims are under a legal duty to
establish if a claimant is liable to pay rent or council tax
decide the value of rent or council tax liability for benefit purposes
identify all members of a claimant’s family and household
calculate the claimant’s Applicable Amount
assess the value of income and capital for benefit purposes
ensure that claims are legally made
respond to requests for reviews or appeals of benefit decisions
pay the correct amount to the payee nominated by the claimant
accurately identify and calculate overpayments of benefit
5.5 In addition, LA’s maintaining claims are encouraged to adopt best practice published by the DWP
and/or CLG.
5.6 Operational procedures provide for each legal duty to be implemented. Various internal and external
auditors inspect the procedures and processes to ensure claims are maintained in accordance with each
legal duty.
6 The Claim Form
Provide a comprehensive Claim Form to request all relevant information and documentary evidence
to support claims
6.1 HB is a state benefit, entitlement to which is means-tested. There are over 100 HB Regulations
applying conditions relating to housing costs liability, treatment of income and capital, impact of dependants
and non-dependants in the household, payee and payment frequencies, notification, and requests for
review and appeal of benefit decisions.
6.2 CTR is a Discount from Council Tax. It is not a state benefit but there are a number of locally approved
rules relating to council tax liability, treatment of income and capital, impact of dependants and nondependants in the household, payee and payment frequencies, notification, and requests for review and
appeal of council tax reduction decisions.
6.3 The Claim Form (this includes the online New Claim Form at
https://wealdenclaims.teamnetsol.com/index.jsp) asks questions clearly and provides explanations of why
certain documents must be provided before any assessment can take place.
6.4 The paper Claim Form is reviewed when a re-print is required. The current claim form was jointly
designed and produced by all East Sussex benefits services. This ensures maximum continuity across the
local area. The form is also discussed with senior staff and decision makers and includes or excludes
questions depending on HB/CTR Regulations changes for the forthcoming year.
6.5 The paper Claim Form is made available to the public in the Council’s reception areas, from Housing
Association offices, Citizens Advice Bureau, parish council offices, Local Taxation and from the Housing
Department where it forms part of the tenancy sign-up pack. It is also issued by post on demand via letter,
fax, telephone, Minicom or e-mail enquiry.
6.6 The Claim Form (whether the paper copy or online) is written in plain-English and has been certified to
that effect by the Word Centre. It complies with best practice with regard to readability, especially important
to those with partial sight or to those with reading difficulties.
6.7 The paper Claim form is available at Council Offices, all Citizens Advice Bureau in the Wealden area,
other voluntary organisations, some parish councils and registered social landlords. It forms part of the
tenant sign-up pack for Council tenants.
6.8 The online Claim Form is available at https://wealdenclaims.teamnetsol.com/index.jsp).
7 Risk Based Verification
Apply the guidance to each claim
7.1 The guidance on risk based verification is used to verify the information provided in support of benefit
claims. The Council adopted the Risk Based Verification Framework in June 2013 which states the items of
evidence based on risk that can be accepted for different incomes, capital, tenancy, rent liability and
identity; and how to verify their authenticity. The Risk Based Framework should be reviewed each year.
7.2 The aim of the risked based guidance, is to prevent fraud and error entering the benefits system, and to
provide assurances that claimants receive their maximum entitlement to benefit – see Counter-Fraud
Policy and Strategy.
7.3 Compliance with the guidance is secured through refresher training sessions, when reviewing
procedures by Senior Benefits Officers, and when errors are discovered through the Management
Checking Procedures.
8 IT system
Correctly record claim data into Academy Benefits
8.1 The HB/CTR Regulations are so complex that the Council uses a large IT software program (Academy
Benefits) to maintain claims.
8.2 As with all IT systems the effectiveness of the programming depends totally on accurate input of data.
Decision makers are trained to use Academy Benefits by experienced staff.
Accurately assess benefit entitlement using Academy Benefits
8.4 Due to the complexity of the Academy Benefits programs the accuracy of benefit and Council Tax
Reduction entitlement is tested every time a new release of software is applied. It is occasionally the case
that new software provided for specific purposes detrimentally affects the operation of previously accurate
software. Testing of new software is undertaken on the Test System before it is applied to the ‘live’ system.
8.5 The Council’s IT Section manage Academy Benefits by ensuring its availability during working hours,
and by maintaining those technical aspects that provide security and continuity of service. Access to
Academy Benefits is tightly controlled to prevent unauthorised use.
8.6 The Council is a member of the Academy Benefits User Group who consider requirement specifications
before software is written. The User Group meets to discuss claim maintenance software strengths and
weaknesses together with development requests. The User Group will discuss these requests, agree on
the priorities and Academy will allocate resources according to the priorities. As a member of this Group the
Council contributes to ensuring that Academy Benefits remains user friendly, and therefore less prone to
assessment error. The Council may also contribute to specialist sub groups of this User Group.
9 Financial responsibilities
Allocate the correct subsidy classification to each benefit payment
9.1 HB is a state benefit that is funded by the government. LA’s act as agents for the government to
administer the HB scheme, and they receive subsidies to contribute towards the costs of administration and
each benefit payment. HB Subsidy is claimed annually.
9.2 Each time a payment is made an IT record is created that identifies the precise subsidy value that is
claimable for that payment. The values range from 100% to nil depending on the circumstances governing
the payment of that benefit. A combination of system parameters and decision maker input routines create
these records, which are externally audited following the submission of each annual HB Subsidy Claim in
May. If the Subsidy Claim is incorrect the Council can be financially penalised.
9.3 Decision makers receive training and refresher training throughout the year in response to Circulars
issued by the DWP, best practice guidance issued by any government department, benchmarking
intelligence that suggests good practice, responses to complaints, errors found through the Management
Checking Procedure and changes in the HB Regulations.
9.5 Operational procedures provide for the regular quality control of work undertaken within the Benefits
Service. Errors made by decision makers are brought to their attention, and amendments are made to their
decisions when the reason for the error has been understood. Decision makers are provided with the
opportunity to discuss any error identified to reinforce their knowledge.
Pay the right claimants the right amount, the right amount, at the right time
The right claimants
9.6 Operational procedures provide for extensive checking of claimants’ identity, in accordance with s19
Social Security Administration (Fraud) Act 1997. Claimants provide evidence of their identity that includes
their National Insurance number, which can be validated using a government database.
9.7 The IT system reports on claims where a person with the same National Insurance number appears to
be a member of more than one household claiming benefit. There are prescribed circumstances when this
is lawful. These claims are checked to ensure that the circumstances are prescribed.
The right amount
9.8 The right amount of benefit depends on the claimant providing accurate data, decision makers
interpreting and treating that data correctly for benefit purposes, and Academy Benefits accurately applying
the appropriate parameters to claimants’ circumstances.
9.9 Customers applying are encouraged to provide accurate data on the Claim Form. If no evidence of
information is provided decision makers write to each claimant listing, in detail, the documents required
before their claim can be assessed.
9.10 The Corporate Fraud Unit respond to referrals of alleged fraud from several sources, including
decision makers, members of the public and other government agencies. Housing Benefit Fraud is referred
to the DWP’s Single Fraud Investigation Unit (SFIS).
9.11 Decision makers are trained extensively on HB/CTR Regulations and internal procedures, taking
around 2 years to become fully experienced. Throughout the year decision makers receive update training
and refresher training in response to Circulars issued by the DWP, best practice guidance issued by any
government department, benchmarking intelligence that suggests good practice, responses to complaints,
errors found through the Management Checking Procedure and changes in the HB/CTR Regulations.
9.12 Due to the complexity of Academy Benefits the accuracy of benefit and Council Tax Reduction
entitlement is tested every time a new release of software is applied. It is occasionally the case that new
software provided for specific purposes detrimentally affects the operation of previously accurate software.
Testing of new software is undertaken on the Test System before it is applied to the ‘live’ system. Bugs or
failures are reported to Academy Benefits.
The right manner at the right time
9.13 HB for Council tenants and CTR for all claimants is paid as a rebate to their rent and Council Tax
accounts held by the Council, by law. Council tenant rent accounts are updated weekly with their rebate
and any adjustments made during the week to reflect any changes in their circumstances or in the HB/CTR
Regulations. The first payment of CTR made each year is paid to next 31st March, and any changes in
claimant circumstances are reflected in adjustments made thereafter.
9.14 Private tenants or their landlords are paid by crossed cheque or BACS transfer. HB Regulations
govern whether or not payments are made in advance or arrears.
9.15 Only in one circumstance can landlords request payment be made direct to them, which is actioned in
accordance with the HB Regulations.
9.16 The Benefits Service Safeguard Policy describes in which circumstances Local Housing Allowance
payments can be made to landlords of private tenants. This policy was produced by East Sussex benefits
services and is published on the Council's website.
10 Decision Notices
Notify claimants and landlords about benefit decisions, in accordance with HB/CTR Regulations
Schedule 9 (Schedule 8 of the State Pension Credit Regulations) prescriptions
10.1 The HB/CTR Regulations prescribe those information items that must comprise each Decision Notice
relating to benefit entitlement. These are the following where applicable:-
a statement as to the right of any ‘person affected’ to request a written statement that explains how the
decision was reached
a statement as to the right of any ‘person affected’ to apply for the decision to be revised, or to appeal
against the decision
where the original decision has been changed, a statement as to the right of any ‘person affected’ to
apply for the new decision to be further revised, or to appeal against the new decision
where the original decision has not been changed, the reasons why the decision has not been revised
weekly eligible rent/Council Tax
amount of any fuel deductions
amount and category of any non-dependant deductions
weekly amount of benefit
1st day of payment for private tenants
1st day of entitlement to benefit
last day of entitlement to benefit, if not ended earlier
claimants duty to notify the Council about changes in circumstances, and the kinds of changes to notify
the claimant’s Applicable Amount, and how it is calculated
the value of any earnings used to decide entitlement
the value of any other income used to decide entitlement
where the claimant has requested direct payment to landlord, the value and date from which the
payment will be made
where the income/capital of a non-dependant has been used to decide entitlement, that fact and the
reasons why the decision has been made thus
where no benefit entitlement is assessed, that fact and the reasons why
where the notification is about an overpayment of HB the items in Overpayment Policy and Strategy
10.2 Operational procedures ensure that the above information items are included in relevant notifications
to claimants and landlords, where applicable.
10.3 Correspondence from the Benefits Service is written in plain English, unless the letter templates
prevent amendments from being made.
11 Claimant and landlord rights
Make claimants aware of their rights to request a review or appeal against decisions
11.1 Operational procedures ensure that the Council
examines the circumstances of each case and makes decisions in accordance with the HB/CTR
Regulations
advises claimants and landlords of their rights – See 9 Notification of an overpayment above
11.2 DWP guidance states that “it is important to recognise that there is a right under the law to appeal and
LA’s should not filter or obstruct the process in any way”.
11.3 Operation procedures make claimants and other ‘persons affected’ aware of their rights to request a
revision or appeal against benefit decisions. These rights are contained in all decision notices relating to
benefit decisions. Operational procedures provide for requests for a revision or appeal to be actioned
according to the DMA Regulations.
11.4 Operational procedures aim to reply to requests for an explanation, review or appeal against
overpayment decisions within 14 days. As well as the appropriate response depending on the request, all
replies contain the following information
the right to appeal further, how and when to do this
a simple and clear form for submitting a further appeal
direct telephone numbers to contact the Benefits team
11.5 Claimants and ‘persons affected’ may appeal outright when receiving a decision. If the Council does
not revise or supersede its original decision in favour of the claimant or landlord the appeal is automatically
submitted, by law, to The Tribunal Service for a tribunal hearing.
11.6 Tribunal hearings are judicial, though less formal than court hearings. A legally qualified Chairman
hears the appeal. All tribunal members are independent of the Council.
11.7 Operation procedures ensure that any decision by the tribunal is actioned on the same or following
working day, unless the Council intends to appeal against the tribunal’s decision. If the Council intends to
appeal the prescribed procedures and time-limits are strictly observed.
11.8 Council Tax Reduction Appeals are dealt with through the Independent Valuation Tribunal like other
Council Tax appeals. Customers have no time limit to appeal to the Local Authority. Once the customer has
appealed to the Council, the Council has 2 months to act on the Appeal. Should the Local Authority not
respond within these 2 months or do it negatively the customer has a further 2 months to refer the appeal to
the Independent Valuation Tribunal.
12 Quality Control and Internal Check
Ensure the Council makes accurate decisions
12.1 The Council has sound and comprehensive mechanisms to ensure the quality of claim maintenance
decision making through regular training of staff, and through the Management Checking Procedure.
12.2 Decision makers receive training and refresher training throughout the year in response to Circulars
issued by the DWP, best practice guidance issued by any government department, benchmarking
intelligence that suggests good practice, responding to complaints, errors found through the Management
Checking Procedure and changes in the HB/CTR Regulations.
12.3 Training is provided via dedicated subject training courses and refresher training sessions
12.4 Operational procedures provide for the regular quality control of work undertaken within the Benefits
Service. Errors made by decision makers are brought to their attention, and amendments are made to their
decisions when the reason for the error has been understood. Decision makers are provided with the
opportunity to discuss any error identified to reinforce their knowledge.
12.5 The overall work of the Benefits Service is independently monitored by Internal Audit to provide
assurance to the Council that procedures are adequate, appropriate and can be audited for financial
probity.
12.6 Internal Audit has an annual plan to monitor the work of the Benefits Service. Any recommendations
made in their reports are actioned within timetables accepted by them.
13 Policy performance
Set challenging and realistic performance targets
13.1 The Service measures its performance against a range of national and local performance indicators
shown in the Corporate Plan. The Benefits Service reviews all targets annually to ensure they remain
relevant to service users.
13.2 Each year a target is based on previous years’ performance and known issues affecting potential
performance in the following year, such as the implementation of Universal Credit. Previous years'
performance and the new targets are discussed as part of the annual staff appraisal process and in regular
1:1’s and team meetings. This ensures all staff are aware about how their work contributes to the Council's
overall objectives. This is commonly known as the 'Golden Thread'.
Monitor performance and report to Members
13.3 Performance is monitored regularly and will be analysed to explain deviation from expected outcomes.
Performance monitoring methods and procedures are to be reviewed regularly.
13.4 Performance is monitored monthly and reported on the Council’s Corporate Performance System.
13.4 Quarterly reports on performance against national indicators are provided for Cabinet and Internal
Scrutiny Committee in Quarterly Performance Management reports.
13.5 Performance against all indicators is published on the Council's website.