TCM0224340 - Payment - overpayments (A-C): overpayments - COP 26 exceptional circumstances - Higher Officers only
Background
As a Higher Officer, you will consider claims where the customer indicates exceptional circumstances have prevented or delayed them meeting their responsibilities under Code Of Practice 26 (COP 26).
If you receive information or evidence about the mental health problem of a customer you can agree not to pursue that customer for payment. This is to prevent any detrimental effect or unreasonable distress to the customer. (This content has been withheld because of exemptions in the Freedom of Information Act 2000)
In the majority of cases, the initial contact about a customer’s mental health problem will be from a third party on behalf of the customer, such as from a doctor or psychiatric nurse. Organisations such as MIND and Citizens Advice Bureaux can also be involved.
Where this is the case, you become the decision maker and must base your decision only on the information available.
If you decide you need further information before you can make a decision, you should ask the caseworker to contact the customer for the additional information.
Although there is no official definition of exceptional circumstances, the guidance in COP 26 Responsibilities provides further background. Each claim is individual and must be considered on its own merits. This guidance leads you through the steps to take, but will not tell you how to make a decision.
Guidance
Step 1
If you are dealing with a request to consider exceptional circumstances for the first time, go to Step 2.
If you are dealing with a request to consider exceptional circumstances after obtaining further information, go to Step 3.
Step 2
Check that all parts of the ‘Overpayments and exceptional circumstances worksheet’ have been completed with the following information.
- the caseworker’s name and contact details
- details of the exceptional circumstances
- all relevant dates.
If all parts of the ‘Overpayments and exceptional circumstances worksheet’ have been completed, go to Step 3.
If all parts of the ‘Overpayments and exceptional circumstances worksheet’ have not been completed
- return the claim to the caseworker, asking them to complete all parts of the worksheet
- take no further action.
Step 3
Review the evidence that has been passed to you. Consider what the exceptional circumstances are, TCM0224280 provides some examples of exceptional circumstances, but this list is not definitive.
Consider whether exceptional circumstances prevented or delayed a customer meeting their responsibilities or whether the exceptional circumstances affect the decision to recover any overpayment.
Note: It may be beneficial to discuss the evidence with the caseworker to ensure you have correctly interpreted their notes.
Treat each claim on its own merits, take the customer’s personal circumstances into account and consider
- if circumstances are unique or rare, it does not necessarily mean that they are exceptional
- exceptional circumstances can also be defined as ‘strong reasons for’
- your decision should be fair and reasonable, based on the facts.
When you have considered all these factors, go to Step 4.
Step 4
Once you have considered all of the evidence you have been given, you must decide whether exceptional circumstances prevented or delayed the customer meeting their responsibilities or their ability to manage their financial affairs because of for example mental illness
- you must take no longer than 48 hours to make your decision
- complete the ‘Overpayments and exceptional circumstances worksheet’ to confirm
- your decision
- any dates that are applicable
- any periods that are applicable
- any amounts that are applicable
- any notes (including your reasons for the decision).
Note: You may decide to remit part or all of the overpayment caused by the exceptional circumstances
- go to Step 5.
Step 5
Return the case papers to the caseworker for them to implement your decision
- record your decision in the Controlled Access Folder (CAF), located in the CSSG HO shared folder
- take no further action.