Exceptional Circumstances (COP 26) - Higher Officer Use Only (AG)

When considering whether exceptional circumstances prevented or delayed a claimant meeting their responsibilities, consider steps 1 to 7 below. The guide is presented as follows

Initial action	Step 1
Overpayments and Exceptional Circumstances worksheet	Step 2
Review evidence provided by caseworker	Step 3
Things to consider each time	Step 4
What are the exceptional circumstances?	Step 5
Make your decision	Step 6
Pass the decision to caseworker	Step 7

Initial action

If you are dealing with a request to consider exceptional circumstances, passed to you for

The first time from a caseworker, go to step 2
A second time following the caseworker completing all parts of the Overpayments and Exceptional Circumstances worksheet correctly, go to step 3
A second time, after obtaining additional information, go to step 3

Overpayments and Exceptional Circumstances worksheet

Each claim will be passed to you with the Overpayments and Exceptional Circumstances worksheet

You must ensure all parts of the worksheet are completed before considering the exceptional circumstances. The following information must be included

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

Not been completed

Return the claim to the caseworker, asking them to complete all parts of the worksheet

Take no further action

Review evidence provided by case worker

Using the Overpayments and Exceptional Circumstances worksheet, review the evidence that has been passed to you

Note: It may be beneficial to discuss the evidence with the caseworker to ensure you have interpreted their notes correctly

Once you are happy that you have understood the details passed to you, go to step 4

Things to consider each time

When considering whether exceptional circumstances prevented or delayed a claimant meeting their responsibilities, remember

To treat each claim on its own merits and take the claimant’s personal circumstances into account
That if circumstances are unique or rare, it does not necessarily mean they are exceptional
That exceptional circumstances can also be defined as ‘strong reasons for’
That your decision should be fair and reasonable, based on the facts

When you have considered all of the above, go to step 5

What are the exceptional circumstances?

5	Consider what the exceptional circumstances are The guidance COP 26 Responsibilities provides some examples of exceptional circumstances, but this list is not definitive Each claim must be considered on its own merits Go to step 6

Make your decision

Once you have considered all of the evidence you have been given, you must decide whether exceptional circumstances prevented or delayed the claimant meeting their responsibilities

Once you have all the information you need, you must take no longer than 48 hours to make your decision

Note: To help keep decisions consistent, contact the Customer Service and Support Group (CSSG) Technical Team HO where you have particularly difficult circumstances to consider

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 7

Pass the decision to caseworker

7	Return the claim to the caseworker for them to implement your decision Then Record your decision on the Controlled Access Folder (CAF), located in the CSSG HO shared folder Note: Contact the CSSG Technical Team HO if you do not have access Take no further action

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