PIP mandatory reconsideration: the medical evidence that actually helps

A mandatory reconsideration is the Department for Work and Pensions looking at your PIP decision again, and it is a step you must normally take before you can appeal to a tribunal. The evidence that helps most is evidence about what you can and cannot actually do, not simply evidence that you have a diagnosis.

What mandatory reconsideration is, and the time limit

When the Department for Work and Pensions, the DWP, decides your Personal Independence Payment claim, you receive a decision letter explaining the outcome and the reasons. If you disagree, the first formal step is to ask for a mandatory reconsideration, which means a different decision maker looks at the claim again. You can ask by phone, by letter, or using form CRMR1. Say clearly that you are asking for a mandatory reconsideration, give your National Insurance number, and keep a copy of whatever you send.

You normally have 1 month from the date on your decision letter. Put the request in before chasing evidence, because you can send supporting documents afterwards. If you are late, do not assume you have lost your chance. Late requests can be accepted where there is a good reason, and there are provisions allowing a late revision request up to 13 months from the decision in some circumstances. Explain the delay factually, for example illness, bereavement or waiting on advice.

Mandatory reconsideration is not the same as an appeal. An appeal goes to an independent tribunal, separate from the DWP, and you normally need the mandatory reconsideration notice before the tribunal will accept your case. Many decisions do change at the reconsideration stage, so it is worth doing properly rather than treating it as a formality on the way to appeal.

PIP is about function, not diagnosis

This is the single most important thing to understand, and the point most rejected claims miss.

PIP is scored against specific daily living and mobility activities, things like preparing food, washing and bathing, dressing, mixing with other people, planning journeys and moving around. Having a condition does not score points. What scores points is how your condition affects those activities.

The legal test is also about reliability. An activity only counts as done if you can do it safely, to an acceptable standard, as often as reasonably required, and within a reasonable time. If you can walk 100 metres but it takes you 3 times longer than most people and leaves you exhausted, that may not count as being able to do it. And if your condition varies, what matters is how you are on more than half of days, so describe your typical reality rather than your best day.

The medical evidence that actually helps

Decision makers find evidence useful when it does 3 things: it confirms the condition from a clinical source, it describes the functional effect in ordinary language, and it says how the writer knows.

A good GP letter separates what is documented in your records, what you have reported, what the GP has directly observed, and the GP’s professional opinion. It describes symptoms and their variability, what you can and cannot do, whether you can do it safely and repeatedly, the help, prompting or supervision you need, how often difficulties occur, and the period the evidence relates to. Vague statements like this patient struggles with daily tasks carry little weight. Specific ones, such as this patient cannot reliably prepare a simple meal without prompting on most days, carry far more.

Send what you already have rather than waiting for perfect evidence: your decision letter, the assessment report if you have requested it, clinic letters, prescription lists, care plans, and a short diary of how your condition affects you across a typical week.

As for the request itself, there is no single letter that suits everyone, and you should be wary of any template that claims otherwise. Your request needs to respond to the reasons in your own decision letter, using facts that are true for you. A workable structure is to state that you are asking for a mandatory reconsideration with your details, then take each activity where you disagree with the points awarded, say briefly why, and point to your evidence. Keep it about the facts, not about how unfair it feels, because decision makers can only act on the facts. If you can, get help from an independent welfare rights service such as Citizens Advice or a local advice charity. They do this every day, they are free, and their help is often the difference between a request that asserts and a request that persuades.

What a GP can and cannot do

A GP can provide factual medical evidence: your conditions as known to the practice, relevant history and treatment, observed findings, and a professional opinion on functional effect where the GP has enough information to form one.

A GP cannot award points, decide your eligibility, write whatever you ask for regardless of the facts, or guarantee that a reconsideration or appeal will succeed. A GP letter is evidence, not advocacy, and it is the factual grounding that gives it weight with decision makers. Payment never guarantees a document or an outcome: the GP writes what the assessment and records support, and if the evidence does not support a statement, it does not go in.

Frequently asked questions

What medical evidence helps a PIP mandatory reconsideration?

Evidence that describes functional effect: what you can and cannot do, whether you can do it safely, to an acceptable standard, repeatedly and in reasonable time, and the help you need. A letter that just names a diagnosis adds little. A letter that explains, with examples, how your condition limits specific PIP activities adds a great deal.

Do I need a letter from my GP for PIP?

No, it is not compulsory, and plenty of claims succeed without one. It is one source of evidence among several, alongside your own account, your diary, and reports from other professionals involved in your care. It helps most when your own evidence and the assessment report disagree on the facts.

How long do I have to ask for a mandatory reconsideration?

Normally 1 month from the date of the decision letter. Late requests can be accepted with a good reason, and there are provisions for late revision up to 13 months in some circumstances, so ask anyway and explain the delay.

What is the difference between mandatory reconsideration and an appeal?

A mandatory reconsideration is the DWP reviewing its own decision. An appeal is heard by an independent tribunal, separate from the DWP. You normally need the reconsideration notice before you can appeal, and many people only win at tribunal, so do not be discouraged if the reconsideration does not change the decision.

Can a GP write my mandatory reconsideration request for me?

A GP provides the medical evidence, not the request itself. The request is yours, and it should respond to the reasons in your decision letter. An independent welfare rights adviser is the right person to help you frame it.

How to arrange an assessment

If you need independent medical evidence for a PIP claim, reconsideration or appeal, Clinique Alpa provides PIP and disability reports from a MedCo registered GP, assessed by secure video. The GP reviews your records and your evidence first, so tell us what the report is for and any deadline when you get in touch. A disability supporting letter is £500, and every report follows an assessment.

Start with our medical reports page, or book an online GP consultation to talk it through first. You can also call 020 8882 8088.

Dr Mitesh Parmar, Principal GP and Clinical Director at Clinique Alpa. MBBS MRCGP, GMC number 6113670.