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Failed ESA medical - what to do next?

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I have just had a letter telling me that I do not qualify for ESA (I got 12 points) and to be honest I think the doctor must have interviewed someone else because the points awarded do NOT represent the answers given to him.

I was in receipt of JSA when I became ill with very achy muscles and joints, especially in my thighs, buttocks, shoulders and my knee which has been so bad I needed a stick, I also get fatigued and get incredibly stiff after I have been sitting for a while. In the mornings I'm so stiff I can't bend to shower properly until I have been up for an hour. I can't stand for more than a few minutes without my lumbar region and my shoulders killing me. Moving about does not help, I just have to sit down until the burning aches have subsided. I do get good days but many days I can't walk 50 yards without desperately needing to sit down or rest due to burning pains in my muscles. It's so frustrating and I don't know from one day to the next how I am going to be. A trip round our very tiny town (500 yards round trip) can leave me exhausted, achy and barely able to drag myself home, needing to sit whenever I can. I am a type 2 diabetic and also have an underactive thyroid (underactive because an overactive one was zapped to cure it).

I was having one of the many flare ups so my doctor signed me off for a month while investigations were done (I have now been off for almost 13 weeks) and I applied for ESA.He prescribed naproxin to help with the pains. Blood tests done by my doctor had been showing raised ESR (inflammation) and low haemoglobin making me anaemic which probably contributes to the fatigue. Since applying for ESA I've had lots of blood tests to rule out Lupus, RA and Polymyalgia. Finally my doctor referred me to a rheumatologist who I will be seeing next week. In the meantime I had to fill out the ESA medical form and I was awarded ESA on the basis of that.

A month ago I had to attend for a medical 16 miles away. I was in the middle of a flare up and having a bad few days. I travelled by bus and taxi and with the aid of my stick and was hobbling and very slow. One of the things the doctor asked me to do was pick something up off the floor and I couldn't (suffering from back pain I'd had for three weeks which is now gone for the moment). He scored 0 for that despite the fact I couldn't bend squat or kneel. I got 6 points for being able to walk no further than 200 yards even though, when asked, I told him that I couldn't walk 50 yards without pain and needing to sit down. I told him that some days I couldn't get as far as the gate before I was hobbling in pain. I made it perfectly clear that 50 yards or less was my max and yet that is not on the results. I got 6 points for not being able to stand for 30 minutes when I made it clear that I was in pain and needed to sit after less than 5 minutes.

So, is it worth appealing? Should I just suck it up and go back on JSA even though I'm clearly not fit for work at the moment and should I get a job would probably take many days off work when I have the regular flare ups, and thus lose the job. I'm 58 and have never been unemployed, except for having my children, until the last couple of years after I was made redundant and then I became ill shortly afterwards (with the overactive thyroid). The 'lies' the doctor must have told on his report have upset me and made me quite tearful and angry. Talk about them making you feel like a fraud. I am going to ask for a copy of the medical but I know there's nothing to be done about how the doctor filled the report in. I really don't know which way to go. I have no other income. I have two weeks to run on my current medical certificate so I am hoping they will still pay my NI stamp. I'll speak to the housing people to see what will happen to my housing benefit. I can retire in two years, thank god ;-)

Sorry this is long winded, I got carried away! Any advice or comments would be appreciated.
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Comments

  • cit_k
    cit_k Posts: 24,812 Forumite
    Personally, I would say appeal.

    See a welfare rights advisor (free) also.

    I know what its like to read those medical reports, everyone I get makes me ill, and furious, and depressed, and so many different emotions over time - its crazy really that they can

    1 - actually let the system produce such rubbish in the first place
    2 - let it get past the doctor who is supposed to authorise it as a true account
    3 - let it get past the atos quality assurance
    4 - let it get past the decision maker

    and then send it to people who are at their most vunerable.

    It should be illegal, it really is a form of torture.

    Good luck, let us all know how your appeal goes - you should be able to get money coming in (via benefits) during the appeal btw.
    [greenhighlight]but it matters when the most senior politician in the land is happy to use language and examples that are simply not true.
    [/greenhighlight][redtitle]
    The impact of this is to stigmatise people on benefits,
    and we should be deeply worried about that
    [/redtitle](house of lords debate, talking about Cameron)
  • healy
    healy Posts: 5,292 Forumite
    Part of the Furniture 1,000 Posts
    If you appeal the decision you will be paid ESA at the assessment rate until the appeal has been heard.

    To help with the appeal it would be a good idea to get help from a welfare rights adviser, these can be found at the CAB, Local Council and at disability organisations such as DIAL.

    From what you have said and the fact that you have aleady scored 12 out of the 15 points required I think you would stand a good chance of success at appeal.
  • McKneff
    McKneff Posts: 38,857 Forumite
    Part of the Furniture 10,000 Posts Name Dropper
    Just a general question please i know the difference between JSA and ESA but what is the financial difference.
    make the most of it, we are only here for the weekend.
    and we will never, ever return.
  • healy
    healy Posts: 5,292 Forumite
    Part of the Furniture 1,000 Posts
    McKneff wrote: »
    Just a general question please i know the difference between JSA and ESA but what is the financial difference.

    JSA is paid at £64.30 per week for a single person.

    ESA is paid as follows:

    Rates
    Weekly rate during the assessment phase

    The assessment phase rate is paid for the first 13 weeks of your claim while a decision is made on your capability for work through the Work Capability Assessment.
    Age of claimant Weekly amount
    A single person aged under 25 up to £50.95
    A single person aged 25 and over up to £64.30

    Weekly rate during the main phase

    The main phase starts from week 14 of your claim, if the Work Capability Assessment shows that your illness or disability does limit your ability to work.
    Type of group Weekly amount
    A single person in the Work Related Activity Group up to £89.80
    A single person in the Support Group up to £95.15
  • mouse_
    mouse_ Posts: 10 Forumite
    Actually I'd like to know the answer to that question. I thought that for the first 13 weeks I'd be getting the same as JSA but I've been getting about £15 a week extra. I phoned to query it after the first payment into my bank and told them that I thought they were paying the service charge element of my rent and that was incorrect because the housing benefit department pay that (and are doing). There's a question on the application form asking if a service charge is paid and I also queried that when I made the application (over the phone) and told them then that it was usually paid by the housing benefit department. I was told to write in and enclose my rent details again, which I did, and I've never had a response. What's a girl to do? The entire system is cocked up.
  • mouse_
    mouse_ Posts: 10 Forumite
    edited 29 August 2009 at 7:44PM
    healy wrote: »
    If you appeal the decision you will be paid ESA at the assessment rate until the appeal has been heard.

    Do you know what the assessment rate is while going through the appeal process?

    By the way thanks for the comment to McKneff re: the rates of benefit. They must be paying me incorrectly despite me telling them twice and writing once to tell them that I thought it was wrong (and still is).
  • MrsA1939
    MrsA1939 Posts: 318 Forumite
    healy wrote: »
    JSA is paid at £64.30 per week for a single person.

    ESA is paid as follows:

    Rates
    Weekly rate during the assessment phase

    The assessment phase rate is paid for the first 13 weeks of your claim while a decision is made on your capability for work through the Work Capability Assessment.
    Age of claimant Weekly amount
    A single person aged under 25 up to £50.95
    A single person aged 25 and over up to £64.30

    Weekly rate during the main phase

    The main phase starts from week 14 of your claim, if the Work Capability Assessment shows that your illness or disability does limit your ability to work.
    Type of group Weekly amount
    A single person in the Work Related Activity Group up to £89.80
    A single person in the Support Group up to £95.15

    Hi Healy
    Can you tell me if my husband is receiving the correct rate £64.30 ESA he had a stroke in October and went onto to ESA in April, he had his ATOS medical at the beginning of August and not yet heard anything :confused:

    Thank you
  • healy
    healy Posts: 5,292 Forumite
    Part of the Furniture 1,000 Posts
    MrsA1939 wrote: »
    Hi Healy
    Can you tell me if my husband is receiving the correct rate £64.30 ESA he had a stroke in October and went onto to ESA in April, he had his ATOS medical at the beginning of August and not yet heard anything :confused:

    Thank you

    Yes that is the correct rate until a decision has been made, if he passes the medical his increased ESA rate will be backdated to the 14th week.
  • MrsA1939
    MrsA1939 Posts: 318 Forumite
    Thanks Healy, much appreciated :A
  • healy
    healy Posts: 5,292 Forumite
    Part of the Furniture 1,000 Posts
    mouse_ wrote: »
    Do you know what the assessment rate is while going through the appeal process?

    By the way thanks for the comment to McKneff re: the rates of benefit. They must be paying me incorrectly despite me telling them twice and writing once to tell them that I thought it was wrong (and still is).

    The assessment rate is as above - £64.30.
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