What to do? ESA appeal and now claiming JSA!

dooney

Hi, ill try and keep it brief, My husband has a motorbike accident last July and has been left with back and knee injuries. After being paid off from work last September he claimed for ESA which he received. In December he was to attend a Atos medical, but last minute they phoned to re arrange till January. January came and he received a letter asking why he did not attend, my husband had the re scheduled date on the calander for a week later. We filled in the form to state they had been a error made with the appointment times, but this was not an acceptable reason for not attending. His ESA was stopped, and he was to re apply for ESA, he was told to apply for a crisis loan in the mean time until an addtional medical was arranged. I currently work 20+ hours a week so we are trying to manage with the help of credit card.
My husband has now received another Atos appointment for a few weeks time.

I am now worried, as I have read if he does not not receive enough points we wont get any money for the weeks while we have been waiting. I don't know what to do, he can't work due to the injuries sustained, and he has been told he can't claim job seekers as he is not fit for work.

He has been recieving physio and attending MRI scan in the very near future.

Any advice would be appreciated,
thanks dooney

melbi_uk

So sorry to hear of your OH accident.

The only thing you can do is be honest with them. You can go in with him too. Some people suggest you record the assessment or take notes.

When I had my assessment just over a week ago I did neither. Probably going to regret that!

Inform your GP about the upcoming assessment. I told mine and he wasn't very happy. I don't know whether ATOS had been in touch with him or he had taken it upon himself to contact them but they had information there that I hadn't mentioned on the form you have to complete when applying for ESA.

They will ask how you got there, that in your OH's case will be very important, as they will use that, so don't play down on it! Make it very clear how difficult it has been for him to get there.

Here is a link that will help you understand more about the medical:
http://www.tameside.gov.uk/esa/wca

Also, when asked questions talk only of his bad days, not the good days (if he is lucky enough to have good days)

Good luck

rogerblack

dooney wrote: »

<snip>
. His ESA was stopped, and he was to re apply for ESA, he was told to apply for a crisis loan in the mean time until an addtional medical was arranged.
<snip>

I am now worried, as I have read if he does not not receive enough points we wont get any money for the weeks while we have been waiting.

This is correct.
Attending the medical, unless you have a really good reason is absolutely vital - there are really limited grounds for it to be ignored.

Now, as to positive suggestions.
I'd first phone ATOS, and see if it's possible to arrange an earlier appointment, or to come in on a cancellation. (I don't think it is - but trying it is worthwhile).

Secondly - read http://www.dwp.gov.uk/publications/specialist-guides/decision-makers-guide/#vol8 - specifically chapter 42 - this is the 'descriptors' for ESA - and their explanation for the 'decision makers' and guidance.
Read all the guidance, it contains such gems as 'if a claimant cannot perform a task with a reasonable regularity throughout the day, they should be taken as unable to perform the task.'

Now, work out what descriptors you are likely to obtain points for.
If there are no descriptors that fit - look at the clause that covers this - 'a severe risk of health to any person if the claimant...'. This is difficult to prove, but a letter from any medical staff may be useful.

If there are descriptors that fit, totalling 15 points or more, get all the evidence to back this up.
Letter from you, letter from any medical professionals you're in contact with specifically addressing these points.

(for example, 'he finds difficulty walking long distances' - may be almost useless - 'He cannot walk more than 20m, slowly, with pauses, and is exhausted by the effort' from your GP or medical personell may be what they are looking for).

In principle the former may be good enough for a tribunal, but this will be another several months down the line with no money.

In short, get any and all evidence bearing on the descriptors in question - this may include stuff like a daily diary of problems.

Make sure you get to the new medical - for example have two means of transport, and get there an hour early.

Consider requesting a home visit, if appropriate.

birkee

rogerblack wrote: »

This is correct.
Attending the medical, unless you have a really good reason is absolutely vital - there are really limited grounds for it to be ignored.

As I read the first post, an appointment was cancelled, so there was, in effect, no medical to attend.
Mindless bureaucracy again?

sunnyone

melbi_uk wrote: »

Also, when asked questions talk only of his bad days, not the good days (if he is lucky enough to have good days)

Good luck

You are fraudulently claiming ESA if you LIE at your medical and what you are suggesting is LIEING.

You are also putting your future benefits at risk because anyone can ring the fraud hotline and when they watch you and see that you lied at your medical you could have to pay the whole lot back including LHA/HB etc. together with an aministration charge if your lucky, or a criminal record if you defraud tham by over £2k.

melbi_uk

sunnyone wrote: »

You are fraudulently claiming ESA if you LIE at your medical and what you are suggesting is LIEING.

You are also putting your future benefits at risk because anyone can ring the fraud hotline and when they watch you and see that you lied at your medical you could have to pay the whole lot back including LHA/HB etc. together with an aministration charge if your lucky, or a criminal record if you defraud tham by over £2k.

When I had my medical the assessor kept asking me if I was talking about a good day or bad day.

It isn't telling lies, you are letting them know how you are most of the time.

What is the point of the OP's OH saying he can walk 50 metres when his pain is not too bad but that might only happen once or twice a week!


Of course if you only have a bad day every blue moon and you used that day, then it would give a false impression!

The OP has stated her OH's health problems, so no, they won't be telling lies if they concentrate on a bad day (which, to me, sounds like he will be suffering most days)

Tehya

OP: Never use the "bad day" idea because you may be accused of fraud. The best way to handle the medical is be honest and talk about your "average day" in other words how you are most of the time. You can mention that you have worse or very bad days and how often they occur.

melbi_uk

whatever!

I still suggest you talk about his condition what he is like on his bad days.

Don't dress his condition down!

melbi_uk

Tehya wrote: »

OP: Never use the "bad day" idea because you may be accused of fraud. The best way to handle the medical is be honest and talk about your "average day" in other words how you are most of the time. You can mention that you have worse or very bad days and how often they occur.

If he isn't able to do things on his bad days then how can that be fraud?

thetriggerhappypwner

I am doing one better and going with my lawyer! I am in a similar situation as the OP on this topic.

dooney

thank you for all your replies.

just to clear up a few things - unfortunatly there will be no need to lie about anything as my husband is in considerable pain most of the time. He is unable to carry out any of the housework or play with our son. Due to the location of our sons nursery he is not even able to pick him up as the path is to long for him to walk down! He also is waking up in the night in pain causing him to be fatigued as well as run down with the length of time that he has been in constant pain. He is able to sit or stand only for short bursts before needing to re-adjust his position due to pain.
The physio he is under is worried about both injuries and due to the lack of results from the work put in at the physio sessions he is now referred for MRI's.

My main worry is that if for some insain reason he is not eligible then how do we back date maybe an income support claim.... even though he is not fit for work - if they deem him fit for work then can we back date a JSa type claim? really confused with all the rules and regs but know that we have no money coming in and a husband who is very poorly!

dooney