WRAG or Support Group?

ltcinter

If a fresh claim (not IB migration) for IRESA is deemed by ATOS not to require a WCA, but instead a decision - by the DWP - is made based on a fit note, ESA50 and ESA113 alone, would it follow that the claimant (who is not exempt) would automatically be put into the support group? If not, how can the HCP/DWP determine - without a WCA - if the claimant has LCWRA or not?

rogerblack

As I understand it, there is no requirement for the claimant to undergo a medical.

A clients file may be passed to 'medical services' (ATOS), who make a recommendation if the client should be called to an in-person medical.
At this stage, without even requiring the ESA50, the client can be put in either group of ESA, if the decision maker so chooses.

The hoops around ESA are almost all of the DWPs choosing.
It's the DWPs decision to make them jump through them or not.

ltcinter

rogerblack wrote: »

At this stage, without even requiring the ESA50, the client can be put in either group of ESA, if the decision maker so chooses.

Thanks Roger,

But if the decision maker decides to rubberstamp ATOS's recommendation that the claimant has enough evidence to forego the need for a WCA, wouldn't it be almost certain that ATOS consider the claimant to have LCWRA?

It seems to me that not requiring a fresh claimaint to undergo a WCA is tantamount to saying that they consider the disability to be of a severity that would exclude them from WRAG. If the decision maker decides that the claimant does not have LCWRA, without a WCA, what would this be based on? And why not just insist on a WCA to make sure?

Cpt.Scarlet

No, what they are saying is that there was sufficient information in the ESA50, any attached evidence, and any report made by a GP or Consultant to make a decision, it has nothing to do with the severity of the claimants condition.

Muttleythefrog

ltcinter wrote: »

Thanks Roger,

But if the decision maker decides to rubberstamp ATOS's recommendation that the claimant has enough evidence to forego the need for a WCA, wouldn't it be almost certain that ATOS consider the claimant to have LCWRA?

It seems to me that not requiring a fresh claimaint to undergo a WCA is tantamount to saying that they consider the disability to be of a severity that would exclude them from WRAG. If the decision maker decides that the claimant does not have LCWRA, without a WCA, what would this be based on? And why not just insist on a WCA to make sure?

I think it might be helpful to think slightly differently. The WCA is carried out regardless (although I'm sure technically there will be exceptions).... whether that WCA requires a face to face medical with ATOS, or even completion of ESA50 form etc is something that is flexible as described above. So "If the decision maker decides that the claimant does not have LCWRA, without a WCA, what would this be based on?" isn't really in the field of play... the claimant does have a WCA.. they just might not require certain fact finding methods in order for the WCA to be carried out. The DWP would take the view that if they find a claimant to have LCWRA or LCW without a face to face medical then it is because they felt sufficient facts were available to decide that.

Unless specific serious conditions/circumstances are declared in a fit note it would seem unlikely that document alone would be used to make WCA determinations since it contains extremely limited information (probably none) regarding the tests for LCW and LCWRA.

ltcinter

Thanks for the comments.

I suppose that this boils down to the decision by the HCP to send a ESA113 to the GP. The HCP decided to send one out based only on the fit note and the completed ESA50.

Why send one at all if the evidence pointed to the claimant having only LCW, but not LCWRA?

I read recently that only around 8% of claimants have ESA113 forms sent to their GPs. If the GP's information on the ESA113 confirms that the information on the claimant's ESA50 is a fair reflection of the kind of difficulties the claimant would have with the descriptors, surely this would result in the claimant being placed in the support group. I say this because - without a face to face assessment - the HCP has to make a call on both LCW and LCWRA.

What I am having trouble understanding is how the HCP can decide if the claimant has scored 15 points on any of the descriptors that would get the claimant into the support group. In fact, without a face to face assessment, how can the HCP make any decision on the points for any descriptor?

Cpt.Scarlet

ltcinter wrote: »

I read recently that only around 8% of claimants have ESA113 forms sent to their GPs. If the GP's information on the ESA113 confirms that the information on the claimant's ESA50 is a fair reflection of the kind of difficulties the claimant would have with the descriptors, surely this would result in the claimant being placed in the support group. I say this because - without a face to face assessment - the HCP has to make a call on both LCW and LCWRA. ?

It doesn't mean this at all. It is perfectly possible, and indeed more likely that the claimant will only match the requirements of the WRAG, just because the GP confirms claimants comments on the ERSA50 has nothing to do with them being eligible for the WRAG.

You are confusing severity with the ability to substantiate a level of disability.

ltcinter

Cpt.Scarlet wrote: »

It doesn't mean this at all. It is perfectly possible, and indeed more likely that the claimant will only match the requirements of the WRAG, just because the GP confirms claimants comments on the ERSA50 has nothing to do with them being eligible for the WRAG.

I am still having trouble understanding this.


If the claimant only matches the requirements of the WRAG, then this begs the question why a face to face assessment was not required.

Cpt.Scarlet wrote: »

You are confusing severity with the ability to substantiate a level of disability.

I think I probably am.

Nevertheless, not providing claimants with a face to face WCA, then saying they do not have LCWRA seems odd. Surely such claimants, who are not even offered the chance of a home visit to demonstrate/substantiate their level of disability to the HCP, would have no choice but to appeal the decision of being placed in WRAG and not the support group.

Muttleythefrog

ltcinter wrote: »

Nevertheless, not providing claimants with a face to face WCA, then saying they do not have LCWRA seems odd. Surely such claimants, who are not even offered the chance of a home visit to demonstrate/substantiate their level of disability to the HCP, would have no choice but to appeal the decision of being placed in WRAG and not the support group.

But you can look at this another way - such a claimant would be in the position of not having to challenge a potentially flawed face to face medical exam report in requesting appeal or reconsideration. In a sense, not using evidence streams available, means those streams aren't possible for DWP to rely on in a challenge. Hence if they take WCA decisions without using full range of evidence streams then they live and die by that decision.

What you're saying could be extrapolated... some people are placed in the WRAG without returning a completed ESA50... it could be argued had they had that chance they may have been able to demonstrate evidence that LCWRA is met. But the door is open to them to make that case through challenge.

The main problems has been the over reliance on dodgy ATOS face to face medicals so the numbers of people complaining about not getting one... especially if passing a WCA.. is probably very low. It definitely has been a much bigger problem that claimants have been getting face to face medicals resulting in appallingly inaccurate and damaging reports... and as a result many have had to appeal against decisions that seemed to use (or rely upon) them. They would probably instead take the view that the face to face medical offered the DWP the opportunity to demonstrate no LCW with a malperforming service.

As per Scarlet regardinmg the other point. I think it would be a mistake to go down the road of thinking that if the DWP DM (or their 'medical services') felt they had good evidence to find LCW without face to face medical that that could imply the claimant may have a good case for LCWRA. It's just too hard to tell... the evidence that convinces of LCW may be quite convincing that LCWRA is not applicable (you would expect particularly where the disability is well documented and straightforward in symptom)... it could indeed altenately be suggestive not just that LCW applies but that there is disability (perhaps not fully explored in available evidence) that may trigger LCWRA.... but in the latter case they take a risk by not exploring this further... as the claimant would face no obvious counter evidence if claiming LCWRA does apply upon challenging.

ltcinter

Muttley thanks for that.

If the claimant gets put in WRAG, then as you say, no face to face assessment seems to leave the door wide open for an appeal or reconsideration.
I have seen the ESA113 and it is very supportive. I am sure that this will be the main evidence should an appeal be lodged.

Muttleythefrog wrote: »

...it could indeed altenately be suggestive not just that LCW applies but that there is disability (perhaps not fully explored in available evidence) that may trigger LCWRA.... but in the latter case they take a risk by not exploring this further... as the claimant would face no obvious counter evidence if claiming LCWRA does apply upon challenging.

This seems to be what is going on. The illness is rare and severe, the MHP requested an ESA113, the GP stated the substancial risk of self-harm,etc. On the basis of this the WCA was not required, and the decision is now being awaited.

But will it be WRAG or SG? I would be interested to know how many fresh claimants are not made to attend a face to face assessment and then subsequently found not to be in the support group.

from the DWP site

42365

It will not be necessary to obtain completion of an ESA50A for LCWRA in every case
where the claimant has already provided information on an ESA50 for LCW. The
HCP should obtain additional information regarding the descriptors in Appendix 2 at
the medical examination for LCW in order to provide an opinion on LCWRA (see
DMG 42382).

Note:

There will be no need for a medical examination if medical services can
confirm on the basis of paper evidence that the claimant is in the support group. If

both LCW and LCWRA can be assessed from the same piece of evidence then

there is no need to obtain further information.

rogerblack

ltcinter wrote: »

But will it be WRAG or SG? I would be interested to know how many fresh claimants are not made to attend a face to face assessment and then subsequently found not to be in the support group.

http://www.whatdotheyknow.com/body/dwp - go for it!