ESA - advice please

smileytiger

Sorry for the long post

We got OH's ESA decision yesterday after his medical last month & as we expected he was put in WRAG - he's been in WRAG since Feb 2010 & is on CB ESA so will lose it in April.

I rang DWP to check when his payments would end as we're on a tight budget & i'm jiggling the numbers to get us through the next few months until our house sells. (anyone who has read any of my previous posts will know we're already selling our house as even with his ESA it's a struggle)

Anyway - nice lady at DWP said that he would get ESA up to end of April - so we have a bit more breathing space:)
She then asked if he claims DLA and i said yes he gets high rate mobility as he doesn't walk well, and his DLA award was based on his ESA medicals and letters from his consultant neurosurgeon. She was stumped as to why he then was in WRAG and not in support group and suggested we appeal the decision. She didn't understand how he did not match the mobility descriptor for the support group. The only reason i could come up with is that he condition varies so although always in pain and difficulty - some days he 'walks' better than others.

She has now sent us an appeal form - is it even worth us appealing as lots of people are now trying to get into support group as CB ESA is ending & to be honest we'll still have to sell up and i'm actually looking forward to being able to spend more time with OH as i'll have a less demanding job when we move.

Am i just being naive thinking that it's a waste of time or should i be doing it anyway in case further down the line he becomes entitled to receive payments again once we have used up all our savings (from the house sale)

Advice welcome & thanks

epitome

How many hours a week do you work now?
How many hours a week will you work when you have changed jobs
How much do you earn/will you earn

It's not just about savings

If he gives up his ESA C now without appealing he will never get it back.

If in the future you qualify for ESA IR your income will be deducted.
ESA C will be forever unaffected by your income.

Is it worth appealing? YES!

rogerblack

epitome wrote: »

If he gives up his ESA C now without appealing he will never get it back.

This isn't quite the case.
If he continues to claim - without it being payable due to the time limits - and later becomes eligible due to being put in the support group - it would then become payable.

However, I definitly agree appeal!

In addition - you want to get a copy of the medical report - then you can comment on any inaccuracies on this.
The HCP is supposed to - where a support group and a WRAG descriptor are similar - consider the support group.
Maybe they did not do this.

smileytiger

epitome wrote: »

How many hours a week do you work now?
How many hours a week will you work when you have changed jobs
How much do you earn/will you earn

It's not just about savings

If he gives up his ESA C now without appealing he will never get it back.

If in the future you qualify for ESA IR your income will be deducted.
ESA C will be forever unaffected by your income.

Is it worth appealing? YES!

Thanks for the reply - i currently work full time earning about £18k (we've just had a £100 per month pay cut due to recession:()
I'll be on less after the move around £14/15k as i'm hoping to do around 30 hours to spend more time with OH.

smileytiger

rogerblack wrote: »

This isn't quite the case.
If he continues to claim - without it being payable due to the time limits - and later becomes eligible due to being put in the support group - it would then become payable.

However, I definitly agree appeal!

In addition - you want to get a copy of the medical report - then you can comment on any inaccuracies on this.
The HCP is supposed to - where a support group and a WRAG descriptor are similar - consider the support group.
Maybe they did not do this.

Thanks - where do i ring for the medical report please DWP or ATOS.
Until OH became like this we'd never had to deal with benefits other than child benefit as we've always both worked & it's such a minefield.

rogerblack

smileytiger wrote: »

Thanks - where do i ring for the medical report please DWP or ATOS.
Until OH became like this we'd never had to deal with benefits other than child benefit as we've always both worked & it's such a minefield.

Just the number on the letter, and ask for a copy of the medical report.

epitome

You can also ask for a copy of the "decision makers justification" is that not right RogerB ? I read about it in a mail shot we had at work.

So OP (smileytiger), he will never get any payment under ESA IR if you work/earn that much & hours. So you should fight to retain the ESA C.

RogerB,
If he stops claiming because he is not eligible for ESA IR, stops submitting Dr's notes, are you saying if years or so later his condition worsens and he makes a new claim is put in the support group he will be allowed to have a conts based claim even though there has been a gap in his claim?

HB58

Epitome, as I understand it, one has to have remained unfit for work to access the support group on a contributary basis as a later date (unless qualifying NI payments have been made in the interim). If the claim is broken then the support group cannot be accessed on a contributary basis.

It is not yet clear how DWP intend to satisfy themselves that the 'unfit for work' criterion has been fulfilled but I suspect it will involve repeated reassessments.

fogartyblue.

Am I right in thinking that appeals are not in the main being made because people think they are in the wrong group, but because if they don't appeal they will lose money?

In which case I would imagine that everybody who is in the Work Group will be putting in an appeal!!

Is that justified even where it is clear to everyone including the claimant that the Work Group is the correct group to be in?

As for the OP, the claimant has been in the Work Group since Feb 2010 - 2 years! Why didn't they appeal against that decision two years ago?

This appears to be an underhanded appeal, not lodged for the right reason but lodged purely for financial reasons!

If I'm thinking that, surely the DWP will also be considering it.

HB58

The tribunals service has the power to reject appeals if they believe that it has been made on purely financial reasons. I assume that they will use this power as and when they see fit.

rogerblack

fogartyblue. wrote: »

Am I right in thinking that appeals are not in the main being made because people think they are in the wrong group, but because if they don't appeal they will lose money?

Or alternatively, because they did not understand initially that the decision was wrong.
The criteria of ESA are complex, and not well understood by claimants.
They are not well explained on the form, or on the decision notices, or at the medical.

Appealing against an incorrect decision is stressful, and may involve significant paperwork - which many may not bother with - even if they are entitled.