Appeal Help

Beetlebug1983

Hi,

I've posted on here a few times about my partner's ESA claim and you are all so helpful.

I'll try and keep it to the point.....

- He suffers from Bipolar and Schizzoaffective Disorder.

- His ESA (365) claim was stopped as of the 30th April.

- We were advise to send of an ESA50 to notify of his condition worsening which we did as it was. We heard nothing but were told over the phone by the DWP that he would not be put back on the benefit he was receiving.

- We then completed the GL24 (as we are appealing that he should be placed in the Suport group) along with a letters from his GP, Social Worker and Consultant Psychologist along with a diary of his thoughts which gives an insight into his condition and how he thinks.

- We have heard nothing but received a letter from the DWP over the weekend (but does not refer to the appeal) with an ATOS Medical Report attached which referrs to a medical taken place in April. He has not been asked to attend a medical and the last appointment he had was in 2010, so this is wrong. The "medical" report goes against everything we put in the ESA50 and its as if they've not even bothered to read it! - How can the make a report on a patient they've not even seen? The letter states that he's scored 15 points and that he will remain on the ESA 365 benefit and that his NI Contributions will be covered and that's it.

- We are now assuming that he will have to attend a Tribunal and we are not sure really what to expect. What further evidence do we need to submit? Is there anything else we can do? What about representation - how many people are allowed in with him?

Its a mine field out there - if we had been told what the 365 benefit was at the begining, we would have appealed for the support group then. I agree with trying to get the people who shouldn't be on benefits off, but the genuine claimants are suffering as a result. His condition has worsened since this began and he's even threatened suicide. I had to get the Home Care Unit from the Psychiatric Hospital over at teh weekend as we were all worried about him. If only the left hand knew what the right was doing at the DWP! Dream on!!

Any advice on Tribunals will be greatly appreciated!

Thank in advance,
Beetlebug xx

Muttleythefrog

Let's clarify. So was getting ESA WRAG and that ended due to the new rules regarding limiting contrib based ESA in WRAG to a year. Presumably he doesn't qualify for income related ESA instead... he remains on the benefit and will continue to get NI contributions...this will continue to happen while he keeps qualifying for WRAG.

You presumably got dubious advice to notify of worsening condition using ESA50. You completed that and got a confusing telephone response.

You used GL24 to appeal with supporting evidence. DWP have sent a letter and attached ATOS medical report. Is this a full medical report (face to face medical report) ESA85 document... or is it an ESA85A document of single page? If it is a full medical report and it is dated as having taken place in April and yet no such medical was attended then this would be bizarre... although certainly not the strangest tale regarding ESA. Or is the report his historical one from 2010?

It sounds like the DWP may not be accepting an appeal. An Appeal is normally required to be requested within 4 weeks of the decision being communicated to you (unless there is good cause for being late)... that decision in this case would be WRAG eligibility after last assessment... but when that last assessment was (and it doesn't need to incldue a face to face medical for fact finding) is not clear here. (Usually at reassessment time the first thing that will happen is ESA50 is sent for completion and then ATOS will determine if face to face medical is required). So it is unclear as to whether an appeal has been accepted as legitimately made.

If they have accepted appeal request then they should first automatically reconsider their decision and communicate the outcome of that first... if they don;t change their mind then they should forward papers to tribunals service. I'm reluctant to go on to give tribunal advice at this point because it is unclear as to whether you're going to get one...same regarding evidence.

It's a really difficult situation and his health sounds really poor.. unfortunately you may find the DWP make things much more complicated than needs be with poor communication. Unless there is any clear communcation that the appeals process or reconsideration is in progress then I would try to find out from them if appeal request has been accepted. If the tribunals service are contacted by the DWP to arrange appealthen tribunals service will normally be fairly quickly in touch in writing to get some basic details required to help arrange the tribunal (like do you want an oral hearing).

rogerblack

Several issues.
Firstly - the DWP ask 'medical services' - ATOS - about their opinion on claimants.
ATOS may either request the claimant comes in for a medical, or decide that a medical is not required, and give an opinion on the papers.
The DWP can overrule them if they chose.
Then you get to procedural rules.

You cannot appeal decisions made over 13 months ago. (this will presumably be the initial decision to put him in the WRAG).
You can appeal properly notified decisions for a period of one month.

Then you can make a late appeal up to 13 months.

You need at the moment to find out what decision was made on the ESA50 you sent, and when this was made.
A decision is not properly made until it's notified, which must be done by post.
(However, it can be taken to be done if it's been sent to you in the post, and lost)

Beetlebug1983

Thank you both for your advice.

I will check the Medical Report (ESA85 / 85A) when i get home from work later.

MY OH has called the DWP and they say a pack (not sure what pack) was requested on the 8th June.

We sent an appeal with regards to being booted of as a result of the reforms - I don't think this was the right thing to do, but we couldn't get any sense from the DWP and they sent us the GL24.

If they don't accept the appeal is he able to re-apply for ESA?

This is soo confusing.

Thank you x

Muttleythefrog

Beetlebug1983 wrote: »

We sent an appeal with regards to being booted of as a result of the reforms - I don't think this was the right thing to do, but we couldn't get any sense from the DWP and they sent us the GL24.

Well this was the wrong thing to do as you suspect... the reform in question is law... the DWP reached the only decision they could regarding payments. It adds to a possibility they may not (yet) consider an appeal to have been made as you may have given no grounds for one. The only way to get into Support Gp is to convince them of meeting the criteria for it.

Beetlebug1983

Thanks for your further reply. I'm home now and have had time to call the DWP and look through my papers.

On 28/03/12 we sent them the ESA50.

On the 26/04/2012 we received a letter advising that payments were stopping as of the 1st May along with details on how to appeal etc.

On the 08/05/2012 we sent them the GL24 referring to their letter of the 26/04/12.

On the 25/05/12 we received a letter confirming they were looking at the appeal.

On 30/05/2012 received a further letter with the ESA85A Report.

I have now telephoned and spoken to the DWP myself (my OH was doing it) but thought better if i spoke to them as information gets lost in translation! They told me that they have requested and ESA55 (does anyone know what this is) and that the appeal is still being looked at and a decision has yet to be made.

I strongly feel that my OH should be placed in the Support group. Every time he goes into a job which he has done (It's not as if he's just claimed all his life) he relapses, ends up in hospital and section for his mental condition. He suffers severe phsycotic highs and when out of hospital after a long stay, he suffers extreme depression which lasts for a very long time. He hasn't chosen this life and if he could do a 9-5 he would love to.

Would it be beneficial for me to write up a letter of support for him too for them to consider? Can anyone advise what possible evidence we coudl give them. We have provided them a letter from our GP, Psychologist, Social Worker. Would they accept diary entries? They do make for sad, upsetting and desperate reading!?

Sorry to keep posting and thanks in advance!

Beetlebug xxx

Muttleythefrog

So their word 'an appeal is still being looked at'... which hmm.. could mean anything... it could be that they're reconsidering... and I would probably assume that to be the case. ESA55 from quick search seems to be a folder for holding documents for transmittal... but can't say for sure... it does suggest they're waiting for evidential paperwork to get to them from ATOS or the like before doing anything else though. But what appears to have happened is that your actions have triggered a reassessment of entitlement and ATOS have been consulted and supplied the ESA50... they've replied to DWP with ESA85A...which is how they provide advice to DWP regarding entitlement when they are not doing a face to face medical (where instead they'd supply ESA85... the lengthy 20 page or so medical report).

Evidence.... focus on the descriptors for Support Gp and perhaps special circumstance criteria that can qualify you for Support gp. The closer the evidence is to supporting a claim of a descriptor applying at the time of the decision from a medical pro the better. MP could help... but not really from an evidential perspective... MPs are probably best reserved for pushing the system along and forcing the DWP to take seriously the job they're charged with. I think while you wait for DWP to do something you should focus on identifying the descriptors applicable (which you'd normally convey in appeal request to confirm why the decision is wrong in your view) and then trying to get the evidence to support. I presume the ESA85A produced by an ATOS HCP supports the DWP position that WRAG is applicable... check. But for evidence.. stay focussed.. GP, psychologist would be ideal for evidential purposes... but only if they convey the appropriate information.

Refer pages 22-36 for criteria for Support Gp.
http://www.dwp.gov.uk/docs/wca-handbook.pdf

Beetlebug1983

Big Thanks - Muttleythefrog. So would it be best to leave something from me out ? I will get on the case of getting further evidence from the relevant professionals etc.

rogerblack

Beetlebug1983 wrote: »

On 28/03/12 we sent them the ESA50.

This is the most important bit.

On the 26/04/2012 we received a letter advising that payments were stopping as of the 1st May along with details on how to appeal etc.

On the 08/05/2012 we sent them the GL24 referring to their letter of the 26/04/12.

On the 25/05/12 we received a letter confirming they were looking at the appeal.

If this is an appeal against the 365 day limiting, it is doomed to fail, and will not proceed to the tribunal. If it does, it will be rejected.

On 30/05/2012 received a further letter with the ESA85A Report.

Diaries and such may be useful for tribunals, yes.

The important thing to work out is if you have a live appeal against the decision made regarding the new ESA50 you submitted.

I don't see this directly addressed.

This is the only decision that can be appealed properly, though it's not impossible you only have a doomed appeal against the decision to terminate on the grounds of time limiting.

As I understand it, the ESA55 is a term for all the evidence in a customers ESA file.

Muttleythefrog

Beetlebug1983 wrote: »

Big Thanks - Muttleythefrog. So would it be best to leave something from me out ? I will get on the case of getting further evidence from the relevant professionals etc.

Agree with Roger's last post btw.... I'm still concerned sitting here that you've made an appeal that is without any basis and the DWP may treat it precisely that way...i.e. that you've appealed against the 365 day limit law rather than the decision of WRAG. And in that regard I'm not sure what to advise.. getting definitive accurate info from DWP might be extremely difficult at least until they've done whatever it is they plan to do. Regarding evidence... assuming an appeal against the WRAG decision has been lodged that support group should apply... I wouldn't rule out any evidence source before at least first identifying exactly which Support group descriptor(s) you would fight a case for applying in his case. The nature of the descriptors might be directing of the evidence source.. and the information you supply to, and request you make of, any 3rd parties.

Beetlebug1983

Yes, Rogerblack & Muttleythefrog this is what has been done in haste an panic and also mis-advised and us not checking properly. The appeal has been sent in with regards to the end of 365 which was wrong.

Not sure what to do now? Are we able to lodge another appeal against the ESA50/WRAG decision on the 30/05/2012 whilst we have the doomed 365 one still in process?

Help (

**Update -
I have since called the DWP and been told that I can lodge a second appeal. I will get on to this asap - and collect as much evidence in as possible. I've emailed his psychologist requesting a further letter of support.

Any advice will be much appreciated!!

Beetlebug xx