atos medical on same day as major operation

miss.average

Just a little update - operation a success, waiting on results now. Heard nothing from dwp yet. thanks again for all your help and support

xylophone

operation a success,

Wonderful news for your neighbour and his friends!

miss.average

The letter from dwp has arrived - I'm not sure I can help him as I don't really understand it and am hoping someone from this site can help??

the letter states his benefit is changing to ESA commencing on 14th December. It is contribution based and placed in the work related activity group. ( His actual money won't change)

A the moment the he is awaiting appointment with his consultant with regard to having to have some of his other kidney removed as there is a tumour there too.

I suppose what I'm asking is does this sound like the right group for him or should he appeal ? sorry to be so vague, and I'll answer any questions ( if I can!!)

thanks

Muttleythefrog

It's a little complicated. I think we are going to have to assume that because he was due surgery he qualified automatically virtue of that for having limited capability for work (the benchmark for WRAG). That would explain the swift shift by ATOS from medical to neighbour providing medical situation and ATOS closing their file... the advice they supplied no doubt was rubber stamped by DWP decision maker and you've now got that decision.

It would be helpful to get understanding as to what was determined. Best way to do this is call the DWP and ask for a written statement of reasons (although you may never see such because this is a 'grey area')... but more importantly perhaps the ask for the ATOS advice which will take the form of an ESA85A report. DWP should be able to supply that report.

So we may be able to clear up the circumstances of the current award. We can then look at the criteria for the benefit... for support group... and see if any descriptor is suitable... exceptional circumstances should definitely not be ignored in this case due to the medical circumstances (which hopefully won't ever include terminal illness diagnosis but may well include ESA significant treatments suggested above by roger, or surgery)... and some exceptional circumstances can lead to support group qualification... any support group descriptor would.

This link here is a convenient reference to the descriptors... firstly it goes throug hthe standard WRAG descriptors, then standard support group descriptors... and then exceptional circumstances. (Where you see reference regarding ESA to limited capability for work.. that's the test for WRAG entitlement... and similarly limited capability for work related activity is the test for Support group entitlement).
http://pseudo-living.blogspot.co.uk/2012/03/esa-descriptors-and-points.html

Here is the handbook for the WCA... this is the 'bible' for reference.
http://www.dwp.gov.uk/docs/wca-handbook.pdf

My guess is that his immediate medical circumstances have led to him being recommended for and found eligible for WRAG... based on the surgery and recovery. The ESA85A hopefully will give a prognosis and that will indicate when they will likely look at his entitlement again.. i.e. subject him to another WCA. It may be at next WCA that a case can be made for support group if at present appealing isn't a logical thing to do. Not sure. What can be said is that contributions based ESA is only payable for 12 months in WRAG.. and so if he would not qualify for income related ESA then support group becomes quite attractive indeed. His currently unaffected payments I assume is due to transitional protections for those moving onto ESA from another benefit.

Make sure to collate all medical related letters and reports... they could always become useful.

miss.average

thank so much for your super quick response. Oh my....... i'm going to make a coffee and sit down to read and re read your answer ( that's how difficult I find all this).

But my understanding is, it's a good idea to write to them asking them for an explanation and written reasons as to the decision as the first step???
off for that coffee and some reading !!
thanks again

Muttleythefrog

miss.average wrote: »

thank so much for your super quick response. Oh my....... i'm going to make a coffee and sit down to read and re read your answer ( that's how difficult I find all this).

But my understanding is, it's a good idea to write to them asking them for an explanation and written reasons as to the decision as the first step???
off for that coffee and some reading !!
thanks again

Call rather than write.. purely to save time and things going 'missing'. Number at top of DWP ESA letters. Tell them you've just received the decision and you want to understand it so ask for written statement of reasons for the decision... but you might get a gibberish response to that... what hopefully you should get a coherent repsonse to is request for a copy of the ESA85A Atos report... that should exist... it is in effect the ATOS advice that substitutues for an ESA85 ATOS medical report had a medical been conducted. Unfortunately the claimant has to deal with what are poorly trained ill educated advisors on the phone... this is frustrating... really you should be able to phone up and say.. just got the decision can I have explanation of it and a copy of all the evidence used to reach it.

miss.average

ok - will ring in the morning. hopefully get a 'helpful' person!
when the response come, I'll see if I can understand their response using the links in your previous post............... but no doubt I have a feeling, I'll be back here relying on the invaluable advice I get every time.
thanks again

sicknotethefirst

Regarding phoning them, I always think its better to send a recorded delivery and create a paper trail, that way they cant deny anything? .

Mojisola

sicknotethefirst wrote: »

Regarding phoning them, I always think its better to send a recorded delivery and create a paper trail, that way they cant deny anything? .

If you want to phone them to get an instant answer, it's worth following it up with a letter saying - "In the phone discussion I had with (give individual's name) today at (state time), it was agreed that X and Y should happen" - adjust wording as appropriate.

miss.average

hi - called them this morning.......... oh my, what a long time.

I initially went through to Incapacity, who said I was talking to the wrong department and it should be Employment Support, so put me though to them ( another very long wait) who said that as he was still on Incapacity benefit it had to be their dept - but would put me though to migration??? eventually spoke to a nice person person who said that they would contact him within the next fortnight over the phone to start the process and discuss his condition - with a view to going on ESA income related at the end of the 365 days? ( as I had explained that it seems - although not certain yet, the half of the second kidney would have to be removed at the beginning of the year, and future treatment was uncertain at this time) - anyway she basically fobbed me off about the explanation/written reasons that I'd asked about. and told me not to worry. However....... think I'm going to write ( recorded) to get the information.
what a palaver....
thanks to all of you for me helping though this, I really am grateful.