ESA- was placed in WRAG, this has stopped, now appealing.

midjet666

Hiya,
I will start off with my health problems so you'll understand why I can't work-
I was born with back to front intestines (malrotation if you want to google it) had to have a big operation at 8 days old and now have a 30cm scar across my stomach that cramps and I have diarrohea on a daily basis.

I then had cancer when I was 14- Hodgkin's Lymphoma, and my parents divorced which resulted in me having a breakdown when I was 16 and I have suffered severe panic attacks and depression ever since. I am now 25. I have been on various medication, tried counselling and all sorts of other mental health programs, and nothing seems to work.

I also suffer from migraines, which runs in the family, and have had them for years- they started when I was a young child. I tend to have daily headaches which begin when I wake up, then they progress into a migraine as the day wears on. I did have prescription sunglasses but can't afford to pay for a new pair as my prescription has changed :mad:

On my original assessment that they did without me, I was scored 15 points. I'm not sure what for, but it was enough for me to be placed in the Work Related Activity Group for a year and then my benefits were stopped. I was also told they wouldn't be stopped by someone in my local job centre.

On my paperwork they have only assessed me for depression, not anxiety or my other health problems. If I'm not close to a toilet, I will genuinely soil myself. It's disgusting and embarrassing but it's the truth. When I go to the toilet, I'm in absolute agony with stomach cramping- to the point of being sick from the pain, so I'm not sure how I'd be able to work being stuck on a toilet most of the day, or lay down because of migraines, or because my medication is making me drowsy...

On the paperwork they said that I had attended a medical but I have never been asked to attend one, but they stated that I had attended- I wouldn't be able to because of my anxiety.

I am now appealing it and was told that attending the appeal has a higher success rate than a paper appeal. I will be having a representative go for me, but I was hoping if there was any tips, or if what they have done is normal in regards to lying about attending the medical. They did it before I was placed in the WRAG too, they said I had attended when I hadn't. I've never received a letter to attend one, so it annoys me as it looks like I have merrily skipped along to the medical when I wouldn't be able to attend!

So yeah, any help would greatly appreciated. I take citalopram and diazepam for depression and anxiety and solpadol and 400mg ibuprofen or these other tablets which I can't remember the name of for headaches and pains in my back/hips (from when I was pregnant I had SPD and had bone marrow removed from my back, 2 epidurals and a lumbar puncture. Since then I've had terrible pains in back and hips.)

Also, I don't claim JSA as I can't get to the place to sign on and I can't actively look for a job, so the only money I'm receiving is lower rate DLA for care and mobility.

Two4Tuesday

If you've had these bowel problems all of your life, then I'm guessing your doctor didn't mention it on your fit note. The same thing happened to me.

You need to get supporting evidence from your doctor about this and send it in to your tribunal. You might need to pay a fee to the GP for the letter but it may be well worth it if you are re-assessed correctly as a result.

You should also talk to your doctor about these issues and see if there is anything they can do. There are some very good colorectal specialist hospitals that you can be referred to, like St. Mark's Hospital in London. They may be able to help you with anything from bowel management to possible further surgery.

[Deleted User]

firstly no one has a medical for esa they have an assessment which is a slightly different thing,did you not appeal the fact that you were put in the wrag at the time and if not why not?
after 365 days in the wrag esa you can continue to get esa(income based)if you have savings below the limit and dont have a partner earning approx below £165 a week(is this the case?)
having said all that it does sound like you may qualify for the support group but this isnt points based

Muttleythefrog

Ouch. .you really have got some problems there. Let me post as I read. So you originally for ESA were awarded WRAG and didn't have a face to face medical as part of that WCA. It's a shame you didn't find out why you qualified for WRAG... the ESA85A would probably have explained as this would have been the ATOS advice to the DWP which the DWP probably effectively rubber stamped as their decision. So you were in placed in WRAG for year.

Now things get a little confusing. If you get contributions based ESA then if you are in WRAG you can only get payments for 12 months. Otherwise (i.e if claiming income related ESA or getting contrib based but in support group) payments are unlimited provided you continue to pass reassessments. You seem to have been given conflicting advice... I wonder if this was because of talking about different things... income related versus contrib based ESA should be viewed as one matter and the actual assessments of your disabilities and the group you get put in is another.

You now want to appeal that WRAG decision... when was that decision (?)... be aware that beyond 4 weeks will be a late appeal (might not be accepted).. and I think you can only appeal up to 13 months from the decision. To clarify... you are not assessed by illness but by the effects of illness, disability or injury... specifically they look to see if various descriptors apply to you... I presume you have studied and udnerstood those descriptors... if not then ASAP you must...they are the only thing that matters.

The DWP claimed a medical took place... if they claim a face to face medical took place and one did not then then what you perhaps could do is tell them to produce a copy of the resulting report. I've never heard of this arising but it wouldn't surprise me.

To be honest we need some clarity here.... it is all a bit confusing to me. WHen were you placed in WRAG? Did your ESA payments stop because you were on contributions based ESA or have you actually failed a reassessment? If you were on contributions based ESA and your only income is DLA then you should be entitled to income related ESA.. I can't explain why you're not on it unless you failed a reassessment or have a stash of savings or a partner.

Regarding appeal... to be honest I'm a little shifted from my zone for advising because I can't get a picture of your situation... it doesn't make sense to me yet. But, yes... do attend if you can.. having someone with you can help too... the greater success rates of oral hearings must be due to the testimony that can be given directly to the 2 person tribunal panel. The issue regarding JSA I'm reluctant to advise on as you may be able to get ESA at basic rate while appealing under cover of sicknotes... I just don't get what has happened in your case so I really don't know. What stands out to me from quick thinking of your circumstances is that support group is a real possibility due to your diarrohea.. if you can make a solid case with medical evidence backing it that the relevant support group descriptor applies then you could win on that point alone.

Any more info you can provide the better... in the meantime I'll leave you with a video that could be useful to watch.

http://www.youtube.com/watch?v=tbWXG6Ho4i8

midjet666

Hiya
Thank you all for your replies. I'll reply in order-

My doctor didn't mention my bowel problems on my original note, it's in my letters but you have to go back to 1987 for that information, if you could see my paper notes (they recently changed to computer as it's a small surgery) there's probably well over 100 letters/ notes etc. I was also diagnosed with IBS when I was about 8 I think, although I'm not sure if I do, I do have the symptoms when looking at it online but then I have the symptoms of most illnesses lol.
The problem with going to specialists is actually getting there now. If I had gone years ago, it'd be fine, but my anxiety has been getting worse since I was 15. I suffered anxiety throughout my childhood, I was attacked by a dog when I was 3 and my head forced under a tap by the panicking owner, since then I had a phobia of water so swimming with the school was a nightmare. My mom would give me rescue remedy (Bachs, I didn't know what it was at the time, just a horrible tasting drop on my tongue). So I have had anxiety pretty much most of my life, my school attendance was always in the 80%'s or below, but I was actually an A* student until the last few years when I got cancer and everything went downhill.

I have had a letter from my doctor which cost me £10 and it says about my diarrhoea, but I don't think he's gone through all my letters which is what I want to do. I don't think all my information was put on the computer system when they swapped onto them. There's nothing about my IBS or anything that I was diagnosed with.

I'll reply to the next poster in a new post.

midjet666

In reply to Woodbine-
I didn't have a fact to face assessment. I'm 25 and so confused by it all. I didn't appeal originally because I was told by the job centre that although I was placed in the back to work group, I would stay in the group for as long as I needed to and would receive benefits. The same guy who told me this was the one who was supposed to see me for regular meetings, I never attended them and I rang him in tears explaining why I couldn't and he said he'd mark it on the system why I couldn't attend.

I was on contributions based ESA, I was incapacity benefit under the young persons rule, I was originally turned down for the claim when I was 17 but then I found this rule and they gave me them then. I have a partner who works 40 hours a week which is why I'm not allowed the income based. Sadly I don't have any savings and we are really struggling.

After looking through the descriptors there's 2 that definitely fit me- the one with the soiling from diarhoea or incontinence. And the inability to cope with change due to my depression and anxiety attacks. I have tried over the years to do work from home- all voluntary, just so I could say I had a job (I don't like having to claim sickness benefits, I wanted to be a criminal psychologist, they tend to label people on benefits as workshy and it annoys me as I want to work but I'm unable to. So being able to say I have a job, even though not paid meant a great deal to me) but having migraines means limited amounts of time on the computer, as well as being stuck on the toilet! And my medication makes me drowsy, I take a lot of diazepam (valium) and my citalopram is for anxiety too (those ending in pam tend to be for anxiety).

I appealed when I had the letter saying my money would stop September 8th 2012. I explained on the phone why I hadn't appealed earlier. I've been given so many conflicting answers and have been so confused by it all. My tablets also have confusen and loss of memory as a side effect, so my mind can be like a sieve at times!

midjet666

Muttleythefrog-
I only ever had one face to face when I was about 18, now 25, and I panicked so much I almost had to be carried out of there. When I had to go for the meeting I had to take imodium which leaves my stomach cramping more as it solidifies the stool leaving me in more pain. I've always thought it was normal but recently speaking to my doctor about it, he said it isn't. My GP before said I would always have problems and the IBS he diagnosed too. So again, we've been left confused with that problem! Our family have our share of ill health. My grandad has had 2 heart attacks and a minor stroke. When he had his first heart attack he was in the hospital with a sick bowl on his head singing and joking. That's what our family is like, we try to laugh through it all.

I'll phone them up today and ask why I have been placed in the WRAG. I did get 15 points and being as they're stingy with points, then they must have seen something wrong with me from my paperwork. And I was on contributions based as my partner works more than 16 hours a week.

The decision was back in September 2011 I think, or just before then. My payments stopped in September 2012. I asked them to look at it again which is in my paperwork that they looked again in June 2012 and they couldn't see any change. I didn't send them enough paperwork nor showed how I fitted the descriptors. I have looked at them since and definitely fit the one about soiling yourself with diarrhoea or incontinence, and inability to cope with change.

I'm hoping my reply above and the other 2 replies will help you understand it better, but tbh I'm just as confused as you are with it all. And I think the Government are too, they keep changing the goalposts and making it more and more difficult! If you want me to type anything from my appeal letters etc, just let me know and I'll sort them all out.

Thank you all again, I really appreciate you helping me.

rogerblack

midjet666 wrote: »

The decision was back in September 2011 I think, or just before then. My payments stopped in September 2012.

Unfortunately, you are now out of time for a 'late appeal', as it's now 14 or 15 months, and the absolute deadline is 13.

You cannot in general as I understand it request a fresh determination of your capacity for work, unless you break your claim for 12 weeks.

The only way of redetermining your condition would be to either break your claim, or to report a changed or altered condition, but this may be (properly) turned down, as there has been no change.

I am unsure if there may be grounds for revising the decision as an 'any time' revision due to 'ignorance of a material fact' - this is a point you'd probably need specialist advice on.

Muttleythefrog

Okay..things are clearer... thanks for your replies midjet.

To get some clarity. I think your appeal will be rejected as you are beyond the 13 month time limit for late appeals... late appeals would be appeals beyond 4 weeks. I'm not sure you have any right of appeal remaining.

Your previous face to face medical we can ignore as it doesn't relate to ESA.

The points system.... that is only relevant to WRAG which you qualified for via those 15 points... to get into support group where payments are not time limited for contribution based ESA you need to be found to meet at least one support group descriptor.

The circumstances of your partner exclude you from income related payments... that now makes sense. Had you been eligible for income related then you could have switched to that and continued to get paymentsbut we can strike out that option. I was assuming wrongly you were probably single given what you claimed was your income.

It sounds like you asked them to reconsider the WRAG award back in June or reassess your entitlement and they didn't change their minds or refused to.... it is a shame you didn't follow through with a late appeal if you were asking for reconsideration.. it could have been accepted if good cause given... and although you seemed to be distinctly lacking evidence a tribunal panel may well have been persuaded by your testimony of your problems particularly pertaining to continence. Reading between the lines.. as you aren't clear... I think you asked for a supercession and it was rejected.. I am therefore for advice purposes rejecting the idea you had a reconsideration.

What people here might advise is this.... remain on ESA even through you will get zero payments.... you will be regularly reassessed... and at next assessment you can make a strong case for support group which at face value you have a strong argument for on at least one descriptor. If you get placed into support group at a reassessment then payments will resume.

So my question to you is where are you regarding appeal.. have you actually tried to appeal yet or are you in the process of completing GL24 form/writing an appeal letter? I think that if my understanding is correct about the 13 months then your appeal will be rejected. I would not assume this to be true without corroboration from someone else... but it could mean you are wasting your efforts. Your efforts should be focussed on ensuring your ESA claim remains open and you are well prepared for your next reassessment where a simple letter from GP or similar could be extremely valuable if it declares your issues regarding continence and their relevance to the descriptor about such.

midjet666

I have already filled in the form for an appeal. I am waiting for the date now. I won't be able to go to court because mainly my anxiety attacks, although the diarrhoea will be a problem (I take imodium from time to time to attend hospital appointments, but am left in agony for the next few days because of the changes to my intestines so can't use it all the time.)

I put in the appeal back in about May or June I think, I'm not quite sure but the form was filled in before the 13 months so that's definitely going through.

I rang my doctors today and I've asked about viewing my files and was told that the doctor may withhold some from me that they deem would be too distressing. I thought by law I was entitled to see everything about me?

I've also contacted the hospital where I had the operation and I have to fill in a form asking to see my notes. It'll cost between £10 -£50 to get copies!!

sunnyone

midjet666 wrote: »

I have already filled in the form for an appeal. I am waiting for the date now. I won't be able to go to court because mainly my anxiety attacks, although the diarrhoea will be a problem (I take imodium from time to time to attend hospital appointments, but am left in agony for the next few days because of the changes to my intestines so can't use it all the time.)

I put in the appeal back in about May or June I think, I'm not quite sure but the form was filled in before the 13 months so that's definitely going through.

I rang my doctors today and I've asked about viewing my files and was told that the doctor may withhold some from me that they deem would be too distressing. I thought by law I was entitled to see everything about me?

I've also contacted the hospital where I had the operation and I have to fill in a form asking to see my notes. It'll cost between £10 -£50 to get copies!!

Notes from when you were a baby are not relevent to your ESA claim, you are just wasting your money getting them as ATOS are only intrested in recent medical evidence.