Help with ESA please

jakes-mum

Firstly please excuse anything that reads a bit funny as I have M.E and find it hard to explain myself and suffer badly with memory.

I have been on ESA for 3 years, last year I appealed my WRAG placing and had a letter on 13/7/12 stating I had been moved to the support group and my review was due 10/7/14. I was paid the support group excess and have a second letter dated 25/1/13 where hey had altered my payments and it still stated a support group top up.

Roll on to today and I have a letter out of the blue saying ive been placed in the WRAG. I rang and asked why I had been moved as I hadn't been called to any meetings, asked to fill in any forms etc, and have been told I was always in the WRAG and the letter saying I was in support group must have been an error.

I now have to appeal my placement in the WRAG and they will decide whether to move me.

Im totally confused as if the support group letter was an error, ive never had a decision from my original appeal

does this mean ive been overpaid for the last year?
will I have to pay it back?
will they stop my money completely as im well over the 12 month limit for WRAG?
Why havent they been chasing me to attend work focused groups if I was always in WRAG?
Do I complain? if so who too?

I just feel so drained by it all, how do I fight it when ive got no energy as it is? every specialist ive seen cant explain to me whats wrong with me how the heck do I explain it to some pen pusher. The last appeal made me so ill that im dreading doing it again (and just to top it all off my DH has had his review letter today aswell and with severe dyslexia, it means I have to do his too, as theres no-one else )

rogerblack

Sigh.

Several issues.
http://www.dwp.gov.uk/docs/financial-redress-for-maladministration.pdf - on compensation for maladministration.
I would strongly recommend applying for compensation - if it turns out - as seems likely - that this is due to their maladministration.

I do hope you've kept the letters?

There are several options.
A) 'computer error' - for whatever reason you were allocated the support group improperly, and without the correct decision being made.
You have possibly been overpaid since this time, but your appeal is still live, as you have not had a decision on this case. You should not have to repay, as you had no means of knowing the decision was not valid.

An error the other way - you have been in the support group, and no legal decision has been made and properly notified to you that you've been placed in the work-related group.

I would recommend asking for a callback from a decisionmaker on the phone to clarify the situation - the first-line staff do not understand the situation properly.
Note - at this time you are _only_ interested in the procedural matter - NOT about your condition.

Questions to ask:
What group are you currently in?
When were you placed in this group, and was the decision notified to you?
If the answer is 'work related' - and the time overlaps the time you were being paid support group (is this still so?):
What is the status of the appeal/reconsideration?

jakes-mum

Thank you so much for replying roger

I had a call back from someone 'to explain the situation' as the call centre didnt have a clue what was going on.

According to the call back, I had always been in the WRAG group and still am in the WRAG group (no explanation for the random letter though so wonder it they have just spotted the error and decided to send me a letter to confirm?)
I do still have the original support group letter and the letter from january about the change of payment that shows the support group payment in the break down.

Im a bit fuzzy on what im actually getting paid for at the minute as ive had so many letters messing around the payments (due to DH becoming ill as well, help with mortgage interest kicking in, being eligable then not eligable for carers allowance . . .) in the last 6 months ive got a bit lost!, but I do know that the payments were matching the letter I received in january that stated I got a support group excess.

Didnt think to ask about my original appeal, so will ring them back and get them to clarify what happened/is happening with it.

jakes-mum

on the phone now and they are saying they have no record of an appeal ever being submitted *sigh*

benefitbaby

Well you have one month to appeal the letter you have recently received stating you have been placed in WRAG so you could consider this.

They cannot ask recover any overpaid ESA from you as this was paid due to official error and there was no way (especially as you have the SG letter) that you could have known you were being overpaid.

If you are able you should contact your local welfare rights office for help with the appeal. You could also consider making a subject access request asking for all the paperwork, screen shots and letters held on your claim to see what has actually happened 'behind the scenes'.

bloolagoon

ME, Fibro etc are the new bad back along with mental health. It's hard to prove as varies and many work full time even with severe symptoms. I can't imagine writing a form where the variations are symptomatic, acute yet fluctuate.

benefitbaby

Although if the OP has been diagnosed by a specialist or referred to a CFS/ME clinic then there is a likelihood they have a moderate or severe case and whilst variable the effects are well documented (even by DWP, see link below to the specialist guides).

Given that the ESA descriptors have to consider what can be done safely, reliably and when called upon to do so the fatigue experienced by people with CFS/ME is very relevant.

http://www.dwp.gov.uk/publications/specialist-guides/medical-conditions/a-z-of-medical-conditions/chronic-fatigue-syndrome/

jakes-mum

Thank you for the replies yes I've had a formal diagnosis and have an m.e specialist ( who has told me there's pretty much nothing he can do for me ) my symptoms are severe enough that I'm actually one of the few patients that does not need to be re- referred by my gp each time I want to see the specialist (which is a new idea that has been introduced as my specialist has so many people on his books now)

I have spoke to ATOS again on a call back and they now say that there are some discrepancies between my husbands and my claims, which I can understand as my form went in quite a few months before my husbands and its very hard to explain how we muddle through each day, so things like my form says I can't wash my own hair quite often, so my husband does it for me and his says he can't wash his feet and legs so I do it. It makes sense to me that he sits on a chair in the shower and I sit on the floor (sorry if that's a bit tmi) but when reading the forms together it may not come across as such.

I'm being rung back again on Wednesday after they have some extra forms they have asked for to try and explain what is going on

The hardest thing I find with the forms is explaining what I have to do each day because there is no-one else but that I'm not actually safe, ie I have to make a meal but due to memory I have to have someone with me as I'm very prone to forgetting ovens are hot and taking trays out with my bare hands, or I get the shakes so often cut myself with knives, but with 2 children, severe food intolerances and a child with coeliacs, I have no choice but to try my best and hope it goes ok.

benefitbaby

Atos should not be 'comparing claims' this is not their job and they are not contracted by DWP to do this. Their job is to review each form, decide whether an assessment is needed, do the assessment and send their report (ESA85) to DWP so a decision maker can determine entitlement.

There is case law re; DLA claimants receiving CA which says it is not unreasonable for one disabled person to assist another e.g. if you have problems reaching up but your carer/partner does not because their problem is bending down - it should turn on the facts of each case and a decision maker (or ultimately tribunal) should determine this NOT atos.

jakes-mum

Omg lol, that's exactly our situation! I can't hold my arms up above my head long enough to shampoo and condition, and DH can't bend low enough to wash below his knees.

I wondered if this is all to do with the move to PIP as don't they just make one payment per household?

There's not a lot I can do till they ring me back but good to know they can't actually compare our claims, though that doesn't explain he letter mistake or randomly writing to me to tell me I'm in a group I've supposedly been in for 3 years

benefitbaby

It will have nothing to do with PIP unless you are in the pilot (pathfinder area).

Hopefully when they call you it will be clearer but if not you could both make subject access requests for your DWP records:
http://www.dwp.gov.uk/privacy-policy/data-protection/