Employment and Support Allowance - Non-intentional prescription fraud

MidnightHour

This happened to a friend of mine back in the old IB days, she was ticking the income support box? turned out she was on contribution based and should have applied for exemption card.

Nothing happened just told her to get a card and she didn't need to repay anything at all.

Stop worrying! or life will really be too short

epitome

missapril75 wrote: »

Just to throw something else into the mix....

The OP claimed both types of ESA and the decision letter apparently refers to entitlement to the income based version, meaning it was applied for.

The following advice is taken from NHS.UK
The OP HAS claimed income-related ESA and even been advised of entitlement to it.


Any recovery action or attempt at imposing a penalty would surely be "laughed out of court" if challenged.



Not suggesting it would go to court, of course, it's just an expression.


But key would be challenging any penalty or demand for repayment.

No, no, no, no, no.

The OP has applied for C & IR and has been found NOT ELIGIBLE to ESA IR. You cannot have both. The prescription box has been ticked incorrectly and the OP will and should have to pay it back UNLESS they can apply for and receive a backdated HC1

missapril75

epitome wrote: »

No, no, no, no, no.

The OP has applied for C & IR and has been found NOT ELIGIBLE to ESA IR. You cannot have both.

Yes, I'm aware of that. That's not what I said.

The NHS website tells people to apply for the income based version of ESA because entitlement to it will give them entitlement to free prescriptions.

The OP did so and an entitlement was confirmed. but the conts based version is in payment instead.

(There are similarities with the situation where someone has an underlying entitlement to a benefit but that particular payment is not made because something else is paid instead.)

The OP has done exactly as people are advised by the NHS website.
We all know what should have happened and it's clearly a misunderstanding for all involved. But you can't just ignore the official advice on the NHS website.

Any request for repayment - if challenged - is very unlikely to succeed.

You can't just assume there will be a request for repayment - especially as a poster above gave an example where correction was all that was required.

Twp1989

missapril75 wrote: »

Yes, I'm aware of that. That's not what I said.

The NHS website tells people to apply for the income based version of ESA because entitlement to it will give them entitlement to free prescriptions.

The OP did so and an entitlement was confirmed. but the conts based version is in payment instead.

(There are similarities with the situation where someone has an underlying entitlement to a benefit but that particular payment is not made because something else is paid instead.)

The OP has done exactly as people are advised by the NHS website.
We all know what should have happened and it's clearly a misunderstanding for all involved. But you can't just ignore the official advice on the NHS website.

Any request for repayment - if challenged - is very unlikely to succeed.

You can't just assume there will be a request for repayment - especially as a poster above gave an example where correction was all that was required.

This makes sense to me if I'm honest because when I went in for ESA, I ticked the box at the very beginning of the form which said "Would you like to apply for Income-based ESA?"

Clearly I was entitled to the IB ESA but I have made enough N.I. payments to allow them to pay me the CB ESA instead. They decided to pay me contribution ESA instead of income ESA.

God, it's all so damn complicated!! :eek:

missapril75

Twp1989 wrote: »

This makes sense to me

Good. That's all I was trying to get over. Officials are not blind to common sense and a bit of a google shows this is not a new situation.

epitome

missapril75 wrote: »

Any request for repayment - if challenged - is very unlikely to succeed.

I don't see how you can say that, you have presumably got no tribunal worked case examples to back that up.

The OP has currently got NO entitlement to ESA IR lets be clear about this, you keep sying they have been found to have entitlement, - they haven't. It doesn't matter that they applied for IR, the only thing that matters is whether IR was awarded and it wasn't.
They needed an HC1 application to get free prescriptions, they have not got/done this, therefore, if there is a request for repayment, I can't see any way it would not be repayable if challenged. I'm all for the OP trying to challenge it at tribunal and it would be nice to know if they win, but I really doubt it would succeed.

You can't just assume there will be a request for repayment - especially as a poster above gave an example where correction was all that was required.

I don't care whether there will be or not but if there is, there is no getting around it IMHO. There is also a post above (saversue) that says the money was asked to be repaid - as you would expect.

missapril75

epitome wrote: »

I don't see how you can say that, you have presumably got no tribunal worked case examples to back that up.

I don't know why so many people believe they need a tribunal to achieve the desired result.

The OP has currently got NO entitlement to ESA IR lets be clear about this, you keep sying they have been found to have entitlement,

No, I have mentioned the OP stated she had a letter confirming it.

- they haven't. It doesn't matter that they applied for IR,

and had entitlement confirmed.

the only thing that matters is whether IR was awarded and it wasn't.

Yes, an award is essential for automatic exemption from prescription costs. Without it, one needs to make a low income claim. I think we've established that about a dozen times so far.

An incorrect declaration was made. We've established that about a dozen times too.

The lack of what should have happened but didn't does not mean there will be a request for repayment.

if there is a request for repayment,

So you do conceded there is a possibility of it not coming to that then.

I can't see any way it would not be repayable if challenged.

Similar to reviews/reconsiderations etc. Just convince them of the common sense argument and the fact there has been no loss to public funds.

A bit like achieved in the example up-thread.

If you concede the possibility of them not seeking recovery in the first place then why would it be impossible to change their minds persuading them of the common sense issue?

Are you seriously saying you've never heard of a case - be it about benefits or anything else - that might have gone to appeal but the deciding body has decided that matters are best served by resolving the issue without that?

There is also a post above (saversue) that says the money was asked to be repaid - as you would expect.

With the important distinction that the alternative in that case was the pre-payment certificate. Why? Because in that case the person did not have the underlying entitlement that the OP has and therefore was NOT exempt in the first place. The person in the other example above where payment was not requested, did qualify for exemption.

The application of common sense would appear to be a factor in those two different outcomes.

Now, you'll not convince me and I'll not convince you. I could blow my own trumpet about my experiences and never losing a case (without even the need of a tribunal and whichever side of the fence I was on or which 'hat' I was wearing) and you could probably blow yours.

But let's give it a rest eh?

Twp1989

To wrap all this up, I have had an in depth phone conversation this morning with the people who deal with the correct payment of prescriptions.

The lady said that as long as I had attempted to claim for the IB ESA and that there was an UNDERLYING CLAIM FOR IT - as stated on my letter of confirmation from the DWP themselves - but that I was awarded Contribution-based ESA instead, I am still seen as exempt from the prescription charges. She said if I felt I wanted to back this up I could apply for a backdated HC1 if I so wished but she said if my claim was ever challenged, I would only have to send them a copy of my DWP letter showing my underlying entitlement to the IB ESA and they would accept that as a valid cause for free medication.

I may go ahead and apply for the Low Income Scheme anyway because I meet the criteria for it but the lady I spoke with today said I had nothing worry about and that I have grounds to claim the free medication.

Twp1989

She also said that as CB ESA is only paid for one year, I will revert to IB ESA at some point in the future anyway as I have the underlying claim for it and that would then entitle me to free prescriptions anyway.

Horseunderwater

Glad you got that sorted out. I'd leave it be. Like the lady on the phone advised.