ESA medical assessment

Humpy

My OH has been on this since August last year submitting Statement of Fitness for Work certificates each month. She was receiving £72.40 a week and we expected it to increase to £101.15 a week after 13 weeks. Nothing happened so she called and was told she would need to attend a medical assessment and this was finally carried in at the end of July.

She has just heard today that she has 'failed' the assessment (whatever that means) so won't be receiving her backdated ESA.

She was unable to work due to depression which thankfully she is over and is no longer signed off but had the assessment been carried out last November I'm sure it would have been a different story.

I presume the letter that is being sent today will give information about how to appeal but is this as long winded as getting the assessment done? And what is the likelihood of the appeal being successful?

rogerblack

The appeal is likely to take several months at least.
The first part is that she (or you if you are dealing with this) will need to contact the DWP and say she wants a reconsideration of the decision.
The DWP will then reconsider the decision, and either place her on ESA, or confirm the original disallowance, and send you a Mandatory Reconsideration Notice.
You then send the notice to the tribunals service, along with why you want to appeal.
When the DWP gets this notice, payments at the assessment rate will resume (including backpay for the time of the reconsideration)
If you win the appeal, it will be backdated to the 13th week of the original claim.

Does she have documentary evidence of her condition at the time of the initial application?

Humpy

Thanks RB.

The only documentary evidence she has of her condition since she was receiving ESA would be the certificates from her own GP.

She is no longer claiming ESA so there is nothing as such to resume but we feel she is owed the difference between the £72.40 and £101.15.

The bottom line is that she was a significantly different person back in November than she is now (hence why she is no longer claiming ESA) and so it seems unfair to base her claim on her health now.

pmlindyloo

Humpy wrote: »

Thanks RB.

The only documentary evidence she has of her condition since she was receiving ESA would be the certificates from her own GP.

She is no longer claiming ESA so there is nothing as such to resume but we feel she is owed the difference between the £72.40 and £101.15.

The bottom line is that she was a significantly different person back in November than she is now (hence why she is no longer claiming ESA) and so it seems unfair to base her claim on her health now.

I can understand why you feel this since the medical assessment wasn't done until July when I am presuming that she was feeling better by then but still claiming ESA. Is this right?

You can certainly appeal but the lack of paperwork detailing her condition at the time will be a major problem. Did you send any paperwork with the original form?

I do not know all the circumstances so forgive me if I've misunderstood.

Humpy

PMLL, you have it all correct. But no, there was no other paperwork sent as she was just under her own GP for her depression.

I think we're going to have a battle on our hands!!!

Humpy

Apologies for resurrecting this old post but could someone advise me.

As my OH has failed her claim for ESA, should they have even been paying her anything after 13 weeks? If they had done the assessment after 13 weeks and she had 'failed' would she continue to have been paid the lower amount (£72.40) or would it have been stopped altogether?

SJI85

Humpy wrote: »

Apologies for resurrecting this old post but could someone advise me.

As my OH has failed her claim for ESA, should they have even been paying her anything after 13 weeks? If they had done the assessment after 13 weeks and she had 'failed' would she continue to have been paid the lower amount (£72.40) or would it have been stopped altogether?

Yes, they should have been paying her for as long as she was providing fit notes, until the assessment.

Had she had the assessment earlier, and been found fit for wok, payments of ESA would have ceased.

This is how ESA works. You apply if unfit for work and paid an assessment rate of £72, sending in fit notes while waiting to be assessed.

After being assessed all those found to have limited capability for work are placed in one of two groups, work related activity and support.

Once in a group payments increase to over £100 a week. This additional payment is backdated to the 13th week of the claim.

Ideally all claimants are assessed within (or soon after) those 13 weeks. However, ATOS, who do the assessments, are overburdened. This means people, such as your partner, are not assessed for many months.

You shouldn't have been told the payments WILL increase after 13 weeks. The payments would have only increase if she was assessed and found to have limited capability for work. Even then, as mentioned, this would have been well after the 13 weeks for some (though the money is backdated).