ESA Claim

SJI85

Hi all,


I was found fit for work following a WCA last month. I've asked for a MR which has come back today, the decision remains.


Shortly after the WCA I was diagnosed with Autism Spectrum Disorder.


I've been advised in the MR that, as the Autism is a "new condition" and not evident at the time of the WCA, it cannot be considered as part of this claim. I therefore have to make a new claim for it be considered.


I don't believe this is the case as Autism is a lifelong condition. It's a new diagnosis, but a condition I've had since birth. Moreoever, I was diagnosed with dyspraxia eight years ago (in my neuro-psychological report, the psychologist suggested further specialist assessment for Aspergers). In my WCA I mentioned to the assessor that I'm awaiting an autism assessment, though the reasons for this were not explored during the assessment. But the fact I was awaiting assessment was referred to and mentioned in my medical report. The difficulties I have due to my dysraxia did form part of me ESA claim, and dyspraxia and ASD do overlap.


I'm therefore concerned about taking my case to appeal. The autism is one central aspect of my case and if it won't be considered at the tribunal then am I not better off making a new claim, so having a new WCA? Of course the difficulty with this option is the decision maker may decide my condition hasn't significantly worsened/the autism is not a "new" condition, and therefore I'm unable to make a new claim.


My other question is that if I do make a new claim, I'm assuming the new claim will be linked with the old claim? So, if successful in the new claim, the WRA/Support group payment will be backdated to last year the 13th week of the original claim?

rogerblack

Your diagnosis is not directly relevant to your claim.
Very few diagnosis (terminal cancer, some communicable diseases) are directly a route into ESA.
ESA is granted because you meet one or more of the descriptors for ESA, or you would be put at risk by having to find work, or having to do 'work related activity'.

The question is:
At the time of the WCA, would they have come to a different conclusion on the various descriptors knowing you had a diagnosis of autism.

This is far from clear.
At tribunal, they would not be interested about conditions occurring and diagnosed after the WCA.
However, a later diagnosis of autism existing before the WCA might throw further light on existing evidence - or evidence that could have been gotten at the time of the WCA - so that is relevant.

If you won the appeal, you would be paid backpay from the 13th week, as I understand it.

SJI85

rogerblack wrote: »

Your diagnosis is not directly relevant to your claim.
Very few diagnosis (terminal cancer, some communicable diseases) are directly a route into ESA.
ESA is granted because you meet one or more of the descriptors for ESA, or you would be put at risk by having to find work, or having to do 'work related activity'.

Sorry, I know the diagnosis isn't directly relevant. I meant the difficulties I face as a result of the autism (which have a bearing on my ability to undertake WRA) form a big part of the claim. Subtle difference.


Had I the diagnosis of autism at the WCA. I would have likely gone into more detail about my difficulties with routine, and in dealing with other people - two ESA descriptors, and a different conclusion might well have been made. Or I hope I would have anyway.

This is far from clear.
At tribunal, they would not be interested about conditions occurring and diagnosed after the WCA.
However, a later diagnosis of autism existing before the WCA might throw further light on existing evidence - or evidence that could have been gotten at the time of the WCA - so that is relevant.

If you won the appeal, you would be paid backpay from the 13th week, as I understand it.

Yes, I understand that if I win the appeal I'll receive backpay. My question is if I made a new claim, have a new WCA, and found to have LC, how far back will I receive backpay?


I made my original claim in April 2014.
I then undertook some work in September - October so cancelled my claim, making a new one when the work ceased in early October.


So, if I'd been found to have had limited capability for work last month, these two claims would have been linked and I would have received backpay from the 13th week of the original claim.


If I make a new claim within the next fortnight, so within eight weeks of my last claim ending, AND I'm successfully awarded ESA following the new WCA, when will the payments be backdated to? The 13th week of my original claim (which will be in July 2014)?

GirlFromMars_2

Presumably you didn't develop any new symptoms on your diagnosis?

If you had the symptoms at the time you completed the ESA50 & WCA assessment then they are part of your claim, and part of your appeal. It is the symptoms that are important.

Assuming you believe you qualify for ESA via the descriptors/special circumstances, I would definitely take this to appeal, the Tribunal will accept new evidence about how you were at the time you filled out the ESA50 & WCA.

For anyone going through this process in the future, remember to describe all of your symptoms adequately, whether you have a diagnosis to understand them or not!

SJI85

GirlFromMars wrote: »

Presumably you didn't develop any new symptoms on your diagnosis?

If you had the symptoms at the time you completed the ESA50 & WCA assessment then they are part of your claim, and part of your appeal. It is the symptoms that are important.

I did. Like I said the condition is lifelong and there have been no new symptoms since diagnosis, or even in the last few years.


In fact, I probably coped with change to my routine far worse when younger, though certain other things have got worse as I've got older, especially as there are more social expectations and demands. But I am much the same now as I was when filling in my ESA50.

Assuming you believe you qualify for ESA via the descriptors/special circumstances, I would definitely take this to appeal, the Tribunal will accept new evidence about how you were at the time you filled out the ESA50 & WCA.

So to take it tribunal instead of making a new claim?


I'm just concerned if I take it to tribunal, the tribunal fails, and then I am able to make a new claim, the two claims won't get linked.

For anyone going through this process in the future, remember to describe all of your symptoms adequately, whether you have a diagnosis to understand them or not![/QUOTE]


This is good sensible advice.



I've filled in to ESA50s, one in late Spring last year and the other in November. I don't think I did a good job of either of them, partly due to difficulty with writing - I should have word processed - and also because I was depressed and struggled to complete them (I had a lack of support from people familiar to me, such as a support worker, and unwillingness to seek support from those unfamiliar to me such as CAB due to social anxiety associated with my conditions). So I just did the best job I could under the circumstances hoping that the WCA would provide an opportunity to discuss things in person but, as mentioned, it was a joke.

nannytone_2

the claims wouldn't be linked anyway.
they are only linked if you were awarded ESA, then stopped claiming for some reason, and the reapplied within a certain time.
you have never been awarded ESA and so if you make a new claim and succeed, the backpay would be given from the start of the 14th week of the new claim.
the only way to get backpay fro the claim you have already made is to go to tribunal and win

TELLIT01

If Autism isn't referred to anywhere in the medical report you can put in a new claim with that as the incapacity. If it had been included in the medical report you wouldn't be able to make a new claim with that incap.,
I would go ahead with the new claim.

SJI85

TELLIT01 wrote: »

If Autism isn't referred to anywhere in the medical report you can put in a new claim with that as the incapacity. If it had been included in the medical report you wouldn't be able to make a new claim with that incap.,
I would go ahead with the new claim.

It was explained to me by the DWP that it would be at the Decision Maker's discretion whether to allow me to make a new claim (with the autism) or not.


It's referred to in the repot, but only in terms of the forthcoming assessment ("my name" is waiting for an Autism assessment"). It is not mention in the list of conditions.

The difficulty with a new claim is I don't want to miss out on potentially £800 (the amount I'd be entitled to in the backdated WRA payment in the current claim). I think I'll take it to appeal.

SJI85

nannytone wrote: »

the claims wouldn't be linked anyway.
they are only linked if you were awarded ESA, then stopped claiming for some reason, and the reapplied within a certain time.
you have never been awarded ESA and so if you make a new claim and succeed, the backpay would be given from the start of the 14th week of the new claim.
the only way to get backpay fro the claim you have already made is to go to tribunal and win

So does this mean my current claim (made in early October 2014) won't be linked with my original claim made in April 2014 (but ended in late September 2014) because I was never actually awarded ESA in that original claim?

nannytone_2

yes.
if you haven't been awarded ESA then there is no claim for a new claim to be linked to.

you say that the report mentions that you are awaiting an assessment for autism isn't good.
that means that they were aware of possible issues around the condition.
although a diagnosis means little, you have already made a case for ESA including the problems caused by this 'suspected condition'

as you have been told by the DWP, it will be up to a CM whether they allow you to treat the ASD as a new condition and so a new claim, or the feel it was covered by the refused claim.

I've just re read your previous post ... what was the outcome of the April 2014 claim?
was that claim successful?

SJI85

nannytone wrote: »

yes.
if you haven't been awarded ESA then there is no claim for a new claim to be linked to.

you say that the report mentions that you are awaiting an assessment for autism isn't good.
that means that they were aware of possible issues around the condition.
although a diagnosis means little, you have already made a case for ESA including the problems caused by this 'suspected condition'

as you have been told by the DWP, it will be up to a CM whether they allow you to treat the ASD as a new condition and so a new claim, or the feel it was covered by the refused claim.

I've just re read your previous post ... what was the outcome of the April 2014 claim?
was that claim successful?

Yeah I was aware because the dyspraxia was already diagnosed and as you might know, there's quite an overlap between dyspraxia and autism. But because of my conditions I found communicating in the assessment (organising and sequencing my thoughts) difficult, and didn't really explain/give a good indication of what I am like. This was not helped by the assessor who rushed me and asked closed or leading questions. So the dyspraxia difficulties, let alone autism, never got discussed in the detail it should have been in the WCA.


I also didn't have good insight into the difficulties caused by the autism. At least not as good insight as I have into my mental health. For my mental health I remember a time when I was well. I've always had the autism so what I experience, to me, is normal.


I did not have a WCA in the original (April 2014) claim so was still on assessment rate when I ended the claim. The claim only came to an end because I took some work for a fortnight. Once that fortnight was over I made a rapid reclaim for ESA.


So made a new claim for ESA in April 2014.
Closed that claim in September 2014 (before WCA was arranged so still on assessment rate) to do some work.
Made a rapid reclaim two weeks later in October 2014 when the work finished.
WCA assessment on 4th February 2015. Deemed fit for work and claim closed on the 16th February 2015.