New illness for ESA

bujin

Hi All. An acquaintance of mine claimed ESA for a health condition and was awarded WRAG Esa. Since then she has developed several ill health conditions much worse and much more debilitating than the original one. Really it looks like she should be in the Support Group. She's anxious about applying again and worried she will lose everything.

In this scenario would she in effect need to make a new claim altogether or ring them and add this condition to the original one? Whats the best way of going about this? Many Thanks

pmlindyloo

bujin wrote: »

Hi All. An acquaintance of mine claimed ESA for a health condition and was awarded WRAG Esa. Since then she has developed several ill health conditions much worse and much more debilitating than the original one. Really it looks like she should be in the Support Group. She's anxious about applying again and worried she will lose everything.

In this scenario would she in effect need to make a new claim altogether or ring them and add this condition to the original one? Whats the best way of going about this? Many Thanks

I hope someone will confirm this but I believe that she should ask for a supersession.

See here:

https://www.citizensadvice.org.uk/benefits/benefits-introduction/problems-with-benefits-and-tax-credits/challenging-a-benefit-decision/challenging-a-dwp-benefit-decision-on-or-after-28-october-2013/changing-a-benefit-decision-by-revision-and-supersession/changing-a-dwp-benefit-decision-by-supersession/

However, I would strongly urge your friend to look at the Support Group descriptors and see which one she believes that she meets. She would need to have evidence from doctor/consultant/health specialist to show that she met the descriptor.

Will be back with the descriptors.

Edit

http://www.benefitsandwork.co.uk/employment-and-support-allowance/esa-glossary/1353-support-group-descriptors

rogerblack

It is not technically a 'whole new claim' in principle, but in practice, yes, it may involve exactly the same procedure unless it can be short-circuited early by specific evidence.

(for example, proof of a terminal illness).
And yes, it risks being found to be fit in principle, if the whole evidence is not strong enough.
Backdating of up to three months may be possible.

bujin

Thanks for these replies. I don't doubt she'd cover quite a few of the descriptors, she has some serious cardiac conditions and is under a consultant. Her Consultant has said she needs cardiac surgery, but they can't do that until they have stabilised her original problems which they don't seem to be having much luck in doing.

So I don't think she would have any problems getting enough supporting evidence etc. So hopefully it may not require her to go through the whole process again as she's really not well. Thanks again.

Studebacher_Hoch

Ideally find the support group criteria you believe apply and if a doctor agrees get them to write a short letter stating it (or write the letter yourself and get the doctor to sign or copy it). Get the Dr.'s letter to say the patient's condition has deteriorated and have them specifically quote the support group descriptor and say that it applies to their patient.

Then send it in to the benefit centre that deals with the claim with a short covering letter asking them to consider a supersession to the support group on the grounds that their condition has worsened and there is medical evidence (i.e. the doctor's letter) that they now meet the criteria for the support group. If you do that there's every chance they'll be put in the support group.

bujin

Studebacher_Hoch wrote: »

Ideally find the support group criteria you believe apply and if a doctor agrees get them to write a short letter stating it (or write the letter yourself and get the doctor to sign or copy it). Get the Dr.'s letter to say the patient's condition has deteriorated and have them specifically quote the support group descriptor and say that it applies to their patient.

Then send it in to the benefit centre that deals with the claim with a short covering letter asking them to consider a supersession to the support group on the grounds that their condition has worsened and there is medical evidence (i.e. the doctor's letter) that they now meet the criteria for the support group. If you do that there's every chance they'll be put in the support group.

Thanks.Well the condition they had in their original claim is nothing to do with the current condition they have developed, which is a new and worse condition, so it's not that the original condition is worse. One of their problems is finding the £50 they say their GP charges to give the evidence they need. It's very difficult and costly for some people, just proving they are ill.

rogerblack

bujin wrote: »

Thanks.Well the condition they had in their original claim is nothing to do with the current condition they have developed, which is a new and worse condition, so it's not that the original condition is worse. One of their problems is finding the £50 they say their GP charges to give the evidence they need. It's very difficult and costly for some people, just proving they are ill.

While it might be nice to supply extracts from a copy of the medical records, or ... - these are not required.
Might they make a claim go smoother - yes.
Do they have any professional that sees them in any capacity about their new conditon?
If not, even you writing a letter about what you've seen will help.
You do not need a diagnosis or any evidence past your word that your condition has worsened.

It is then the DWPs responsibility to evaluate this claim.
If you do not have external evidence, it is almost certain that you will face an in-person health assessment to gather this.

However, backdating is a problem - and the sooner a change is reported, the sooner it will come into payment.
On a technical matter.
If a random reassessment or end of a fixed period happens before she reports the worsening, then it is very unlikely that any payment will be backdate before the in-person assessment.
This could mean that if she got an ESA50 in the post next month, and a WCA 6 months in the future, she would not get any support group money for those 7 months - even if she is found to be in the support group.
Reporting it yourself means that the change happens from the date you report it.

bujin

rogerblack wrote: »

While it might be nice to supply extracts from a copy of the medical records, or ... - these are not required.
Might they make a claim go smoother - yes.
Do they have any professional that sees them in any capacity about their new conditon?
If not, even you writing a letter about what you've seen will help.
You do not need a diagnosis or any evidence past your word that your condition has worsened.

Fair enough I'll let her know. I think people know others are being helped by producing evidence and get anxious if they can't, but as you say, sometimes there's not even a diagnosis to give.

rogerblack wrote: »

It is then the DWPs responsibility to evaluate this claim.
If you do not have external evidence, it is almost certain that you will face an in-person health assessment to gather this.

However, backdating is a problem - and the sooner a change is reported, the sooner it will come into payment.
On a technical matter.
If a random reassessment or end of a fixed period happens before she reports the worsening, then it is very unlikely that any payment will be backdate before the in-person assessment.
This could mean that if she got an ESA50 in the post next month, and a WCA 6 months in the future, she would not get any support group money for those 7 months - even if she is found to be in the support group.
Reporting it yourself means that the change happens from the date you report it.

Right that's really important to know. I believe she had her last WCA last year so it would seem sensible to get this sorted sooner rather than later. Thanks again.