ESA Decision. Appeal or New Claim ?

MarioZena

Hi, I will try to keep this short but much help is needed ! My employer finished me in 2007 and handed me a form for Incapacity Benefit due to ill health both mental & physical. I could've taken them to a tribunal but didn't have the fight in me. In July 2015 I was called for WCA under the migration from Incapacity to ESA scoring zero on the assessment and told to apply for JSA and wouldn't apply because I am unable to work and my Incapacity ended August 2015. Well I just became worse and worse and simply couldn't fight this due to my emotional state. My partner offered to support me financially as it was upsetting him to see me like this. Well we have now hit rock bottom and can't sustain this arrangement, ie, mortgage and 1 income for us both. l've had no income since August 2015 ! My partner earns (although off work at moment recovering from cancer) just above the amount to be able to receive Income Related ESA. Here are some questions for anyone that can help us.
1. Do I put in a fresh claim for ESA ? I am confused as to whether my class 1 national insurance credits (paid by Incapacity) count towards contributory ESA. If they DO count my partner will not be assessed. If they DON'T count it would be Income Related and not qualify. I get mixed messages about this online and over phone as to whether these Class 1 Credits count or not.
2. Do I try to appeal the original decision of last July on my WCA if I have sufficient proof that I was inaccurately scored ? I think I had one month to do this, however special circumstances may allow up to 13 months, but don't know what these circumstances are. I was far too ill to appeal at that time.
3. Those migrating from contribution Incapacity and unsuccessful in their WCA are forced onto JSA during the appeals process, and if successful onto ESA. Is this considered as a break in their benefits and treated as a new claim losing their entitlement to contribution based benefits due to no fault of their own, if the class 1 credits don't count ? If this is the case my opinion is that if successful in an appeal that person should not be worse off than before and still remain on a contributory benefit.
4. Those migrating from contributory Incapacity and successful in the WCA and move onto ESA is this also a break in benefit losing contributory entitlement and assessed as means tested or does everything remain the same, ie, contributory as it was before migration ?

I emphasise income related, contributory ESA and ni contributions, because we wouldn't qualify for income related, albeit we are really struggling financially which is beginning to affect the relationship. Thank you for reading, hoping that someone on here has suffered a similar situation. All help appreciated before I move on with this.
THANK YOU !!

pmlindyloo

I think you are going to need specialist advice about this - try a welfare advisor or CAB (you will need a benefits specialist)

My opinion.

Since your IB claim has ended and you did not claim JSA or appeal then since that time you would not have been receiving NI Credits. I do not know whether a new claim for ESA (which must be based on a new condition or a substantially worsening condition) would take into account the past 'credits' from the Incapacity Benefit. I can find no help on line for this.

If for a new claim the 'credits' are not taken into account for a new claim then the most straightforward way would be to put in for a late appeal. Since it is a considerable time since the usual one month time allowed you would have to have had a very good reason for not having done this earlier. (you would need advice about this)

If the late appeal is disallowed then you could then try for a new claim if your doctor would write on your fit note any new condition or substantially worsening ********.

I am also not sure if you were allowed to appeal whether you would have to go through a mandatory reconsideration first and supply fit notes since August 2015.

Very complicated so do get some professional help.

If your partner's earnings just make you ineligible for income based ESA I am also wondering if there are any other benefits that you may be entitled to?

To help further could you answer these questions please?

Ages?
Children?
Number of hours your partner works? Salary?
Do either of you receive DLA/PIP?

TELLIT01

I agree with pmlindyloo, you need specialist advice on this one as it has the potential to be far from straightforward.

MarioZena

Hi, thanks for your response. Im am 50 and my partner is 61, we have no dependant children. My partner gets £ 28,000 a year gross and £ 10,000 savings, but is off sick at moment recovering from cancer treatment and maybe all clear but won't know till July following test results. Neither of us are in receipt of any benefits. The issue over my NI insurance contributions being counted for somewhat confuses me as it states NI credits count towards certain benefits one being ESA according to the Gov website on NI credits, unless I have interpreted this incorrectly. Based on this website I do qualify in terms of NI as long as I qualify for ESA either on successful appeal or new claim. On the other hand I have contacted the helpline to this website and National Insurance who tell me they only count towards pension and not benefit. Hope this helps. I was just wondering if there was anyone else that has been through a similar situation. Thanks again for your reply.

MarioZena

Hi, thank you, it would appear that would need to take that route of specialist advice as it seems so complicated and also like opening a can of worms !

pmlindyloo

On that salary I do not believe that you would be eligible for any benefits unless you qualify for PIP. Do either of you meet the descriptors? This is not means tested so if you meet the descriptors then apply.

If an appeal or new claim actually happens then you would only be awarded £70 ish a week to start with.

Is your husband getting full pay?

Does he have any critical illness cover for the mortgage? (Often forgotten about)

Could you ask you mortgage lender for a payment holiday whilst your husband is off sick and you are struggling financially?

Am wondering why you are struggling so much on that salary.

The Debtfree Wannabe Forum (not just for those with debts) is a very supportive forum and are excellent at suggesting ways you can reduce expenditure.

I don't wish to pry but unless you have a huge mortgage or debts then reading this website and the many forums should help you reduce your expenditure.

Anything we can help with?

MarioZena

Hi, thanks for the pointers I will take a look at other forums too and take your advice on the mortgage which is something we hadn't thought about at all. It does take up a considerable amount of the income though, and over these last few months has brought us into financial difficulties. Thanks for your advice and I will see what can be salvaged from this. Thank you.

WillowCat

I can't answer all your questions, but in terms of the contributions credits you received they are partly taken into account for a new claim. You need to have had credits/contributions in the relevant tax years - currently 2013/14 and 2014/15. These must include at least six months of PAID contributions (i.e from working) and the rest of the two years can be from your ESA/incapacity/JSA claim.

pmlindyloo

WillowCat wrote: »

I can't answer all your questions, but in terms of the contributions credits you received they are partly taken into account for a new claim. You need to have had credits/contributions in the relevant tax years - currently 2013/14 and 2014/15. These must include at least six months of PAID contributions (i.e from working) and the rest of the two years can be from your ESA/incapacity/JSA claim.

Does this still apply if you switch from IB to ESA?

I understood that switching from IB to ESA means that it is an automatic contribution based claim (ie not requiring the 6 months of paid work)

Would this have any bearing on a new claim? Is there any protection from the IB claim?

MarioZena

That is interesting and thank you, it may have solved my NI confusion ! If this is the case of the relevant tax years being 2013/14 and 2014/15, I have the contributions for those periods in full but only from incapacity and not paid work. So I guess my mission on the NI front with regards to a claim for Contributory ESA has failed, unless I have worked for 6 months which of course has not been possible. Thank You.

MarioZena

pmlindyloo wrote: »

Does this still apply if you switch from IB to ESA?

I understood that switching from IB to ESA means that it is an automatic contribution based claim (ie not requiring the 6 months of paid work)

Would this have any bearing on a new claim? Is there any protection from the IB claim?

You have a good point !. I think that switching from IB to ESA would offer the protection to remain on contributory in the first instance if I had passed the WCA. That would probably be reinstated if I could win an appeal by providing sufficient evidence (which I have) that the WCA decision at the time was incorrect. Also that would only apply if a late mandatory reconsideration was to be accepted based on my inability to challenge at that time because it completely destroyed me. I do have the sufficient evidence to prove it, I am just concerned if they don't accept it being late it would mean I am back to income related assessment which is pointless. I have become much worse since with other physical illnesses diagnosed but that means nothing if my NI contributions aren't taken into consideration on a fresh claim. So maybe I will try for pip instead if all else fails. Thank you.