Need help from any medical /legal experts regarding ESA fraud

steveactual

Hi,


I wondered if anyone with any in depth knowledge of the DWP and/or legal matters could help me regarding my recent problem over my ESA claim.


Basically, I am 34 years old and have advanced osteoarthritis in my left hip. Its unusual for someone of my age to have this but I got pneumonia when I was 13 which led to an infection in the hip joint that destroyed most of the cartilage in the joint. This meant that my hip joint was unable to bend and left me with very limited movement and rotation in the leg. Over time, the pain and discomfort has become more of an issue (for example, I cannot sit in a chair for more than 10 or 15 minutes without discomfort) so a while back I went to see an Orthopaedic Consultant who sent me for an MRI which confirmed that the remaining cartilage has completely worn away (obliterated as he put it) so its effectively bone on bone. The consultant informed me that it was unlikely at this age that I'd be given a hip replacement but agreed that I shouldn't have to look for work with this limiting condition so I went onto ESA a year ago.


In April this year, I went for my ESA Work Capability Assessment and stunningly, the Healthcare Professional declared I was fit for work! I was sent the report which quoted aspects of the HCP's report and I was alarmed that the HCP had blatantly lied about my leg (he claimed I can fully bend my left hip, which is impossible, and he exaggerated my capabilities). I was aware before the WCA that the culture was for them to exaggerate but didn't think they would actually lie. Anyway, I immediately sent my Mandatory Reconsideration (a very detailed 7 page report with evidence that refuted the HCP on almost everything) and was told it would take 'quite a while' to hear back. After a couple of months without hearing anything, I contacted them to be told that they had never received it! They suggested I send it again and it shouldn't be a problem. Six weeks later, I get a letter informing me that it was not a good enough reason for being late and therefore I would not be getting a reconsideration, which obviously means it cant go to an appeal either. In my opinion, the person reviewing my report likely agreed that I had a strong case and rather than overturning the original decision, decided it was easier to use the fact it was late as a reason not to have to do that. Anyway, I asked for the full HCP report along with his name and position to be sent to me which I received a couple of days ago.


The report itself is utterly shocking. The HCP has not just claimed I can bend my left hip, he has actually claimed there is almost no problem whatsoever! For example; on the 'Medical Examination Findings' page, he has claimed my Left Leg Hip Flexion to be '130 degrees (normal)' which is PHYSICALLY IMPOSSIBLE, because the joint is practically fused together and cannot bend. He also claims my 'External Hip Rotation is 45 degrees (normal)' which again, is impossible. Just for perspective, I need help maintaining my left toe nails because I am unable to bend the leg! No independent doctor in the country would back up this individuals lies. He could not claim to be misinformed over this, even someone with no medical training would be able to tell that the left hip is severely limited in movement. He has also made several other lies and exaggerations such as claiming the assessment ended much later than it did (my TFL Oyster card journey history is proof I was back on the bus several minutes before he claims it even finished).


Anyway, I am now left with an ESA case that has been closed with no appeal due to a HCP that has committed fraud by misrepresentation (I'm not a legal expert but think that's the term?). This is absolutely and totally unacceptable that the DWP can use a fraudulent document by a corrupt Registered Nurse to stop my rightful benefits. I am determined to pursue the absolute maximum justice against the DWP and the individual himself. In this country, given the laws we have, and (for now at least) European law's, how can this sort of blatant criminal activity be allowed to take place? I have been advised to first pursue a complaint with the HCP's employer Maximus and then the Nursing and Midwifery Council, but that isn't enough in my opinion. I would like to bring criminal charges against the DWP and this individual because I have the physical evidence to prove his lies and they really have nothing whatsoever.


So, I have a couple of questions for anyone with expertise in this matter;


Given that I am easily able to prove the HCP's lies, would anything be likely to come from reporting him to the Nursing Council? Has any HCP ever been struck off for lying in WCA reports?


Will I get anywhere if I decide to pursue a criminal case against the DWP and the HCP? Surely fraud is fraud regardless of whether you are a Government Department or not?


Is it worth me pursing this with the DWP themselves and trying to get my case looked at again or are they generally happy to go to court over these things?


I know I have written a lot but hopefully someone will have some advice on what I should do. Either way, I do not intend to let them get away with it.


Thanks!

TELLIT01

Your first step should be to write a formal complaint to ESA about the handling of the Mandatory Reconsideration. If that doesn't achieve the desired result i.e. initiating the appeals process, you should contact your local MP.
It is far to early in the process to start thinking about taking legal action against anybody.

CIS

I have been advised to first pursue a complaint with the HCP's employer Maximus and then the Nursing and Midwifery Council, but that isn't enough in my opinion.

If you feel that their standard of practice was below that which should be expected you can complain to the NMC in respect of a registered nurse. They would then determine if there was any case to answer. https://www.nmc.org.uk/concerns-nurses-midwives/

sangie595

Until two weeks ago I had advanced osteoarthritis in both hips, both bone on bone plus in the right ankle and the spine. And osteonecrosis in the left hip. Plus a couple of other things things into the mix. Totally unable to move the left hip at all, and permanent excruciating pain. I was so disabled that I wouldn't even have been able to get on a bus, never mind make the journey. I couldn't walk to the bus stop!

I worked. Full time.

There are many adjustments that can be made in the work environment to manage osteoarthritis including special seating and rise and fall desks.

I had a hip replacement in the left hip two weeks ago. And a great many people have hip replacement treatment at younger ages than you. If you surgically need a hip replacement, the NHS is obliged to provide it. I would suggest that toy get further medical advice on this. The hip replacement is liberating, and obtaining this would be much more to your benefit than fighting for out of work benefits. Lots of people work with very severe osteoarthritis.

steveactual

TELLIT01 wrote: »

Your first step should be to write a formal complaint to ESA about the handling of the Mandatory Reconsideration. If that doesn't achieve the desired result i.e. initiating the appeals process, you should contact your local MP.
It is far to early in the process to start thinking about taking legal action against anybody.

Thanks for your reply. I could write to the ESA and see if I can get anywhere with that but the letter clearly states the 'decision cannot be appealed'. In regards to the MP, I have considered this but apart from raising the issue in parliament, I am unsure what he could specifically do to help my case?

steveactual

CIS wrote: »

If you feel that their standard of practice was below that which should be expected you can complain to the NMC in respect of a registered nurse. They would then determine if there was any case to answer.

Thanks, I will definitely be making a complaint with them because I don't see how he can justify lying about my condition.

steveactual

sangie595 wrote: »

Until two weeks ago I had advanced osteoarthritis in both hips, both bone on bone plus in the right ankle and the spine. And osteonecrosis in the left hip. Plus a couple of other things things into the mix. Totally unable to move the left hip at all, and permanent excruciating pain. I was so disabled that I wouldn't even have been able to get on a bus, never mind make the journey. I couldn't walk to the bus stop!

I worked. Full time.

There are many adjustments that can be made in the work environment to manage osteoarthritis including special seating and rise and fall desks.

I had a hip replacement in the left hip two weeks ago. And a great many people have hip replacement treatment at younger ages than you. If you surgically need a hip replacement, the NHS is obliged to provide it. I would suggest that toy get further medical advice on this. The hip replacement is liberating, and obtaining this would be much more to your benefit than fighting for out of work benefits. Lots of people work with very severe osteoarthritis.

It does sound like your condition was a lot worse than mine and it is admirable that you worked full time! I personally don't think you should have been expected to work with that limiting condition but that's a different debate I guess!


However, my understanding of the ESA criteria and the 15 point requirement is that I would have easily qualified under the mobility section.


Either way, regardless of whether I am fit for work or not, the HCP is required to judge it based on facts and not fraudulent claims about my condition.

sangie595

steveactual wrote: »

It does sound like your condition was a lot worse than mine and it is admirable that you worked full time! However, my understanding of the ESA criteria and the 15 point requirement is that I would have easily qualified under the mobility section.


Either way, regardless of whether I am fit for work or not, the HCP is required to judge it based on facts and not fraudulent claims about my condition.

I would have qualified for PIP - although I chose not to apply as I have a good enough income to not need it. But that is incidental. I was under the impression that being able to make a bus journey would have meant you would not qualify under the mobility criteria. But others would know better than I. My real point is that you should challenge that medical opinion. If your osteoarthritis as that bad then you need the surgery, and the new lease of life it gives is fantastic. When I was in the hospital there was an 18 year old woman having a hip replacement! If you need it, then age isn't relevant. we were walking within 12 hours of surgery, out of hospital by 18 hours, and today my surgeon has discharged me back to the GP after just two weeks - only annual MOTs now! Hip replacement is now the most successful surgical procedure, and the change it would make to your life will be fantastic.

NeilCr

steveactual wrote: »

Thanks for your reply. I could write to the ESA and see if I can get anywhere with that but the letter clearly states the 'decision cannot be appealed'. In regards to the MP, I have considered this but apart from raising the issue in parliament, I am unsure what he could specifically do to help my case?

MPs have a quick "in " to ministers and their departments. It isn't a question of raising it in Parliament it's about them being able to bring up an individual case with the department concerned - if they think it merits it

But I'd agree with TELLIT01 that I'd start with challenging the MR decision etc

Without being rude I've heard this a number of times

"However, my understanding of the ESA criteria and the 15 point requirement is that I would have easily qualified under the mobility section."

You may well think this but it's about two differing opinions (right or wrong) so going through the DWP complaint process is probably the best first step. It will also demonstrate, should you wish to take it further, that you have tried to sort it out with the DWP

Good luck

steveactual

sangie595 wrote: »

I would have qualified for PIP - although I chose not to apply as I have a good enough income to not need it. But that is incidental. I was under the impression that being able to make a bus journey would have meant you would not qualify under the mobility criteria. But others would know better than I. My real point is that you should challenge that medical opinion. If your osteoarthritis as that bad then you need the surgery, and the new lease of life it gives is fantastic. When I was in the hospital there was an 18 year old woman having a hip replacement! If you need it, then age isn't relevant. we were walking within 12 hours of surgery, out of hospital by 18 hours, and today my surgeon has discharged me back to the GP after just two weeks - only annual MOTs now! Hip replacement is now the most successful surgical procedure, and the change it would make to your life will be fantastic.

I've actually made a claim for PIP a few days ago, so I will see how that goes. I imagine they wont want to give me very much but as my condition is quite limiting, I should be entitled to something.


As for the hip replacement, it is definitely an option in the long term.


I need to pursue this first though because as I've said, regardless of my capability for work, they should not be able to get away with fraud.

steveactual

NeilCr wrote: »

MPs have a quick "in " to ministers and their departments. It isn't a question of raising it in Parliament it's about them being able to bring up an individual case with the department concerned - if they think it merits it

But I'd agree with TELLIT01 that I'd start with challenging the MR decision etc

Ok thanks, I will definitely contact my MP and see what he says. As for the MR decision, does anyone know where I would specifically send this? Do I just send it to the standard ESA address or would their be a department within the ESA that it should go to?