failed ESA medical because husband hasnt attempted to commit suicide!

System

rockingbilly wrote: »

The diagnosis for depression and anxiety is generally made after the patient fills out a self assessment form. I have filled out many myself in a honest way and quite rightly the way I was treated by the GP/psychiatrist was in accord of my self assessment. On one occasion I misread one of the questions and gave a firm positive to suicidal thoughts and already knowing how I was to carry them out. This resulted in an urgent referral back to the psychiatrist. It was then that I realised my mistake.
So it is entirely possible that someone could 'over state' their mental health issues and be treated on the basis that they were worse than they actually were. This could result in a report going to the DWP overstating their difficulties.

Id like to see them try. I;ve been asking to be referred back to CMHT for about 2 years now (4 years since i was discharged), i'm not coping and my episode have become more frequent and severe. Thankfully my doctor is recommending i get referred as he can see it would be beneficial but its taken a long time of being without help to get where i am now and even now i might noy get taken on as i'm not currently in crisis and MH cuts to services )though honestly i feel i'm heading towards another depressive episode after my hypomanic one.

I can see a GP diagnosing depression yes, but my bipolar as diagnosed by a psych, i;ve just been left to flounder since. Good luck to anyone trying to fake it cos the help really isn;t there.

Bulldog-1979

pmlindyloo wrote: »

I wonder if this will help.

Getting ESA whilst appealing

On or after 30 March 2015 if you are appealing against a decision that you have failed the Work Capability Assessment(WCA), then depending on the facts, you can still be treated as having limited capability for work and so be entitled to ESA whilst appealing in the following situations;

if the WCA failure that you are appealing against is the first such failure (or the first since a previous decision that you passed the WCA),
where the WCA failure that you are appealing is the second or subsequent WCA failure and your condition has got significantly worse or you have a new health condition.

I think the new claim was allowed because the doctor eventually wrote that the claimant's condition had worsened?

I also think the appeal can go ahead for the original claim.

I agree that help from CAB asap because of the time limits should be a priority.

Trouble is the call centre staff are just not trained properly and it is hit or miss whether you get someone who knows the 'rules'.

pmlindyloo wrote: »

QUOTE

You have mental health problems and report occasional suicidal thoughts but you have not acted on these and have no fixed plan or intent.
You have no psychiatric input and have had no hospital admissions for a number of years." (he has previously been sectioned for a number of months for trying to commit suicide!)

This is where medical evidence is a must - was the letter about his being sectioned sent as evidence? If so then this can be used in the appeal to refute the assessor's findings. Or if it wasn't sent then it needs to be.

jaylee3 wrote: »

I am a little bit confused OP. So has your husband now been accepted for ESA then?

Also, I voted no to the poll, because although there are many genuine cases of mental health issues, and depression etc, there are also many that swing the lead, and don't actually have that much wrong with them. Many of the latter most likely had a time when they were quite low and depressed and were written off work long-term with depression, but instead of returning when they got a bit better, they just stayed off. I think in many cases, they got so used to being at home, that they didn't want to go back to work.

This is understandable, but too many people are off work with depression who really could work. As has been said (on here quite often,) depression is the new 'bad back.' I mean, pre mid 1990's, no-one was ever off work with depression, (no-one I knew anyway,) and I don't recall there ever being any benefits for it.

So the DWP need to ensure that anyone who is claiming the benefit is entitled to it. With illnesses you can't see (IYSWIM,) it can be hard to prove anything; and it's especially hard if the person has not been to the doctors for several years, or had any meds, or seen a specialist etc...

I am sure your husband is a genuine case, and I am sorry he is suffering, and I know some of these assessors (and the company they represent like ATOS for example,) have behaved badly in the past, but at the same time, I don't think on this occasion, that the assessor has done anything wrong.

I wish you and your husband well. Sounds like he is quite poorly.

Thanks for your message and best of luck with your fight aswell!

I haven't seen his medical records & as far as i know he hasn't got them? Maybe worth asking the Dr - The last time he was seeing a psychiatrist was approx 10 yrs ago. we are waiting again now after being referred and in answer to your question yes unfortunately he does keep having suicidal thoughts! - Which scares me but so far he has always said when he is having them rather than going off and trying to deal with them himself!

The Dr has been treating him regularly but she has said that she is as far as she can go & that he needs professional assistance - and HAS asked him if a spell in hospital would help - he said no because he didn't want to be away from me!:(

HONEYMONSTER

Firstly, I am so sorry for the grief you are going through and you need to appeal the original disallowance for ESA - the one where you lost the mandatory reconsideration. It is my understanding that once you appeal and it goes for a lower level appeal that they re-instate your ESA until a decision is made, but I'm not an expert.

Its possible your husband scored 0 points on his physical health but you need to appeal citing Regulation 29 which allows them to consider whether or not there would be a substantial risk to your husbands health or that of other around him if he were found NOT to have limited capability to work (so looking at his psychological health). They have to look at his journey to work and being in the workplace. I'm sort of thinking that if he can't get to the jobcentre by himself without breaking into a sweat and having you for support then he is going to struggle getting to any job. Has he been having counselling? If so ask your GP for a copy of his assessment letter. Generally when you attend counselling each time you go they ask you to compete a tick list about how you are feeling and those scores give an indication of the level of your issues. They generally do this assessment when you apply for counselling as part of the assessment process so even if he is on a waiting list, there will be a record of his current status and your GP will have been copied in on this. As your GP for a copy of it and submit it with your appeal. Also if he has registered for counselling (even if it hasn't started and he is on a waiting list) and you have proof of that, send copies of those as well.

I have reactive depression due to some very tragic events in close succession. I was on ESA, attended the Health Assessment and was found capable of work gaining 0 points, I claimed JSA but put in a mandatory reconsideration with all of the above information and the decision was revised. I was awarded backdated ESA.

You need to appeal because the law changed at the beginning of April and if your husband is put in the work capability group, a new claim from April will no longer receive the higher rate after 13 week. If you appeal the original decision and they find in your favour, its my understanding that as your claim will have originally been conceived before April 17, you will continue on the higher rate.

Sorry not sure if that is clear as I am no expert but appeal and get help filling in the forms. Good Luck!

Bulldog-1979

Hi Everyone,

Thank you all for your posts - I apologise for not being online and responding as things have been very difficult over the past few months with my husband getting worse and actually leaving the house to commit suicide - thankfully he decided against it and went to the hospital instead asking for help! - He actually left the hospital because he was just put in a cubical and told to wait for over hour as the MH Nurse was dealing with someone else. So he left and thankfully came home - the police came round 4-5hrs later because the hospital informed them that my husband had left and they were worried! - What an AWFUL experience and one that haunts me EVERY Day - im frightened to leave him on his own - he said that he can be in a room full of family members who love him and he feels alone!!! - How are we to cope with that!

He has since been managed by the Crisis Team and has been offered a 10-day residential mental health retreat but he has refused as the last think he wants to do is be away from me? -What do I do - do i tell him to go? the last thing I want to do is stand in his way of getting better - I need him!! - He has been assessed 3 times by different mental health teams and each one has passed him on as he is too intense for them - we now have a Psychologist appt for October - so we will wait for that - because he has suicidal thoughts daily he also has to attend self-help therapy sessions weekly. I dont know if they help - even his medication has been increased but he has to go weekly to pick it up - they dont trust him with more than a week's worth of tablets!!!

I have to say that the benefits have become a second issue which has just run on and I've ignored, to be honest as Ive had more important things to worry about! But I have literally just realised that surely he should have been re-assessed after the 13 weeks now? Its been 5 months? - I give up with the ESA now I really do - my priority is my husband byut a littlte financial help would DEFINITELY been appreciated where it is due!

Just keep us in your prayers please and of course your wonderful advice is always appreciated!

KxMx

I'm really sorry to hear what you have both been through.
The 13 week ESA assessment target is just that, a target. Many areas still have backlogs caused when ATOS gave up the contract a few years ago. Even before that I don't know of many cases where the assessment actually happened after 13 weeks.

pmlindyloo

I too am very sorry to hear of your husband's illness.

I would be encouraging him to attend the mental health retreat. Can you visit daily? As we all know mental illness is not well served in the UK so such an offer should be taken very seriously. Hope you can persuade him.

As regards his ESA claim. I am presuming that you did not appeal the first decision?

If this is correct and your OH has not been called for an assessment (and yes, 13 weeks is only a guide) then please make sure that you have sent further evidence of his interaction with all medical professionals. This can be done at any time.

From CAB's website:

Sending medical evidence after you've sent your form

It’s never too late to send medical evidence - you must send the ESA50 form itself back within 28 days, but you can send evidence any time afterwards. Remember to send it to the Health Assessment Advisory Service, not to Jobcentre Plus. You can get the address of your local Health Assessment Advisory Service by calling 0800 288 8777 for free or you can find the address on their website.

Write a covering letter

It’s important to write a covering letter if you send medical evidence after you’ve sent back your ESA50 form.

You should include:

your name
your National Insurance number
a note to say that the evidence supports your ESA claim - include the date you sent your ESA50 form

epitome

If you did not appeal the 15th March 2017 decision, then you should do that urgently NOW, by sending an appeal form SSCS1 (downloadable online) and a copy of the Mandatory Reconsideration Letter dated in April that you said you had received. If you have lost the Mandatory Reconsideration Notice then you can ask DWP-ESA to send you a duplicate.

You should also put in on your SSCS1 form the reasons the appeal is being submitted late... one of which would be you were incorrectly advised by the DWP in April, that he cannot appeal now that he has made a new claim to ESA. A matter which you have now been made aware was incorrect advise.

The reason you should appeal, is because if he is assessed again, and fails again, he cannot be paid ESA on appeal for the second failure... He can only possibly be paid on appeal for the first failure, so the sooner you do it, the better.

Regarding the new claim and waiting 5 months.
5 months is not unusual.
But it is also not unusual for the DWP to have made an error and forgot to refer him for a medical.

Are you sending in fit notes?
Is he being paid ESA?

Phone 0800 2 777888 in his name and NINO
And ask... "Is there a live referral for me for ESA WCA?"
If they say yes, "Is there a WCA appointment that has been made yet, when will it be?

If they say "There is no live referral", then phone ESA and tell them they have forgotten to do the WCA referral at the start of the claim.

It's up to you, what you do, but if it were my claim, after appealing and confirming the appeal has been "accepted as late" by getting a letter from Tribunal, I would then, send my tribunal letter to ESA, and once it is confirmed by DWP as appeal has been received, I would then ask DWP ESA to confirm that ... he would be entitled to payments of ESA on appeal. (be careful of ESA Conts payment on appeal, it will be restricted to a time limit, there would be no time limit of ESA IR payments on appeal).
.........once I knew I would be entitled to ESA payments on appeal, I would request my current ESA claim to be closed, pending the outcome of the appeal. If I lost the appeal, I would ask for a new claim to ESA on the same basis as the 2nd claim that was allowed in April 2017. Then he would be referred again for a medical. If you do it my way you maximise your potential benefits and minimise your potential pitfalls and hassle.....but should also be aware of UC roll out making any future new claim to ESA impossible,

Bulldog-1979

Hi everyone and thank you for your comments/advice. I would have taken more head about going against the decision but I've been too busy with my husband.and ultimately would there be any back-pay /extra that would be worth the hassle of it all? thank you again though!

He has now had an appt with a psychiatrist at our local Mental Health NHS Hospital and he has now been diagnosed with "psychotic depression" - which is a mixture of psychosis plus depression - my understanding is that he has been effectively diagnosed as clinical depression. He has had an ECG the same day and is due back again on Tuesday to change his medication.

I just wanted to ask what difference (if at all) that would make to his ESA claim? does it continue - is he now within the support group or does he go to dla now?

Sorry to ask more questions but i didn't know where else to turn - whether to start a new post or continue on this one but as everyone had been so nice i wanted to continue!?

KxMx

Having read your posts he is still in the assessment phase of ESA for the second claim.

He won't be put into a group until after the assessment and that's only if he passes.

So no, no difference to his ESA claim.

By all means apply for what is now Personal Independence Payment (PIP). That is separate entirely from ESA and both can be gotten at the same time.

Do get help filling in the forms.

epitome

He is not in the Support Group, he is on assessment rate.

He will be assessed again soon.

If he fails, he WILL NOT be paid on appeal for the second failure.

He can ONLY be paid on appeal for the first failure.

Post #48 explains this to you, if you want any chance of being paid on appeal, I suggest you appeal "claim 1" ASAP.