mandatory reconsideration medical evidence

pampam

mandatory reconsideration medical evidence
Can anyone answer my question please?
I am helping my friend with his mandatory reconsideration/
We have followed the advice online and requested this both by phone and a follow up letter.
I am collecting medical evidence to forward to the ESA Decision makers but it is taking longer than I thought it would.
Does anyone know how long we will have to send in all this info and our letter explaining why we are asking for the reconsideration please?

poppy12345

pampam wrote: »

mandatory reconsideration medical evidence
Can anyone answer my question please?
I am helping my friend with his mandatory reconsideration/
We have followed the advice online and requested this both by phone and a follow up letter.
I am collecting medical evidence to forward to the ESA Decision makers but it is taking longer than I thought it would.
Does anyone know how long we will have to send in all this info and our letter explaining why we are asking for the reconsideration please?

You have 1 month from the date of the decision.

NeilCr

There is information here

https://www.citizensadvice.org.uk/benefits/sick-or-disabled-people-and-carers/employment-and-support-allowance/while-youre-getting-esa/challenging-an-esa-decision/

Particularly look at the bit about medical evidence

Have you, specifically, told them you will be sending more medical evidence in?

pampam

Yes I told them in the letter I sent, (see extract below)

I phoned your office on 12th October to request copies of all the evidence that was used in making the decision.

I would be grateful if you would not take any further action until I have had a chance to peruse and respond to that evidence when I receive it and to gather the medical evidence to support my case..

Alice_Holt

pampam wrote: »

Yes I told them in the letter I sent, (see extract below)

I would be grateful if you would not take any further action until I have had a chance to peruse and respond to that evidence when I receive it and to gather the medical evidence to support my case..

I'd do it differently. Because:
1) The DWP rarely change their decision at MR stage (80% of decisions unchanged)
2) Once an appeal is lodged with the Tribunal Service (TS), and logged with the DWP your friend can ask for ESA payments to be resumed pending appeal.

Consequently, I would try to get to the appeal stage asap, by.
A) Submitting an MR asap with any medical evidence readily to hand,
Not requesting a delay of the MR decision,
C) Chasing the DWP for a quick MRN letter,
D) When you have the MRN then lodge the appeal asap - using the SSCS1 form https://formfinder.hmctsformfinder.justice.gov.uk/sscs1-eng.pdf

Your friend can then ask for ESA payments to resume.
You & your friend can source relevant medical evidence in the period before the tribunal hearing (usually 2/3 months or so). You friend will get the DWP evidence bundle, from which you can prepare a submission outlining why the DWP decision was wrong & which ESA descriptors apply (backed up my medical evidence referencing the relevant descriptors, and your friend's verbal evidence at the hearing).
At tribunal approx 60% of appeals succeed.
Are ESA regs 29 & 35 relevant?

This is a good summary of the appeal process (for PIP, but ESA appeals follow the same process):
http://www.advicenow.org.uk/guides/how-win-pip-appeal
Also this site is very helpful:
https://www.benefitsandwork.co.uk/employment-and-support-allowance/esa-appeals

This is from CPAG and worth reading about ESA MR / appeal tactics:
"Although the provision of further information or evidence could increase the chances of a successful MR, it may also delay the process. It appears, for example, that where a claimant indicates that s/he can submit further written evidence, the decision maker will postpone the MR for a month. Unless, therefore, the claimant can submit compelling evidence within a month which is likely to result in a successful MR, it may be better to wait until the appeal stage to provide further evidence. Perversely, therefore, MR may mean that it is in the claimant’s best interests to provide as little additional information and evidence as possible during the process (including in the telephone call from the DWP), to minimise the time it takes to issue a MR decision."
http://www.cpag.org.uk/content/benefit-during-employment-and-support-allowance-dispute

I would suggest you may be able to best support your friend to achieve a successful outcome by facilitating him to get help from his local CAB / advice agency.
His chances of success will increase if he can gain access to a benefits specialist who can guide him (and you) through the appeal process. At our CAB we get a 85+% success rate on benefit appeals.

How many points did he score, and what ESA descriptors does he (and you) should have been given to get him an award?

pampam

Thank you for your advice.
He scored 0 points in the physical. Totally wrong as he has injuries to both shoulders that severely restrict his movements and manual dexterity.
Scored 12 in the mental, cognitive and intellectual function.
6 for getting about and 6 for coping socially.
He has Post Traumatic Stress Syndrome following a being knocked down by a car in a hit and run road accident

pampam

He was placed in the WRAG group by the way

Alice_Holt

As 15 points are required
Did he get into the WRAG on Reg 29 then?

If you are appealing to get into the Support Group, what grounds are you citing?

pampam

Physical problems not taken seriously or examined properly and mixing with people he doesn't know well is very distressing for him due to PTSD. He would not cope with WRAG interviews etc.

pampam

There is no mention of Reg 29 or Reg 35 in the ESA85 that he received?

Alice_Holt

I'm slightly puzzled, as to be put into the WRAG group of ESA requires 15 points.
If your friend was only awarded 12 points that would not get him an award.
Is he actually receiving ESA payments following the WCA?

He could be placed into the WRAG on the basis of the exceptional circumstances regulations.
This could be if being assessed as fit for work would pose a significant risk to his health (or others).

I took from your post 7 that he was placed in the ESA WRAG group after the WCA and DWP decision.
If this is correct, what have you asked the DWP to look at again in your MR request?

Sorry to labour the point, but I'm not sure of the substance of your case if he is indeed getting ESA.
There is a danger in requesting an MR, as this enables another DWP decision maker to review the original decision. And in some cases, the original favourable decision has been withdrawn on MR.