Called in for medical assessment after winning esa appeal

NeilCr

TELLIT01 wrote: »

Thanks for picking up on the error NeilCr. I have edited my previous post to correct it - added NOT!

Just another example of CAB volunteers picking up a mistake by paid (and ex paid) DWP staff.

:rotfl::rotfl:

TELLIT01

NeilCr wrote: »

Just another example of CAB volunteers picking up a mistake by paid (and ex paid) DWP staff.

:rotfl::rotfl:

Touche. Sadly, I must stand by my comment about the quality of information provided by CAB staff being variable. Mind you, I wouldn't necessarily rely on information provided by DWP call centre staff these days either. Their role originally was simply to field calls and pass them on to the relevant department. My understanding now is that most calls a supposed to be anwered by the call centre. How much training are they given?

epitome

DM = Decision Maker
DRT = The appeals section at ESA

I can boil this whole saga down to two very simple scenarios. Working on the assumption that claimant will fail the next medical.

A)
Leave claim2 open,
Appeal result comes in, claimant gets £102 per week WRAG rate
Attend medical, likely result is a fail
ESA is closed for No LCW (fail medical)
Unsuccesful requests that claim is opened again on basis of tribunal decision...unsuccesful because claimant has had fresh assessment and failed.
Claimant appeals "no LCW" (again) only difference is that this time payment on appeal is allowed £73.10 per week.
Claimant eventually wins or loses the appeal


Close claim2 before the medical appointment. Make sure medical appointment has been thus cancelled.

All payments stop.

Appeal is processed and accepted:
Best case ...ESA is opened at £102 a week on claim 1
Worst case... ESA appeal win arrears are paid to make £102 per week, but only up to point where claim 2 closed. Claimant would be told if you want further payment have to make new claim.

Claimant makes new claim to ESA from date of closure.
New claim links to old claim and is paid at £102 (but possibly £73 though £73 is unlikely)

Possibly on new claim a new referral..but also possible to have no referral for 2 years.



Scenario A puts the claim at severe risk of disallowance and having to fight another appeal straight away after having won an appeal, and would only get paid £73 a week going forward and requiring continuous sick notes, and could lose appeal this time around.

Scenario B is completely legal, removes the immediate threat of claim closure. And on the new claim (if required) claimant likely to get £102 per week. DWP would have to allow the new claim. And may have another medical in 6 months or may be in 2 years. Thus delays any necessary appeal for 6 months or 2 years


All the options of what might happen...are to me...entirely at the whim of the processors and decision makers and essentially luck. Due to unusual circumstances. Trying to challenge any of it would be difficult.

If anyone can shoot any holes in scenario B - I'm all ears.

Alice_Holt

Re Epitome's post @ 34 I'll repeat some comments from an earlier post:

It is quite possible that if Rose cancels her current ESA claim she will need
- to re-apply for ESA,
- complete a new ESA50 (and have this accepted by the DWP),
- have her HB ended (if in receipt of HB) and then need to complete a nil income form.
There could be a 7 day waiting period - http://www.cpag.org.uk/content/waiting-days-jsa-and-esa

Rose should check that her area has not moved to a UC full service area.. If it has then her situation becomes more problematic.
- She will have a 5 week wait before payment.
- Her HB (if she receives this) will end.
- For the period before the UC WCA she will be likely to be assumed to have capability for work .
- Any potential disability premiums relating to PIP will be lost. Etc,etc

Rose will need to have a WCA at some point. It strikes me that this may be the best time to be assessed, as she has the Tribunal Decision Notice placing her in the WRAG. She may also have her Benefits Caseworkers submission and medical evidence.
I don't share Epitome's opinion that she will fail the WCA. It is unusual for the DWP to accept a claim on the basis of a worsening condition (her current claim) - she must have some fairly convincing medical evidence. This evidence will be available to the assessor.
Whichever option Rose takes she will need to attend a WCA, as they are a necessary condition for claiming ESA. At a future WCA the evidence may not be so compelling.

Epitome and myself are coming at this from different perspectives. I don't have the detailed knowledge that he has on the DWP ESA procedures. I know that this has been extremely helpful for many previous OP's.
However, coming from a more generalist background, I can see some difficulties for Rose should she cancel her current claim. I feel I should point these out.

It is for Rose to decide.
This isn't a criticism of Epitome's posts, but a counterpoint for the OP to consider.

epitome

Alice_Holt wrote: »

There could be a 7 day waiting period - http://www.cpag.org.uk/content/waiting-days-jsa-and-esa

There could not be 7 days waiting,... claims will link.

Rose should check that her area has not moved to a UC full service area.. If it has then her situation becomes more problematic.
- She will have a 5 week wait before payment.
- Her HB (if she receives this) will end.
- For the period before the UC WCA she will be likely to be assumed to have capability for work .
- Any potential disability premiums relating to PIP will be lost. Etc,etc

I agree with this entirely, blasted UC always makes things complicated. I confess I had totally forgotten about UC. Rose you would have to check if you are in a UC full service area or not, as this would be a significant blow to "scenario B" possibly kills scenario B.

Rose will need to have a WCA at some point. It strikes me that this may be the best time to be assessed, as she has the Tribunal Decision Notice placing her in the WRAG. She may also have her Benefits Caseworkers submission and medical evidence.

This is something I also considered and it is a valid argument.

It is unusual for the DWP to accept a claim on the basis of a worsening condition (her current claim)

I'm afraid I disagree, it is fairly easy to get a worsening claim opened, not so easy to convince the assessors though.

However, coming from a more generalist background, I can see some difficulties for Rose should she cancel her current claim. I feel I should point these out.

It is for Rose to decide.
This isn't a criticism of Epitome's posts, but a counterpoint for the OP to consider.

I agree.

Will wait and see