(Unusual request) Mandatory reconsideration (ESA)

nicetomeetyou

This is a unusual request. I went to my ESA review and gave them a letter my CPN wrote (They had very little information on me before I arrived) My assessor said if they'd of been sent the letter before the assessment they wouldn't of called me too one, Said I was clearly seriously affected my mental health condition. I was in and out the building within 15 minutes. He didn't fill anything on the computer, said everything he needed was in the letter.

My supported living manager asked what happens now and he said my money will remain the same and not to worry, he said he can't award me exempt criteria because my mental health condition could improve, he said he will award me the maximum which I presume is 3 years.

The things is on reading the guidelines on reassessment and Scenarios here I fit in their criteria. (Schizophrenia near the bottom)

https://www.disabilityrightsuk.org/sites/default/files/pdf/DWP%20WCA%20Guidance%20on%20Severe%20Conditions%20DL.pdf

Schizoaffective is a lifelong condition and says Chronic in may medical notes.
Been sectioned 11 times in 7 years
Live in 24/7 supported living
Can't manage money (social services appointeeship)
On a Community Treatment Order since 2011
Forced to take depot antipsychotics
Extensive input from Learning Disability services.

Do you think I should appeal to be put in the exempt category considering my evidence. I think my assessor has made a mistake awarding me 3 years? I can hopefully get more supporting letters from my care team.. How do I go about it? I have a appointee do I go through him? Thanks?

pmlindyloo

According to this link there is no appeal process for this but you can ask for the decision to be looked at again.

The Department for Work and Pensions (DWP) has released new criteria to be used when making decisions as to whether or not someone claiming Employment and Support Allowance (ESA) can be exempt from re-assessment.
The first condition for exemption is that you must be in either the ESA Support Group or the Universal Credit equivalent of this (the Limited Capability for Work-Related Activity group). This group must have been accessed via one of the Support Group descriptors. This means that if you have accessed the Support Group via Regulation 35(2)(b) only, you may not be exempt from re-assessments.
In addition to this, you must also meet the following four criteria:
Your level of function must be consistent enough to always meet Low Capability for Work. This means you are unlikely to meet this criterion if you have periods of reasonable function.
The condition must be lifelong once diagnosed.
There must be no realistic prospect of future function.
It is an unambiguous condition.
Since 29 September, these criteria have been considered as part of Work Capability Assessments. You will be told if you meet the above criteria following the work capability decision by a DWP decision-maker. If you disagree with the decision, you can ask the DWP to look at it again, but there is no right to the formal mandatory reconsideration and appeals process after this.

nicetomeetyou

Is there a cut off date. You know Mandatory reconsideration is within one month. Is there a cut off date for asking for it to be looked at again and who looks at it, the ESA medical assessor? He didn't get the full picture of my illness when he gave me 3 years.

poppy12345

What's the reason for you being placed in the Support Group? reg 35?

nicetomeetyou

serious self harm from psychosis resulting in air ambulance paramedics. He asked me about staff and I told him this is a 24/7 staffed supported living complex for 6 people.

pmlindyloo

You would need to go through your appointee if you wished for the decision to be looked at again. No time limit is specified but within a month seems sensible.

If the decision remains unchanged and you have to have another review and your condition remains unchanged then, based on your previous post it is likely that it would be a paper based assessment.

TELLIT01

I may be wrong but would think that any incapacity which has the potential to respond to treatment would fall outside the scope of the exempt category. Treatment methods develop over time so it would be unwise simply to right somebody off, as was often the case with IB.

BorisThomson

TELLIT01 wrote: »

I may be wrong but would think that any incapacity which has the potential to respond to treatment would fall outside the scope of the exempt category. Treatment methods develop over time so it would be unwise simply to right somebody off, as was often the case with IB.

The decision is made on the basis of treatment currently available in the NHS. If it was based on treatment that may be available in the future then no one would qualify. It's worth reading through the examples given by the DWP, mental health conditions are covered there.

In the OP's case I suspect they are still relatively young, so there may be a prospect of their condition becoming more manageable and there may be medications and treatments not yet tried. Or not. If they were 50 and had been ill for thirty years I'd expect them to be placed in the exempt group.

TELLIT01

BorisThomson wrote: »

The decision is made on the basis of treatment currently available in the NHS. If it was based on treatment that may be available in the future then no one would qualify. It's worth reading through the examples given by the DWP, mental health conditions are covered there.

In the OP's case I suspect they are still relatively young, so there may be a prospect of their condition becoming more manageable and there may be medications and treatments not yet tried. Or not. If they were 50 and had been ill for thirty years I'd expect them to be placed in the exempt group.

My previous post was poorly worded, or at least poorly laid out. The two paragraphs weren't intended to relate directly to each other. In the first para I do refer to potential to respond, and by that I meant where there is current treatment available but a patient/claimant isn't yet receiving it, or hasn't experienced the full benefit of the treatment.

nicetomeetyou

Every time I have been to a mental health tribunal to get off my community treatment order which I have been on since 2011 they have always wrote I have a chronic schizoaffective disorder plus a mild learning disability. I don't know if I qualify but as my LD community nurse wrote in the letter I gave to the ESA assessor I have 'extensive support from the CLDT plus I live in 24/7 staffed supportive living, also being forcible injected against my will and have a social services appointee because they deem me a high risk of absconding to India to become a Bhuddest monk therefore they have took my benefits off me. I don't know if I meet the exempted criteria but its worth a try. I'm not going to lose any money trying.

In the DWP Scenarios listed on the website above regarding I am similar to the schizophrenia, I don't suffer from negative systems as much but they've wrote about me becoming psychotic within 8 days of refusing antipsychotic medication and thats grounds to recall me on CTO and section me because they say I become really unwell and a danger to myself, in 2016 trying to cut a mirochop out my armpit resulting in air ambulance paramedics rushing me to hospital and sectioned for 8 weeks, also on mood stabilsing meds.

poppy12345

nicetomeetyou wrote: »

Every time I have been to a mental health tribunal to get off my community treatment order which I have been on since 2011 they have always wrote I have a chronic schizoaffective disorder plus a mild learning disability. I don't know if I qualify but as my LD community nurse wrote in the letter I gave to the ESA assessor I have 'extensive support from the CLDT plus I live in 24/7 staffed supportive living, also being forcible injected against my will and have a social services appointee because they deem me a high risk of absconding to India to become a Bhuddest monk therefore they have took my benefits off me. I don't know if I meet the exempted criteria but its worth a try. I'm not going to lose any money trying.

In the DWP Scenarios listed on the website above regarding I am similar to the schizophrenia, I don't suffer from negative systems as much but they've wrote about me becoming psychotic within 8 days of refusing antipsychotic medication and thats grounds to recall me on CTO and section me because they say I become really unwell and a danger to myself, in 2016 trying to cut a mirochop out my armpit resulting in air ambulance paramedics rushing me to hospital and sectioned for 8 weeks, also on mood stabilsing meds.

Either way, you'll still need to speak to your appointee about this. They are the ones that will have to request the MR and not you.