Should I appeal my PIP Decision?

poppy12345

MalMonroe said:

Also, most applicants for PIP fail at the first submission and have to appeal, after which it is awarded. I think tax payers need to be made aware that this is a regular occurrence. People who really are entitled to benefits have to beg and beg again to be given them, and go through hell before they can actually receive them.

I don't think that's quite correct. The majority of people that claim PIP are awarded successfully first time without any problems at all. No one needs to beg to be successful.

Myself and my daughter both claim PIP successfully first time without any problems at all.

The issue is that naturally you'll only ever hear the bad stories because if someone's had a decision they're happy with then we don't hear their story. In fact, since Covid19 even more people have successfully claimed it. The MR decisions have also gone from 17% success to a whopping 54%.

Not sure what you mean about tax payers because PIP has nothing to do with those at all. People claim PIP whether they work or not.

Spoonie_Turtle

^ I think the comment about taxpayers is that benefits are all from public funds (I think, or that's certainly the perception anyway). Also the DWP and the appeals are all funded by public money too, and so many appeals would not have been necessary if the DWP had done their job properly in the first place, so overall the wrong decisions are a huge waste of money. But thankfully things do seem to be going in the right direction as you pointed out

Damienkryx

Appeal! 2 years ago I was awarded 0 points. I've just had my tribunal and has been awarded 12 points in both categories. I get both enhanced payments. Always challenge it! 

Nannytone

Most Pip refusals are due to the form not having sufficient information or evidence for a successful claim
It's too easy to blame the system when a lot of claimants are partially at fault

Spoonie_Turtle

Nannytone said:

Most Pip refusals are due to the form not having sufficient information or evidence for a successful claim
It's too easy to blame the system when a lot of claimants are partially at fault

While sort of true, part of the DWP Decision Makers' job is to request more information if necessary - whether from medical professionals or from the claimant themselves. So many of the horror stories* include the reports being full of lies, completely ignoring or contradicting the evidence and what is stated on the form, which is the fault of assessors but at the same time the DM is supposed to look at all the evidence, not just the report (equally true for ESA and PIP). The fact that tribunal waiting lists got to over a year is surely an indication that something was systematically wrong.

*I know horror stories aren't representative of the average, but they certainly weren't rare either.

Thankfully things do seem to be getting better though! It seems that the DWP have realised it might be more efficient to request extra information and make the proper decisions themselves rather than letting every challenged decision almost automatically go to tribunal

Nannytone

O how a decision is made based on the report and the evidence provided.

Yes I could chase up clarification and further medical reports but when you are making a claim, you only need to provide evidence for that one claim rather than leaving it up to a total stranger to chase around on your behalf.

It makes sense for things to be a simple as possible and that includes providing your own evidence.
I moved from DLA to Pip totally seamlessly but I provided the information they needed to know rather than expecting other people to chase around and and find the information out for themselves

poppy12345

Spoonie_Turtle said:

Nannytone said:

Most Pip refusals are due to the form not having sufficient information or evidence for a successful claim
It's too easy to blame the system when a lot of claimants are partially at fault

While sort of true, part of the DWP Decision Makers' job is to request more information if necessary - whether from medical professionals or from the claimant themselves.

That's not quite correct. The onus is always on the claimant to send evidence to support their claim to prove they qualify and not DWP's or the health assessment providers. They very rarely contact anyone for any evidence.

poppy12345

Nannytone said:

Most Pip refusals are due to the form not having sufficient information or evidence for a successful claim
It's too easy to blame the system when a lot of claimants are partially at fault

Totally agree with this. A claim pack is mostly to blame for lack of information. People think they can just write a few words and leave it at that. Or they will state they can't do an activity but then forget to explain the reasons why they can do it. Hardly a great start for any disability benefit claim.

Spoonie_Turtle

poppy12345 said:

Spoonie_Turtle said:

Nannytone said:

Most Pip refusals are due to the form not having sufficient information or evidence for a successful claim
It's too easy to blame the system when a lot of claimants are partially at fault

While sort of true, part of the DWP Decision Makers' job is to request more information if necessary - whether from medical professionals or from the claimant themselves.

That's not quite correct. The onus is always on the claimant to send evidence to support their claim to prove they qualify and not DWP's or the health assessment providers. They very rarely contact anyone for any evidence.

I had misremembered, sorry. Part 1 of the assessment guidance states that HPs (i.e. assessors) should seek extra evidence if it would help clarify things (including if it would mean they could do a paper-based assessment instead of face-to-face) and also that DMs should seek further info from HPs if they feel they need to. So no, it's not quite the DM's job, but it is part of the assessor's job if it would help inform the case.

Reading the guidance makes it very clear that for a number of years what should be happening isn't always necessarily what was/is happening. 

I also agree that claimants give themselves the best chance if they explain as clearly as possible, but if a filled in form hasn't explained why someone can't do things then the assessor *should* be asking the claimant for more details (i.e., 'why?') Their job is to give a high-quality report, with advice justified by the evidence. The DM's job is then to consider the evidence - including the HP's recommendation in the report - and make a fair, lawful decision.

https://www.gov.uk/government/publications/personal-independence-payment-assessment-guide-for-assessment-providers/pip-assessment-guide-part-1-the-assessment-process

Yes the REALITY is that they rarely contact anyone for further evidence, rarely consider anything other than the report from the assessment (and also rarely do paper-based assessments). I was not disputing that, just saying what SHOULD be happening (which turned out to be not entirely accurate because I got the DM mixed up with the HP). In REALITY the claimant needs to give the very best and clearest evidence they can right from the start, but those who administer the benefits are supposed to be the experts, and a fair process should not rely on vulnerable claimants being able to understand the law about how PIP is assessed and not giving them much chance otherwise.

This isn't an ideal world, I know that. And like I've already said, it looks like the process is getting better anyway, which is good news for all of us.

Jordan_UK

poppy12345 said:

Nannytone said:

Most Pip refusals are due to the form not having sufficient information or evidence for a successful claim
It's too easy to blame the system when a lot of claimants are partially at fault

Totally agree with this. A claim pack is mostly to blame for lack of information. People think they can just write a few words and leave it at that. Or they will state they can't do an activity but then forget to explain the reasons why they can do it. Hardly a great start for any disability benefit claim.

I had a phone interview that moved pretty quickly, after me saying I can't do these things for x,y,z reasons, and they would not record the interview so I don't have a record of what was said. The assessor moved on very quickly after I had said that I can't do said tasks, we assumed that was because saying I can't do said tasks was enough for them and they didn't need follow up information. 
However for my mandatory reconsideration I went into great detail point by point refuting 90% of what was said in the decision maker's report, things like being unable to turn over in bed, inability to process basic information when my symptoms are aggravated, how almost all tasks aggravate my symptoms to some degree and require periods of rest afterwards, how I have to choose which of these essential tasks I can perform in a given day, and which I have to skip/get help with. Again going through these point by point in detail and I still have a copy of the mandatory report that I sent in for reference.
Regarding the quote I gave about making my meals, I used that portion only to illustrate that they have ignored what I said and have written something else, it feels like the DM has just re-read the inaccurate report the assessor submitted and ignored the multiple pages I sent in with the Mandatory Reconsideration. 

This is the paragraph that we sent in regarding only the meals (my Mum wrote the main body, I proof-read it and added to it where necessary, I signed the document before we sent it in. I was not up to writing it all myself due to health flare-ups):
Daily Living

1.       Preparing Food

“you can prepare and cook a simple meal unaided”

Not consistently, and not if he is expected to eat every day. As we specified in the interview, he sometimes cooks a batch of rice when able, but this is a VERY simple meal and hardly accounts for daily living needs.

What the interviewer did not ask is, how often, what happens if he spills something, does he need to sit down while preparing it, can he clean up afterwards, is he able to repeat this for a second meal in the same day? Jordan is only able to do this once every few weeks. This is one of the activities he will attempt, consistent with his desire to recover in the long term and return to a normal living standard.  He is not able to attempt this on days where his symptoms are aggravated, or even on a 'normal' day, only when he is having an above average day.

If he makes a spill in the kitchen, he is not able to clear it up, somebody needs to help him do this. He often leaves the cooker on because of poor memory and mental exhaustion, or boils the kettle without a lid on etc. He is not able to complete the cooking task alone and will usually need to lie down while somebody else finishes off for him. He is not able to stand long enough to clean up dishes etc. after cooking, so he would not be able to live alone from that point of view.

What was not properly interpreted at the interview is whether these activities can be achieved in the same day. They can't. So, if he were to stand and wash the dishes he used, it would mean something else would need to be sacrificed, like having a daily wash, or making the actual meal. So, if the choice comes down to either making the meal, or cleaning up after the meal, one can imagine this scenario a few days down the line if he is not receiving help from other people. Also, Jordan cannot make multiple meals in one day, he does not eat breakfast and does not ever make the evening meal, this is provided by a family member.

On days where his symptoms are aggravated, Jordan is confined to bed by his symptoms for the majority of the day and is unable to make or fetch food for himself and he is totally reliant on other people preparing his meals.

Jordan sometimes misses meals altogether because he is not able to make them himself and someone isn't around to make it (he does not always let people know when he is unable to make a simple meal for himself). His symptoms are sometimes so severe that he refuses food altogether and forgoes eating a meal that evening.

 --- end of quote

This is the reply from the decision maker and contains their whole response to meals and eating: 
"...in your reconsideration letter, you said that you have difficulty with all activities due to fatigue and associated poor levels of comprehension. However, at the assessment you said that you will cook lunch and sometimes dinner (This is absolutely not what I said as I never cook the evening meal), you are able to use a knife and fork and eat every day..." 

That's all they said. In the letter I got back the furthest they go to saying anything is wrong with me is 'you state that you are impacted by fatigue' which they say three times and that line about comprehension in the quote. I've detailed chronic headaches which are constant, severe exhaustion, muscle and joint pain, muscle spasms, tremors, inability to think or process simple information when my symptoms are aggravated (and spoken about what aggravated my symptoms, which is basically everything to some degree) and a very weak immune system. 

The thing about, M.E as has been mentioned already, is there is a stigma surrounding it in many medical communities, it's looked on with scepticism because it's diagnosed by eliminating other possibilities, there is no tests for it, only the patient's word on how they're feeling. 
There are also difficulties getting benefits for M.E because of the lack of medical evidence you can bring, aside from the diagnosis from a doctor. There isn't treatment for it or hospital visits that support your claim, which is one reason I had trouble with ESA. Seems like PIP works a bit differently though which is good, but they have completely ignored my anecdotal evidence which they're supposedly supposed to be relying on (?) which did go into detail, not only stating my inability to do certain tasks and unequivocally stating that what was stated in the report (point by point) was not true, and detailing why that is the case and what happens when I absolutely have to perform said tasks.  
To say 'no one needs to beg to be successful' is a little naive. Maybe I'm not entitled to it, maybe I am, but there are enough horror stories that it's clear this is sadly the case sometimes.

I do appreciate the help though and will be sure to drive these points home in the tribunal.