Long Covid - universal credit/pip claim struggle!

fenace

Hi everyone 👋

I have recently joined the community here in hope that I can find information and help in what seems to be a minefield of a situation. A bit of a quick background...

My mum unfortunately had to give up her 20+ years teaching career due to Long Covid/Chronic Fatigue in August 2022 (which she was officially diagnosed with in November 2022). Since then she has been claiming Universal Credit with no problems up until recently. After a medical assessment in February 2023, UC have decided she is "fit for work" despite being diagnosed with Long Covid/Chronic Fatigue etc.

It seems despite having a written letter from her GP stating her medical condition (Long Covid Syndrome and Chronic Fatigue) as well as medical recognition that any working role at this time is not possible, is unfortunately not enough evidence for Universal Credit to revert their decision. The short story of events is that Universal Credit don't deem Long Covid as an illness as it "has no weight" as a medical condition for her capability to work (as told to us by a UC decision maker).

Our plan as a next step was to proceed with a tribunal. However, after hours of research and reading (gathering MORE evidence from Doctors and the Long Covid clinic) it seems that you can't show how the health condition has deteriorated and that the decision would be based on the medical assessment at the time. 

Along with this, my mums Universal Credit work coach stated to us a few weeks ago that she can't "accept Fit Notes" that say the same as the previous Fit Note that would have been submitted i.e we can't say "long covid syndrome" (despite this being the diagnosis my mum has been given). 

When I questioned the work coach on this information I asked "what an earth are we supposed to put down" and her response was "anything except what the previous Fit Note says". This to me is a massive red flag. Of course I contacted the GP surgery to confirm that Fit Notes can't be amended to another false illness to cover my back. I am yet to respond to my Mums work coach and inform her that the Fit Note can not and will not be amended and she will unfortunately have to find a way to process that through her system.

My question to anyone who may be able to help is:

• Is there anyone out there having such troubles with Long Covid and claiming universal credit?

It looks like our next step and plan will be to report a health change to UC and ask for a reassessment (I'd be surprised if this will happen). Along with this, from some of the forums and the Covid Aid charity community I have joined it looks as though PIP may well be the next thing to try and get financial help from. 

It's a minefield of a situation and I feel as though I am fighting a loosing battle! Any help or advice is hugely appreciated!! 

Thanks in advance. 

HillStreetBlues

First start is for your mum to submit a mandatory reconsideration (MR)  as that is needed before an appeal.

If the MR  confirms the decision then she can take it to a tribunal.

From personally experience a tribunal is a lot more understanding, they will base their decision on what your mum can or can't do, not that she has LC. 
This it the process the DWP should use, but again in my personal experience, they sometimes fail do.  

poppy12345

For the WCA it's not about a diagnosis, it's how those conditions affect your ability to do any type of work. Her work coach is correct in saying that no further fit notes will be accepted for the same condition, unless they state a significant worsening of an existing condition.

However, if you send more fit notes with a worsening of condition then this could prompt a further referral for another work capability assessment. This may not be the right thing to do because doing so using the same evidence she privously used will likely see the same outcome. Then the whole process starts again.

For this reason i'd advise your mum to request the Tribunal. The Tribunal will not be able to take into consideration any worsening of condition because it's their job to look at whether the decision was correct at the time it was made. If she either appears in person, or has a telephone/video hearing then these will give her the best chance of a decision in her favour.

I don't know if you've had a look at the descriptors for LCWRA but you can see them here. https://www.benefitsandwork.co.uk/universal-credit-uc/uc-faq/limited-capability-for-work-related-activity only one of those needs to apply. If found to have this she will be entitled to extra money from the 4th month of her claim.

For LCW there's no extra money. You can see the descriptors here for this and you need to score at least 15 points. https://www.benefitsandwork.co.uk/universal-credit-uc/uc-faq/limited-capability-for-work

Spoonie_Turtle

The important thing is to understand how the WCA is assessed, what descriptors are used, and which ones she meets.  There is also the issue of 'significant risk of harm' - there is significant risk of deterioration for one type of LC if someone pushes their body to do more than it can.  (Recognised as Post-Exertional Malaise in ME/CFS, which many people with LC actually meet the criteria for.)

Process-wise, you should appeal if you can identify specifically which descriptors she meets for the WCA (including significant risk of harm).  I infer you've already tried a Mandatory Reconsideration from your reference to a GP letter 'not being enough to change their mind' but if not then you need to do that first.

https://www.entitledto.co.uk/help/esa_criteria
https://www.benefitsandwork.co.uk/universal-credit-uc/uc-faq/limited-capability-for-work-related-activity
https://wcainfo.net/issues/substantial-risk-lcw
https://wcainfo.net/issues/substantial-risk-lcwra

For whether someone 'can' do something, they have to be able to do it repeatedly and safely.  With LC fatigue, repeatedly could be a big problem, as could safely if doing it (or doing it multiple times) will cause deterioration.  It is also based on how someone is the majority of the time (>50%), not one-off abilities on a 'better' day.
The WCA handbook says the descriptor chosen for each activity should be the one that "reflects the claimant's level of functioning most of the time, taking into account such factors as pain, stiffness, fatigue, response to treatment and variability of symptoms".

[Typed before the previous replies were posted so some information may be duplicate, I don't have the brain power to rewrite.]

fenace

Thanks both. 

I forgot to mention that we have been through the Mandatory Reconsideration process and unfortunately the decision was still not reversed even with further evidence. 

The Tribunal has felt incredibly overwhelming and intimidating for us both and we have no idea where to start. We started to draft a letter but felt hopeless and wasn't sure what the best thing to write would be  

rosewalk

Have you tried to access any support with the appeal from your local Citizens Advice or Welfare Rights organisation? They often have staff who can support with appeals.  

peteuk

Just to clarify, the title mentions PIP but theres no mention of a PIP assessment or outcome in your post.

Long Covid is obviously a new disease and falls, as you say under the chronic fatigue due to the symptoms being similar.  But simply relying on a diagnosis certainly for PIP is not enough.  

Also for PIP a letter from a Gp carries very little weight, especially compared to serial letters from consultants and out patient's which are more specialised. 

Equally just because a medical assessment has suggested she is fit for work, it doesnt mean back to teaching, it might be that she is fit to do a p/t role and therefore claim UC to boost her income. 

Rubyroobs

Not what you are asking, but I just wanted to let you know that I have recently supported a client to claim PIP and whilst they didn't quite get the enhanced rates they wanted , they were awarded standard rates of PIP. As explained in comments above though, PIP is not based on a diagnosis but on how the illness or disability affects a person in relation to the PIP descriptors. The person I supported was extremely ill in hospital for months, not expected to survive and left with chronic fatigue, breathlessness, and mobility issues. If your mum does decide to make a claim for PIP then make sure you gather as much medical evidence as possible to support what she can't manage in relation to the PIP descriptors. Evidence form long covid clinic etc may be helpful.

poppy12345

The most likely outcome of any MR will be the decision remains the same so it's not surprising it didn't change. In my opinion, starting the process all over again isn't the answer.

You can see what advice agency is local to you here. https://advicelocal.uk/welfare-benefits

HillStreetBlues

I echo poppy's advice, just doing the  same again is doomed to failure.
With LC / CFS  by far your best chance to get an award is via a Tribunal

poppy12345

This is where a lot of people make a big mistake, when they start the whole process again, rather than take it straight to Tribunal.