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    • Sammy19897
    • By Sammy19897 26th Mar 17, 7:58 PM
    • 12Posts
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    Sammy19897
    PIP confusing decision! Furious!
    • #1
    • 26th Mar 17, 7:58 PM
    PIP confusing decision! Furious! 26th Mar 17 at 7:58 PM
    Hello all I'm new to these forums and just need to rant while also seeking supportive views from others.
    just quickly add some info about myself before I go into any detail, well my name is Samantha but prefer to be called Sam, I'm a 27 year old female who works as a part-time cashier and enjoy photography and editing in my spare time. But I also battle everyday with long-term disability and this has limited my life in many ways not just work. I suffer with Joint Hypermobility, Spinal stenosis, degenerative joint disease and mental health issues.
    I was originally in receipt of DLA high mobility and middle care before the move to PIP.
    I completed my application and sent it off.
    Now here's where it gets confusing 7th January 2017 I severely broke my leg, tib, fib and femur around my knee practically shattered. this required metal work some left to heal alone, surgery was performed 11th January 2017. I was invited to an assessment with ATOS 27th February 2017 which I attended despite requesting a home visit, I travelled there and the journey was very painful, each bump or knock is enough to have me scream in pain, I had to attend in a wheelchair as I cannot manage weight baring on my good leg for long. I had my assessment with a fairly nice lady, she made it clear that we were discussing what I could do before I broke my leg. she saw when I lifted my other leg the spasms due to weakness from the spinal stenosis and degeneration and even saw all my hypermobile joints.
    About a week following the assessment I had a phone call from the decision maker as to whether my break was from accident or something else, I stated it was from an accident and gave him details of the hospital I attended.
    A week 15th march 2017 following that phone call I received the decision letter in the post....
    the decision letter dated 7.03.2017 stated that I scored 13 daily living therefore I cannot be awarded, scored 12 mobility therefore I cannot be awarded, they believe that my condition will improve in 3 months, yes they are probably right when considering my broken leg and neglecting everything else just find it funny how they mention my medical history is consistent... very annoyed and frustrated, I put in for Mandatory Reconsideration 17.03.2017 unsure of what to write as I couldn't list category's I wrote something I'm not sure is appropriate they received it and were scanning it onto the system 21.03.2017 so now I'm just stuck here stewing in anger and frustration. I will copy and paste my letter to them in the comments below, I'm so confused and frustrated and panicking as I'm not sure what to do, 31.03.2017 if I'm not better by this time it would be my works 12 week sick policy therefore I would lose my only source of income, I keep getting reoccurring fevers and my balance is almost non existent same as my strength, I'm losing faith just hope I don't have to wait long to hear, please feel free to leave your opinions.
Page 2
    • Sammy19897
    • By Sammy19897 28th Mar 17, 11:05 PM
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    Sammy19897
    I wonder if the DWP Decision Maker made a mistake and related the points awarded in your assessment to your broken leg (hence you not achieving the 9 months forward test).

    So I would hope the second DWP Decision Maker would carefully consider your MR, since it clearly differentiates between your pre-existing conditions (which the assessor stated she was basing her report on) and the broken leg. I would hope the DM would review the assessment to check that the assessment points were indeed based on your pre-existing conditions. This may lead to a change of the decision at MR stage.

    If the MR notice doesn't change the decision, then you need to lodge an appeal with the Tribunal Service (TS). This guide explains the process:

    Getting a copy of the medical assessment (as suggested by Muttley) is sensible. If it's very clear that the assessor did write the report based on your pre-existing conditions and it has been misinterpreted by both the DWP DM's - then I suggest you consider (in addition to continuing with the appeal to the TS) making a compliant to the DWP about those decisions.
    You may wish to involve your MP.
    This is an unusual step to take, but I suggest it because it may lead to a quicker resolution than the appeal.

    Getting help with your appeal from your local CAB is sensible. They can also do a benefit check, and advise on claiming ESA when your SSP ends.

    Good luck. Let us now how you get on as we may be able to help with any further developments.
    Originally posted by Alice Holt
    Vitally important here... frustrating the MR already made (although I wonder if they'll still have time to add comment into the process for MR after acquiring PA4.. in requesting the PA4 they can ask for confirmation their MR has been received for peace of mind)... and that DWP don't as standard supply the evidence they use to make decision. It is scandalous that PA4 and ESA85 are not as standard supplied with decisions where they exist for claims of PIP or ESA... bearing in mind many claimants evidently are... and I say this politely... clueless (due to ignorance or disability etc) about the process or its composition or their rights and options. But that 'prognosis' detail here could be key. For the reference of Sammy... it'll be in three places in the report... at end of Daily Living section and at end of Mobility section..then after the mobility section will be the second image format. (Taken from my PA4)

    Originally posted by Muttleythefrog
    Thank you Alice and Muttley, on Monday I requested the PA4 as you advised and checked the progress of my MR which still is yet to be looked at, so hopefully enough time before any decisions are made, I will update you all once I get that through the post. And Alice I'm wondering the same myself whether they had just given me points in regards to my broken leg instead of my actual long term conditions, I keep hoping that hopefully the DM calls me again like he did previously so I can have a long chat with him to clear this up, I'm not after both higher rates just some support would be appreciated and I know full well that I'm definitely entitled to some form of help as these conditions are a constant impact in my life just a shame it has to go down this route.
    • Sammy19897
    • By Sammy19897 28th Mar 17, 11:16 PM
    • 12 Posts
    • 12 Thanks
    Sammy19897
    No practical help here but I really hope they sort this out.

    I have been ill since 2009.. I had my PIP changeover late last year and following a fall was in a knee brace which obviously restricted me a fair bit. I told my assessor it was a temporary thing and not part of the reason I was claiming and as i received my claim I assume it was ignored.

    So it very much seems to me that something has gone very wrong with your report. I hope its all remedied soon.
    Originally posted by Cyclamen
    Thank you cyclamen, its very confusing and strange, the assessor definitely said to me and my partner that she was basing the assessment before my broken leg, it does leave to believe that it must of been during the decision process the DM looked and gone based it on my broken leg as I had a call from him roughly a week before my decision asking me about my leg whether it was from an accident or something else? as I say to Alice and Muttley I will soon post an update as soon as the PA4 comes through the post, hopefully will have some answers there.
    • Alice Holt
    • By Alice Holt 29th Mar 17, 7:43 PM
    • 2,405 Posts
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    Alice Holt
    I know full well that I'm definitely entitled to some form of help as these conditions are a constant impact in my life just a shame it has to go down this route.
    Originally posted by Sammy19897
    Totally agree.
    If you were on HR DLA mob & MR care, and your conditions haven't improved, then there has been a DWP !!!!-up.
    Indeed the broken leg is linked to your pre-existing conditions.
    It doesn't make sense.

    I'm sure this will be rectified, and if it has to go to tribunal a sensible decision will be made.
    But lets hope he DWP put it right themselves.and you don't have to wait to go down this route.
    • rockingbilly
    • By rockingbilly 29th Mar 17, 8:08 PM
    • 834 Posts
    • 249 Thanks
    rockingbilly
    I keep hoping that hopefully the DM calls me again like he did previously so I can have a long chat with him to clear this up, I'm not after both higher rates just some support would be appreciated and I know full well that I'm definitely entitled to some form of help as these conditions are a constant impact in my life just a shame it has to go down this route.
    Originally posted by Sammy19897
    From my experience of transferring from DLA to PIP anything is possible where the DWP are involved. I too thought like you - I know full well that I'm definitely entitled to some form of help as these conditions are a constant impact in my life - but you thinking and believing that is no guarantee that the DWP will think the same. By the way I was on High Mobility/Middle Care too.
    • Sammy19897
    • By Sammy19897 2nd Apr 17, 7:26 PM
    • 12 Posts
    • 12 Thanks
    Sammy19897
    Totally agree.
    If you were on HR DLA mob & MR care, and your conditions haven't improved, then there has been a DWP !!!!-up.
    Indeed the broken leg is linked to your pre-existing conditions.
    It doesn't make sense.

    I'm sure this will be rectified, and if it has to go to tribunal a sensible decision will be made.
    But lets hope he DWP put it right themselves.and you don't have to wait to go down this route.
    Originally posted by Alice Holt
    Hi Alice,
    I got my PA4 through the post and I am more so confused as the assessor did base the length of present conditions on my broken leg, yet despite noting on MSO: 'left leg bending slightly reduced, power in left leg slightly reduced, ability to lift straight left leg reduced, spine can bend forward to reach knee level only, declined mso to right leg due to brace and pain (fractured leg)' so she noted complications that weren't linked to my broken leg but my long term conditions, yet based the length of present conditions on my broken leg... she does quote at the end of the report 'Due to recent and acute nature of condition, a short term review is required to see if symptoms still remain. With complexity of the fracture, its unknown whether her symptoms will improve or deteriorate.... review set for 3 months time guessing that is from date of the assessment. I called them quite angry and said although whats shes written in the report is fairly accurate but its worse so with a broken leg as activities are much more difficult shes based alot of the activities on my broken leg despite her clarifying with me that i was stating this is what it was like before my broken leg for each activity, upon reading the report i remember clearly stating to her that before i broke my leg i could walk up to 50 yards with a break or too but yet shes put i cannot walk further than 20 metres! with comments in regards to my broken leg in almost every activity... i am beyond livid.
    • Alice Holt
    • By Alice Holt 2nd Apr 17, 9:57 PM
    • 2,405 Posts
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    Alice Holt
    Hi Alice,
    I got my PA4 through the post and I am more so confused as the assessor did base the length of present conditions on my broken leg,
    Originally posted by Sammy19897
    Which isn't what she told you at the assessment!
    Remind me, did you go to the assessment on your own or with someone? If so, perhaps they could document their recollection of that conversation.

    It's possible this will go to a tribunal decision.
    So, it's a matter of gathering your evidence (and I remember that you did submit evidence with the MR).
    Would your GP be supportive?
    The How to win your appeal guide I linked to in post 17, has a section on getting medical evidence.
    The most helpful evidence directly links your conditions to the PIP activities, points, and descriptors.

    I would suggest:
    1) Going through the PIP points carefully:
    http://www.benefitsandwork.co.uk/personal-independence-payment-pip/pip-points-system

    This is also helpful on the interpretation on the points (Pages 86 on, and 97-134)
    https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/547146/pip-assessment-guide.pdf

    2) Identifying where you score the necessary 8 points for an award (12 for enhanced) on both DL and Mob components.

    3) Asking your GP (or another healthcare professional) to confirm in writing that your pre-existing conditions meant that you couldn't do these specific activities reliably .
    You mentioned in an earlier post that you had proof from "physiotherapists from 2013 stating how long I can stand before my legs buckle and even how far I can walk"; ask the physio / GP to confirm that your condition hasn't improved between 2013 and when you had the assessment.

    4) Also get evidence from family / friends which also relate the PIP activities to your pre-existing conditions.
    If you were accompanied to the assessment than the note recalling the conversation would be good.

    5) Do you have a copy of the DLA form / award letter / DWP confirmation of the award / etc.
    That, together with confirmation that there is no improvement to your pre-existing condition would be helpful (and indeed that the broken leg is linked).

    It's a case of getting all the relevant evidence together. A tribunal will make a decision on the strength of the evidence before it, so get confirmation from GP / physio that your pre- existing conditions do meet the PIP criteria and won't improve in 9 months.

    I do think it's worth checking if there is help available from your local CAB. If a caseworker could take your case on, then they will do most of the legwork (sorry!!) for you. For instance they may be able to write to your GP to obtain medical evidence.

    Good luck.
    • Bananas123
    • By Bananas123 2nd Apr 17, 10:02 PM
    • 302 Posts
    • 132 Thanks
    Bananas123
    hello sam,

    the broken leg is not important really in your case, because it is expected that a broken leg will heal (they guessed 3 months as an average time to heal your broken leg).

    they test your joint flexibility for ESA and PIP, again if you have not informed them of physical problems the flexibility section is not really relavant either (unless you have chronic physical problems also, then you should argue them, obviously)

    it would be a good idea to get help really from citizens advice or somebody ideally, because although the broken leg doesn't matter towards your claim, the situation and happenings may very well do.

    >>>if you broke your leg because of reduced awareness from mental illness, that IS very important<<<

    but a broken leg will heal, usually, so not relavant.

    -------------------------

    there's a massive amount that hinges on very small details and sometimes unfortunately you really do need to go get help from someone to help you say the right things.

    it's good that you got the report, next step for me was getting a highlighter, finding errors, and then the next step... trying to clearly write them down for the tribunal people.

    i think they are trying to transition alot of people away from PIP at the moment..

    good luck!
    • Alice Holt
    • By Alice Holt 2nd Apr 17, 10:10 PM
    • 2,405 Posts
    • 2,793 Thanks
    Alice Holt
    If the decision isn't changed at MR stage, this is the form you need to appeal on to the Tribunal Service (TS):
    https://formfinder.hmctsformfinder.justice.gov.uk/sscs001-eng.pdf

    I would suggest -
    Do opt to attend the hearing so that you can explain how your long-term condition affects the PIP criteria - your verbal evidence will be very important.
    Don't opt for short notice of the hearing date - gives you time to get any last bits of evidence to the TS / arrange for someone to go with you / etc
    You need to attach a copy of the MRN to the SSCS1.

    Having completed the SSCS1 form (which lodges the appeal with the TS) you can follow up with evidence, a statement, etc (see http://www.advicenow.org.uk/guides/how-win-pip-appeal).

    More info at:
    http://www.benefitsandwork.co.uk/personal-independence-payment-pip/pip-appeals
    https://www.citizensadvice.org.uk/benefits/sick-or-disabled-people-and-carers/pip/appeals/apply-to-tribunal/
    Last edited by Alice Holt; 02-04-2017 at 10:13 PM.
    • Muttleythefrog
    • By Muttleythefrog 2nd Apr 17, 11:46 PM
    • 12,825 Posts
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    Muttleythefrog
    Agree with the Alice advice. There is substantial incompetence in these assessments... but not common I suspect for a HCP to reiterate correctly their technical role and responsibility and then construct a report that fundamentally seems to run counter to their words in technical regard.

    Very frustrating. I do think ultimately you'll get joy with this claim... but it may not be at MR stage. I would spell out very clearly (if true) that you consider your broken leg a temporary issue.. a matter upon which you did not base any part of your claim for PIP... a matter that the HCP detailed at assessment was not going to be considered but seems to have featured as key to short longevity of disabilities (prognosis?). Suggest that the HCP has made an error in this regard and encourage a DM to examine that matter and return determinations of disabilities and their requirement for review accordingly to the exclusion of this temporary broken leg. Evidence your long term disabilities and describe them well in relation to the descriptors.

    Messy but I do think ultimately you'll prevail. If you can get professional assistance then it may well be worth it.
    Last edited by Muttleythefrog; 02-04-2017 at 11:51 PM.
    "Do not attribute to conspiracy what can adequately be explained by incompetence" - rogerblack
    • john2054
    • By john2054 3rd Apr 17, 3:02 AM
    • 160 Posts
    • 32 Thanks
    john2054
    i didn't get pip neither. these guys are crooks!
    • Melissa332
    • By Melissa332 3rd Apr 17, 3:05 AM
    • 8 Posts
    • 16 Thanks
    Melissa332
    if you are entitled to statutory sick pay then you should be paid for 28 weeks.
    • Sammy19897
    • By Sammy19897 15th May 18, 10:00 PM
    • 12 Posts
    • 12 Thanks
    Sammy19897
    Hello everyone thought I'd give you all an update, the reconsideration was refused and I had to put in for an appeal it was a very long wait but I'm pleased to say that last week I won the appeal 4 years with enhanced rate on both components, very pleased with the outcome. I was very nervous but i will say the judge and doctor was very polite and patient, due to panic attacks I can stutter and repeat myself quite a bit, despite this they didn't make me feel rushed or anything, they were nice people, I hope this information helps others in simular situation and thanks to all for your responses and support.
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