Disability & assessments

[Lapsed Workaholic]

Rather than disturb the flow of a live thread, which appears to be suffering from an uncoordinated and scattered approach for over 6 months as it is, I thought it would be generally more expedient to start a new thread that would not intrude or encroach on any one individual's personal issues and battles.

I was prompted into starting this post by the link posted by Honeybee early this morning:

http://www.consumeractiongroup.co.uk...3-esa-medicals

The post in the link relates the experiences of a claimant, Leemac, who describes how the whole assessment system is fraught with obstacles that are seeming deliberately designed to result in the claimants being unsuccessful in their claim. There appears to be no depth to which those responsible for those assessment will not stoop to in their determination to deny the claimant a fair crack of the whip.

It seems to me that in order to be successful in a claim a claimant must have above average mental agility and dexterity. It's as if the mere fact of qualifying renders the claimant ineligible, especially where mental disabilities are concerned.

Leemac writes about his experiences in 2010, over 6 years ago. Reading recent posts would indicate that Leemac's challenges then are still being experienced today. The arsenal of dirty tricks, deception and downright lies appears to have gone from strength to strength while the position of the claimant has, if anything, become even more tenuous.

Surely the time has come to make a determined effort to face up to and defeat this inhumanity once and for all. There are many who contribute to this site with a wealth of personal experiences and examples of what works and what does not. All this should be collected and collated into a definitive and determined counter attack so that we are prepared, ready, willing and able to assist positively when called upon to do so.

 

We have done much to help combat the worst excesses of sanctions, UJM, placements, and the like, let's set about with a will to face this scourge faced by the most vulnerable and which, for sheer inhumanity and brutality, outweighs all others.

Please use this thread to air views, ideas, proposals and examples of how best to progress and beat this thing.

For a start, perhaps we could:

a. compile a list of all the various types of invalidity or disability benefits there are. Define ESA, PIP, DLA etc.

b. how many types of assessment forms there are, how and where to go about getting them.

 

 

 

 

[Lapsed Workaholic]

ESA - Employment and Support Allowance - is a social security benefit for people who have an illness, health condition or disability that makes it difficult or impossible to work normally. Remember that ESA is specifically aimed at getting you back into work, not just to cater for your well-being.

 

Before claiming ESA you must check that you are eligible. If you have an illness, a health condition, or a disability, then you are eligible to make a claim.

 

Applying for ESA can take quite a long time from start to finish, it can take up to a year to get a final decision based on an assessment. If this is the first time you’re applying you will get some money straight away, or in about 3 weeks, if the Department for Work and Pensions (DWP) thinks you’re likely to be eligible.

 

Having satisfied yourself that you are eligible, the next step is to get a sick note from your doctor (GP). You will need this.

 

The next step is to start your ESA claim. You need the claim form ESA1 in order to do this. A copy of this form may be downloaded from the Government website at:

 

https://www.gov.uk/government/publications/employment-and-support-allowance-claim-form

 

What with explanatory notes and all this form is 57 pages long. I'd advise putting the kettle on and making a cup of tea at this stage before getting stuck in.

 

Some people find it easier to start the claim over the phone. An adviser will fill in the form for you during the call.

 

Normal phone/mobile - 0800 055 6688 - Free calls with BT land lines. Mobiles will probably be charged by their supplier. I've heard that the following suppliers do not charge you - O2, 3, EE, Vodafone, T-Mobile, Virgin Media and Tesco Mobile, but PLEASE CHECK about your supplier's policy on 0800 numbers.

 

Even if you opt for starting your claim by phone it might still be useful to download a hard copy. You can familiarise yourself with what's involved beforehand and save getting confused by a sudden bombardment of questions over the phone once the adviser gets going.

 

Whichever way you choose to start the claim you will need the following information to hand:

 

 

• your National Insurance number
  
• what your illness or disability is
  
• your doctor’s contact details
  
• work you’re currently doing or details of benefits that you get
  
• rent or mortgage details for where you live
  
• any savings or investments you’ve got, or other money coming in (like benefits or child maintenance)
  
• bank account details for where you want ESA paid
  

 

With that you should be ready to go.

PS: Some words or terms in the post are designated as links by CAG automatically. Those links have nothing to do with the contents of the post or the information I am attempting to convey. If I knew of a way to stop it, I would.

[Nystagmite]

The link in your OP doesn't work?

 

I am happy to write my experience of having a PIP assessment. I was lucky that I didn't need one for ESA.

[Lapsed Workaholic]

The link in your OP doesn't work?

 

I am happy to write my experience of having a PIP assessment. I was lucky that I didn't need one for ESA.

This is an ominous beginning to my project. The link I tried to post was the one Honeybee13 gave to Leemack's account of preparing for and attending an ESA Assessment.

Let me have another go:

http://www.consumeractiongroup.co.uk/forum/showthread.php?287253-esa-medicals

Many people raise issues with PIP. It would be very helpful if someone who went through the assessment for could set out what PiP means, what exactly it's for, how it differs from other benefits and the pitfalls to look out for when applying and preparing for it.

Are the same parameters or descriptors used in PIP Assessments as are used in ESA Assessments?

[Nystagmite]

Ah, now it works!

 

There is some similar criteria in both benefits. Both for example, noted that I can't read large print. This was enough to get ESA support group. But only scored me 2 points for PIP.

 

They do ask some questions that aren't asked on the form. I, for example, was asked if I drive. Now, if I said yes, (I don't) that would have backed up her original claim (I couldn't produce a piece of paper stating I'm registered partially sighted - it's 9 years old and I've moved 3 times in that period) that I'm not partially sighted. I then had to do an eye test which backed up my GPs claim that I am on the register.

 

They observe everything you do. I was apparently observed reading something. I passed a letter to my friend to find something. I would never be able to read that unaided. I only knew it was that document because there were 3 different letters from 2 surgeries and 1 hospital. Those I can tell the difference between. But I couldn't tell you what each letter says. I know what the letters are about though.

[reallymadwoman]

ESA is an 'income replacement' benefit for anyone who is not fit for work. It can either be paid based on your National Insurance contributions or be means tested.

 

PIP (or it's predecessor, DLA) is a benefit intended to meet the additonal costs associated with a disability or long-term health condition and is payable regardless of NI contributions or income, and whether or not someone is working. For most puposes such as tax and benefits, PIP is not treated as income so won't reduce other benefits or increase your tax bill, but it can also act as a passport to other benefits, such as disability premiums or a blue badge.

 

The criteria for ESA are intended to measure whether you are fit to do some work, unfortunately it doesn't distinguish between those fit for perhaps a couple of hours a week and those fit for full-time work so many people who have no chance of actually getting a job because of their health are deemed fit for work. Those who are found unfit for work are either placed in the 'work related activity' group or the support group, currently both groups are paid an additional amount, the support group getting most, but the additonal amount for WRAG is I believe being discontinued for new claims after April. The theory was that those in the WRAG would be helped to identify and overcome any barriers to their eventual return to work. In practice, those in the WRAG are actually treated much like anyone on JSA and get no extra help at all and a lot of people who are only going to get worse and have no realistic prospect of ever returning to work, e.g. people with MS or Parkinsons, are wrongly put in WRAG because the criteria for the support group are set so high.

 

An award of PIP is based upon care or mobility needs, regardless of whether those needs are actually being met. For each of the criteria, you are awarded points based on the extent of the help you need. For each component the award can be at the standard or enhanced level, standard needing 8 points and enhanced needing 12.

 

I have been through the assessment process for both benefits and am now in the Support group for ESA and have enhanced Care and Mobility for PIP - i.e. the maximum award of both which you can get, so I'm not complaining because I didn't get the award I thought I should, but in both cases the assessment itself was a complete nightmare. If anyone wants details, I have threads for both, but a quick summary is that the ESA assessment took just short of 2 years to complete due to multiple cancelled appointments by ATOS and the PIP assessment was a shambles - despite including proof from their own doctor that I have to have a home assessment they first asked me to travel over 40 miles (well outside the 90 minute maximum) then just didn't turn up for a home appointment. The report was riddled with errors which, as it was eventually done 'on paper', no-one can suggest is due to me mis-remembering what was said etc, and the whole thing is now waiting to be considered by the Independent Case Examiner.

[Lapsed Workaholic]

ESA - Employment and Support Allowance - Is a welfare benefit. The law that introduced it, The Welfare Reform Act 2007, Section 1, Part 1, defines it as an 'allowance':

1 Employment and support allowance

 

(1) An allowance, to be known as an employment and support allowance, shall be payable in accordance with the provisions of this Part.

 

(2) Subject to the provisions of this Part, a claimant is entitled to an employment

and support allowance if he satisfies the basic conditions and either—

(a) the first and the second conditions set out in Part 1 of Schedule 1 (conditions relating to national insurance) or the third condition set out in that Part of that Schedule (condition relating to youth), or

(b) the conditions set out in Part 2 of that Schedule (conditions relating to financial position).

 

(3) The basic conditions are that the claimant—

(a) has limited capability for work,

(b) is at least 16 years old,

© has not reached pensionable age,

(d) is in Great Britain,

(e) is not entitled to income support, and

(f) is not entitled to a jobseeker’s allowance (and is not a member of a couple who are entitled to a joint-claim jobseeker’s allowance).

(4) For the purposes of this Part, a person has limited capability for work if—

(a) his capability for work is limited by his physical or mental condition, and

(b) the limitation is such that it is not reasonable to require him to work.

 

(5) An employment and support allowance is payable in respect of a week.

 

(6) In subsection (3)—

“joint-claim jobseeker’s allowance” means a jobseeker’s allowance entitlement to which arises by virtue of section 1(2B) of the Jobseekers Act 1995 (c. 18); “pensionable age” has the meaning given by the rules in paragraph 1 of Schedule 4 to the Pensions Act 1995 (c. 26).

 

(7) In this Part—

“contributory allowance” means an employment and support allowance entitlement to which is based on subsection (2)(a); “income-related allowance” means an employment and support allowance entitlement to which is based on subsection (2)(b).

 

It obviously replaces income that might be earned or obtained in some other way but is that not what all social security benefits purport to do? Even then it only replaces other income if certain conditions are met.

 

My own view is that the legal definition should be used wherever possible. It is remarkable the number of instances where claimants fail to get their entitlements because they misinterpreted or accepted an erroneous interpretation of their rights and entitlements.

[antone]

It obviously replaces income that might be earned or obtained in some other way but is that not what all social security benefits purport to do? Even then it only replaces other income if certain conditions are met.

Just to clarify (although I'm really just repeating what reallymadwoman said), there is a real difference between "income replacement" benefits and other benefits. Not all benefits purport to replace income in the way I think you mean. If we're attempting to understand why the DWP sees things the way it does, and why the rules for any particular benefit are written the way they are, this distinction is important.

 

Income replacement benefits include JSA, ESA, and IS. They're intended to cover the general costs of living that everyone has: electricity, gas, food etc. People who don't have a job but are looking for one might claim JSA to cover these costs, someone who is ill might claim ESA and so on.

 

Other benefits such as DLA/PIP/AA are intended to cover additional costs that go along with a disability: some people might need extra assistance in keeping their house clean, or getting dressed, or are unable to drive or use most public transport etc. So they're not "income replacement" benefits in the DWP technical sense - they are additional income, not replacements for it. That's why most of these benefits are non contributory and non means tested - even millionaires are theoretically entitled.

 

My own view is that the legal definition should be used wherever possible. It is remarkable the number of instances where claimants fail to get their entitlements because they misinterpreted or accepted an erroneous interpretation of their rights and entitlements.

Sure, yes. "Income replacement benefit" is a term that's used internally by the DWP to distinguish between different types of benefit. There is commonality, for example, between the rules for ESA and JSA. I'm not sure if the term appears in any legislation but it's clearly useful when we're thinking about what is required to obtain any particular benefit. For example, you will not, when claiming PIP, be asked about your income or savings, because they are not relevant.

 

Ages ago I started writing a "Principles of Benefits" type primer. I can get back and complete that project if anyone thinks it would be useful.

[Lapsed Workaholic]

So far I have just about managed to write down the legal definition of ESA. A definition given by the law and used by all reputable organisations who inform and advise on it. I have also set out the initial step that the law and the DWP itself says one is required to take to claim it.

 

I have been unable to progress any further because a difference of opinion appears to have arisen over the legal definition that I used.

 

Whatever the internal machinations of the almighty DWP, many of which are objectionable to say the least, my efforts are meant to help those who do not move in such illustrious circles. I try to keep as near as possible to the language, terms and definitions in general use. Less confusion, I think, this way.

 

Goes without saying if anyone chooses vague definitions, or their own definitions, rather than the lawful ones in common use, by all means feel free. It's the claimant seeking the guidance or advice that will be the worst for it.

 

The only reason I started this project was because I believe that not only do people want it, they need it , or something like it. There are people out there suffering daily, dying even, for want of it, or something like it.

 

Not only do I believe that people would find the sort of primer that you say you started ages ago useful, I believe that they would regard it as vital that you complete it.

[Lapsed Workaholic]

Meanwhile, back at the Front:

Whilst still in the initial stages of making your ESA claim you will need to be aware that there are 2 types of ESA benefit.

1. Contribution-Based ESA.

2. Income-Related ESA.

 

The notes pages at the beginning of form ESA1 give a full description of those 2 types of ESA. Here again is the link to that form:

 

https://www.gov.uk/government/publications/employment-and-support-allowance-claim-form

When you make your claim, a check is carried out by the DWP on your National Insurance Contributions record. If you meet the criteria in the relevant years you qualify for contribution-based ESA. This will be paid regardless of other income into your household.

If your National Insurance Contributions record doesn’t qualify you for Contribution-Based ESA, the DWP carries out a “means test” to assess your needs. They look at any other income, including benefits, that you may have, as well as any savings or capital (over £6,000). If you don’t have enough to live on, you will be entitled to income-related ESA.

[Lapsed Workaholic]

When you have completed the form, answered all the questions, and sent it to the address as directed (see Part 25 of the form on the link) along with all the documentation asked for all you can do then is wait for them to write to you with their decision. If you completed the form over the phone you will still have to wait to be informed of the decision in writing, but perhaps not as long.

 

If it has been decided that you are entitled to ESA the letter will explain how your benefit will be worked out and how you will be paid.

 

If it has been decided that you are not entitled to ESA the letter will explain why your claim has been rejected and what you need to do if you disagree with the decision.

 

In ESA eligibility decisions, if you are not satisfied with the decision, the first thing to do is ask for the decision to be looked at again. This is called Mandatory Reconsideration and you need to do this within one month of the date of the decision. You will need to explain why you are challenging the decision, and provide any further evidence you may have to support your challenge.

A good guide to Mandatory Reconsideration by Citizens Advice called "Challenging an ESA Decision" may be read and/or downloaded from the link at:

 

https://www.citizensadvice.org.uk/benefits/sick-or-disabled-people-and-carers/employment-and-support-allowance/while-youre-getting-esa/challenging-an-esa-decision/

Other guides are also available on various websites to peruse and download.

[Lapsed Workaholic]

That was a reasonably concise and comprehensive description of the process to follow as the first stage for claiming entitlement to ESA. The process looks straight forward enough and ideally it should not be too difficult to get through. We have not got to the challenges that assessments and such throw up yet, that's a whole other kettle of fish which will need to be addressed once it has been decided that you are entitled to ESA.

 

So, the question is what can go wrong, I mean with the process as described so far, from making the claim to the entitlement being confirmed? What difficulties are envisaged?

 

Anyone who has gone through it may recount their experiences during this stage, and the difficulties, if any, that cropped up, and how they were overcome.