ESA & PIP appeals system

Hello all

There has been a change announced to the way appeals against ESA and PIP are dealt with. See the benefits and work new for the detail: http://www.benefitsandwork.co.uk/news/3555-28-september-2016-update

​Essentially it seems the DWP are unhappy with the number of appeals that are held and particularly with the number where the claimant wins.

So their latest tactic is to change the rules about the way appeals are dealt with. This is how I see it:

  • The right to appeal may be decided by a case officer, ie the decision as to whether an appeal is in time also the method of appeal that is most appropriate.
  • More appeals will be decided ‘on the papers’, ie. in writing. And the decision as to whether this is appropriate is decided by the DWP.
  • Even if you avoid the decision to have your appeal decided in writing, the DWP will be able to hold appeal hearings over the phone or by video conference. If they consider it appropriate.
  • The DWP may be encouraging you to accept a lower award that that you feel entitled to rather than have a tribunal decide.
  • There will be fewer panel members, at present there must be a medical professional on the panel, your appeal may in future be decided by just one person, possibly just one retired solicitor sitting alone.

To to me this says, when you get your DLA to PIP claim, your PIP renewal, your ESA renewal or other benefit claim or renewal, you need to try to get the correct decision made from your original claim. You can’t rely on an appeal being held. Or in any appeal being decided in your favour, or in fact having any consideration by a medical professional.

So when you are making a claim or renewing your claim, make sure you:

  • Get help or advice in filling in your form, if you can’t get a welfare rights officer (eg CAB) to help, at least use one of the online guides such as Benefits - Citizens Advice or join: http://www.benefitsandwork.co.uk
  • Whether or not you get help, try to include examples to support what you are saying.
  • Send appropriate documentary evidence with your claim form, eg letters from your neurologist, your council care plan, etc
  • Read through your completed claim form critically, look at the various descriptors (for PIP) and the points awarded for each activity for ESA, make sure you fit the criteria you think you should. If possible, get someone who’s opinion you value and who understands the process to read the form with the same things in mind.
  • If you are sending additional information, number each page and write a list of what you are sending noting each page number as appropriate.
  • Make sure you are aware of and meet all time limits. The DWP will not accept late forms, requests for reconsideration or appeals.
  • Take copies of everything you send the DWP.
  • Send forms and letters by recorded delivery.
  • If you are refused, request a reconsideration within the one month time frame, give your reasons, follow all the same steps as in your original claim.
  • If you are offered a compromise following reconsideration, ie a lesser award than you think you are entitled to, consider accepting it to avoid further stress but remember you can still request an appeal.

Please be aware that I am not an expert, I read the same things many of you do, feel free to disagree with me or do it your own way. This is just my opinion.

Sue

2 Likes

Sue speaks a lot of sense here about getting your application right from the get go - relying on any appeal process to rectify basic errors is a bit of a silly plan. The interesting thing for me is that the Government is trying to introduce the same gatekeeping procedures and new technology in the tribunals as they have done in other courts and tribunals like the criminal courts. Nowadays it is not uncommon for criminal cases to be heard in “virtual courts” by videolink and for more routine procedures to be carried out by non legally qualified “lay presenters” or by the Court Clerk without a magistrate present under their “delegated powers”

Sorry. Got a bit carried away talking about my “specialist subject”. What I wanted to say was that these changes (if they are ever can be introduced which, in my experience of the Ministry of Justice, is not a definite) are not the decision of the DWP. The DWP might not be opposed to them but they are part of a much bigger obsession of the MofJ that all the delays and costs of the legal system can be eradicated simply by doing everything “virtually”. It might have more of a chance in succeeding in this drem if they had the slightest idea about the Internet of course :frowning:

I completely agree that this is part of a wider push to change the judicial system and of course, may never happen. But I do think it’s worth considering in the light of this general intention by the DWP to reduce a) appeals and b) successful appeals, that they will try everything they can to make it harder to appeal. So my general point, that you’ve picked up on, is that it’s worth doing everything possible to get the claim right (with obviously the highest award possible given ones circumstances) in the first instance, rather than having to rely on reconsideration and appeal.

Sue

These changes are to try to hide further cuts to benefits by sneaking them through the back door by reducing the number of successful appeals. The current rate of successful appeals is 67 percent.

[quote=“Ssssue”] So my general point, that you’ve picked up on, is that it’s worth doing everything possible to get the claim right (with obviously the highest award possible given ones circumstances) in the first instance, rather than having to rely on reconsideration and appeal.

Sue

[/quote] Definitely. Definitely. DEFINITELY! I am very much of the opinion that expecting a third party to “put everything right” is never going to work - although the presence of an appeals system is a great safety net. Perhaps Admin should think of starting a “Practical tips for a good benefits application” sticky thread. It’s too easy to get carried away with complaining that “it’s not fair” when you need to help yourself by playing the game that is there well!

1 Like

OMG! More for us to fret about!!!

Whatever next!

Pollx

Hello

i was lucky in that I got the decision that I expected, but if I had to go to appeal then a video link would be so much less stressful than having to attend a hearing.

paul

Really? Obviously there’s no travel involved, but it would be a one on one conversation, the person wouldn’t see you and be able to observe any physical difficulties you have. I understand that travel complicates things massively, not to mention needing to check there’s access, loos, etc at the venue. But I can also imagine it being immensely off putting to many people.

Of course we are all different and it might be a different thing if there were to be a change in that the claimant could choose to attend a tribunal hearing, or have a video hearing, or have a phone hearing. I think the most dangerous suggestion of all though is that the tribunal may not be required to include a medical professional, and could be reduced to one persons view of your complex personal care and mobility needs without actually seeing you in person.

Sue

Hmm… this is shifting the debate - towards the ‘form of reconsideration’ - and away from demanding that PIP be scrapped altogether!

Disability is hard to assess and judge accurately: PIP, in its current form, is more a test of ones cognitive abilities - to collect the necessary documents - the pushy ones will do well here - not the shy or the anxious or depressed - they won’t be able to gather the documents on time and complete the complex form.

I say…Axe PIP assessments.

Let GPs issue a certificate based on an OT and Community Rehab/Specialist Nurse assessment, to be sent to the DWP.

At the moment GPs are paid £33 for a ‘Factual Report’ by the DWP - so we don’t need PIP assessments at all.

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I doubt that GPs would be at all happy with your proposals PJday. They are already massively overworked, if I want to see a GP on a non urgent matter, I have to make an appointment for at least 2 weeks time. If I need more urgent medical help, I can see a ‘triage nurse’ on the day (if I phone at 8am) who is able to prescribe.

Other than GPs, I don’t think that the other people who we see, OT, Physio, etc necessarily have a complete picture of your abilities and care or mobility needs. Nor are they knowledgable about benefits.

MS Nurses are very willing in the main, but the problem I found with my previous MS nurse was firstly that she wanted all her patients to qualify for the maximum amount. This meant that when she completed a DLA form on my behalf, she exaggerated certain aspects and I was unhappy to sign a form that did not accurately depict me, so I phoned and had a new form sent out and did it myself. The second problem with her completing the form is that she actually didn’t understand the rules as well as I do (and I realise that I am in a minority having had a lot of experience with benefits), so she didn’t express things in quite the same way I would, or use enough examples to illustrate statements. By the way, when I received my decision that time, I was awarded maximum care and mobility for life (hah, as if!), even without the exaggerations.

So I feel that MS nurses would not be the best people to make comprehensive statements with regard to benefits.

You are absolutely right of course that disability is extremely difficult to assess. Even people with the same diagnosis have vastly differing symptoms meaning they have differing abilities with regard to work and also care and mobility needs. And you are also right that PIP claims (and ESA plus many other benefits) are complex, difficult to complete and collate all the necessary documents. I disagree of course that ‘pushy people’ get their benefits whilst shy and retiring types don’t. Although of course, completing mammoth claim forms is likely to add to depression and stress.

This is why I always recommend that people get specialist advice, from CAB or other welfare rights specialists. Failing that, use good easily understandable guides such as those available from benefits and work. And get help from your friends, just to read through the descriptors, and make sure that your statements on the forms are accurate in the light of those descriptors.

I have absolutely no idea what could replace the current form of physical assessment, you are right in suggesting that the assessments by ATOS and Capita don’t always work, but using non specialists to take their place isn’t going to work either.

Sue

1 Like

[quote=“PJday”]

At the moment GPs are paid £33 for a ‘Factual Report’ by the DWP - so we don’t need PIP assessments at all.

P [/quote] But in the majority of cases the DWP don’t actually ask for the reports and when they do the consultant/GP doesn’t actually agree to do one - they are under no contractual obligation to do them (it’s not a NHS duty) and generally their professional governing body advises them not to.

Hi Boblatina,

Re. My comment: ‘At the moment GPs are paid £33 for a ‘Factual Report’ by the DWP’ -

and your comment: ’ they [GPs] are under no contractual obligation to do them (it’s not a NHS duty) and generally their professional governing body advises them not to.’

GPs are under contract to provide the DWP with a ‘Factual Report’ on you and your condition. See below:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/524047/medical-reports-completion-guidance.pdf

3 Essential Details

3.1 Contractual Obligations

“3.1.1 General Practitioners There is a contractual obligation for any GP who has issued a Med3 (fit note) to provide medical reports in relation to Universal Credit or Employment and Support Allowance on an ESA113. This should be done free of charge as covered by the contractual arrangements between GPs and the relevant Primary Care Trust.”

(Page 15)

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/524047/medical-reports-completion-guidance.pdf