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Need help with my husband's PIP claim

nafta

I need some help with my husbands claim for PIP. Can someone here help?

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Chris_Alumni

Hi @nafta, I've moved your post to our benefits advisors' page, but they will need some more information to assist you. Can you tell us a little about your husband's situation, the help you need and any problems you've encountered?

nafta

Thank you @Chris_Scope

My hsband was on medium rate living and high rate mobility on DLA.
He has to move to PIP. In PIP he has been giving enhanced rate living but standard rate for mobility. Our issued is that he should have been awarded enhanced for mobility.
The ward letter says on an imformal assesmemnt they could see he walks with a stick and unsteady gait. they said he could walk 25 meters to the room. they score him 10 popint for being able to walk more than 20 and less that 50. The distance walked to room was certainly less than 25 meters. you could definitely not fit two busses there and he stopped at least twice..
For the question about planning and following route the question was lead towards a familiar route and we said he could plan a route to the shops round the corner as it is a familiar route but he could not follow it on his own as unexpected noises make him stressed and anxious and that he also risks falling and he is not able to help himself up. He will not leave the house unless accompanied. We also added that he would not be able to do so with an unfamiliar route. he was given a score of 0???

BenefitsTrainingCo

Hello Nafta

When you challenge a PIP decision that you disagree with you have one month in which to lodge firstly a Mandatory Reconsideration and if this is not successful then one month to lodge an appeal. The month time limit runs from the date of the decision letter.

If you have passed this one month deadline, you can lodge a late challenge but have to give reasons as to why the challenge has been sent late. Please post again if this is the case.

It however sounds like you are at the first stage of challenge that is at a mandatory reconsideration. As such, you can lodge a mandatory reconsideration over the phone to PIP or by letter. It is advisable to send a letter as you can then keep a copy, as a record of this request. When sending the mandatory reconsideration request letter head it 'mandatory reconsideration'. Make sure you also quote

1. Your husbands National Insurance Number, and
2. The date of the PIP decision letter that you are challenging, and
3. the reasons you disagree with the decision

You have already given good grounds for challenging the decision in your post, in that you question the distance your husband was judged as being able to walk, and question the assumption he can leave his home alone.

When assessing PIP a decision maker must take into account whether someone can do a task reliably, and for the majority of the time. I would question whether a snap shot of a person walking 25 metres (with stops) amounts to a person being able to walk 20-50 metres most of the time.

PLEASE BE AWARE that when you ask PIP to look again at their decision, they will look at the whole award. This means that then can increase the award, keep it at the same rate, reduce the award or stop it completly.

In regards to the distance being observed to walk, in that you dispute that the corridor was 25 meters. You can lodge a complaint against the agency i.e. ATOS or CAPITA. The below links explain the complaint procedure for both agencies:

http://www.atoshealthcare.com/downloads/Atos_PIP_Feedback_Book.pdf

http://www.capita-pip.co.uk/en/complaints.html

Keep us posted, and good luck
Maria

nafta

Hi Maria,

Thank you for your comments.
We have been lucky enough to speak to a DWP worker. A friend of my brother in law. She was shocked with award and has managed to get us a meeting with Mind in a weeks time so they can help us with the MR. Our GP has also said she will fully support us with whatever documents we need. The DWP worker said that the decision makers cannot go against the words of a medical professional.
IF this is true then we need to ask GP to add weight to the mobility part in particular. Do you think this would be enough?

BenefitsTrainingCo

Hi nafta

A short letter from a GP focused on the issues in which they express an opinion based on their knowledge of the patient and their medical problems goes a long way in deciding many claims.

Unfortunately it is not uncommon for a GP to write a report containing lines like - 'Mr Smith tells me...' or 'Mr Smith reports...' and these carry little if any weight because no medical opinion is expressed, rather they are merely a report of what the patient has said to the GP.

A decision maker would have no problem dismissing the latter style of report I describe but would find the former far more compelling and persuasive.

As my colleague Maria advised a decision maker or tribunal will look at the whole of any entitlement and are not restricted to the areas raised by the appeal. With this in mind it is best to try and cover all areas if possible with your medical evidence rather than focusing on one aspect of the claim.

I hope that helps

Best wishes

Paul

nafta

Thank you Paul. We are now waiting for GP to write letter. Fingers crossed she writes it as you say. Will keep you up to date.

nafta

We have nor received the copy of the assessment and the are a number of untruths and very important information missing.

The HCP says my husband walked from the carpark and stopped for or after a minute. This is simply not true as we said we park on the side road to the building and he had to stopped twice or three times after a few steps.

The HCP says my husband walked 25 metres to the assessment room. This is not true as there are less than 20 metres but she also failed to mention he stopped at least twice.

There is a list of comments under mental health. I have included this and attached it here.
I will bring the attention to several of them.

He does not look tired - he was tired because he was not feeling very well and he is always tired.
Looks unwell- so she did notice this one.
Increase sweating was not apparent - My husband asked her to please open the door as he started to feel sweaty and uncomfortable. The HCP refused on the basis it was a private meeting? I then helped my husband to take a jumper off.
Interaction normal, not restless or withdrawn - He was very restless and he kept changing his position on the chair
Normal manner not anxious agitated or tense. - My husband was so distressed and anxious because of the pressure the HCP was putting on him to answer the questions quickly that he started scratching his arm and made himself bleed. The HCP noticed this and asked him if he had hurt himself. I told he he was distress and frustrated because he kept asking him to answer a question and he was trying to make sense of it in his mind and that he was not able to do so. The particular question was about if he could walk a minute. The HCP here also in my opinion was a bit rude and told him he had to answer the question. My husband apologised and said yes. I quickly added he could not do this reliably and that he might be able to cover 10 meters and that he could not keep doing it through out the day because of fatigue and pain.
Did not require prompting I had to help him all the time and most times He looked at me for help to answer.

About planning and following a route we said yes to the corner shop as in he could plan it but he could not follow it on his own. The HCP fails to mention that he does not do it as going out on his own cause him sever anxiety and distress . He falls and he is unable to help himself ( she said he fell once?) and that sudden loud noises like car horns, car doors shutting, children shouting etc make him anxious and jumpy and affect his balance, coordination etc making it unsafe so that he cannot do this reliably and he also mention the same applied even more for unfamiliar routes. So you can see there is vital information missing.

When it comes to moving around again he answered yes to walking for a minute but this was done under pressure and we also insisted that he could not do this reliably. Whilst she took note that it would take him 30 minutes to do this walk she fail to say it would take me 10 so she has failed to give vital information there to make a comparision about standard and time that applies to reliably.
The walk from the car park is simply untrue as she ask us where we parked and we said the road at the side of the building in yellow lines with blue badge ( this is legal to do) and we said that even it is a very short walk my husband had to stop after a few steps as he was particularly unwell and in pain

So I guess these are the argument we need to mention on the MR but how can we do this and how can we prove our word against the HCPs?

BenefitsTrainingCo

Hi nafta, yes those are the arguments you should mention on the MR - show where the assessment is incorrect or inconsistent. You can prove your facts by stating what your husband can and cannot do and giving examples from his every day life. It's not absolutely necessary to have a doctor's letter (though it is helpful), but any examples of what happens on a daily basis are important.

I'd also bear in mind that not all issues are relevant to PIP, and try to concentrate on areas where he should have scored more points. You can try going through the self-test with your husband which will help you to focus on the activities where points are scored.

As my colleague Maria points out, you should only be told you can do things if you can do them safely, repeatedly, within a reasonable time (so if it takes your husband twice as long to do something as most people, he cannot do it), and to a reasonable standard.

I know it's daunting but wherever the HCP report is wrong say so, and explain what in your husband's daily life shows that the HCP statements are wrong.

It's not so simple as HCP versus medical professional - if it were to go to a tribunal, the tribunal would decide which evidence was more reliable and consistent. Your husband's own evidence, about his own life, is also evidence! Right now though, you are at MR stage and so it's going to be the DWP looking at it again anyway. So try if you can to say clearly what points he should have got and why - make it easy for them, if you can, and back it up with stories from your husband's life.

But also, as my colleagues say, do go through all the activities which apply, not just the ones where he didn't score enough points.

I also think you should consider a complaint against whichever assessment company it was - as Maria has suggested above.

Will

nafta

Thank you Paul for this advice. We got help form Welfare Rights to do the MR. we really appreciate it but unfortunately in their letter to DWP they did not mention any of the inconsistencies I wrote in "my letter" as they felt it was important to keep emotions aside. I know they are experts but now we have received the MR letter and they are saying nothing has changed and are still using the wrong/false information for their decision.
And this time it seems that the DM is a bit more confused as he is mixing up information some given some not.....how on earth can we proof that some things that were said were omitted. that the HCP wrote things down that were not said and that the information they are using to make their decision is a pack of lies? MY husband was given 10 points rather than the 12 he should have been awarded based on the fact that the assessor wrote she observed him walk 25 metres to the room. she never mentioned he did stop a couple of times. The true distance walked was less than 25 metres. can we ask to go and measure it to prove this is false? the other piece of information given was that we said we walked from the car park and stopped after a minute. We park on the side road and not the car park. My husband stopped for the first time after crossing the road (about 10 steps?) they have a little camera outside the buzzer on the door. I wonder if that shows him walking to the building and stopping several times? We really need some help here because this is causing us both a los of heartache, anxiety and distress. I am myself not sleeping and i am on anxiety medication. Can we phone and asked to speak to the Decision Maker? or should we leave all this for the appeal?

nafta

I have spoken to Welfare Rights and they have assure us that if they did not thing we have a chance they would have told us as they have many cases to go through. That is good to hear.

I downloaded the File"Ways to challenge a PIP medical report" and I felt that it was exactly what we needed. Bring to their attention the discrepancies of the assessment hoping to put a strong appeal case and even get a chance for the DWP to change their decision and stop appeal.

But the answer from the Welfare Rights person was that we should not over complicate matters with these things as the Courts have seen and heard it all before? That we are only arguing the mobility "plan and follow a route" So if we don't write all these things down on the appeal letter on what basis are we appealing? Am I missing something? I know they have many years experience but i don't understand how we should not tell the court that the DM decided that my husband could walk 20meter based on a false observation and only that. Nothing else. The HCP said she saw my husband walk 25 meters to the room without stops (lie) and the DM says "i have decided you can walk 20 but no more than 50 becasue the HCP has told me so". For sure if we measured the distance and proof it was less than 20 meters that should be enough for the Courts to say that his decision was based on inaccurate/false information?

Apologies for my frustrations and maybe "tone" but my husband feels so impotent and let down but the system. And when I am told that we don't need this for the appeal I am totally lost.

Can you please give me your advice? Am I missing something?

BenefitsTrainingCo

Hi Nafta,

You said I think in one of the posts above that your husband only got 10 points instead of the 12 he should have got. Was that in the mobility component? And were some of the points in the moving around activity and some in planning and following journeys? It sounds as if welfare rights think you should concentrate on planning and following journeys, perhaps because they think there is more evidence about this (eg from your husband's GP). And from what you say in one of your other posts, following journeys is something your husband has difficulties with.

What welfare rights may be thinking is that it will be straightforward to show that he should get more points in the planning and following a journey activity. However, based on what you've said, the assessor's estimate of his moving around ability was also wrong. One thing to bear in mind is that there is a case saying that once a tribunal has got to the 12 points, they don't have to carry on looking at other activities. So maybe welfare rights are thinking that your husband will get 12 points without having to argue about the moving around activity?

I'd ask them why they are taking this tactic, to clarify how they are planning to get your husband the 12 points and therefore the enhanced rate of PIP. It may be they feel the 12 points can be won without having to go into the walking error (as your husband will get 8 points based on what the DM says about his walking, he only needs another 4 points to get the enhanced rate). I can really see from your point of view that you want the whole thing to be accurate, but welfare rights may be tactically correct to focus on just getting to 12 points via the route most likely to convince the tribunal.

Meanwhile, given what you say about the false information given by the HCP, and the DM's decision about your husband's walking based on this, I would definitely also complain about your assessment (my colleague Maria explains how to do this in an earlier post on this thread).

Perhaps you could ask welfare rights to explain their tactics a bit further to you, and you might also want to see your MP to discuss with them the upset caused by the HCP's misinformation, not to mention the incorrect award of PIP. They might be willing to help with the complaint depending on how far you take it.

Will

nafta

Hi and thank you so much for your comments. My husband was scored 10 point for moving around and 0 for planning and following. Yes my husband has problems following routes on his own. And welfare right feel he should have been scored points (10) on that activity alone giving my husband a total of 20 point in his mobility. We are definitely going to complain about the Atos . Thank you again and will keep you posted

BenefitsTrainingCo

Hi nafta, yes I see that makes sense. So probably if justice were done then he should have got 12 in moving around and 10 in planning and following! But like I say PIP case law suggests the tribunal should stop looking at the points once it's clear your husband should get the enhanced rate.

Anyway, yes please do let us know how you get on.

Will

nafta

Just a quick update. The appeal has been sent and we have nor received standard letter saying waiting for DWP to respond. However, yesterday I got a call for the welfare rights officer helping us and said he has now received a letter from the GP and he feels it is so strong that could make the DWP change the award on this alone and avoid a hearing. I know I might be reading to much into this but before sending appeal forms I asked him about the chance of the DWP changing their minds and avoid tribunal and he replied that this was very rare maybe 1/1000 and that we should focus on attending a hearing. Yet now he thinks this could be 1/1000 chance? My argument is that he could just simply called me to tell me he has received the letter and that he was sending it and not say anything else but based on his years of experience this must be a strong possibility otherwise he would not have said it to me and raise my hopes up?

BenefitsTrainingCo

Hi nafta,

I'm glad the GP letter is a strong one, but I still agree with what your welfare rights officer told you beforehand. It's very rare indeed for the DWP to change the decision before the hearing. They have the power to do so, and it is definitely worth trying, but I don't think this reduces the probability, which is still very low. On the plus side, you clearly have some strong evidence, so even if (which is still relatively likely) the decision isn't changed and you go ahead to hearing, you've got a strong chance of getting the decision changed there.

I would concentrate more on the fact that you now have some fantastic supporting evidence, but be prepared for the fact that you may still have to go to the hearing.

Will

wildlife

Sorry to interrupt but my case is so similar to Nafta's. I also got 10 points for the moving around and 0 for planning and following a journey. A lot of the other things at the assessment were also the same. I complained to ATOS about all the things I disagreed with on the assessor's report giving references to medical evidence or daily life situations to back up each argument. I kept this separate from the MR which was focussed on the score I got for each activity and the score I should have got. I presented an argument backed up by ref: such & such document (medical evidence). My question for the Advisors here is, as my Dr. isn't keen on using her precious time writing benefit letters and IAPT psychological therapy service don't do them either what other evidence can I use to prove that planning and following the route of an unfamiliar journey without another person is a no go area as it is for me? I argued their reasons to say I could do this did not prove anything of the sort and they had no evidence of me going anywhere on my own. Also I have 40 years of recorded appts and treatment for mental health issues, anxiety and panic attacks. these are the symptoms that prevent me travelling out of the local area. Nafta on reading your story this descriptor may be more suited to your husband than the familiar journey one your trying to argue for as it would mean he could go to the shops but anywhere outside his comfort zone and you would have to be with him.
My Doctor told me that DWP have been told to believe what disabled people are telling them to save Doctors having to write so many letters.It doesn't look like this is happening.