Can I challenge PIP medical assessment report before decision?

amandadv

Hi everyone,

I've just joined the community for what I guess is a pretty common reason - problems and worries with claiming PIP!

I have relapsing-remitting multiple sclerosis. It got bad enough that after relapsing on disease-modifying treatment I was switched to a highly aggressive immunosuppressive treatment. After my second round in January last year, I relapsed again. The fatigue and pain are so bad when I push myself that I very reluctantly had to give up work last autumn. I successfully claimed Employment and Support Allowance and was put in the Support Group. You could have knocked me over with a feather! I was so shocked and happy when I got that letter.

I finally brought myself to claim PIP because I struggle on a daily basis with cooking, showering and mobility. I was given a home assessment even though I did not request one. The assessor was pleasant and listened to me. However, I've requested a copy of his report and it contains a number of areas that worry me or are just plain misinterpretations of what I can manage to do repeatedly, reliably and safely without being in significant pain. For example, at a number of points in the report the assessor states that I did not appear fatigued or tired, and that I 'looked well'.What I'd like to know is whether I can challenge this or make a submission pointing out where it is not what I said *before* the decision.

For those interested, here is more detail about some of the problems with his report. If you just want to answer my question without reading all the details then stop here. :-)

Thank you so much in advance for any advice,
Amanda

Despite stating clearly at the start of the report that I have two good days a week, which are the days I can manage activity, he then fails to take account of this in the scoring section. I can't cook or shower more than 50% of the time, meaning that I need help to do things like cook a meal otherwise I eat toast or yoghurt. That's a maximum of twice a week I can cook. He's rated me as 'needs to use an aid or appliance' which only scores two points. He said that although I report restrictions caused by fatigue I did not appear fatigued or tired, and that I 'was not in pain on exertion'. I'm assuming this is from the very short physical exam. As if that is the same as standing, or even sitting, and preparing a meal! He says the fact I could tolerate sitting for 60 minutes and have normal grip shows my ability to use aids or appliances to prepare and cook a simple meal. I very clearly told him that I can manage this activity on a good day, of which I have a maximum of two per week, and ONLY if I haven't done other activities like showering or walking. This is the same for the washing and bathing descriptor.

He disregards aids I use such as my pill organisers, which I need because otherwise I forget if I have taken my medication and because it is too tiring for me to sort out my numerous pills every morning and evening. He states that although I report I am forgetful so I use a pill box, I have intact cognition with good general memory and concentration, so I can manage my condition unaided and score no points. The fact that I need a perching stool to empty my bowels at all, or without causing haemorrhoids is also disregarded.

It leaves out important things I said, such as that the recovery time if I push myself to e.g. walk too far can be days or weeks. He's put one or two days. I said that when I cook, I have to space out preparation throughout the day (meaning I don't fulfil the 'reasonable time' test). He doesn't mention this. He's said that although I report balance problems, I remained balanced during the assessment.

If the decision-maker follows his recommendations on points, I would score:
Preparing food - 2 points
Washing and bathing - 2 points
Moving around - 8 points

That means I wouldn't get the daily living component at all, but would get mobility at the lower rate. I would quibble a bit with his mobility assessment, but will take it as it meets the points criteria. Daily living is where I really struggle, probably more than mobility! If I score myself against the criteria, I think I should get 16-20 points in that section. That's a BIG difference!
Preparing food - 8 (but I'd settle for 4)
Managing condition - 1
Washing and bathing - 3 
Managing toilet needs - 2
Engaging with other people - 4
Making budgeting decisions - 2

cristobal

@amandadv - I’ve only had one assessment, and I know that there are others who post on here with more experience of what goes on.

In my experience trying to get the assessor, through whichever company they work for, to correct their report is almost impossible. There seem to be two reasons for this:-

Firstly, they don't want to amend anything so the response I got was either that the assessor “can’t remember” or that the assessment report is not intended to be a “verbatim record”, both of which are hard to challenge.

Secondly, a lot of the assessment is a matter of opinion.

The assessor’s opinion is that your memory/ cognition is sufficient that you don’t need a pill box, and don’t have problems budgeting; you disagree but, in the absence of good evidence to the contrary they will go with the assessor’s opinion.[I formed the impression that unless your GP has referred you for specialist help with cognition you almost certainly score 0, but I may be wrong]

I’d be inclined to ask for a mandatory reconsideration.

Set out where you think you should have scored points, and give examples of what you can’t do, and how you manage or what aids you use. Keeping a diary may help as well.

Good luck…

poppy123456

Hi,

You could try ringing DWP to speak to a case manager before a decision is made but it's highly unlikely they would go against the report because they mostly go with it. They won't be interested at all in any lies or contradictions that may have been told in the report. Same for the Tribunal.

Once the decision is made you have 1 month from that date to request the MR. You should put this in writing stating where you think you should have scored those points and your reasons why. Adding 2-3 real like examples of what happened the last time you attempted that activity for each descriptor that applies to you.

Most MR decisions remain the same so you'll most likely have to take it to Tribunal. Appearing in person will give you the best chance of a decision in your favour.

For the descriptors, if they think you can reasonably use an aid then you'll score points for this. If you can't use an aid then you need to give examples of what happened the last time you used the aid and why you need assistance. As pointed out here in this link. Scroll down to aids an appliances. https://www.gov.uk/government/publications/personal-independence-payment-assessment-guide-for-assessment-providers/pip-assessment-guide-part-2-the-assessment-criteria

This link is also very good to read.

https://www.gov.uk/government/publications/personal-independence-payment-assessment-guide-for-assessment-providers/pip-assessment-guide-part-2-the-assessment-criteria#daily-living-activities

They will also look at the whole decision again and not just part of it. No one can tell you whether there's any risk to any award you may have. Face to face advice is needed for this. https://advicelocal.uk/

atlas46

Hi @amandav

A very warm welcome.

My best advice for you is to seek, face to face advice from a local welfare rights organisation.

Google your postcode with the words “ welfare rights”.

You could also speak to the MS Society helpline, as they have in-depth knowledge of the PIP claims process.

Keep us informed.

Chloe_Scope

Hi @amandadv and a warm welcome to the community! I am sorry the recommendations don't fit with how your condition affects you and that you feel the report is incorrect.

Like other members have suggested, you will probably have to take it to Mandatory Reconsideration (more information can be found here) and it also may be a good idea to seek face to face advice which can be from Citizens Advice.

Please do keep us updated and I hope things all work out for you. If you need anything else then please do let us know