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Pip letter and assessment letter
adammh00
Member Posts: 3 Listener
i got a letter to say I was refused pip. I phoned and asked for a mandatory reconsideration form. I’ve just received my assessment letter and it says to review me in 18 months like I’ve got it. Don’t understand it. Has dwp said no. I can’t phone until Tuesday just seeing if anyone else has had this
Replies
In regards to the above post about reassessment in 18 months time, how much weight would a doctor's expertise have in their decision as to when or if reassessment is necessary?
I recently submitted to the PIP my mandatory appeal with a detailed letter from my doctor stating how my disability affects me, and in the report my doctor says I am a safety risk to myself and others and that the condition is untreatable and incurable. She informed them of other examples such as if in the general population I would be taken advantage of (and that I have had done) and various other risks.
it was a pretty good letter (from my perspective) because it rules out the possibility of looking for work.
Everything she put in the report almost ticked all the criteria for the PIP assessment.
However, would ESA work capability assessment take into account what the PIP assessors have done - i.e. rejected my claim - or will they look at the application and see that I pretty much fail most assessment criteria.
Given GPs are the main people dealing with day to day needs of patients, I would say they are probably the most likely to know how patients capabilities might be affected, the only people I would put above this is perhaps carers and OT's.
The question is just me trying to understand if its unpublished DWP policy to think GPs dont know what they doing and are prone to been dishonest, or if there has been some kind of study into GPs, or if its just your opinion, thanks.
What I'm going on is the fact that GPs, as far as I know, are trained to diagnose and treat conditions not on their functional effect (which is a different specialism.) Their contract doesn't include benefit-claim work.
Personally I can't think of a time when my GP has ever commented on how my condition affected me - possibly when he/she has written a sick note for work?
I asked my GP and was told that if I tell her what she wanted me to write she would if she had time.
If what is written above is correct, then it doesn't matter what any expert writes because it is the assessor who just turns around and says 'nope, I will be rejecting this person's claim just because I can'. I have submitted evidence from at least three psychiatrists and 2 psychologists, and for what? Nothing. For example, the doctor could write medical expertise letter prior to the PIP or ESA assessment, which you submit in with the application, and then you turn up and meet the criteria and then they just decide that actually they don't want you to have PIP just to reduce the cost to the DWP.
I can understand why so many claims are rejected - because it isn't based on any medical expertise but the opinion of an unqualified assessor who's sole purpose is to reject an application for PIP or ESA. That is why the success rate at tribunal is so high - because the Judges base their decisions on medical evidence, not the opinion of someone unqualified. How would a judge feel if their opinion was also overruled about the law? Its the same principle.
And what does the CAB do any different anyway? Just a re-wording in a more legal way about how your disability affects you, based on the reports you have submitted. Again from doctors.
I don't think that anyone doubts the skill and expertise that GPs but when they are writing up their notes etc they are concentrating on diagnosis and treatment. In your case it sounds like you doctor has examined you specifically to evidence the PIP descriptors which I imagine is really valuable evidence if he/she has done this for all of them.
I was fortunate to be examined by an OH consultant prior to being medically retired from my job. He was not concerned about diagnosis at all - but spent over an hour examining me, watching me carrying out basic tasks etc. His report was really valuable and, since he is a specialist in this field, effectively beyond dispute...
I wonder if the best advice might be simply to read through what you GP writes, if they are prepared to write a report for you, and see whether it just repeats what you have just told them?
Alternatively you could see an OH consultant privately...
My evidence states I was a safety risk to myself and others, that I have and would be taken advantage of if allowed out by myself. That I need constant supervision when taking medication for safety reasons. That I cut my thumb off when attempting to cook food by myself (I showed the assessor evidence of it) because of my inability to cook food, and because I often wonder away and leave the gas on which has burnt pots and nearly caused fires. It mentioned extreme anxiety and an inability to communicate with others. There was a lot the report said that would easily pass the criteria. Based on the safety reasons alone I would have scored very highly.
Not everyone has the opportunity or financial resources to pay for an occupational therapist. At the end of the day, most people are rejected because it is bias. Take the example of someone with schizophrenia who is in the middle of psychosis. They could be feeling persecuted and being very aggressive because of it, and clearly in no position to work. Yet the assessor would say 'well he can walk, he can read and he is able to communicate with me, so I shall reject him'. Then they apply for a job and the employer would say you aren't fit to work, so we can't offer you a job (which I have actually heard to be true). Where is the fairness in that?
If I go to the CAB, how would they help? What do they do that would argue my case successfully?
@sceneparade - I wouldn't advise going to the CAB. My personal opinion is that the don't do anything that you can't do yourself.
If your GP has examined you and found that you are not safe to cook, are unable to communicate with others and need help with medication etc and has reported this then you will obviously score points for them. Personally if this is what your doctor has written then I can't see how anyone can disagree. An obvious question which might be asked is that if you GP is reporting that you are unsafe then what is he/she suggesting is done about this? Do they suggest any aids/ adaptations etc as you might be able to use this as well??
Hopefully everything will be sorted out at the MR
Good luck anyway
@cristobal - my doctor said in the report that it was a neurological condition (ASD) and it was an inability to socially communicate with others, and that because I don't understand social skills or nuances. She said it is untreatable and incurable and would require lifetime treatment. She added that she has known me since I was 11, so about 25 years.
@poppy123456 - The doctor stated I am a risk to myself. She gave an example where I was on on my iPad game when out with relatives, and whilst they were paying bills in the post office someone asked if they could have a go and that because I can't read or understand others they took it and fled with the iPad and hence was taken advantage of. She did give other good examples too. My doctor also described a few times where I over medicated and had to be taken to hospital, hence I need supervision at all times. She also said that because of the nature of the condition, I find it hard to regulate emotions and sometimes can get angry and lash out impulsively, which finds relationships difficult. It is all part of the ASD.
Can I point out a couple of things which I think might help?
When your doctor says that you are a risk to yourself is he/she linking this with 'Engaging with people face to face' as this refers to behaviour which would result in 'substantial risk of harm to the claimant or another person'?
If so I personally don't think that the iPad example is a good one as there is no 'harm'..
Also your GP say that you 'sometimes lash out' - this doesn't sound like it happens for the majority of the time - has she/he specified anywhere how frequent this actually is?
Good luck - I hope that you find this helpful
In her report she said I was a risk to both myself and others. For example, the nature of the condition is that because you can't reason emotionally, you lash out aggressively to people you feel are frustrating you, or you then hurt yourself by banging your head against the wall, or picking cuts or scrapes, or self harm through medication and blades. There was also evidence of being referred to a psychiatric hospital as a result of self harm. This was caused by relating to others.
In regards to the iPad incident. She said that it led to an emotional breakdown and depression that lasted weeks and affected my ability to do anything, including self-harm. There is documented reports from psychiatrists of 'lashing out' which states it has alienated others and that relationships are extremely difficult. She stated that - collectively - there is. no cure for it, which infers a-lot of the time.
And thanks, I have found everyones advice very insightful and helpful. I realise that there is enough evidence to not be as concerned about an appeal or going to the tribunal, as I feel a. bit more confident.
Your GP sounds to have been very thorough - hopefully you should get a better result at MR, or tribunal ...
But if you self-harm around others, or act out aggressively - as demonstrated by commitment to a psychiatric unit - how can they expect you to still work, albeit with support. The nature of ASD is that they will not tolerate people unfamiliar to them. They will react strongly against anyone they do not trust. My nephew is the same. He would have a serious breakdown if his mum wasn't with him 24/7. He is her life-support. In addition, if they believe I need support at work, that would cost the employer a lot of money in funding a support worker to work alongside me, which they would never entertain. Furthermore, employing a support worker to prevent myself from being vulnerable wouldn't help with anxiety in relating to others in general. Even without being taken advantage of, I have evidence backed by the doctor that states relationships in themselves lead to anxiety, depression and even stated this had led to psychosis-NOS on a number of cases.
Does anyone know the difference(s) between the support group and the work-related group? For example, constant face-to-face meetings at the job centre, training courses, weekly payments received etc.
I am currently on contribution-related ESA. So how does this effect me financially? I have looked into it and it states that you should get the following:
Disability premium: £34.35 per week
Severe disability premium: £65.85 per week
Enhanced disability premium: £16.80 per week
Would these be paid in addition to the £111.65 per week in the support group?
It states this: "If you don’t have enough National Insurance contributions and you don’t have enough money to live on,* you might qualify for income-related ESA.
You might be entitled to contribution based ESA and an additional amount of income-related ESA, but this will depend on your circumstances."
But I am confused as to what it means.
@kami24 - Have you attended an work capability assessment? If so, what happened? What did they ask? Did you get approved for ESA?
Of course in situations where you perhaps see a different GP every time you go to surgery or you dont see GP very often, or have a new GP, then obviously yes then the GP wont know much. So my context was assuming you have had a GP thats been dealing with you for a long time.
"If they know anything more then it will be because their patient has told them". Of course any medical professional will need to work on what the patient is telling them, if you only finding things out solely on scans and blood tests then you are operating in a very limited scope. I just find this attitude bizarre.
In terms of functional affect, my GP was able to provide information as notes are on my file left from my occupational therapist which was detailed by my GP on the form supplied to the DWP. Also the GP likely has experience accrued over the years from their collection of patients in terms of how they get affected by various conditions and symptoms.
Some GPs are very good and thorough, but I accept the quality of any assistance will be highly variable, health service in itself is a lottery. I dont agree with a generic advice tho telling people to not bother.
Also in my case my GP provided documented evidence to back up various things I told the assessor myself, e.g. I said I have needed assistance in integrating with society, which was a very short and vague statement, on the form from the GP, she detailed exactly what assistance I had, the professionals I seen, length of treatment, result, diagnosis etc. None of that would have been there without my GP.
I can accept that many GPs perhaps just either cant be bothered, or simply havent got the information to offer an informed opinion, but I dont think it would be the case for every single GP, thats all.
What I can tell you my form filled in by my GP had more information and effort put into it than the one one from the HCP that assessed me, was a "lot" more than list of meds and symptoms.
However one would think even a list of symptoms would be evidence, what happens if the patient tells you that they have symptoms but you dont see them on the day? do you accept their word or would something like a GP confirming those symptoms hold some weight, curious on that one.
For reference 6 of my 8 points according to my HCP on daily needs were awarded based on my GP supporting evidence, whats your thoughts on that one?
Specific wording was "verified by GP supplied by OT".
You are very knowledgeable on the descriptors themselves which I accept, but I dont understand how you can decide how a GP would know how their own patient would be affected, when the GP not only has history with the patient but also access to all reports from medical professionals the patient has seen. The GP is certainly better placed than a HCP who sees the claimant just once for a brief assessment, however I do accept the point made by cristobal that GP's are not trained to specifically look at benefit descriptors but instead they there to help people get better and manage conditions. My next question to you would have been if the GP doesnt know, then who does know? but you dont want to say anything else so I will respect that.
But maybe cristobal or ilovecats can offer an answer to that question should they choose to.
So effectively, the new benefits were introduced so that any new claimants would NEVER be able to get additional financial support, unless they were on income-related JSA. What additional help is there fore people getting contribution bases ESA? Is sounds as though income-related ESA or income support = additional payments totally roughly £200 per week, whereas contribution-based ESA = None, totally the basic £111 per week.
If I do get my PIP reinstated on appeal, how will this effect my ESA payments? Would I be entitled to the SDP and EDP? What exactly is 'contribution-based' about contribution-based ESA?
It seems the 'New Style' ESA and the Contribution-Based ESA are the same.
"To get ‘new style’ ESA you’ll need to have been an employee or self-employed and paid National Insurance contributions, usually in the last 2 to 3 years. National Insurance credits can also count.
"You’ll also need to have an illness or disability that affects your ability to work.
You can only apply for contribution-based ESA if you have an illness or disability that affects your ability to work, and you either:
You’ll also need to have been an employee or self-employed and paid National Insurance contributions, usually in the last 2 to 3 years. National Insurance credits can also count."
I dont know about you but, for me when I am filling in forms, and am in an assessment it is inevitable I will miss stuff or even misquote stuff e.g. since my assessment I know I forgot to mention multiple diagnosis, and to me it seems inevitable most claimants will miss perhaps important parts of their symptoms, diagnosis etc., to support their descriptor choice.
Also a now good friend of mine works with a lot of people who go to him for help, he represents many people at tribunals, and has a lot of experience, he doesnt work for anyone like cab or welfare rights but attends mental health meeting awareness groups, and thats how people get his contact details. His opinion has always been if you have a supporting GP it doesnt hurt to ask and given his huge experience and the notes on my report from my HCP I will go with that.
Also I forgot who mentioned it, but I didnt pay for my OT, I got my OT via a referral from my GP and I think the OT was funded by the council.
But you can be on contribution based "and" get a income related topup.
Basically normally historically what happens is if you qualify for "both" income related and contribution based, you would be given contribution based benefit. However you can if you pass the means testing, get a income related top up qualification, if you manage to get this, then for the purpose of SDP/EDP, you will be treated as if on income based ESA.
Okay, thanks. So I would be receiving the same as claimants on income-related ESA, just that it would fall under contribution-based ESA?
Basically savings below 16k (under 6k for full entitlement) and practically zero income other than your benefits.
did sceneparade actually say they on the new style ESA?
The reason I want to verify this is this was quoted.
"You might be entitled to contribution based ESA and an additional amount of income-related ESA, but this will depend on your circumstances."
That doesnt sound like something they would put in a letter if there was no IR topups available.
I started my ESA claim in May, but I have paid five years contribution of NI. So I am in the contribution-based ESA. Hopefully that means I still can claim the income-related top-ups too.
At the moment I get only contribution-based ESA at £73 per week, and universal credit of about £367 per week, which covers the rent. I get no other income from universal credit other than housing benefit.
Would I still get additional payment as you stated above (LCWRA)? I am not receiving any additional money from UC in regards to any disability
And how can I be receiving 'new style' ESA if I have worked for 5 years? It states under 'new style' ESA that you have to be paying NI for at least 2 years (which I have paid for 5), but doesn't take into account PIP and, therefore, the SDP.
Why is it called a contribution-based ESA if you have been paying into the NI for at least two years but can't claim? Why pay into the NI if you didn't receive anything for it? It might as well just say ESA
So the point of the new benefits is to reduce people's money, not replace it? Effectively, the government could, next week, remove the income-related JSA, contribution based ESA and new style' ESA and replace with x benefit with a benefit rate of just £40 per week (in principle). It isn't about helping people but about removing costs to the government.
If I was claiming Higher rate care component DLA and Lower rate DLA mobility component for the last 11 years, would I, theoretically (based on DLA which entitles DP and EDP if unemployed), be able to claim the DP and SDP based on being eligible for it under the terms of DLA (if that makes sense)?
£128.45 ESA + EDP
£150.93 (approx) UC LCWRA (was a monthly figure so I had to translate into weekly).
When I calculated it, I worked it out at around £200 per week based on the old contribution-based ESA, plus DP, SDP and EDP. So its less.
Right now you dont get PIP, I believe you have no eligibility for SDP even if you was on the old style ESA. Many people are the same, most IR ESA SG claimants do not qualify for SDP and as such would gain under UC.
So, if I was put in the Support part of 'new style' ESA, and managed to get my PIP back to higher rate care component (as most tribunals are successful), what would my estimate be from both the extra UC and in total?
UC would be exactly the same, it would only be different if you was an old style claimant and moved over via managed migration at which point you would get extra for transitional protection.
Its not as bad as you think tho since UC pays about £22 a week more than ESA + EDP. So you would be losing about 2/3 of SDP and none of the EDP, instead of all of EDP and all of SDP as you originally thought compared to an old ESA claimant.
Yes, I have put in for a MR, but I don't hold out much hope as most are unsuccessful. My doctor has written a really good letter stating how disability affects me (preparing for food, communicating, eating etc) where I believe I would score at least the higher component of the care allowance. But, even so, I am not hopeful because its a case of them wanting to decline your application to reduce costs to the government. I am still waiting for a decision on my MR but my hope is on the tribunal, which will be in many months I would imagine.
Doesn't the UC include LWRA? What if I was put into the LWRA (support group ESA equivalent). Doesn't that include support for people with disabilities? If not, my point has been proven that for anyone claiming a new benefit has been vindicated, as they would have reduced new claimants any extra income, irrespective of claiming PIP. It would be a cost cutting benefit.
UC includes LCWRA topup providing the DM decides you qualify for that level of support. LCWRA is the SG equivalent. LCW is for WRAG.
For claimants that dont even claim PIP and are entitled to LCWRA support, it is more generous than IR ESA.
"For claimants that dont even claim PIP and are entitled to LCWRA support, it is more generous than IR ESA"
Does this mean it would be more if PIP was reinstated?
Okay, thanks for the knowledge. It has been insightful and helpful.
£194 per week is a lot of money compared to UC. Its about £40 per week more, at least.
So for new UCWRLA, it is, in fact, less than old system benefits for disabled people