Hi, my name is maddanj! I have a rather protracted ESA claim from November 2019

maddanj

I have a rather protracted ESA claim from November 2019 where Health Assessment Advisory Service recieved my initial ESA50 form but didn't action or they tell me the DWP didn't action it.  I hope this experience is useful to others in a similar position.

The form was a few weeks late as I was making moving arrangements with no help. At that time I had around 4 medical conditions which meant I was unable to work and limited my daily living and mobility. I moved mid Jan 2020 and by mid-March lockdown started so I was told assessments were delayed. Despite continuous Fit Notes and no work based commitments, I kept being sent JC work search appointments by many - c. 10 Work Coaches, having to keep repeating my conditions. There was no disability officer assigned until April 2022 when my GP wrote on my Fit Note that the surgery had provided around 14 fit notes and they needed to assess me.

This then triggered an investigation to how my ESA50 was not actioned by ESA dept of DWP and I was told I needed to fill in a UC50 as I was transferred to UC for a living allowance payment after the 1 year ESA contribution based benefit expired.

I found it incredibly stressful fillnig in the UC50 again as 2 more conditions and symptoms plus how these affect me go across 4 of the conditions so I kept overthinking about how to get the relevant informaiton in the form and FB4J told me I had too much info, it will get lost or not scanned or the assessor won't read it. But it was all relevant and info that the form requested. DWP said they won't pressure me for the form to be returned and that the HAAS would call me to offer help and if I want to continue the claim. they did neither. The JC disability officer called every few weeks to check progress and my daughter helped me in the end to fill it in by typing it over a number of sessions so I wasn't too overwhelmed and she put the info I couldn't fit on the form into a format which was the same for every condition so easy to follow.

In the interim I had a phone assessment appointment told me by JC disability officer who said I didn't need to send the form, she said DWP had requested info from my GP via a UC/ESA 113 form. I said I want to finish the form as it's my representation of how these conditions affect my daily living capabilities and I hadnt given permission for my GP to be contacted. I got a copy of the form from my GP which was around 90% correct. I found all the medical evidence and sent the form.

I was offered another phone assessment date and requested audio recording, my daughter to be dialed in and that they call my home phone as my mobile loudspeaker doesn't work. On the day, the assessor called and had not recieved this request so couldn't go ahead. I asked her to find out why this had also been mishandled as felt devistated that after all the issues and the wait it couldn't go ahead on the day as no way to audio record and provided 3 other dates that and the following week my daughter was available.

She messaged her manager and called me twice that day but not able to get a response. She said she'd call me the next day and did not. I called the Assessment Centre the day after and found they simply rebooked on a day my daughter couldn't make it due to work. The woman on the phone was very emapthetic and said she'd speak with her manager and came back to me to say her manager was aware of my case and was looking into it and they would come back to me that day.  1 hour later I was called back by her and told that there was a doctor in the centre that day and he'd had a look at my file and said I didn't need to have a phone assessment as my evidence was sufficient.

She said I'd recieve a letter in the post. I said I was unsure if this was a good outcome as I hadn't had chance to respond on any questions from the daily living tasks so I was really confused as to how this was a fair assessment. Did the assessor have enough time with my file to adequately assess my capability for work and the time to write a report reflecting this.

I'm told paper assessments mainly have a good outcome but surely they would have offered me on in the first place rather than as a reaction due to thier own ability to be prepared for booked assessements.

maddanj

Update on this. I recieved LCWRA and ESA Support group. ESA awarded me the 3 years backpay but UC said I didn't declare fit notes for 9 months during Covid lockdowns and restrictions period in 2020-21 which it's evident that I have in my Journal.

Initially they said I went over the benefit cap in one assessment period in April 2021 then changed thier mind on this I said I couldn't have done so they must owe me the £7.16 for the that period. The Decision Maker then dropped this tact and came up with a missing Fit Notes issue to stop awarding me the full arrears.

So I have an issue where both UC and ESA have given me backpay as a dual claim but only one should do this - ESA usually takes precedence but UC want to take back 2 years of ESA backpayment and leave me with the 1 year they decided on. It's a complete mess after a 3 year wait.
CAB are going to do an MR but not on the Fit Notes which I can prove and my daughter has written up and referenced the journals but on the grounds of ESA taking precedence at the outset of the claim.

It took 3 weeks to get the specialist team advise back on this the 3 issues I'd reported and by then I was over the 4 weeks for MR but this can go to 13 months if you have a good reason.  Unfortunately the CAB adviser had misinterpreted 2 of these and hadn't responded to my feedback on thier email asking this to be sent to the specialist team so it's going to take some time with them to resolve this but at least I've now been given a CAB adviser who works full time as I struggled to get response from the young woman who was really nice but seemed more interested that my case was interesting rather than the grief and anxiety it continued to cause me..

In the meantime, I've written a journal for my Case Manager refencing where the Fit Notes are reported in my journal, the issue with the Fit Note Task not being sent and the responses from JC staff having recieved at lease one of these. I also asked them to define the meaning of "declaring a fit note" as opposed to reporting it in my journal and posting it to the JC. I said I've done as much as I can to provide these. The DWP implemented a Covid19 operating model which meant JC's were closed and staff didn't know what to do with the Fit Notes so not to send them to the JC at one stage. It's been chaotic and frustrating.

I also pointed out that the Workcoach or UC system should have flagged up that my Fit Notes had not been validated by work coach or an agent at the time and a sanction applied, not wait to penalise me retrospectively for something outside of my control.

calcotti

If you were put in the ESA Support Group, regardless of what the UC DM says about the Fit Notes, you should be paid LCWRA for any month in which you were in ESA Support Group. That appears to be the case that CAB have decided to run.

maddanj

Hi Calcotti,

thank you for your response. I'm afraid I don't understand what you mean by the last sentence about the case CAB have decided to run.  Could you please provide the source of your advice?

I added the question here https://forum.scope.org.uk/discussion/comment/561782#Comment_561782  as it was soley about the issue with Fit Notes so as not to confuse others seeking information about this.

calcotti

https://www.legislation.gov.uk/uksi/2013/376/regulation/40

40.—(1) A claimant has limited capability for work and work-related activity if—

(a) it has been determined that—

(i) the claimant has limited capability for work and work-related activity on the basis of an assessment under this Part, or

(ii) the claimant has limited capability for work related activity on the basis of an assessment under Part 5 of ESA Regulations

maddanj

In the end, I had to get my MP to raise a complaint to DWP. I hope this helps others.

The DWP complaints representative's decision was that I should have been awarded the full UC backpayment as ESA were able to locate all of my fit notes on thier system. They should have communicated with each other, as I'd requested.  They also awarded me limited compensation.

This was a case of a DM deliberately seeking a reason not to award me the full amount due to the UC system not sending the automated action for requesting a Fit Note for those periods. Despite the fact that I had provided the information in my Journal and the name of the Workcoach who the Fit Notes were posted to at the job centre and the dates of posting plus the journal entries where the Job centre representative stated these were recieved.

Had I had the capacity, I would have requested my MP raise another complaint about the 3 years it took to get the WCA and ESA not processing my ESA50 which was reicieved by them and UC asking me to provide another 2 years later. Constant calls from Workcoaches to review my obvious long term conditions during these years.

 Plus the WCA HCA not being given the information to include calling my daughter to participate and she was not able to do this as was working from home.

 

poppy123456

Glad it’s all been sorted. 

Albus_Scope

So glad it's been sorted @maddanj! I also had to get my MP involved after my 18 month PIP fight.  It got seen to amazingly quickly after he wrote to the DWP. 

WhatThe

Calcotti, hi

40.—(1) A claimant has limited capability for work and work-related activity if—

(a) it has been determined that—

(i) the claimant has limited capability for work and work-related activity on the basis of an assessment under this Part, or

(ii) the claimant has limited capability for work related activity on the basis of an assessment under Part 5 of ESA Regulations

This is interesting because it mentions LCWRA in Part 5 of the regs - where did you source this? 
The link above this passage is for something else.

Thank you

poppy123456

WhatThe said:

Calcotti, hi

40.—(1) A claimant has limited capability for work and work-related activity if—

(a) it has been determined that—

(i) the claimant has limited capability for work and work-related activity on the basis of an assessment under this Part, or

(ii) the claimant has limited capability for work related activity on the basis of an assessment under Part 5 of ESA Regulations

This is interesting because it mentions LCWRA in Part 5 of the regs - where did you source this? 
The link above this passage is for something else.

Thank you

Calcotti had already posted a link to where they got the information from. It's the UC regulations 2013, you can see them here. https://www.legislation.gov.uk/uksi/2013/376/regulation/40

Sadly, calcotti hasn't been active for quite sometime due to health reasons. I had been in contact with them but haven't had a reply to my last PM which was about 2 weeks ago.

WhatThe

This is interesting because it mentions LCWRA in Part 5 of the ESA regs - where did you source this? 
The link above this passage is for something else.

This is what I meant to say.

I don't check in when I'm unwell so I'm happy to wait for Calcotti's reply, thank you!