Confused by ESA letter

mumsgirl wrote: Just wanted to let you know that I received my SAR (which consists of a one page ESA85a, my ESA50 and lots of printouts, no other reports. On the ESA85a I think I got through on Excep. Cir because it says “I advise that the client meets the SG criteria as they are suffering from specific disease or bodily or mental disablement and, by reasons of such disease or disablement, there would be a substantial risk to the mental or physical health of any person if they were found not to have LCWRA.”?
But for prognosis it just says “I advise the work is unlikely in the longer term.” It doesn’t mention the 2 years that I received in a separate letter.

It also says they used the ESA50 and med 3 as evidence (would that be the original med 3 I sent 3 years ago because I haven’t sent any since?).

I didn’t know whether to laugh or cry the Justification of Advice – “ ESA50 is completed by the claimant who also provides 62 pages of extra information with further supplements. This information given by the claimant is rambling and repetitive describing in details why each and every aspect of the ESA should apply, including LCWRA categories. This indeed is within keeping of the Personality disorder that is confirmed by the Psychiatrist letter kindly supplied by the claimant”.

On the printouts I have one concern (so far) – it still says “date of next full case check 30/07/13”. This is exactly the same as the last SAR (around 20 months ago). What exactly does ‘date of next full case check mean’? I thought it may have may that I was to be reassessed by that date, but it can’t be because I’ve just been assessed and the date is still the same.

It also says ‘System set case control type – Automatic WCA referral. Original maturity date 10/4/15 activity start date 09/04/15’ – what does that mean? I would have thought it would be when they send out the next ESA50, but looking at my last SAR I was place in SG for 2 years from Sep 13 and it says date of next maturity is 8/7/13, date of next WCA 8/7/13 and i was sent a form at beginning of May (4 months before prognosis is ‘up’ date but 2 months before 8/7/13). So maybe they will send me out a form in Feb 2015 (4 months before prognosis date is ‘up’). it also says date of next WCA 12/6/15

Hi mg,

Yes, you have been placed into The SG under ESA Reg 35 (2) (a) & (b)

" 35.(2) A claimant who does not have limited capability for work-related activity as determined in accordance with regulation 34(1) is to be treated as having limited capability for work-related activity if—

(a)the claimant suffers from some specific disease or bodily or mental disablement;

and

(b)by reasons of such disease or disablement, there would be a substantial risk to the mental or physical health of any person if the claimant were found not to have limited capability for work-related activity."

From :

ESA Reg 35 for entry to The SG (LCWRA)

So they are saying that you did not qualify for the SG under any of the functional descriptors at Schedule 3 (ESA Reg 34 (1) )

SG (LCWRA)Schedule 3 Descriptors

You qualified as there would have been a "Substantial Risk" to your own or someone else's mental or physical health if you hadn't been placed into The SG.

In the longer term is terminology generated by the LiMA software, and is generally used where a prognosis of 2 years or more is recommended.

The DM then decides whether to award 2 years or 3 years, etc.

Take no notice of the MED 3 comment, again this is generated by LiMA, the HCP has simply failed to amend the wording.

So it looks like they have assessed you on the ESA50 alone, and have not contacted your G.P. as there is no mention of an ESA113.

As for all the other terminology, the important bit is at the bottom :

"date of next WCA 12/6/15" This is the date of your next reassessment, although as you know you should receive a new ESA50 around 8 weeks or more before that.

Therefore, you could use the ESA85A as evidence with your DLA renewal, to reiterate your MH conditions.

bro58

Thanks bro for you advice and reassurance!

I don't think there was an ESA113 because it was all done in 8 days(4-12 June) and there isn't one in the SAR.

Do you really think it is a good idea to use the ESA85a as DLA evidence? I am worried that if I send it and I fail I will have nothing 'up my sleeve', whereas if I have to appeal I can send this? Or is that just stupid?

mumsgirl wrote: Thanks bro for you advice and reassurance!

I don't think there was an ESA113 because it was all done in 8 days(4-12 June) and there isn't one in the SAR.

Do you really think it is a good idea to use the ESA85a as DLA evidence? I am worried that if I send it and I fail I will have nothing 'up my sleeve', whereas if I have to appeal I can send this? Or is that just stupid?

Hi mg,

If you are happy that it is supportive, then I would use it in the first instance.

There is no benefit whatsoever in holding any supportive evidence back.

The whole idea is to gain a renewal of your DLA without having to appeal, go through a reconsideration, and if not successful then, endure a lengthy wait for an appeal hearing.

Don't forget, once your current DLA award runs out, you would not receive any monies whilst appealing, if it was necessary.

bro58

Ok, gotcha - you're right (as always!) lol. thanks

All the ESA85a says is exactly what I wrote earlier this evening, so I don't think there is anything 'detrimental'?

mumsgirl wrote: Ok, gotcha - you're right (as always!) lol. thanks

All the ESA85a says is exactly what I wrote earlier this evening, so I don't think there is anything 'detrimental'?

Hi mg,

If you are to use it, and there is no reason why you shouldn't from what you say, try and refer to it and tie it in with the limitations/needs that you suffer, that would give you the correct DLA award.

bro58

Hi, just wanted to let you know that I posted my DLA on Friday (26 Jul), they received it on 29th and today I got a letter dated 31st to say that my reward is staying the same! So it's now a double celebration for me! And a big thank you to the brilliant B & W! I enclosed my copy ESA85a as you suggested bro58. My award is apparently for 5 years but I know I will be assessed for PIP - when is the earliest I can be assessed, is it 2014 or 2015 (that's assuming I don't get one of those Right Payment things first!)