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Unusual Situation re ESA

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9 years 11 months ago - 9 years 11 months ago #121145 by Bamboozal
Unusual Situation re ESA was created by Bamboozal
Hi,

I have an unusual situation with my friend re ESA, I will try and be as brief
as poss but apologies if it appears long

My friend claimed incap ben, was transfered to esa found fit to work after medical &
was placed into the WRAG group on appeal in Aug 2013 under reg 29 as he has mental
health probs,agraphonbia, depression since a brain bleed 20 yrs ago.

After 12 months his ESA stopped and due to the nature of his illness he couldn't
face/cope with opening the letters & didn't tell anyone (among various other letters and bills)
so they all piled up as he didn't send in the details for means testing. After getting in debt and
having no money to survive on a friend discovered the pile of letters unopened so
completed the means test form 8 mths after it was sent and it was duly re enstated
and backdated to Aug so ok with the WARG component.

In the pile was also an ESA50 form, again it wasn't completed and out of date but on re enstatement of his ESA he was called for a medical this week which he attended with
his friend. He was seen by a occy nurse who suspended the medical when she asked
so what is ur illness (as she had no idea cos she had no ESA50 to work from) & he
replied well since I had a brain bleed.....it was suspended for a month as they say
he has to have his medical conducted by a doctor. So poor bolke is panicking.

My question is does he treat this as a review and ask his GP to re write the
report she provided for his successful appeal and add that there has been no change or
improvement in his condition in the intervening period with a forwarding letter explaining his difficulties & subsquent hardship finanically as he couldn't face opening the letters?

Thanks to everyone for reading anyone comments would be very welcome

Bam
Last edit: 9 years 11 months ago by Gordon.

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9 years 11 months ago #121149 by Gordon
Replied by Gordon on topic Unusual Situation re ESA
Bam

I am afraid there is only one reason for ATOS assessment to be done and that is to decide further eligibility for ESA.

As it appears he only qualified before on Regulation 29 he is in a difficult position especially as no ESA50 has been filled in regarding with his current disabilities, I assume one was completed when he was transferred from IB.

Given the timescales and his apparent inability to deal with the matters surrounding his claim, I would strongly recommend that he speaks to his GP. It is important that he stresses that whilst they might, ATOS and the DWP are under no obligation to seek further evidence from his GP, so it is really important that they provide a letter and/or report before the assessment so that it can be sent to both parties.

I've included the workings for both Regulation 29 which covers the WRAG and Regulation 35 which covers the Support Group, the important bits are in bold, it may be worth passing these to the GP as well.

29. (1) A claimant who does not have limited capability for work as determined in accordance with the limited capability for work assessment is to be treated as having limited capability for work if paragraph (2) applies to the claimant.

(2) Subject to paragraph (3) this paragraph applies if—

(a) the claimant is suffering from a life threatening disease in relation to which—

(i) there is medical evidence that the disease is uncontrollable, or uncontrolled, by a recognised therapeutic procedure; and
(ii) in the case of a disease that is uncontrolled, there is a reasonable cause for it not to be controlled by a recognised therapeutic procedure; or

(b) the claimant suffers from some 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 the claimant were found not to have limited capability for work.

“(3) Paragraph (2)(b) does not apply where the risk could be reduced by a significant amount by—

(a) reasonable adjustments being made in the claimant’s workplace; or

(b) the claimant taking medication to manage the claimant’s condition where such medication has been prescribed for the claimant by a registered medical practitioner treating the claimant.”.


35. (1) A claimant is to be treated as having limited capability for work-related activity if—

(a) the claimant is terminally ill;

(b) the claimant is-

(i) receiving treatment for cancer by way of chemotherapy or radiotherapy;
(ii) likely to receive such treatment within six months after the date of the determination of capability for work-related activity; or
(iii) recovering from such treatment,

and the Secretary of State is satisfied that the claimant should be treated as having limited capability for work-related activity; or”.

(c) in the case of a woman, she is pregnant and there is a serious risk of damage to her health or to the health of her unborn child if she does not refrain from work-related activity.

(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.


Gordon

Nothing on this board constitutes legal advice - always consult a professional about specific problems
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9 years 11 months ago - 9 years 11 months ago #121151 by Bamboozal
Replied by Bamboozal on topic Unusual Situation re ESA
Hi Gordon,

On transfer from Incap to ESA he did fill in an ESA50 form but he hadn't a clue
he only answered briefly to the questions and a friend had to fill it in for him , he was
found fit for work , then appealed, which took 12 months. That was june 2013
with a recommendation he wasn't retested for 12 months. The jobcentre also
gave him one telephone interview and said they wouldn't be contacting him again
re work related activity.

This time his money has been backdated and a lump some paid into his account that
is the sum of 8 months ESA with the WRAG component so that was why I wondered if
they were treating it as a review, can't understand why they didn't send another ESA50
out.

He has an app to see his GP next week so will advise him to get a report.
When you say the report needs to be sent to both parties do u mean one to ATOS
and one to DWP?

Bam
Last edit: 9 years 11 months ago by Gordon.

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9 years 11 months ago #121152 by Gordon
Replied by Gordon on topic Unusual Situation re ESA
Bam

The DWP can re-assess a claimant with Mental Health issues without issuing an ESA50, the normal procedure is for ATOS to contact the claimants GP, but we are aware of numerous examples where this has not happened to the disadvantage of the claimant.

Gordon

Nothing on this board constitutes legal advice - always consult a professional about specific problems
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9 years 11 months ago #121153 by Bamboozal
Replied by Bamboozal on topic Unusual Situation re ESA
Thank you so much Gordon I will pass ur info on

Bam

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