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Mandatory Reconsideration - ending up on JSA?
- Izzy
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8 years 6 months ago #142253 by Izzy
Mandatory Reconsideration - ending up on JSA? was created by Izzy
Hi
I have several medical conditions, but have been placed in the WRAG!
I am thinking about going for Mandatory Reconsideration, but am concerned about the risk of losing ESA altogether and ending up on JSA. I submitted all the evidence I could with my ESA 50, so I'm not sure what else I could provide.
It's unclear from the so-called medical report what evidence was submitted on my behalf and when I tried to find this out from the DWP they said they didn't have this information. Only the health assessors (Maximus) did!
The medical report mentions that a Med 3 was submitted, but my GP practice couldn't find this on their computer system. They said I would have to request to see it, (if it exists), in writing. If I did this they would then look further to find it. I appreciate that the reference to a Med 3 may be erroneous though.
Secondly, I provided the contact details of the Community Mental Health Team on my ESA 50, but I'm not sure they were asked to provide any evidence either. I have rung the CMHT and the last person who saw me said he, personally, didn't write anything on my behalf. It doesn't mean no-one did, though.
However, it is looking quite possible that neither the CMHT, or my GP, were contacted by Maximus.
When I rang the DWP to try and find out what was submitted on my behalf, they asked if I wanted to go for Mandatory Reconsideration and I said I was unsure because I was afraid that I could potentially end up on JSA, because the review might remove some of the points already awarded.
His reply was that this couldn't happen, because MR would only look at whether I should be in the Support Group or not. No points already awarded would be deducted! Just thought this might be of interest, as I was under the impression losing points was a definite risk.
I am also concerned about quality of the "medical report" I received a few days ago. I was put in the WRAG without a medical and only 3 sentences related to me, specifically. The rest of it was copy and paste, saying that I didn't satisfy this and that criteria.
I would like to know whether the DWP decision maker ever sees the ESA 50 + evidence submitted, or whether they only see the "medical report", upon which to base their decision? I'm shocked because the 3 sentences didn't exactly cover it!!!
I have several medical conditions, but have been placed in the WRAG!
I am thinking about going for Mandatory Reconsideration, but am concerned about the risk of losing ESA altogether and ending up on JSA. I submitted all the evidence I could with my ESA 50, so I'm not sure what else I could provide.
It's unclear from the so-called medical report what evidence was submitted on my behalf and when I tried to find this out from the DWP they said they didn't have this information. Only the health assessors (Maximus) did!
The medical report mentions that a Med 3 was submitted, but my GP practice couldn't find this on their computer system. They said I would have to request to see it, (if it exists), in writing. If I did this they would then look further to find it. I appreciate that the reference to a Med 3 may be erroneous though.
Secondly, I provided the contact details of the Community Mental Health Team on my ESA 50, but I'm not sure they were asked to provide any evidence either. I have rung the CMHT and the last person who saw me said he, personally, didn't write anything on my behalf. It doesn't mean no-one did, though.
However, it is looking quite possible that neither the CMHT, or my GP, were contacted by Maximus.
When I rang the DWP to try and find out what was submitted on my behalf, they asked if I wanted to go for Mandatory Reconsideration and I said I was unsure because I was afraid that I could potentially end up on JSA, because the review might remove some of the points already awarded.
His reply was that this couldn't happen, because MR would only look at whether I should be in the Support Group or not. No points already awarded would be deducted! Just thought this might be of interest, as I was under the impression losing points was a definite risk.
I am also concerned about quality of the "medical report" I received a few days ago. I was put in the WRAG without a medical and only 3 sentences related to me, specifically. The rest of it was copy and paste, saying that I didn't satisfy this and that criteria.
I would like to know whether the DWP decision maker ever sees the ESA 50 + evidence submitted, or whether they only see the "medical report", upon which to base their decision? I'm shocked because the 3 sentences didn't exactly cover it!!!
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- Gordon
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8 years 6 months ago - 8 years 6 months ago #142271 by Gordon
Nothing on this board constitutes legal advice - always consult a professional about specific problems
Replied by Gordon on topic Mandatory Reconsideration - ending up on JSA?
Izzy
Welcome to the forum.
Answering your questions from the bottom up!
The Decision Maker should review all of the evidence available with the claim, this should include the ESA50 and any evidence that you attached, the assessment report and any information collected by the Assessment Provider (AP). At this time we have no information on how Maximus are managing the collection of information from a claimants nominated medical support, however, the figure for ATOS, the former AP, was claimed to be 25% but that was not supported by the experience of members on the forum.
There is no legal requirement for them to collect additional information.
You can request a copy of all the information used in the making of the Decision, but it may be quicker to ask your medical support whether they were contacted or not.
Asking for a Mandatory Reconsideration invites the DWP to re-make the Decision, as a consequence they can make any Decision that was available originally, this means they move you to the Support Group, leave you in the WRAG or find you Fit for Work. Despite what you were told on the phone there is no way to restrict the MR to just looking at you being placed in the SG.
That said many MRs do not impact on the original award and some, admittedly only a few, do actually result in an increased award, but I have to warn you that we also see members report that there award has been reduced (in the case of PIP), or removed.
Before you ask for an MR you need to ask yourself two questions;
Do you meet one or more the SG Descriptors and if you do, do you have sufficient evidence to reasonably show this. If you cannot show that you meet the SG criteria then you should seriously consider whether it is worth asking for an MR.
Secondly, how secure is your current award, you need 15 points to be placed in the WRAG, if you scored more than this then the risk will be lower.
If you wish to go ahead then you need to request an MR, this needs to be done in writing to the DWP, within one month of the Decision, to the office that dealt with your claim, have a look at our ESA MR & Appeal guide for details of the process and template letters that you can use to make the request with.
www.benefitsandwork.co.uk/help-for-claimants/ESA1
You should contact the DWP for a copy of the assessment report (ESA85) if you have not already done so, I would phone them but again follow up the request in writing. Once you have the assessment report you will have a better understanding of how the DWP Decision Maker has come to their conclusions and will then be able to argue against them.
Your primary task is to show that you meet the criteria, there are many reasons you may have failed, you need to address each of these but don't get bogged down in criticising the assessment report unless you can clearly show that it is incorrect, it is a lot easier to argue the facts of the situation;
"the assessor recorded that I walked 50m, I did but they have failed to document that I had to stop every 10m for a rest due to breathlessness"
than their opinions
"based on my observations of the claimant walking I believe that they can reliably walk more than 200m.
When you have a better idea of the issues with your claim, come back to the forum and we will do our best to help.
Gordon
Welcome to the forum.
Answering your questions from the bottom up!
The Decision Maker should review all of the evidence available with the claim, this should include the ESA50 and any evidence that you attached, the assessment report and any information collected by the Assessment Provider (AP). At this time we have no information on how Maximus are managing the collection of information from a claimants nominated medical support, however, the figure for ATOS, the former AP, was claimed to be 25% but that was not supported by the experience of members on the forum.
There is no legal requirement for them to collect additional information.
You can request a copy of all the information used in the making of the Decision, but it may be quicker to ask your medical support whether they were contacted or not.
Asking for a Mandatory Reconsideration invites the DWP to re-make the Decision, as a consequence they can make any Decision that was available originally, this means they move you to the Support Group, leave you in the WRAG or find you Fit for Work. Despite what you were told on the phone there is no way to restrict the MR to just looking at you being placed in the SG.
That said many MRs do not impact on the original award and some, admittedly only a few, do actually result in an increased award, but I have to warn you that we also see members report that there award has been reduced (in the case of PIP), or removed.
Before you ask for an MR you need to ask yourself two questions;
Do you meet one or more the SG Descriptors and if you do, do you have sufficient evidence to reasonably show this. If you cannot show that you meet the SG criteria then you should seriously consider whether it is worth asking for an MR.
Secondly, how secure is your current award, you need 15 points to be placed in the WRAG, if you scored more than this then the risk will be lower.
If you wish to go ahead then you need to request an MR, this needs to be done in writing to the DWP, within one month of the Decision, to the office that dealt with your claim, have a look at our ESA MR & Appeal guide for details of the process and template letters that you can use to make the request with.
www.benefitsandwork.co.uk/help-for-claimants/ESA1
You should contact the DWP for a copy of the assessment report (ESA85) if you have not already done so, I would phone them but again follow up the request in writing. Once you have the assessment report you will have a better understanding of how the DWP Decision Maker has come to their conclusions and will then be able to argue against them.
Your primary task is to show that you meet the criteria, there are many reasons you may have failed, you need to address each of these but don't get bogged down in criticising the assessment report unless you can clearly show that it is incorrect, it is a lot easier to argue the facts of the situation;
"the assessor recorded that I walked 50m, I did but they have failed to document that I had to stop every 10m for a rest due to breathlessness"
than their opinions
"based on my observations of the claimant walking I believe that they can reliably walk more than 200m.
When you have a better idea of the issues with your claim, come back to the forum and we will do our best to help.
Gordon
Nothing on this board constitutes legal advice - always consult a professional about specific problems
Last edit: 8 years 6 months ago by Gordon.
The following user(s) said Thank You: Izzy
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- Izzy
- Topic Author
8 years 6 months ago #142313 by Izzy
Replied by Izzy on topic Mandatory Reconsideration - ending up on JSA?
Thank you so much for your substantial reply Gordon.
I have looked at the SG descriptors and I can't claim that any apply to me, but what I had hoped is that I would be put in the SG, due to the substantial risk regulations. I am a transfer case from IS/SDA to ESA and feel that I am vulnerable. Some of the new guidance in your latest PDF applies to me, (the Step 5 bit), but, as you have said, this is only guidance for them. It also looks like they have completely ignored the risk of a deterioration in my health.
What I find interesting is that of all the people I know with the same condition as me, I am the only person who has not been put in the Support Group - and they all went in without a medical! In addition, some of them don't have serious physical conditions too, like me. I am also the only one to be assessed by Maximus, not Atos. I wonder whether this is significant? Or perhaps I've just been unlucky?
Thanks for informing me that the Decision Maker would have had all the info upon which to make a decision. That clarifies things for me. I do have a copy of the assessment report, (ESA85). The trouble is, although I feel that I am very vulnerable, I'm not sure I could get the evidence to back this up, because my MH condition has been pretty stable for a long time. I do have a very long history of problems, since childhood, but I'm actually discharged from the CMHT, apart from seeing them again very recently. But as we all know, discharge does not mean cured - far from it!
All things considered, I'm thinking, at the moment(!) I'm going to have to take a huge deep breath and not challenge their decision to put me in the WRAG. I have read that if your Personal Advisor at the Job Centre feels, after getting to know you, that you are really in the wrong place, they can recommend that your case is looked at again, which should add weight to my case.
To be honest, although I have grave reservations about being in the WRAG, I'm not entirely sure where my own limitations lie, these days, and as my dad has said to me, if you cannot do what they ask, you just can't! So if I fall flat on my face, then hopefully my PA will see that and realise that the WRAG is the wrong place for me. I'm aware that they can't force me to take a job, only do some WRA, in negotiation with me. Hope I'm not being too naive!?!
I know it sounds like a high risk strategy, but I think it's looking like the lesser risk. If I went for MR, I would spend the next few weeks fretting about it - every single day! As you said in your guide, the assessor would need to have a good understanding of a claimant, to decide if they are at substantial risk. I hope my PA at JC+ will develop that understanding!
Thanks again.
I have looked at the SG descriptors and I can't claim that any apply to me, but what I had hoped is that I would be put in the SG, due to the substantial risk regulations. I am a transfer case from IS/SDA to ESA and feel that I am vulnerable. Some of the new guidance in your latest PDF applies to me, (the Step 5 bit), but, as you have said, this is only guidance for them. It also looks like they have completely ignored the risk of a deterioration in my health.
What I find interesting is that of all the people I know with the same condition as me, I am the only person who has not been put in the Support Group - and they all went in without a medical! In addition, some of them don't have serious physical conditions too, like me. I am also the only one to be assessed by Maximus, not Atos. I wonder whether this is significant? Or perhaps I've just been unlucky?
Thanks for informing me that the Decision Maker would have had all the info upon which to make a decision. That clarifies things for me. I do have a copy of the assessment report, (ESA85). The trouble is, although I feel that I am very vulnerable, I'm not sure I could get the evidence to back this up, because my MH condition has been pretty stable for a long time. I do have a very long history of problems, since childhood, but I'm actually discharged from the CMHT, apart from seeing them again very recently. But as we all know, discharge does not mean cured - far from it!
All things considered, I'm thinking, at the moment(!) I'm going to have to take a huge deep breath and not challenge their decision to put me in the WRAG. I have read that if your Personal Advisor at the Job Centre feels, after getting to know you, that you are really in the wrong place, they can recommend that your case is looked at again, which should add weight to my case.
To be honest, although I have grave reservations about being in the WRAG, I'm not entirely sure where my own limitations lie, these days, and as my dad has said to me, if you cannot do what they ask, you just can't! So if I fall flat on my face, then hopefully my PA will see that and realise that the WRAG is the wrong place for me. I'm aware that they can't force me to take a job, only do some WRA, in negotiation with me. Hope I'm not being too naive!?!
I know it sounds like a high risk strategy, but I think it's looking like the lesser risk. If I went for MR, I would spend the next few weeks fretting about it - every single day! As you said in your guide, the assessor would need to have a good understanding of a claimant, to decide if they are at substantial risk. I hope my PA at JC+ will develop that understanding!
Thanks again.
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- Gordon
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8 years 6 months ago - 8 years 6 months ago #142317 by Gordon
Nothing on this board constitutes legal advice - always consult a professional about specific problems
Replied by Gordon on topic Mandatory Reconsideration - ending up on JSA?
Izzy
Unfortunately, there are many who are too ill for WRAG but not limited enough for the SG!
You need to be aware that whilst a JC+ advisor must take into account the limitations that result from your condition(s) in setting Work Related Activity for you to do, your benefit can be sanctioned if you still fail to participate without Good Cause.
Although we always refer to an MR request needing to be made within a month of the Decision it can be made up to 13 months after providing the claimant explains why the request is late and those reasons are accepted by the DWP.
Gordon
Unfortunately, there are many who are too ill for WRAG but not limited enough for the SG!
You need to be aware that whilst a JC+ advisor must take into account the limitations that result from your condition(s) in setting Work Related Activity for you to do, your benefit can be sanctioned if you still fail to participate without Good Cause.
Although we always refer to an MR request needing to be made within a month of the Decision it can be made up to 13 months after providing the claimant explains why the request is late and those reasons are accepted by the DWP.
Gordon
Nothing on this board constitutes legal advice - always consult a professional about specific problems
Last edit: 8 years 6 months ago by Gordon.
The following user(s) said Thank You: Izzy
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- Izzy
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8 years 6 months ago #142416 by Izzy
Replied by Izzy on topic Mandatory Reconsideration - ending up on JSA?
OK. Thanks for the warning regarding sanctions Gordon. I think I'm just going to have to hope my PA is understanding! Will feel better, (hopefully), when I've met them. I haven't been called in yet.
Thanks also for letting me know that I can go for MR up to 13 months late, so long as the DWP accept the reasons given. That could be very useful.
Really grateful for all the support and guidance on this site! It's the uncertainty that's the worst thing........
This site is an invaluable resource. Thanks to everyone involved.
Thanks also for letting me know that I can go for MR up to 13 months late, so long as the DWP accept the reasons given. That could be very useful.
Really grateful for all the support and guidance on this site! It's the uncertainty that's the worst thing........
This site is an invaluable resource. Thanks to everyone involved.
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