Wife kicked off ESA (from SG). Please help!

I got zero points despite being on incapacity benefit for 18 years. I don't think it is that rare; rather more a tactic they use.

The best thing to do is make sure that you read all the information in the guides and understand what the process is about. You have time to do that.

Your wife will only be able to get support group status is you can prove she qualifies in the mobility descriptor or failing that, Reg 35. Be sure you understand that points are not relevant to getting into the support group.

Pay attention to the specific wording and in particular repeatedly, reliably and safely. I would also recommend reading the assessors guide for WCA as well. It's a lengthy document but you will be able to see where the assessor failed to follow the guide to come to the scores they did. Expect the medical report from the assessor to make interesting reading!.

Next stage is MR but this too is likely too to result in the same decision but after that you can lodge the Appeal documents and this is when she can get back onto the benefit while the appeal is taking place.

For the appeal it may be critical to offer new evidence to them, so think about if there is any medical person who can do that for you. In particular it would need to confirm the support group descriptor for mobility or Reg 35 and the precise wording can be very important.

I used a solicitor to put in the Appeal document and got new evidence from my consultant and the DWP reversed their decision before it went to Appeal.

Try to stay positive and pace yourself with the work and stress because it is a lot to deal with. Good luck.

Fantastic advice guys, thank you so much! Apologies for the delays but my own health isn't great (I'm waiting for a kidney removed) and it's taken some time to draft our MA letter/arguments. I will spare you all posting up the whole thing here (it's six full A4 pages long without being repetitive), but the gist of it is that:

1) My wife has since (last week) been diagnosed with cauda equina. This is classed as a medical emergency and causes all the symptoms she explained in her original ESA50 (incontinence, loss of use of one side of the body, severe pain etc).

2) The medical professional said it should have been picked up a year ago but since it hasn't, my wife will now be permanently damaged (some paralysis, loss of function in her left arm and leg, incontinence etc).

3) This diagnosis supports my wife's arguments and statement of symptoms, and refutes their own medical professional's 'belief' that it is 'unlikely' she suffers significant deficits in mobility or dexterity.

I outlined it in the way of 'On page 3 of the report Ms X states I walked 10 metres to the examination room. She failed to mention that I stopped twice along the way, once due to severe pain and once because my paralysis of the left leg caused me to stumble. The law states that the point at which a claimant stops should be considered the limit of their ability to mobilise, regardless of their ability to later resume the walk. I submit that as such I qualify for points based on this descriptor and should therefore have been awarded at the original assessment.'

I continued in this vein emphasising that my wife can't use a manual wheelchair, despite their HCP suggesting one, because of the weakness and paralysis of her left arm. I also made clear that while there was some function it quickly evaporated during light use, and as such she could not safely or repeatedly carry out any activity with the arm, thus arguing she should be classed as unable to do them at all as per the regulations.

The HCP stated my wife presented 'no upper limb problems and appeared fluid in movements'. This is blatantly a lie, and since my wife has been diagnosed as partially paralysed in her left arm since that assessment, due to cauda equina, it is clear on balance that the evidence supports the fact their HCP was 'mistaken' in her belief. I outlined similar arguments for the incontinence issues, and was clear she suffered at least once or twice a week (a SG qualifier - and also true).

Do you think we're along the right lines here please guys? It needs sending off tomorrow by recorded delivery, as the deadline is starting to loom (28th). Thanks SO much again, I sincerely appreciate your help and advice to date.

Gordon wrote: RainmakerRaw

What you have posted seems fine, but you should be aware that the DWP Decision Maker has no medical training and may not be able to interpret the effects of your wife's now diagnosed condition, would your GP be prepared to write a letter confirming the effects and specifically how your wife is effected?

Gordon

Hi again Gordon,

Yes the GP would be amenable but we can't get it in time for the MA deadline. I was recalcitrant to include 'evidence to follow' lest it delay the MA even further, hedging bets that we might get a better decision this time but if not we'd have loads more new ammo (not yet received surgical report, GP letter and physio report) for any appeal.

I was mindful of their lack of medical training. As I'm used to writing academic papers (with the ethos of 'write and explain everything as if to a layman'), everything is clearly spelled out. Where terms were used (eg cauda equina) there follows a concise bullet point list of what this means, the symptoms, their effects, how it relates to the ESA50 and how it contradicts their HCP's report. It was this that contributed to the length of the 'letter' but I hoped it might be beneficial.

It's ironic that my wife has worked all her life (13 years in this current job, from which she is still on leave), but finds it so hard to get support back from 'the system' she's paid into so faithfully. She's never been unemployed and works hard for her money, but austerity cuts do seem rather keener at the working man's end, don't they?

Anyway, I'll keep you updated. Sincere thanks once again. You have the patience of a saint and I can't thank you enough for your time and assistance thus far.

Hi again,

Bad news. We sent off the (six page) letter requesting the MA. A week later, my wife received a new report from a new physiotherapist (who is also a doctor) confirming that her issues are much more severe than her doctors originally thought. It confirms she has severe difficulties with mobility and incontinence, and confirms that this HCP has referred her to a spinal surgeon for urgent investigation and potential treatment. The report also made clear that because of the delay in diagnosis (cauda equina) the effects are now likely permanent and beyond treatment.

This report was sent by recorded delivery to DWP, and they received it weeks ago.

Today my wife received the MA notice which states that the decision has not been changed. This is because, according to the letter:

* DWP acknowledge my wife has serious medical issues
* DWP acknowledge my wife has serious mobility and incontinence issues
* Their HCP stated my wife has no difficulties in daily activities
* Although my wife has severe mobility and incontinence issues there was no new evidence submitted to confirm this or to suggest any new referrals or treatment

This contradicts the original decision makers' letter, which said that my wife had 'no mobility or incontinence issues'. It also is despite them being shown to have received the new medical report and its cover letter some two weeks before they considered the MA request. This is ample time for them to have put it towards the evidence bundle for the MA.

My wife is obviously wishing to lodge an appeal and we have downloaded the form for this. However, I would like to ask whether it's worth ringing DWP to ask why the new report wasn't acknowledged or used as part of the MA? We have received no phone call from them as part of the MA process (even though they did ring before delivering the original decision). Had they phoned as part of the MA my wife would have been able to draw to their attention the fact they had been sent new evidence which strongly supported her claim.

All this additional stress just before Christmas isn't ideal. Any help or advice would be gratefully received. Thanks so much in advance.