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Assessment report received/MR advice needed please
- enigma75
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7 years 9 months ago #164381 by enigma75
Assessment report received/MR advice needed please was created by enigma75
Hello again,
As mentioned in my previous post, I've been awarded Standard Care and Enhnced Mobility. The thing is, although I was always borderline MRC/HRC with DLA so never appealed, it's much more clear-cut that I'm eligible for Enhanced Care with PIP. And yet despite explaining my issues in detail and backing them up with evidence from my consultant, my GP and my friends who provide support, I only just scraped through with 8 points. Most concerningly, the DM has vastly underestimated my difficulties. For example:
1) I've been given 2 points for preparing food on the basis that I 'can use a microwave'. I use one to heat up ready meals and meals others have cooked for me. Heating a meal someone else has cooked shouldn't count as preparing a meal, should it? I should have scored 4 or 8 points for this, on the basis that I can't prepare food reliably, to an acceptable standard, as often as I need to and in a reasonable time, which should count as not being able to do it at all.
2) I got 2 points for needing an aid/appliance for 3 other questions, despite the fact that I explained clearly that my aids don't help when the weakness / light-headedness / fatigue etc set in, plus I have other issues such as needing regular prompting and not being safe doing certain activities because of cognitive impairment.
3) The DM said that there was 'no evidence of substantial functional impairment or mental health difficulties', despite my GP and consultant backing up my claim. I 'appeared calm and relaxed' and my 'mood appeared stable' (my friend who was with me disagrees), so that snapshot apparently means I don't have depression. I'm cured! Apparently I can always understand complex written information, which is news to me and my cognitive issues.
TL;DR, they've accepted the fluctuating nature of my condition and that I can't reliably/repeatedly mobilise more than 20m, and yet they've disregarded that same thing when it comes to the daily living section - despite it being the same symptoms stopping me from doing both! Surely as I was too weak and exhausted to even stand up properly during the examination, then that suggests substantial functional impairment.
But I'm financially no worse off, so I honestly don't know whether it's worth the stress of an appeal. But will not appealing work against me in the future? Will they try to claim that not appealing means I agreed with the assessment? Could it work against me when my ESA claim is reassessed?
Also, how will it work with the new PIP review form? For those of us who should have received a higher award but chose not to appeal, will that work against us? Assuming things haven't got worse but we should have had a higher award, would it be better to tick 'no change' or 'got worse'?
I've 75% decided not to appeal in case my award is decreased and this has made me ill enough already, but I feel like I can't let the egregious inaccuracies in the DM's decision letter go unchallenged. I thought about writing a letter explaining I don't want to appeal but I want it on record that I don't agree and why, but I've been advised that that could make things worse. A local charity can help me if I decide to appeal, but due to massive understaffing they can't help me decide whether to appeal, as the appeal specialist isn't familiar with my claim. So I'm on my own with that decision.
Well done and thank you if you got through all of that! This post has taken me almost a week to compose and write, so apologies for its sprawling nature.
As mentioned in my previous post, I've been awarded Standard Care and Enhnced Mobility. The thing is, although I was always borderline MRC/HRC with DLA so never appealed, it's much more clear-cut that I'm eligible for Enhanced Care with PIP. And yet despite explaining my issues in detail and backing them up with evidence from my consultant, my GP and my friends who provide support, I only just scraped through with 8 points. Most concerningly, the DM has vastly underestimated my difficulties. For example:
1) I've been given 2 points for preparing food on the basis that I 'can use a microwave'. I use one to heat up ready meals and meals others have cooked for me. Heating a meal someone else has cooked shouldn't count as preparing a meal, should it? I should have scored 4 or 8 points for this, on the basis that I can't prepare food reliably, to an acceptable standard, as often as I need to and in a reasonable time, which should count as not being able to do it at all.
2) I got 2 points for needing an aid/appliance for 3 other questions, despite the fact that I explained clearly that my aids don't help when the weakness / light-headedness / fatigue etc set in, plus I have other issues such as needing regular prompting and not being safe doing certain activities because of cognitive impairment.
3) The DM said that there was 'no evidence of substantial functional impairment or mental health difficulties', despite my GP and consultant backing up my claim. I 'appeared calm and relaxed' and my 'mood appeared stable' (my friend who was with me disagrees), so that snapshot apparently means I don't have depression. I'm cured! Apparently I can always understand complex written information, which is news to me and my cognitive issues.
TL;DR, they've accepted the fluctuating nature of my condition and that I can't reliably/repeatedly mobilise more than 20m, and yet they've disregarded that same thing when it comes to the daily living section - despite it being the same symptoms stopping me from doing both! Surely as I was too weak and exhausted to even stand up properly during the examination, then that suggests substantial functional impairment.
But I'm financially no worse off, so I honestly don't know whether it's worth the stress of an appeal. But will not appealing work against me in the future? Will they try to claim that not appealing means I agreed with the assessment? Could it work against me when my ESA claim is reassessed?
Also, how will it work with the new PIP review form? For those of us who should have received a higher award but chose not to appeal, will that work against us? Assuming things haven't got worse but we should have had a higher award, would it be better to tick 'no change' or 'got worse'?
I've 75% decided not to appeal in case my award is decreased and this has made me ill enough already, but I feel like I can't let the egregious inaccuracies in the DM's decision letter go unchallenged. I thought about writing a letter explaining I don't want to appeal but I want it on record that I don't agree and why, but I've been advised that that could make things worse. A local charity can help me if I decide to appeal, but due to massive understaffing they can't help me decide whether to appeal, as the appeal specialist isn't familiar with my claim. So I'm on my own with that decision.
Well done and thank you if you got through all of that! This post has taken me almost a week to compose and write, so apologies for its sprawling nature.
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7 years 8 months ago #164410 by Gordon
Nothing on this board constitutes legal advice - always consult a professional about specific problems
Replied by Gordon on topic Assessment report received/MR advice needed please
Cat
We don't see too many claims where the claimant loses points at MR, however, it most certainly happens and there is no way to constrain the DWP to just looking at the Daily Living Component.
Also, the more detailed your original submission was the less likely that the Decision will be revised at MR, unless something fundamental has been missed, this means that you may need to be prepared to take it to appeal, if nothing else this will considerably extend the time it takes.
If you want to go ahead then the first stage to challenging a Decision is for you to request a Mandatory Reconsideration, 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 PIP MR & Appeal guide for details of the process, the PIP area also has template letters that you can use to make the request with.
www.benefitsandwork.co.uk/help-for-claimants/pip
You should contact the DWP for a copy of the assessment report 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
We don't see too many claims where the claimant loses points at MR, however, it most certainly happens and there is no way to constrain the DWP to just looking at the Daily Living Component.
Also, the more detailed your original submission was the less likely that the Decision will be revised at MR, unless something fundamental has been missed, this means that you may need to be prepared to take it to appeal, if nothing else this will considerably extend the time it takes.
If you want to go ahead then the first stage to challenging a Decision is for you to request a Mandatory Reconsideration, 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 PIP MR & Appeal guide for details of the process, the PIP area also has template letters that you can use to make the request with.
www.benefitsandwork.co.uk/help-for-claimants/pip
You should contact the DWP for a copy of the assessment report 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
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7 years 8 months ago #164428 by enigma75
Replied by enigma75 on topic Assessment report received/MR advice needed please
Thank you Gordon.
I haven't got the resources to read and understand the guides atm so I'll have to ask a friend to do it for me - so please forgive me if a question I ask is already answered in them.
What if the assessment report doesn't arrive in time? Their letters take between 1-2 weeks to get to me, so I only have 2 weeks left to receive the report, read/understand it and write back to them. Can I tell them I'm requesting a MR and that a detailed letter will follow in due course? I don't want them to reconsider it without my challenge.
My concern is as you say: my original submission was already very detailed, so I can only assume that the DM simply didn't believe me. I explained in detail how my illness fluctuates, I spend the majority of my time stuck in bed, and that any activity triggers a symptom flare so I can't do anything reliably/repeatedly etc - and my GP's letter in particular backed that up. None of these things can reliably be observed in a single 2-hour assessment.
I can only hope that another DM will disagree with the first one and increase the award (this actually happened to me once when my DLA was cut), but I appreciate that it's a different benefit, so if the chances of that happening again are slim, I'm not sure I want to put myself through the appeal process.
My consultant has offered further help, though. Would a consultant letter challenging the decision/ assessment be helpful?
I haven't got the resources to read and understand the guides atm so I'll have to ask a friend to do it for me - so please forgive me if a question I ask is already answered in them.
What if the assessment report doesn't arrive in time? Their letters take between 1-2 weeks to get to me, so I only have 2 weeks left to receive the report, read/understand it and write back to them. Can I tell them I'm requesting a MR and that a detailed letter will follow in due course? I don't want them to reconsider it without my challenge.
My concern is as you say: my original submission was already very detailed, so I can only assume that the DM simply didn't believe me. I explained in detail how my illness fluctuates, I spend the majority of my time stuck in bed, and that any activity triggers a symptom flare so I can't do anything reliably/repeatedly etc - and my GP's letter in particular backed that up. None of these things can reliably be observed in a single 2-hour assessment.
I can only hope that another DM will disagree with the first one and increase the award (this actually happened to me once when my DLA was cut), but I appreciate that it's a different benefit, so if the chances of that happening again are slim, I'm not sure I want to put myself through the appeal process.
My consultant has offered further help, though. Would a consultant letter challenging the decision/ assessment be helpful?
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7 years 8 months ago #164438 by enigma75
Replied by enigma75 on topic Assessment report received/MR advice needed please
Oh, and could it go against me / count as agreement with the decision if I do nothing? That's my biggest concern right now.
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7 years 8 months ago #164439 by Gordon
Nothing on this board constitutes legal advice - always consult a professional about specific problems
Replied by Gordon on topic Assessment report received/MR advice needed please
Cat
The important thing is that the DWP receive the request for an MR within one month of the Decision date or you then introduce a whole set of new issues. You can make the request and tell them that you will send further information as soon as your receive the report.
The revision rate at MR is supposed to be about 20-30%, we don't see anything like this rate on the forum, at best we might see one or two a month, so I would not peg your hopes on a second DM, who is not medically trained, revising the Decision. A Tribunal will look at all of the information from scratch and there will be a doctor on the panel.
A letter from a Consultant may help, but for it to have any real weight then it will need to address the issues you have in completing the PIP activities, will they be able to make such comment?
Gordon
The important thing is that the DWP receive the request for an MR within one month of the Decision date or you then introduce a whole set of new issues. You can make the request and tell them that you will send further information as soon as your receive the report.
The revision rate at MR is supposed to be about 20-30%, we don't see anything like this rate on the forum, at best we might see one or two a month, so I would not peg your hopes on a second DM, who is not medically trained, revising the Decision. A Tribunal will look at all of the information from scratch and there will be a doctor on the panel.
A letter from a Consultant may help, but for it to have any real weight then it will need to address the issues you have in completing the PIP activities, will they be able to make such comment?
Gordon
Nothing on this board constitutes legal advice - always consult a professional about specific problems
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7 years 8 months ago #164440 by Gordon
Each Decision is based on your problems at a particular point in time, in the vast majority of cases, that Decision only considers the documents that were produced for that assessment, there is no referral to previous reports, etc.
Gordon
Nothing on this board constitutes legal advice - always consult a professional about specific problems
Replied by Gordon on topic Assessment report received/MR advice needed please
Cat wrote: Oh, and could it go against me / count as agreement with the decision if I do nothing? That's my biggest concern right now.
Each Decision is based on your problems at a particular point in time, in the vast majority of cases, that Decision only considers the documents that were produced for that assessment, there is no referral to previous reports, etc.
Gordon
Nothing on this board constitutes legal advice - always consult a professional about specific problems
The following user(s) said Thank You: enigma75
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