Contradiction in terms ESA medical report

This is my first ever post on any forum, so please excuse me if I get any protocol wrong.
I have been migrated from Incapacity benefit to ESA WRAG. The procedure was as follows
:

I was telephoned to be informed I would receive a form ESA50 to fill in. Informed in this call that no previous information from Incapacity benefit or DLA would be taken into account, so I should describe fully my impairments and health conditions. I would be called for a medical examination after I submitted the form when I would have opportunity to provide more information if required.

I was not called for a medical, but received notice that I am on CONTRIBUTION BASED ESA. For 365 days. At my request I was sent a medical report that states I meet the criteria for having limited capability for work. Also that the prognosis is that a return to work in he long term is unlikely. Also that my condition is unlikely to improve in the long term. What I don't understand is, with such a prognosis, how can I not be eligible for benefit beyond 365 days? I have had degenerative arthritis for over 40 years, several other medical conditions, and due to have two major abdominal operations in the next few weeks, so it will be impossible for me to attend the WRAG activities.

I intend to appeal, but I am confused by the fact that despite being told in the telephone conversation prior to filling in the ESA50 form that no medical evidence from previous benefit would be used, the justification of advice notice states that available evidence to reach the decision came from ESA50, Med3 ( which my GP did not provide) and previous report.

I am very confused, and not able to get advice from welfare benefit agency until after the four week window to appeal, so any advice would be appreciated.

PC wrote:

This is my first ever post on any forum, so please excuse me if I get any protocol wrong.
I have been migrated from Incapacity benefit to ESA WRAG. The procedure was as follows
:

I was telephoned to be informed I would receive a form ESA50 to fill in. Informed in this call that no previous information from Incapacity benefit or DLA would be taken into account, so I should describe fully my impairments and health conditions. I would be called for a medical examination after I submitted the form when I would have opportunity to provide more information if required.

I was not called for a medical, but received notice that I am on CONTRIBUTION BASED ESA. For 365 days. At my request I was sent a medical report that states I meet the criteria for having limited capability for work. Also that the prognosis is that a return to work in he long term is unlikely. Also that my condition is unlikely to improve in the long term. What I don't understand is, with such a prognosis, how can I not be eligible for benefit beyond 365 days? I have had degenerative arthritis for over 40 years, several other medical conditions, and due to have two major abdominal operations in the next few weeks, so it will be impossible for me to attend the WRAG activities.

I intend to appeal, but I am confused by the fact that despite being told in the telephone conversation prior to filling in the ESA50 form that no medical evidence from previous benefit would be used, the justification of advice notice states that available evidence to reach the decision came from ESA50, Med3 ( which my GP did not provide) and previous report.

I am very confused, and not able to get advice from welfare benefit agency until after the four week window to appeal, so any advice would be appreciated.

Hi PC,

I can understand your confusion.

The fact that you are only entitled to 365 days "payment" of Contributary ESA in the WRAG, does not mean that your qualification for ESA in the WRAG only lasts for 365 days.

After the payments cease, you will still be entitled to NI Credits whilst you remain entitled to ESA WRAG, hopefully this link will explain it for you :

12 Month Limit for ESA(CB) Updated 10/03/12

12 Month Limit for ESA(CB) – Implementation New

If you feel that you should have been placed into the Support Group, then you have one month to appeal, see :

Appeals FAQ’s

See also :

Qualifying for the Support Group

Many members have reported that a MED3 has been referred to in the WCA, when their G.P. had not issued one, you may wish to query this.

You may be able to gain help from potential sources on this link :

Where to get advice?

If you have any further questions, please return here.

bro58

Hi PC,

I also understand how you feel that your "prognosis" of "In the longer term" is contradictory to placing you in the WRAG, as being in the WRAG is supposed to prepare you for work at some time in the future.

Here is an extract from the WCA Handbook, which is a guide for ATOS HCP's :

3.10.1.2 Advice that a return to work is unlikely In the Longer Term

"Where at assessment you find a substantial degree of functional impairment resulting from a serious medical problem which is chronic or will inevitably deteriorate further, even with optimal treatment, you should select "in the longer term". For example it may be appropriate to apply “in the longer term” to someone with a progressive neurological condition."

You may wish to use the argument that this is contradictory to placing you in the WRAG, as "In the longer term" is the longest prognosis available to the ATOS HCP.

The extract that I have quoted above starts in section 3.10. Medical Advice on Prognosis at Examination, on page 123 of the WCA Handbook which is the 7th link down on this page :

ESA Guides

Hope this helps.

bro58

Thank you all for your advice. I intend to appeal, and will follow your guides. If I don't get into the support group my benefit will stop after 365 days, as I will not meet the criteria for income based ESA. also, I fear that this will just be the start of the erosion of my benefits, as if not in the support group the DWP may see this as not requiring high rate mobility and middle rate care when they reassess my needs for DLA when that changes to PIP.

ironically, the reason I wouldn't qualify for income based ESA is that my husband received a redundancy payment and retirement lump sum when he took early retirement to look after me. He doesn't receive any benefits, perhaps he should apply for ESA, job seekers allowance, or careers allowance. We are seeking advice of welfare benefit solicitor, as we are totally confused and dismayed by the benefit system.

PC wrote:

Thank you all for your advice. I intend to appeal, and will follow your guides. If I don't get into the support group my benefit will stop after 365 days, as I will not meet the criteria for income based ESA. also, I fear that this will just be the start of the erosion of my benefits, as if not in the support group the DWP may see this as not requiring high rate mobility and middle rate care when they reassess my needs for DLA when that changes to PIP.

ironically, the reason I wouldn't qualify for income based ESA is that my husband received a redundancy payment and retirement lump sum when he took early retirement to look after me. He doesn't receive any benefits, perhaps he should apply for ESA, job seekers allowance, or careers allowance. We are seeking advice of welfare benefit solicitor, as we are totally confused and dismayed by the benefit system.

Good Luck PC.

bro58