IB to ESA Medical

I am brand new to this site. If only I discovered you a few months ago!

My apologies for posting a long post and for the 20 questions, I am very desperate for some assistance.

I am enquiring about my brother who is severely disabled, a wheelchair user, severe scoliosis, chronic back pain all of which will get worse. He claimed incapacity benefit 5 years ago following a serious mental health diagnosis and hospitalisation. Since then, he's been in remission mentally but his physical problems have gotten worse. He still has a whole host of mental and physical issues that mean that there is no way in hell he could get back to work or attend mandatory work related interviews. The saddest thing is that this is the sort of person that this sort of benefit should support and not punish.

When he went on IB, he had a sick certificate from his GP signing him off work indefinitely.

He got the ESA50 and we were totally clueless about it all and messed up his form - if only we had known about this site! The form is littered with lots of "it varies" and appears better than his actual illness. However, the form is very clear on mobilising for less than 50 metres point which should get him to support group. He also submitted zero medical evidence with the form because he had assumed they would have previous certificates or request from GP if they needed to.

Questions

I would be very grateful for your help with the following questions.

1. He's now been called for a medical and we're trying to see whether there is anything we can do to remedy the situation. He's been asked to attend a place with no wheelchair access even though he clearly asked for access. Could this be used if we need to appeal to show that they didn't even bother reading his form before calling for face to face?

2. I'll go with him to ask his GP for a letter but no idea if she would say yes as she can be unhelpful. If she agrees to write a letter of support, is it OK to ask her to refer to the particular descriptors that would get him into support group such as mobilising 50 metres or is this a big no no?

3. My brother has been extremely stressed, panic attacks with the ESA. I'm convinced he'll end up in psychiatric ward again if it doesn't go our way. Is this what the exceptional circumstances cover (substantial risk to the mental or physical health if he were found not to have limited capability for work-related activity) or does this mean harm to others and not the claimant? Will it be OK for GP to refer to this exception?

4. If GP refuses to write, will any special weight be attached to asking a family friend or two who are medical doctors to write in a personal capacity but including details of medical conditions? We'd rather not do this unless it will help as my brother doesn't really want family friends knowing about ESA.

5. I live with my brother and would like to write a letter of support for how his disabilities affect him. Is any weight given to letters written by friends and family or is this a complete waste of time? Similarly, can I refer to the 50 meters descriptor and the exceptional circumstances, if applicable?

6. If he admitted waiting for CBT, will that automatically get him into work related group?

7. His income is over the means tested threshold, does that mean that even though he was on IB indefinitely, unless he get into the support group, he can only claim ESA for one year? If so, when does the one year start and after the year, is there ability to re-apply?

Apologies once again for the numerous questions and thank you very much for your help.

Hi b2013,

Welcome to Benefits and Work

1. If there are access problems at the venue that ATOS have stipulated for the assessment, you should contact them.

There are contact details on the right, under : "ESA/WCA Customer Service:"

On their website : Here

If you are to phone them, I would back any verbal request up in writing by e-mail to create a paper trail.

Any requests for "Reasonable Adjustments" due to his disabilities, should be made formal, citing Sections 20-22 (Adjustments for disabled persons) of EA 2010 :

www.legislation.gov.uk/ukpga/2010/15/contents

Whilst in contact with ATOS, you could also request that the assessment is recorded :

DRUK FAQ on Audio Recording of WCA Assessments

Which has a link which takes you to this PDF

Audio Recording of WCA FAQ PDF

See further information from Hansards : Here

2. Yes you could ask the G.P. to make comments with respect to the relevant SG descriptors. Try not to lead, or put words into the G.P.'s mouth though.

If G.P. won't provide letter of support you could request copies of his G.P. records from reception, (there will probably be a charge) and use any relevant extracts as evidence. :

Requesting your medical records

If you obtain these before the assessment, you could post copies of relevant extracts to ATOS at the same address as the ESA50 went to, and also take copies to the assessment and hand them to the ATOS HCP before the assessment starts. They are supposed to read them.

Sending Documents to the DWP or ATOS

3. ESA Reg 35 would apply, if pertinent, to substantial risk to the mental or physical health of your brother or other people.

Yes, you could also ask the G.P. to comment on this as a back up, it would help if evidence was provided to show how and why there would be "Substantial Risk" rather than just stating it. :

ESA Reg 35 for entry to The SG (LCWRA)

PLUS Post 28/01/13 Amendment of :

(3) In regulation 35(1) (certain claimants to be treated as having limited capability for work-related activity)(6), for sub-paragraph (b) substitute—

“(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”.

From :

www.legislation.gov.uk/uksi/2012/3096/regulation/4/made

There is no legal definition regarding "Substantial" but it would obviously be somewhat more than average risk.

With respect the SG Descriptors, and being classed as being able to carry them out, see :

ESA Reg 34. (2) Applicable to Support Group :

“A descriptor applies to a claimant if that descriptor applies to the claimant for the majority of the time or, as the case may be, on the majority of occasions on which the claimant undertakes or attempts to undertake the activity described by that descriptor”

www.legislation.gov.uk/uksi/2008/794/regulation/34/made

4. Any letters of support from friends, carers, relatives etc, etc who know how his limitations affect him on a day to day basis should be taken into account, also.

5. As 4. above, it would be best to go into detail regarding how you witness his limitations on a daily basis. You could also highlight how and why he qualifies for The SG.

"6. If he admitted waiting for CBT, will that automatically get him into work related group?"

Please clarify, I don't know what is meant by "CBT" ?

7. If he is successfully transferred to The WRAG, in receipt of CB ESA only he would receive this for 365 days from the active date of the WRAG award. Then, if he was not entitled to IR ESA, payments would cease, and he would receive NI Credits only for the purposes of State Pension.

If he is placed into The SG, time spent in the SG does not count against the 365 day entitlement, and he would continue to receive CB ESA in The SG for as long as he remained in The SG. :

12 Month Limit for ESA(CB)

You may wish to review our : ESA Claims Guides

See also :

Qualifying for the Support Group

&

ESA Medical – What to expect

From our : ESA FAQ’s

These may also help : IB, IS, SDA, Migration to ESA FAQ’s

Please reply to this topic with any further queries. (please try to keep future posts to a shorter format. )

bro58

Wow. Bros58, thank you so much for that comprehensive reply!

1. We called immediately we got the appointment and changed the venue but it still makes me think they didn't bother reading his form.

6. CBT is cognitive behavioural therapy which he's had previously with a psychotherapy and might get privately again to help with his mental health issues. I think it's one of the things in WRAG and we're hoping the fact he admitted to seeking this wouldn't count against him because right now, he won't go for CBT.

New Question: Throughout his years on IB, my brother was never called for medical. Does being called for medical mean he'll most likely not get support group or are most people transferring being called for face to face?

Thanks very much.

belle2013 wrote: Wow. Bros58, thank you so much for that comprehensive reply!

1. We called immediately we got the appointment and changed the venue but it still makes me think they didn't bother reading his form.

6. CBT is cognitive behavioural therapy which he's had previously with a psychotherapy and might get privately again to help with his mental health issues. I think it's one of the things in WRAG and we're hoping the fact he admitted to seeking this wouldn't count against him because right now, he won't go for CBT.

New Question: Throughout his years on IB, my brother was never called for medical. Does being called for medical mean he'll most likely not get support group or are most people transferring being called for face to face?

Thanks very much.

Hi b2013,

Thanks for the explanation regarding CBT.

Not sure what you mean by " I think it's one of the things in WRAG"

To gain entry to the WRAG he must score at least 15 points cumulatively across any of the :

WRAG (LCW)Schedule 2 Descriptors

Or by fulfilling any of the criteria under :

ESA Reg 29 for entry to The WRAG (LCW)

PLUS Post 28/01/13 Amendment of :

(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.”.

From :

www.legislation.gov.uk/uksi/2012/3096/regulation/3/made


To qualify for The SG, he must fulfill any one of :

SG (LCWRA)Schedule 3 Descriptors

Or under any of the criteria covered by ESA Reg 35.

With regards to your question, sometimes appointments for face to face assessments are made before The ESA50 has been viewed, as the appointments are made by a different department.

Some IB Claimants were PCA exempt, (Personal Capability Assessment) so never had to have an assessment.

There is no such exemption with the ESA WCA. (Works Capability Assessment)

ATOS state that if enough evidence is provided by the claimant in the ESA50 and any added evidence that where possible they will carry out a paper assessment.

I can't put an exact percentage on how many of our members have face to face assessments, and how many have a paper assessment.

We have members who have been placed into The WRAG and The SG after either type of assessment.

The main difference is, that a claimant cannot be assessed as fit for work without first having a face to face assessment.

Have a read of The WCA Handbook 2nd from bottom link on this page :

ESA Claims Guides

bro58