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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

To appeal sister’s benefits?

113 replies

toappealthisdecision · 10/04/2025 07:22

Younger sister (in her 30s), I am her primary guardian as parents are incapacitated themselves unfortunately.

She has complex diagnoses - autism, ADHD, dyspraxia, dyscalcula, mild/borderline learning disability (IQ 70), a lot of mental health stuff (on 3 psychotropics including mood stabilisers) but no concrete diagnosis. She has epilepsy (generalised since childhood), asthma and IBS. She was queried for a genetic syndrome, they think possibly fragile X via my father - but not sure.

She has never worked or earned a wage. She lives in supported living scheme with 24/7 on site carers, although overnight they are not in her flat but are just down one flight of stairs on a sleeping shift - no waking staff overnight.

I can’t see her coping with a job. She does a voluntary thing 2 hours a day,, and she has a 2 or 3 basic qualifications (ie about the level you’d expect of a 11 year old) and can to an extent do kitchen portering and handle a till, again to a very limited extent. But she can’t do any of this to a level she would get paid for. No one would employ her. Reading age is about 9, writing is far lower.

She has zero idea of value of money or impulse control. Socially she is years and years behind and can be very disinhibited. She struggles to keep relationships and doesn’t know what is and isn’t appropriate. She really needs someone with her all the time who knows her and can help her - if she gets upset or overwhelmed she can go into sabotage mode and has been sectioned on 136 a few times because she’s a danger to herself and others. A lot of self harm and violence towards others. She’s also doubly incontinent for psychological reasons and struggles to keep herself clean.

She will never not need care. She doesn’t see it this way and believes she is going to find herself a neurotypical girlfriend and get married and have a lovely house with pets.

Her benefits have changed recently and she’s been told she’s losing £400 per month as she’s not allowed ESA anymore; so will lose severe disability payment - also has to change to UC. She will possibly have enough to live off but only just - ie she will struggle to pay for utility bills, will have a very, very basic standard of living.

I don’t know if that also affects council tax and housing benefit but suspect it will. she also has to pay a chunk towards her care that goes up every year.

Our local council have just made the step of closing down vast majority of learning disability and elderly care services - 70% of all council employees have been let go, most sheltered housing, care homes and similar are gone, no care at home workers, and there are now no day services either. Sister no longer has a social worker, he’s been made redundant as he only worked part time. I don’t know anyone is going to take over but I doubt it - because she is borderline IQ and has some family around she is not classed as highly in need.

I work full time but I only just earn enough for my own bills despite being band 5 NHS, I can’t afford to pay for her too much as I wish I could. One parent is in a care home and exists on £45 per week for personal spends, the other wouldn’t and couldn’t for various reasons.

She is however, only getting the lower rates of PIP, which makes me think we should appeal? Their argument is she can walk, eat and wash but she can only do these things with a trained adult or often 2 adults.

I’ve talked her through what I can and have explained I am prepared to try and appeal. Is it worth trying? I can’t believe her benefits can just drop by that amount so quickly.

There doesn’t seem to be any real support or advice out there for anyone in this boat, it’s not what I expected at 34 to be trying to sort out! I’ve got a couple of relatives who are my rock at the moment but just trying to find independent opinions on what to do

OP posts:
itsgettingweird · 10/04/2025 11:58

Absolutely appeal.

That level of need should reach enhanced care of nothing else. The fact she lives in supported living shows she needs someone to print and guide her to do everyday activities.

RubyOrca · 10/04/2025 11:58

I’m not in your system so no direct advice on appealing.

however - if your sister is going to be assessed - do not help her put her best foot forward! Unfortunately that may mean leaving your sister without adequate care for a short period of time.

Eg You mentioned she needs help to dress/shower. If you provide that care then they’ll conclude she doesn’t need FUNDED support - cause look see she’s clean, dressed etc.

Don’t leave her in danger - but don’t hide her challenges from the assessors.

TheWisePlumDuck · 10/04/2025 11:58

Be prepared to go to tribunal.

They very often award the points people actually deserve, it really is worth persevering with.

As an aside, I am very sorry you and your family are having to go through with this. I voted Labour but am appalled by their treatment of the disabled, especially that disgusting rhetoric they were spouting before the spring budget, I will never be voting for them again.

PIPnamechanged · 10/04/2025 12:01

OP, do you happen to have her PIP scores at hand? If so, let me know what they were for each activity. Even better if you have the form with the justifications on it. From what you’ve said, the lower rate is definitely not appropriate.

Vespanest · 10/04/2025 12:03

not having a named social worker is a bit irrelevant as she is still in and known to adult services and must have current risk assessments and care plans in place. It is these documents that make PIP slightly easier especially when a person has enough capacity to answer questions but not enough to understand the consequences and reality of the answers given.

EnjoyingTheArmoire · 10/04/2025 12:05

KitsyWitsy · 10/04/2025 08:30

Surely she is just changing over to UC asESA is an old benefit? It doesn’t sound like she will have any issue getting the full rate of UC with the limited capability of work. No point whatsoever appealing as her benefits haven’t been reduced, they are just changing to the new system

This is incorrect.

Whilst the Tories tried to convince everyone that UC would mean more money for all this is simply not the case.

I was migrated across a few months ago, and as a disabled lone parent I am £360/mth worse off due the difference in rates between ESA (with premiums) and UC.

I haven't magically become less disabled in this time, and will lose my transitional protection when we need to move house over the summer (due to dc's disability).

The two are not equal.

Discoprincess6 · 10/04/2025 12:10

toappealthisdecision · 10/04/2025 07:22

Younger sister (in her 30s), I am her primary guardian as parents are incapacitated themselves unfortunately.

She has complex diagnoses - autism, ADHD, dyspraxia, dyscalcula, mild/borderline learning disability (IQ 70), a lot of mental health stuff (on 3 psychotropics including mood stabilisers) but no concrete diagnosis. She has epilepsy (generalised since childhood), asthma and IBS. She was queried for a genetic syndrome, they think possibly fragile X via my father - but not sure.

She has never worked or earned a wage. She lives in supported living scheme with 24/7 on site carers, although overnight they are not in her flat but are just down one flight of stairs on a sleeping shift - no waking staff overnight.

I can’t see her coping with a job. She does a voluntary thing 2 hours a day,, and she has a 2 or 3 basic qualifications (ie about the level you’d expect of a 11 year old) and can to an extent do kitchen portering and handle a till, again to a very limited extent. But she can’t do any of this to a level she would get paid for. No one would employ her. Reading age is about 9, writing is far lower.

She has zero idea of value of money or impulse control. Socially she is years and years behind and can be very disinhibited. She struggles to keep relationships and doesn’t know what is and isn’t appropriate. She really needs someone with her all the time who knows her and can help her - if she gets upset or overwhelmed she can go into sabotage mode and has been sectioned on 136 a few times because she’s a danger to herself and others. A lot of self harm and violence towards others. She’s also doubly incontinent for psychological reasons and struggles to keep herself clean.

She will never not need care. She doesn’t see it this way and believes she is going to find herself a neurotypical girlfriend and get married and have a lovely house with pets.

Her benefits have changed recently and she’s been told she’s losing £400 per month as she’s not allowed ESA anymore; so will lose severe disability payment - also has to change to UC. She will possibly have enough to live off but only just - ie she will struggle to pay for utility bills, will have a very, very basic standard of living.

I don’t know if that also affects council tax and housing benefit but suspect it will. she also has to pay a chunk towards her care that goes up every year.

Our local council have just made the step of closing down vast majority of learning disability and elderly care services - 70% of all council employees have been let go, most sheltered housing, care homes and similar are gone, no care at home workers, and there are now no day services either. Sister no longer has a social worker, he’s been made redundant as he only worked part time. I don’t know anyone is going to take over but I doubt it - because she is borderline IQ and has some family around she is not classed as highly in need.

I work full time but I only just earn enough for my own bills despite being band 5 NHS, I can’t afford to pay for her too much as I wish I could. One parent is in a care home and exists on £45 per week for personal spends, the other wouldn’t and couldn’t for various reasons.

She is however, only getting the lower rates of PIP, which makes me think we should appeal? Their argument is she can walk, eat and wash but she can only do these things with a trained adult or often 2 adults.

I’ve talked her through what I can and have explained I am prepared to try and appeal. Is it worth trying? I can’t believe her benefits can just drop by that amount so quickly.

There doesn’t seem to be any real support or advice out there for anyone in this boat, it’s not what I expected at 34 to be trying to sort out! I’ve got a couple of relatives who are my rock at the moment but just trying to find independent opinions on what to do

Appeal appeal appeal.

The sods shouldn’t be allowed to get away with this.

I’m so sorry you both are facing this. You shouldn’t have to. She needs the support I can see that in your post so why can’t they!

Get in touch with citizens advice, disability help website (sorry forget its name) and have a look at mind. Mind have a helpline that assists with benefits they might be able to advise you.

ByBoldOP · 10/04/2025 12:21

Hi @toappealthisdecision

No other advise but an appeal is always worth a try.

Could I PM you ? My DD has similar needs but is much younger. I wondering how she was when younger and if needs increased? We are struggling now but unsure if level of n ed will be consistent, improve or get worse

KitsyWitsy · 10/04/2025 12:32

EnjoyingTheArmoire · 10/04/2025 12:05

This is incorrect.

Whilst the Tories tried to convince everyone that UC would mean more money for all this is simply not the case.

I was migrated across a few months ago, and as a disabled lone parent I am £360/mth worse off due the difference in rates between ESA (with premiums) and UC.

I haven't magically become less disabled in this time, and will lose my transitional protection when we need to move house over the summer (due to dc's disability).

The two are not equal.

I get that makes things difficult for you. It isn’t fair though that you were £360 better off than other disabled people on different benefits?

Everyone does need to be on the same system for fairness.

fortniteplaya · 10/04/2025 12:35

Appeal!! There is currently a 69% success rate for people that appeal.
Disability Support Project are a charity that can help I believe. I haven't used them yet but intend to when my adult daughter gets migrated from DLA to PIP.
The DLA forms were hideous to fill in, dreading it.

OriginalUsername2 · 10/04/2025 12:36

It’s always worth appealing. Some say expect to appeal. Absolutely do it.

Themadhatterr · 10/04/2025 12:42

But you will not get SDP with the new Universal Credit

Aknifewith16blades · 10/04/2025 12:43

OP, for support and guidence for you, you might find it helpful to check out https://www.sibs.org.uk/

Sibs - for brothers and sisters

Sibs is the UK charity for people who grow up with a disabled brother or sister.

https://www.sibs.org.uk

Kattekittt · 10/04/2025 12:43

This website will offer so much advice for you.
https://www.turn2us.org.uk/
It was so helpful when I had to appeal my original PIP decision.
It goes through all the criteria and also offers further advice on possible grants and other benefits that may be available.
I’d always recommend appealing a decision especially when it seems so unfair. Good luck

""

Turn2us

Turn2us is a national charity providing practical help to those of us facing financial insecurity.

https://www.turn2us.org.uk

NineteenSeventyNine · 10/04/2025 12:48

The system relies on a substantial percentage of applicants not having the time, strength, education, etc to appeal - it’s a sort of unofficial built-in hurdle that penalises the most vulnerable and it’s an absolute disgrace. Definitely appeal and contact Citizens Advice for guidance. You sound like a lovely sister. Good luck x

Trallala · 10/04/2025 12:50

Under Freedom of Information you should be able to get copies of all her medical notes from GPs, consultants etc. Be specific in your request for it to include ALL correspondence from specialists, social services etc. Also contact your local NHS trust and request all medical notes from hospital visits etc. You can do the same with social services and whoever provides her supported living. Again, be specific and ask for care plans and especially risk assessments.

Also, if she can't go out/ use public transport without support then you should try for the mobility element.

Lastly, your GP may also provide a supporting letter (but you may need to pay for this).

Mirabai · 10/04/2025 12:50

First contact Scope for advice.

CAB is ok for appeals but hard to get hold of. If you can afford it it would be better to get an experienced benefits lawyer - appeal would cost around £1500.

There is no question that DSIS should be on highest rate care and mobility because she can’t do anything unaided.

The key to getting PIP is in the way you do the form and appealing on the right grounds.

For a start go to Benefits and Work forum, make an account and download their guide to form filling and appeals.

Then you must get all the medical documentation you have from your mum or request it from DSIS’s GP’s surgery/trust.

Then you or a CAB representative need to write a detailed diary to show how DSIS’s condition affects her care and mobility need. In the diary cover every activity on the form - eating, drinking, washing, self care, dressing, socialising, managing money and journeys etc to show precisely how her conditions affect her.

Obviously things have now changed and there will be major cuts to PIP and only the most disabled will qualify, however, DSIS should by rights still meet the new more stringent criteria.

Mirabai · 10/04/2025 12:51

Trallala · 10/04/2025 12:50

Under Freedom of Information you should be able to get copies of all her medical notes from GPs, consultants etc. Be specific in your request for it to include ALL correspondence from specialists, social services etc. Also contact your local NHS trust and request all medical notes from hospital visits etc. You can do the same with social services and whoever provides her supported living. Again, be specific and ask for care plans and especially risk assessments.

Also, if she can't go out/ use public transport without support then you should try for the mobility element.

Lastly, your GP may also provide a supporting letter (but you may need to pay for this).

Yes absolutely, you need all the documentation you can gather.

AnnaQuayInTheUk · 10/04/2025 12:53

BananaSpanner · 10/04/2025 07:29

I think I just voted yabu by accident so apologies for that. Yes, appeal. She sounds like someone benefits were invented to support and I’m very sorry for you they’ve been reduced. I don’t know how successful appeals are. Would your local MP get involved?

You can change your vote as long as the poll is still open. Just go back and click on the option you want

TheFastTraybake · 10/04/2025 12:54

TigerRag · 10/04/2025 11:50

Don't pay for advice. There should be someone within her local supported living scheme who can advise on benefits. Either that or someone like CAB

That's not great advice. CAB aren't specialists in applying for PIP. I would always advocate someone getting a specialist agency to assist with their claim/appeal. Apart from anything else, the tribunal process is genuinely traumatic and I'd never advise anyone to attend without a trained adviser accompanying them. Giving a percentage of your back payment/small fee to a not for profit organisation is preferable to being refused PIP altogether.

leli · 10/04/2025 12:56

She's very lucky to have you. I'm glad you do have supportive relatives yourself. Best of luck.

Unpaidviewer · 10/04/2025 12:59

You've got nothing to lose by appealing. Citizens advice might be able to help you with the paperwork.

AnotherEmma · 10/04/2025 14:20

Hi OP. I work for citizens advice.

First things first; are you her appointee for benefits? Do you have POA? If not you need to sort that first.

I gather from your posts that she was found "fit for work" after a work capability assessment. Based on what you've said about her, it sounds very much like the wrong decision and you should definitely challenge it. The first step is to request a mandatory reconsideration (MR):
https://www.citizensadvice.org.uk/benefits/sick-or-disabled-people-and-carers/employment-and-support-allowance/problems-with-esa/challenging-an-esa-decision/

You should include medical evidence when you do this. Get a Patient Summary Record for her - you can ask the GP receptionist for this and it's free. (Assume you have POA or other authority to talk to her GP on her behalf - if not she will obviously need to ask or authorise your request.)

At my branch of citizens advice we have limited resources and don't tend to help with MR requests as many are unsuccessful, unfortunately. However, it is worth contacting your local citizens advice to ask. If your MR is unsuccessful you can then appeal at tribunal and it is most definitely worth getting citizens advice or another benefit specialist organisation to help with it.

Assume she has been claiming Housing Benefit to cover her rent? This will stop now her ESA has stopped. You can contact the council and ask them to reinstate it; they'll most probably ask for more information including bank statements.

Given that her only income now will be PIP, she probably does need to claim UC. Unfortunately she will just get the standard rate unless/until she can get the WCA decision overturned. At that point they can then treat it as if she had a live ESA claim when she claimed UC, which means she'll get some transitional protection, and her "unfit for work" status will be applied without needing another assessment.

If she can manage without UC just until she gets the MR decision back, it might be worth waiting for that.

If you think your ESA decision is wrong - mandatory reconsideration

How to challenge a decision about your ESA, what is mandatory reconsideration, what to put in your letter, what to do if you miss the deadline, how to appeal.

https://www.citizensadvice.org.uk/benefits/sick-or-disabled-people-and-carers/employment-and-support-allowance/problems-with-esa/challenging-an-esa-decision/

DazzlingCuckoos · 10/04/2025 15:46

Aknifewith16blades · 10/04/2025 12:43

OP, for support and guidence for you, you might find it helpful to check out https://www.sibs.org.uk/

Thanks for sharing this. I've just applied to join the facebook group.

I don't currently have any responsibilities for my sister as my parents are currently able to do this, but one day I will need to take over POA, etc, so I think this group will be a massive support and I'll learn a lot in the meantime.

Fairyladyonwheels · 10/04/2025 17:09

Definitely appeal. My sister's husband has dsypaxia and gets the highest pip and classed as able bodied. I am surprised he got the highest pip as he works, owns his place and can do things. Crazy system.