My ESA has been stopped after medical assessment. Should I appeal?

[JoJo2106]

Hi (Apologies if this is a bit long but really need some help/advice)

I have been on ESA benefit for quite a while now, I have had numerous problems with my health for the last few years and been unable to work. I had breast cancer a few years ago (lumpectomy, mastectomy, chemotherapy etc) recovered slowly after this horrible time in my life. Then about a year or 2 after this I developed endometriosis and adenomyosis which was diagnosed during a laparoscopy. Unfortunately I can't have treatment for this the way they would treat it normally with trying various hormone treatments as my breast cancer was positive for hormones so not allowed anything for the rest of my life containing hormones. I have suffered a great deal of pain with this for quite a while now and it rules my life. I have had surgery a couple of times to try and excise it but still been left in pain. I very very unexpectedly fell pregnant at the end of 2016 and had my little boy Sept 2017. He is a real miracle baby as due to all my health issues he really by rights shouldn't be here buy somehow he is smile.

My endometriosis returned a while after giving birth and am still in a lot of pain with it. And a lot of the time I do need help from my mum as I'm in a great deal of pain an struggle to do things or sometimes even move.

Anyway I have been exactly the same and nothing has changed in my condition at all in fact it's slightly worse since I've had my son. But I attended a medical assessment for my ESA last month and the man who done this was not nice at all. He wouldn't really let me elaborate on anything to explain how my condition affects my life on a daily basis. He seemed to think he knew more than my gynaecologist who is a specialist in his field. Told me my medication I take wasnt good enough and "isnt really a painkiller" even though this has been prescribed by my gynae? I came away very frustrated. I had a phone call on Wednesday to tell me the decision, the man on the phone basically told me I had been awarded ZERO points at my assessment (you need 15 to be on ESA). How can I be awarded 0 points when my condition is still the same if not worse now? I was also told the assessor had ignored a lot of stuff I had tried to say, changed things I had said and also said I got up onto the couch to be examined. This didn't happen and I wasn't examined.

The man on the phone then asked if there was anything I disagreed with so obviously I told him the things I've just explained above. He said give me an hour I will phone you back with the decision. Phoned me back and he then said he had awarded me 9 points as the assessor seemed to have missed that part. Bearing in mind I was awarded 0 points by been seen in person then all of a sudden I am awarded 9 points over the phone? I needed 15 points to stay on ESA so am 6 short so they have stopped my ESA now.

I would just like to know if this mockery of an assessment and the fact I've gone from 0-9 points just over the phone is good grounds to appeal this decision? I am getting a written letter from my gynecologist am also something from mental health team as I suffer with anxiety and depression also. I am now on my own with a 2 year old with barely any money 9 weeks before Christmas and dont really know what to do. How likely Is it I could win my appeal if I do appeal this.

Thanks so much for reading x

This is helpful:
www.citizensadvice.org.uk/benefits/sick-or-disabled-people-and-carers/employment-and-support-allowance/while-youre-getting-esa/esa-money-and-benefits-during-reconsideration/

@AnotherEmma thank you for going into so much detail I really appreciate it. I have just had a look on Google about PIP and you could be right as a lot of what is mentioned I do get help with when I am in a lot of pain. Might be worth looking into this further thank you.

Yes I get CTC, child benefit and also child maintenance from my sons father.

The thought of going to another medical assessment after experiencing that horrible man sends my anxiety through the roof. Imagine if I got the same man for my PIP assessment lol.

I fully get what you are saying about hanging back and not applying for UC as yet. I think I could possibly manage on what I have, although it could be tight but its doable at a push I think. I was completely unaware I could still get ESA while waiting for appeal so thank you for that.

You've been really helpful. Thank you

You're very welcome. It's my day job but I'm so passionate about it that I end up posting about it on mumsnet too

I do understand not wanting to go through another assessment but I assure you it WON'T be the same person!

My advice is to make the phone call to start a PIP claim - if you change your mind, you don't have to go ahead with it and send back the form. But if you do go ahead and are successful, it will be backdated.

Anyway best of luck with it all. If you post again I will be interested to know how you get on!

@JoJo2106 yes, you can. It is about halfway down the page I linked to, did it work? Here's a bit of it:

If the DWP doesn't change its decision, you can appeal the decision to an independent tribunal.

You can be paid ESA until the appeal is heard if you’re appealing a decision that found you failed the work capability assessment.

You’ll only be paid ESA if this is either:

the first time you failed the work capability assessment

the first time you’ve failed the work capability assessment since a previous decision that you met it

At that point you will also get backpay for the period of the Mandatory Reconsideration if you supply a fit note.

PIP is to cover the extra costs incurred by people who need support, assistance or aids to carry out tasks relating to daily living and/or mobility on at least half of their days. There's a lot of text on this page, but it covers all the questions and how points can be scored for each. Have a read and think about whether it would be worth putting in a claim. I'd say so; you won't lose anything by doing it (although it can be stressful, of course)

www.benefitsandwork.co.uk/personal-independence-payment-pip/pip-points-system

If you are awarded PIP daily living and you do get your ESA reinstated, you may be entitled to have a premium added to your ESA that is not available on UC. A lot of things will have to happen for you to get it, but it is worth considering the possibility before jumping to UC. Having to go without income for the MR period is shit, though.

@AnotherEmma I can tell you are lol. I'm so glad I posted on here now as I did hesitate at first but I've found out very helpful info. Definitely not going to apply for UC. Not yet at least until I know what's what.

I will look into the PIP claim aswell.

Will definitely let you know how I get on, Thank you again x

Just realised that I'm just telling you the same things as AnotherEmma That's what happens when it takes me so long to type messages and I don't refresh the page before finally pressing send. Anyway, good luck with it.

@flourella I actually think I've been getting confused between the 2 of you as you've both said similar stuff lol. Thank you for all your help I never expected to find out so much just by posting on here. Just had a look at the link you posted and I did the mock PIP test and the outcome was I would be entitled to it judging by my answers. So its definitely worth looking at. Although yes its more stress lol.

So if I get a fit note from the doctor they can also pay me while I'm awaiting the mandatory reconsideration? When would I have to get this fit note would I have to include it with my info for the mandatory reconsideration?

@flourella ahh just realised it says on the link you posted earlier that you won't get ESA while waiting for a mandatory reconsideration if the following applies:

You won't get any ESA payments while you're asking for a mandatory reconsideration if you were told you couldn't get ESA because:

you didn't score enough points at your medical

Damn!

@JoJo2106 If the DWP do not change their mind at MR you will get ESA back until the tribunal, and if you can get a fit note for the period between your money stopping and the MR decision, they will award back pay. But unfortunately there will be several weeks without payment.

@flourella thank you for that its really good to know all of this. So should I get the fit note asap so I have it or wait until I apply back for the mandatory reconsideration?

That's a good question! The CAB page makes it sound as though you get it after the MR and have it backdated to cover the weeks since your money stopped. But you should ask an expert like AnotherEmma to be sure! I'm just a fellow claimant and I've luckily never had to appeal.

About the PIP self test: it's easy to over-score yourself (I did! But still got an award) but doing it is useful because it familiarises you with the descriptors and which ones you might meet. Have a look at this link as well and think about how well you can manage each task in the context of these reliability criteria. Even if you can do something without aids or assistance, if you can't do it reliably you can still be awarded points

www.mypipassessment.co.uk/news/what-are-the-reliability-criteria-that-are-used-during-the-pip-assessment/

If you are going to appeal and can manage while your mandatory reconsideration is decided on. DO NOT APPPY FOR UNIVERSAL CREDIT. if you apply you can't go back to being on ESA even if you win your appeal.

One your appeal is lodged you can receive the assessment rate if ESA while you are waiting for the appeal to be heard.

Send in medical evidence with your MR. As much as you can. It won't be successful without evidence. But don't delay getting it in as you won't receive any money while you are waiting for MR decision , you only get it at appeal stage.

If you don't have medical evidence for the MR you will have plenty of time to get it together and send it in when you appeal. You can do this at any time prior to the appeal date (a few dats before at least).

Get a copy of the assessment report, go through it & pick all the discrepancies, then write a letter promising all the discrepancies & the correct information, supply medical evidence if you can, this is your mandatory reconsideration, you have 28 days from the decision to contact the DWP to tell them you want them to look at the decision again & 28 days from the date you tell them to send the information in. If this gets turned down, complete the online application to appeal, the DWP then has 28 days to check everything & send it off to the tribunal service, lots of people are winning at this stage, otherwise you have to wait for a hearing date which at the moment is around a year. Contact your MP & ask them to support you, send them a copy of your assessment report, your letter turning down your claim & any other correspondence.

An MP is not the best person to help with this Citizens Advice or a similar organisation (welfare benefits advice) are much better placed.

"So should I get the fit note asap so I have it or wait until I apply back for the mandatory reconsideration?"
I don't actually know (this is benefit specialist territory and I'd be handing over to them at appeal stage) but I should think it would be sensible to get fit notes now because I don't know if GPs can issue them retrospectively. You'll need fit notes to cover the period from the day your ESA is/was stopped until you get your MRN (Mandatory Reconsideration Notice) and can submit the first appeal form. I think you would send them in with the form.

For now though I suggest you focus on starting the PIP claim and getting some evidence (as much as you can get together quickly - don't worry if you can't get it all) so you can send off your MR request ASAP. If your evidence is strong you might well be lucky and succeed at MR stage.

Good advice from a PP to request a copy of your assessment report. If you get that you could quote bits of it that are wrong. It's not essential at MR stage though so only do it if you can or if you are getting help from someone who can.

Thanks so much to everyone for all advice it's been really really helpful.

Reading through the various comments about Universal Credit I have definitely decided I will not be applying for this now. Am going to try and cope on what I have and hopefully an appeal will be successful if the mandatory reconsideration is not. I can only hope.

@AnotherEmma yes I just remembered this morning that a lady from the citizens advice comes every Wednesday to a local womens help centre sort of place we have here, I have managed to get an appointment for Wednesday afternoon to see her which I'm pleased about. I have just received my letter in the post also with my decision from ESA so now I have this I can get the wheels in motion. Although the man on the phone said he would send me a copy of my assessment but that hasn't came. Might have to chase that up again.

In your personal opinion though, the fact that the health care professional who did my health care assessment ignored a lot of what I said and did not note down what I said either and awarded me 0 points but then i was awarded 9 over the phone by someone who never even saw me, could this help my case the fact that my issues and assessment were not dealt with appropriately? The decision maker even wrote in the letter i got this morning that certain things had seemed to be 'ignored' by the health care professional.

I will ring my gp on Monday morning and ask about a fit note, do you know if this is something I will have to get repeatedly or can it cover you for say a couple of months?

I will definitely be looking into a PIP claim also.

I would have surgery to have it all removed as it's not going to improve and could well spread throughout the abdomen making the situation worse. Hope things improve for you, endometriosis is just an awful under reported and misunderstood condition.

@yellowallpaper I have had surgery twice to remove it and it never helps I am still in pain after. The problem is I have adenomyosis aswell which is basically endometriosis inside my womb. I am on the waiting list again for surgery to try excision surgery again. Worst bit is I cant be treated for it I can only have surgery because of my breast cancer diagnosis.

No its not nice at all. In some countries endometriosis is recognised as a disability, but unfortunately not in the UK as yet.

Anotheremma Getting support from your MP gives your appeal extra weight, yes use either CAB or a welfare support worker, but if you have supporting letters from your MP often means that your claim will be looked at by a higher grade officer, be dealt with quicker & more efficiently & often the MP can take your case to the parliamentary group for welfare benefits who can help to get decisions overturned. Mine was taken by my MP to the parliamentary group meeting & within 2 weeks my award was reinstated, she also complained to the DWP & the assessment company. The only way things will change is through parliament & unless the MP's know what is happening, they can't raise it in parliament.

"could this help my case the fact that my issues and assessment were not dealt with appropriately?"
I've typed an answer to this and then deleted it! The thing is that I don't do appeals myself so I don't know for sure. It does seem unusual that the decision maker conceded that the assessor missed things, and that should work in your favour. I am sure that if you have some medical evidence to support your case, you will be in a strong position. If you can get a letter from your gynaecologist that would be very helpful. (Ideally it would cover the criteria for ESA and PIP so you can use it for both.) A quick and easy "win" is to ask the receptionist at your GP surgery to print your Patient Summary Record. It won't have the detail that your gynaecologist can provide but should still be helpful.

"I will ring my gp on Monday morning and ask about a fit note, do you know if this is something I will have to get repeatedly or can it cover you for say a couple of months?"
As far as I'm aware, this is at the discretion of your GP, it depends on your health condition(s) and how long they think you are likely to be unfit for work before they need to see you again to issue a new one.

@Nat6999
Fair enough! I'm glad that your MP was so incredibly helpful. (Labour, by any chance?!)
I expect some MPs will be more helpful than others, worth asking but I wouldn't count on it unless you have a good MP.

@AnotherEmma yes I found it very strange tbh, I have never had anything like that happen before as in awarding the points over the phone because the assessor missed something. I am hoping that does work in my favour.

I will ask when I go to see the gp about my patient summary record, thanks for that. Yes am hoping to get something soon from my gynaecologist, I left a message for his secretary, she was off work until Monday so fingers crossed this helps. I do have some other letters aswell from him but they are old letters from around 3 years ago, but it does go into detail about my condition and how it is a chronic debilitating condition and it stops me from working etc. Do you think I should send a copy in with my mandatory reconsideration even though it's an old letter? Suppose it shows how long I've suffered for aswell. Or is that not a good idea? So confused what to do for the best lol.

If you can't get a new letter from your gynae within a week or so, I advise you to send off the CRMR1 with your patient summary record and the old gynae letter(s) - whatever is most recent and/or relevant - but send in your new gynae letter as soon as you get it. There is space on the form to tell them that you will be sending more medical evidence later.

@Nat6999 yes I intend to go through the report and pick out anything that's wrong or he missed etc. Wow a year to wait to go on front of a tribunal? So I could be waiting a year to actually appeal this decision?

(Also, sorry if this is obvious, but do keep a copy of everything you send - the CRMR1 form and all medical evidence.)

@AnotherEmma thank you. I also have letters from the mental health service also I plan to send in as I have suffered with anxiety and depression for a lot of years on and off which also affects my life, again some of these are older letters too but are relevant so just gonna send them anyway as it explains my issues etc.