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

@AnotherEmma I will keep copies thanks for the reminder. I have so much going on in my head I may have not remembered.

Hi, I'm on ESA too in the support group, so I know a little about it. I have also had to appeal PIP and won after they took me off it similar to yours. I also have something similar to endo...anyway if it helps any how it worked with PIP was that they can't just take it off you, but they have to show there has been a 'change in circumstances' or that some thing does not apply anymore (for example in the ranking which you got before) -

some things which may help you specifically would be a medical report which you can ask for when they originally gave you ESA. This is called ESA85- ring ESA and ask them for it or you can get it in the appeal bundle. You can then say how things are still the same -

also because you had it originally it may well be the new assessment clashes with the info there, this happened with my PIP.

What else? Oh, keep to times so I think it is 4 weeks to do an MR and after that to appeal. There are guides to this or you can just ask for it over the phone or write.

It would also be useful for you to know about whether you are on contribution based or income related and in support group or work related. as the income one is changing to UC but the other one is not.

Complicated, but hope you get there, just keep going and ignore the rubbish.

@Orangeblossom78 ah right, seems to be happening quite a lot doesn't it. Nothing has changed in my conditions except the last time I had an assessment done I was pregnant and was having problems and had a catheter in etc. I was put into the support group after that assessment. But I have been on ESA even long before that for the same issues I have now and have always got it no problem. It was the man that done this latest assessment that just didn't listen, thought he knew better than the gynecologist and saying my medication was wrong. Wouldn't let me elaborate at all on my condition as it varies but I have more bad days than good. And then I've ended up with zero points. I'm absolutely baffled by it. Not sure if its cos I was worse at my previous assessment when I was pregnant or not but to be awarded zero was shocking. I actually do have a copy of my previous assessment but as I was pregnant it maybe wont help at the moment as circumstances were slightly different.

I have 9 points now which I was given over the phone so I need 6 more.

When you say the new assessment could clash with the info there, how do you mean?

Mine is income related. Yes I know it's very stressful isnt it. Its not helping my anxiety and depression put it that way!

@AnotherEmma ( thanks for all you do) and anyone else who is interested in Citizens Advice.

Each local Citizens Advice is an independent charity, which means that the services they're able to offer vary considerably due to the funding they're able to secure. So, some will be able to take on benefit appeals and others won't.

Due to the nature of the service they attract very few donations. (notable exception is the lovely Martin Lewis who is a big fan). Frequently, funders are reluctant to allow local Citizens Advice services to help people outside of the local area.

This is why some of them are harder to get through to than others.

@Catmint agreed!! she has helped me a lot on this thread. So grateful for all help I've had so far as I just didn't know where to turn in this situation.

What I mean is that this new guy might not have read all the stuff that came with your original award so this looks bad for them. For example with mine, they said silly things like 'no formal diagnosis' (as they hadn't read the previous consultants letters just the more recent stuff) which was an obvious mistake, so things like that can help you as they look bad (good for you) - so having it before is a good thing, in a way.

Yes it may be just that their support group category has changed or something, I was in this 'risk' group (work could cause risk to health) but they changed the rules for it and it meant I didn't fit in it anymore, (but did another one)

If you are in the support group it is not about points just a category. The 15 points is for the working related group.

Also as they have given you these 9 points they do agree you have stuff wrong and should get it on appeal / MR...best of luck

If you have a copy what does it say on there?

@Orangeblossom78 ah right I'm with you now. Well I seriously hope you're right and it does make that assessor look bad. Even just the fact he awarded me zero points but yet I was awarded points over the phone makes a mockery of the whole thing in my opinion.

Before I was pregnant and had such a problem pregnancy I was in the work related group. Think I was put into the support group because of my pregnancy and the problems I had, but ironically I had those problems due to my existing endometriosis condition. At this latest assessment I maybe expected to be taken back off the support group or something but not to be awarded any points at all.

I dont have a copy of my latest assessment they haven't sent it so I'll be chasing that up, but it's a copy of my last assessment when I was pregnant I have so the circumstances are a bit different in that. Can you request even older copies of your previous assessments or just the last one you had done?

Thanks for your help I do hope you're right and it goes in my favour. I'm stressed and anxious already and I haven't even began to challenge it yet.

Yes you can and you will also get any copies of it if you appeal- you can also ask for something called a SAR which means they send you all paperwork.

basically having these previous assessments should be helpful as builds a picture of you having problems for a long time- not just when pregnant- and hopefully it may get sorted before appeal.

@Orangeblossom78 fab thank you, I have just been onto Gov.uk and requested this information online. They have one month to send me it. Thank you for that

Yes there is this form you can send, to data information team mark it something like that.

it all takes ages so maybe in meantime get a benefit check from CAB and make sure you are getting all the UC or other things you are entitled to to tide you over, as well. good luck.

@Orangeblossom78 thank you, I am seeing someone from CAB on Wednesday which I'm pleased about.

Yes Its great i could apply online for it I just had to type in my details and what I wanted from them and dates etc, easier and quicker than having to write to them or phoning and been on hold for half an hour.

Just went on here:

www.gov.uk/guidance/request-your-personal-information-from-the-department-for-work-and-pensions

Hi, you have had some excellent advice on here and I just wanted to add something. One of the WCA exceptional conditions that requires no points to pass is whether there is a substantial risk to your (or anyone else's) mental or physical health should you be found fit for work.
Interestingly the another one is if you are awaiting, receiving or recovering from cancer treatment.
If you are at risk of deterioration of any of your conditions as a result of this decision or being found capable of work then this will apply and you will pass 🤞🏻🤞🏻🤞🏻.
This, in addition to medical evidence to support that should work without needing any extra points, but if you get them too it all gives you a better chance of a pass as you are already close with 9 points.
I think you have a very good chance of winning an appeal, with the right words ie: risk of deterioration, and supporting evidence, you might even get it changed at MR stage.
Good luck
Ex WCA DM x

You can and should appeal.
You can get PIP even if you’re working!
You can excellent advice here : fightback4justice.co.uk
You can get ESA while you are appealing but it’s ONLY the s8ngle persons allowance, all others stop, u til decision is amended.
And the person on the phone, likely wasn’t medically qualified, so ask for the decision in writing, to use against them.

Also if applying for PIP and have ESA can use that info in regard for evidence for PIP...(the ESA medical report) they are meant to be combining the two but still good plan to send copy of reports to the other one- they do use it (usually) but definitely be good for appeal.

PS Appeals success rate for ESA and PIP now 75%

www.disabilityrightsuk.org/news/2019/september/pip-and-esa-appeal-success-rate-now-75-cent

Bringmegin there have been some changes to the risk category by DWP around 2015 to make it less easy to pass which may apply to the OP- might need to check but it seems to be changing all the time.

If we're talking statistics, the most recent ones (for ESA) are:
Mandatory Reconsideration: 15% successful (66% WRAG & 34% SG)
Appeal (tribunal): 64% successful (95% WRAG & 5% SG)

However, statistics are only useful up to a point. As already discussed, it depends on the individual case.

PS Source
assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/831104/esa-wca-summary-september-2019.pdf

@BringmeGin thank you, not too sure if this applies to me or not tbh. I'm hoping to find out more when I speak to CAB and also when i can get an appointment to see the benefits advice service which won't be for a few weeks yet as they are really backed up with appointments but at least they'll be able to help me if/when ut gets to tribunal stage.

@user1486131602 no the person on the phone wasn't medically qualified he told me he wasn't, hes the one that awarded me the 9 points though which is just crazy because the person who is supposed to be medically qualified ignored everything I said and gave me 0 points lol. Absolute madness!!

Got a lot to do by the look of it. Not gonna be easy but I need to fight for this. Pisses me off as I know of people on these benefits and there is nothing wrong with them they are just milking the system, they drink alcohol an walk the street with a can in their hand even on a morning. Whereas I am genuinely struggling with a real condition often struggling to even move when the pain is that bad, and I have a 2 year old too. It's all so so wrong. This system stinks!

I don't know about the people you know. But I have come across plenty of alcoholics who claim ESA and PIP. Alcoholism is an illness and it causes a huge amount of secondary health problems.

These are just people I see living close to where I live. They are on drugs and drink, you sometimes see some of them hobbling with a stick like they are finding it difficult to walk but then 2 of them got into a fight in the street and all of a sudden the stick became irrelevant and he even started running down the street after the other bloke at one point.

It's a bit of a sore subject with me as when I had breast cancer they denied me any benefit as they said my treatment was going to be less than 6 months. So I had to force myself to go back to work within 8 weeks of finishing chemo. I was really poorly and I collapsed at work, but then I seen a man and a woman in my gp waiting area saying they couldn't wait to go and draw their benefits out of the bank to go buy some smack needless to say i was infuriated the fact a cancer patient was refused it and those people had it.

If you want to read the most recent guidance on assessing people it is online if that helps any. It tells you what they look for etc

assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/777221/wca-handbook.pdf

@Orangeblossom78 that's great thank you