Transcript PIP Part 3 - Mutual Support

PIP/ESA Problems, Challenges
and Appeals
Receiving The Decision
• Decisions on entitlement to benefit are made by a DWP
Decision Maker (called Case Managers in PIP). They are not
medically trained, and do not specialise in any particular
condition.
• To decide on a claim they use all the evidence available
– the claim form you filled in
– the assessment report
– any reports from your doctors/nurses the DWP may have
requested
– any extra evidence that you might have supplied
• You will be notified of any decision in writing, although a
decision maker may phone you to explain the decision before
its is sent out.
How Many Appeals Are Successful?
Tribunal statistics (2011–2012)
• There were 380,000 benefit appeals made in the year
2011 – 2012
• 83,000 DLA appeals
• 41% of DLA appeals were overturned in client’s favour
• 181,000 ESA appeals
• 42% of ESA appeals were overturned in client’s favour
• 793,000 ‘fit for work/not entitled to ESA’ decisions
were made from October 2008 to February 2012
• Almost 17% of those decisions have been successfully
overturned by the claimant
What Do I do If I Disagree?
• Ask for further information. If you get an
explanation of why they made their decision you
may realise that the DWP are missing an
important piece of evidence
• Ask the DWP to reconsider their decision. Send
them any extra evidence you have. Make sure you
explain how the evidence relates to the qualifying
conditions of the benefit you are applying for
• APPEAL
• SEEK ADVICE
Appealing Against an ESA Decision
• If your application has been rejected by the DWP,
or you disagree with their decision about your
capability for work, you can appeal.
• There are now 3 levels of appeal.
• The timeframe for appeal is very short, you need
to process your appeal very quickly. I would
suggest that when you send in your ESA
application, you start to prepare your case for
appeal – evidence (preferably new evidence) is
essential.
Appealing Against an ESA Decision
• Details of how to appeal will be included with the
decision letter you receive from the DWP.
• First Level of Appeal – Reconsideration.
• Write to the DWP and request a reconsideration
of the Decision Maker’s ‘Decision’.
• You should provide additional evidence at this
stage, particularly if you omitted anything in your
original application.
• KEEP COPIES OF EVERYTHING! Send your letter
by Recorded Delivery so you can show that you
appealed within the 1 month limit!
Appealing Against an ESA Decision
• Reconsiderations can take up to 11 weeks,
possibly even more.
• You will get a letter from the DWP saying they
are reconsidering your application.
• Assume the reconsideration will fail – start to
assemble a body of evidence to take to the
First Tier Appeal – you won’t get a better
opportunity to do this.
Appealing Against an ESA Decision
• SECOND LEVEL OF APPEAL – First Tier Tribunal
• If you wish to against the DWP’S Reconsideration
rejection:
• Write to the DWP and within one month – allow
for postal delays – DWP uses 2nd Class Mail – up
to 5 days.
• You will receive a GL24 appeal form. Once you
have returned the completed GL24 + evidence
you will receive further information about the
appeal.
Appealing Against an ESA Decision
• To be able to appeal through this route, you will
need to examine minutely the ‘Descriptors’ in
your original application to see how they apply to
your condition, and provide concrete evidence to
support this.
• First Tier Tribunal appeals mean that you will
have a tribunal hearing. The tribunal will include
a doctor and a judge (barrister or solicitor). You
may receive the decision on the day, or they may
write to you with the decision.
Appealing Against an ESA Decision
• Third Level of Appeal – the upper tribunal.
• This level of appeal only applies if there is
evidence that the first tier tribunal made an ‘error
of law’ when considering your appeal.
• An example would be that the first tier tribunal
had, or did not make use of, an evidential basis
for its decision.
• At this stage you cannot ask for additional
evidence to be considered.
• There is no other legal avenue left to you.