Help re: appeal paperwork

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Help re: appeal paperwork

Postby JimS » Mon May 06, 2013 12:55 pm

Hi Guys

I am suffering mental fog at the moment so the answers might already be here but I cant get my head around finding them.

Basically last year after a atos medical I was placed in the work related activities group.
I immediately with the help of my then local CABs welfare rights officer put in a appeal to be placed in to a support group which as you know is reviewed by DWP and if unsuccessful goes to the tribunal.

Since then I have moved to a different part of the country.

After several calls over 6 months to DWP they finally got round to reviewing my documents and said they would not change their findings and that I had to go forward to the tribunal.
So I got in touch with my local CAB and asked if they could help like my previous CAB helped me.
After waiting a month for an appointment they have now told me they are to short staffed to help me so I will have to obtain medical evidence etc myself and go to the tribunal on my own

So thats seven months of my one year before they stop my benefits wasted.

This is where the panic attacks come in to play and the mental fog.

Can any one please tell me what documents I need to send to my Dr to ask for medical information are there any forms/questionaires I need to send to him to be completed.

If there are any forms etc does anyone know where I can download them also what do I put in to the letter to the Dr.

I hope someone can advise me before I go completely dolallytap

Cheers Jim
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Re: Help re: appeal paperwork

Postby FluppyPuffy » Mon May 06, 2013 1:39 pm

It's basically everything and anything that you think will help support your case Jim. There have been mentions on here of copies of letters regarding different appts with and responses from specialists, clinics, therapists that people have seen. Statements from people who are regularly and actively involved in your care may help. To find out what might be helpful from your GP, giving your surgery a call and speaking to the admin staff might be somewhere to start, they might be able to give you an idea of the sort of things to discuss with your GP that could be included to give you the bestest fighting chance possible.

Another thought......have you had a look to see who else in your area might be able to help you with your appeal. If Googlying your area and benefits advice/help doesn't throw anything up, you could try contacting your local council as they tend to have the details of such groups and organisations in your area.

I'm sure there a lots of other things I should be including as well, but even tho it's glorious sunshine here at the moment, the fog doesn't want to leave my head either :oops: :oops: :oops: :oops: :oops:
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Re: Help re: appeal paperwork

Postby anonymouse » Mon May 06, 2013 2:02 pm

Hi JimS,

Try to take it one step at a time, when they send you tribunal notification you have 14 days to respond and a further 14 days to submit a case. It is best ti get copies of everything medically since diagnosis if you can however I know you mention going to your GP to get a specific report. I have not got any sample letters at the moment but depending on how helpful your GP is you may not need any. Looking at the law on the subject I'm unsure if you will be tested against the 2013 amendments or 2012 so I will go for the most up to date stuff regarding the support group:

The legislation this decision is based on is Regulation 30 of The Employment and Support Allowance Regulations 2013 which states:

“By reason of a claimant’s physical or mental condition, at least one of the descriptors set out in Schedule 3 applies to the claimant, the claimant has limited capability for work-related activity and the limitation must be such that it is not reasonable to require that claimant to undertake such activity. 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 the occasions on which the claimant undertakes or attempts to undertake the activity described by that descriptor.”

You now need to read the “descriptors” in The Employment and Support Allowance Regulations 2013 SCHEDULE 3 and decide if you meet any of these criteria.If you believe you meet one of these “descriptors” and you believe you should be treated as having “limited capability for work related activity” then you can choose to appeal. I would then read the rest of Regulation 30 of The Employment and Support Allowance Regulations 2013 as it contains a little more detail of exactly how to apply the “descriptors” depending on your level of capability.

You should write your appeal along these lines: “I believe that I should be treated as having limited capability for work related activity as [Descriptor Number(s) and Name(s)] in Schedule 3 of Employment and Support Allowance Regulations 2013 apply to me and my condition. This is because I am not able to do [Descriptor] under the circumstances outlined in Regulation 30 of The Employment and Support Allowance Regulations 2013″

What I would also do (if you have a helpful GP) is take a print out of regulation 30 and schedule 3 to your GP and tell him you have to get medical evidence specifically proving one of these discriptors applies to you. There is another rare but of legislation to get into the support group which I have used before to tribunals and I will dig this out for you. Oh and just copy and paste the titles for the legislation into google and you should find them quickly.

Really hope it helps
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Re: Help re: appeal paperwork

Postby anonymouse » Mon May 06, 2013 2:56 pm

Hi again, I have some information on the other way into the support group for you. It is the "Regulation 31 argument" as I call it:

There is a further piece of legislation that I have used before to appeal against someone being deemed not to have Limited Capability for Work Related Activity. It is very rare that this will apply to your case and your Fibromyalgia must be quite severe for this to apply, however you need to be aware of this section so you can decide if this applies to you. The Employment and Support Allowance Regulations 2013 Regulation 31 (2) states:

A claimant who does not have limited capability for work-related activity as determined in accordance with regulation 30(1) is to be treated as having limited capability for work-related activity if—

(a) the claimant suffers from some specific disease or bodily or mental disablement; and

(b) by reason of such disease or disablement, there would be a substantial risk to the mental or physical health of any person if the claimant were found not to have limited capability for work-related activity.


So first of all, in part (a), the claimant must suffer from some sort of specific disease or bodily or mental disablement. My interpretation of that legislation is that Fibromyalgia would fit that criteria as Fibromyalgia is a specific condition that can be diagnosed by an accepted criteria. Secondly in part (b) because of this disease or disablement there would be a substantial risk to your health either mentally or physically if you were not found to have limited capability for work related activity. So would there be a substantial risk to your health if you were not placed in the Support Group? This section does not supply a lot of information about what would be deemed as a substantial risk to your health so it is up to you to show there would be a substantial risk and the reasons for it.

Appeals & Tribunals based on this legislation are rare, they are far more likely to be appealing a decision makers decision, a Work Capability Assessment or the main rules under Regulation 15 & 30. Therefore information about how this has been interpreted in tribunals is rare. Like any law, court decisions show how rigidly (or not) certain legislation should be applied, I do not have this information about the Regulation 31 argument. Therefore only use this if you believe you can prove a substantial risk to your mental or physical health and also try and submit an argument about Regulation 15 & 30 if it should be found that 31 does not apply as you may need a “safety net” if this argument fails.

Again I don't know if it is applicable to your your case, but if you think it might be then print it off and take it with you. A doctors letter saying he believes as substantial risk..... Would be a powerful piece of evidence in your case. I wish you the best of luck with your case, take things step by step and if you can have a read through the regulations yourself as being able to understand the law behind ESA will be very useful to you.

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Re: Help re: appeal paperwork

Postby JimS » Mon May 06, 2013 6:45 pm

Thank you very much for the most helpful information.

Someone/somewhere did tell me (I cant remember who) that there was a form that should be sent to the Dr for completion in which he can detail my health problems, does anyone know if this is correct.

I do believe I meet one of the descriptors (bowel control) so hopefully I can get a useful report off my new Dr.

I just cant get my head around writing the letter for some reason, I know it sounds stupid as I am capable of writing this email.
Its just the stress which brings on the depression which brings on the fog etc etc etc.

Thanks again for the help.

Cheers Jim
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Re: Help re: appeal paperwork

Postby anonymouse » Mon May 06, 2013 8:19 pm

Hi Jim,

Thanks for your post and good news about the descriptors. Its always worth putting something in about the WRAG group so if the decline your support Group claim they at least give you WRAG status even though I know its not what you want, its only a safety net. WRAG is regulation 15 and schedule 2 of the same act.

I came across a file on my hard drive me like sample letters and stuff, I need to review to see how up to date it is then work out a way to get it to you within the forum rules. Also if you are being judged my different versions of the ESA act like 2012 and 2011 then it should say on your case file that they send you when the Tribunal gets it from DWP. If that is the case its just as easy to look them up and there are only minor differences.

I know what you mean about the stress, sometimes you know how important the decision is which leads to pressure you put on yourself then out come the symptoms, we know it oh so well! Keep looking for help with your tribunal if you can, there are charities etc and if you get a decent person on the phone from DWP they may point you in the right direction.

All the very best with the Tribunal and if you can update this thread as it all helps people here and helps me when giving out advice and I will be thrilled if you win too!

Anonymouse
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Re: Help re: appeal paperwork

Postby anonymouse » Tue May 07, 2013 12:27 am

Just a quick update Jim as I came across some info from CAB:

http://www.adviceguide.org.uk/scotland/employment_and_support_allowance_appeals_guide.pdf is the link for the guide pack they publish and http://www.adviceguide.org.uk/scotland/benefits_s/benefits_sick_or_disabled_people_and_carers_s/employment_and_support_allowance.htm is their page on ESA in full.

Anonymouse
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Re: Help re: appeal paperwork

Postby zappa20 » Tue May 07, 2013 3:59 am

If you go onto the Benefit and Work section of the Consumer Action Group forum , there is a sticky post written by one of the site team on appealing ATOS decisions . Has a rough template on how to lay out an appeal , together with general info about Tribunal panels and what happens. Might help to ahve a quick read at this and get you started.

For bowel/bladder incontinance to meet the Support group criteria , there needs to be substantial loss of control while conscious , not just leakage , such as would require a change of clothing a minimum frequency of once per week. A letter of support from your continance support nurse would greatly assist you here.

Would probably be easier to just make an appointment to go and see your your GP or surgery manager, explain you are appealing, and ask for a letter of support. There may be a charge for it. Gives you the chance to discuss what type of info you are looking for , as many GP's tend to write letters confirming dignosis and medication only. If your GP can confirm in his letter which Support descriptors you meet and why you meet them , that will be very helpful.

In your post you say there is only a few months before your 365 days are up? If you don't have a partner who works or some other form of income , after 365 days you can transfer onto ESA Income based and continue to be paid ESA in the WRAG group. Is this an option for you?
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Re: Help re: appeal paperwork

Postby JimS » Wed May 08, 2013 11:41 am

Thanks once again for the helpful information I am in the process of composing a letter its only taken 2 days so far lol.

In answer to your question zappa20 my wife works 20 hrs per week at just above minimum wage so we are entitled to no benefits once my 365 days are up unless I can get in to the support group.
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Re: Help re: appeal paperwork

Postby JimS » Wed May 08, 2013 1:39 pm

I have finally completed the letter :)

I have attached it below for any helpful comments & maybe it will be of use to anyone else who finds them selves in the same position.

Dear Dr XXXXXXXXXX

We recently discussed at one of my appointments that I currently had an appeal on going regarding my claim for ESA to get my status changed from the work related group to the support group as they will be stopping my benefits in August.

The legislation this decision is based on is Regulation 30 of The Employment and Support Allowance Regulations 2013 which states: “By reason of a claimant’s physical or mental condition, at least one of the descriptors set out in Schedule 3 applies to the claimant,

I have attached a copy of the descriptors for you.
You will see from them that I meet the criteria for section 8 of the descriptors.

I would like to ask if you are in a position to help in the matter by supplying me with medical evidence to my current health problems that I can submit towards my appeal.

It remains the case of the appeals system that I am responsible for obtaining my own medical evidence to support my claim. The appeals system therefore relies on the goodwill of my own doctor or specialist to enable me to support my appeal with medical evidence.



Yours Faithfully
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Re: Help re: appeal paperwork

Postby anonymouse » Wed May 08, 2013 2:51 pm

That sounds really good to me, well done.

You have described exactly what you need and given him the descriptor (normally in tribunals the DWP try to rubbish GP evidence by saying they do not have regard to the legislation and discriptors) so if he provides you anyone mentioning that discriptor your giving him or words it in the same way you have excellent evidence and a counter argument for the DWP as the GP has used a specific descriptor.

I hope it hasn't taken a lot out of you and I hope your GP will help you out, then it may give you a well earned "boost"

Well done
Anonymouse
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