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ESA Reconsideration

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7 years 3 weeks ago #182679 by Betsy
ESA Reconsideration was created by Betsy
:unsure:
Firstly, thank you for this excellent site and forum. I am supporting my sister who has a number of mental health issues. She had been on ESA in the support group for 2 years but has now, having had to reapply been put in the WRAG group. the decision letter was dated the 6th Feb and we wrote requesting a mandatory reconsideration on the 15th Feb.we stated that there would be further evidence to follow.

Prior to submitting her claim and subsequently her mental health worsened and she started self harming more frequently, we discovered that she hadn't seen her GP for months. I made her an appt. and took her, the GP made an urgent referral back to the mental health team and we saw them on the 2nd Feb. I am confused as to whether we can use this as evidence as we have requested a supporting letter from the mental health team and her GP, but it was after her form was submitted and after the medical but before the date of the decision.

We have received the medical report and need to correct some of what has been written but are still waiting for the written statement of reasons. I did chase this up a couple of days ago and was told it had been requested but most people just use the medical report, I requested an extension of the month, but was told it wasn't possible - is that correct ?

Thank you in advance for your help and apologies for my long winded questions but as my sister can't go out on her own and won't use the phone or see friends or family at the moment I am trying to make it as least stressful as possible for her.

Betsy

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7 years 3 weeks ago #182691 by Gordon
Replied by Gordon on topic ESA Reconsideration
Betsy

Strictly a change of condition after the Decision is made is excluded from any MR or appeal, however, you say that she was affected before she returned the form, would there GP be in a position to confirm this, even if they did not see her before the Decision was made they may be able to state with reasonable assurity that the change occurred before the Decision.

Do you know she qualified for the SG previously? If was Regulation 35 then the DWP guidance on this has changed in the last year and this may be why she has only qualified for the WRAG this time, see the ESA Claim guide for more details.

I know it can be tempting to deal with the assessment report first, but she will only be moved back to the SG by you/her showing that she meets one or more of the SG Descriptors.

If you have further questions then please reply to this post and we will do our best to help.

Gordon

Nothing on this board constitutes legal advice - always consult a professional about specific problems

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7 years 3 weeks ago #182698 by Betsy
Replied by Betsy on topic ESA Reconsideration
Hello
Thank you for your quick response, she definately saw the GP and mental health team before the decision and can get evidence of this and I think we might be able to get proof she was still unwell prior to completing the form. Looking at the medical report the Health Care Professional struggles between Reg 29 and 35, I think that Reg 35 might be more appropriate, so can we state why we think that, then the descriptor and the assessment or is that too much ?.......... there is definately 1 of the SG descriptors that is relevant. Can we ask for an extension as we are waiting for evidence as I was told yesterday that we couldn't. Thanks again for all your help.
Betsy

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7 years 3 weeks ago #182720 by Gordon
Replied by Gordon on topic ESA Reconsideration
Betsy

You should be given four weeks from 15 February to submit any additional information, but you need to send it earlier if at all possible.

It will be Reg. 35 if applicable,.29 relates to the WRAG.

There's no problem with you stating what Descriptors your sister meets and why but you do need to be careful, the ESA Descriptors and Reg.35 in particular have multiple elements and you sister must show that she meets all of these to meet the general requirement. Also, take the words of the Descriptors literally, one of the most common causes of claimants failing to meet the requirements for ESA is that they start to interpret the Descriptors to fit their conditions.

Reg. 35 is covered under Substantial Risk in the ESA Claim guides.

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7 years 2 weeks ago #183249 by Betsy
Replied by Betsy on topic ESA Reconsideration
Hello and thanks for your advice so far. We have started to put together the MR and only stated actual facts that were incorrect on the HCP report, such as, 'she takes no painkillers' ( my sister does daily ) and she has and uses 2 phones ( she doesn't ever use a phone ) and that she refused a physical examination( she wasn't offered one) etc. Is it ok to point those out ?

We have then concentrated on Reg 35 and the descriptors. My worry is that we still haven't had the DM statement of reasons and therefore the only idea of the scoring is by using the medical report. I have rung and requested it and followed it up in writing and rang again today to be told that everything needed to be back with them by the 6th March which is one month from the decision. As you know we requested the MR on the 15th Feb and said we had further evidence etc. I questioned the date when on the phone but she was adamant everything had to be back by the 6th March....even though we haven't seen the statement of reasons and my sisters GP and Consultant haven't prepared their reports yet (half term etc.).....

Do we just send whatever we have got ? or ask to talk to a manager ? or have I just got confused-easily done for me :laugh:

Thanks again
Betsy

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7 years 2 weeks ago #183277 by Gordon
Replied by Gordon on topic ESA Reconsideration
Betsy

You can try ringing again, you may well get a different answer, but if not then you need to send what you have now, I'm afraid the DWP are law unto themselves in regard to MRs.

Gordon

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