ESA IR claim - Support Group and PIP Review

Hello Gordon,

I am currently undergoing a review for PIP and have sent off my PIP AR1 form together with additional sheets addressing the activities, up to date medical evidence, a carer's letter and a prescription list. Because the health condition for which I get PIP is the same as that for which I get ESA, I was wondering whether or not any decision maker (either at IAS or the DWP) would then look at my ESA85a (I was awarded without a f-2-f WCA). So, my question is does the basis for awarding me ESA affect whether my PIP award will be renewed, if the functional limitations have overlaps with both awards?

Looking at my ESA85a, it seems to suggest I was awarded ESA on the basis of regulation 29 and regulation 35 (I am in the Support Group with a prognosis of work within 18 months). The reason I say that is because the HCP writes she has based her decision on my med 3 (fit note I submitted), questionnaire (assume this is the ESA50 I completed) and GP letter (which explicitly states I am not considered fit for work or work related activity due to my health condition because of risk of deterioration, in spite of medication increase) but... there is no mention in the HCP's report of points being awarded for LCW or whether I met any of the Support Group descriptors. Is it usual for an HCP to make a finding of meeting the exceptional circumstances/substantial risk provisions for LCW and LCWRA without addressing whether or not I scored any points? Or, do they not consider whether I meet the points for LCW or satisfy a support group descriptor if they think there is strong enough evidence for the substantial risk provision to be met at the outset?

I suppose why I am asking this is I wonder if the fact that I had to stop working and claim ESA, when my PIP was originally awarded when I was working, helps my PIP renewal or not. I just can't work out why there is no indication of points scored for activities relating to LCW (some of which overlap with PIP descriptors) on my ESA85a because I thought that you had to satisfy getting at least 15 points before going on to consider LCWRA. And, I thought you had to not meet any Support group descriptor before the substantial risk provision under section 35 qualified you to be considered as having LCWRA.

I mention in my PIP review form that my health has deteriorated and I had to apply for ESA earlier this year and so I would expect that it might mean that a decision maker will be interested in my ESA85a report because my ESA award is for the same illness/health condition.

I've raised this query within this thread, even though it relates to PIP because I just want to understand why my ESA85a report does not refer to any points scored and if the way it is written and the advice given is standard when the exceptional circumstances/substantial risk provisions kick in.

Thank you for any help in understanding this.

Libra

Thank you Gordon.

I wasn't really querying an equivalence between regulation 29 and 35 with ESA and how PIP is awarded.

I was really asking, with regard to my ESA85a report completed by a Maximus health assessor, if the lack of reference to any points being scored for limited capability for work (LCW) or lack of reference to not meeting any Support Group Descriptors for limited capability for work related activity (LCWRA) could harm my PIP review in any way. Is it implicit in my ESA85a that I didn't meet enough points without the exceptional circumstances/substantial risk regulations being used to recommend an award? Your helpful guides do refer to the DWP using reports for either ESA or PIP to influence their decision making on either of these benefits - even though they are different benefits - if there are areas of overlap. I have read your guide on areas of overlap and in my case, there are some.

I know that under UC regulations, a health professional can award LCW and LCWRA under exceptional circumstances/substantial risk provisions at the outset without the need to consider point scoring. However, under ESA regulations, they have to consider that there are insufficient points for LCW before considering regulation 29 to award LCW under substantial risk. They can then go on to award LCWRA, under regulation 35 because obviously no support group descriptor is met.

In my ESA85a report, the HP does not mention whether or not I meet any points for LCW. There is no breakdown of the activities and descriptors as you would normally see - with reference to which descriptors do or do not apply, with points scored or nil points. There is no explicit mention that I scored insufficient points for LCW or LCWRA, either. It is as if the HP used the UC regulations rather than the ESA regulations to recommend I be placed in the Support Group under regulations 29 and 35. She says: 'I advise that the client meets the criteria for LCW and LCWRA as they are suffering from some specific disease or bodily or mental disablement and, by reasons of such disease or disablement, there would be a substantial risk to the mental or physical health of any person if they were found not to have limited capability for work and work-related activity..' She then goes on to say this is based on considering my ESA50 questionnaire and medical evidence submitted to justify her decision. She then gives a prognosis of 18 months before review. That's it.

Maybe, it isn't an issue as to whether or not it affects my PIP review. I am just curious about why my ESA85a report is so slim (literally one page) and whether the way she drafted it (without a breakdown regarding activities/descriptors/points) is standard if an award is recommended under exceptional circumstances/substantial risk, regardless.

I do remember that I had confirmation from the DWP and from Maximus that my ESA50 etc arrived on 26th February 2020, when we phoned them. The ESA85a report is dated 27th February 2020. It was done in less than 24 hours! DWP decision came about a month later.

Thanks, again.

I have to say I am shocked that I didn't score any points to meet the criteria for any of the ESA activities. We were thorough (with a lot of help from my sister) in completing the ESA50. It makes me wonder what we could have got so wrong.

The Maximus assessor does mention that as well as my ESA50 questionnaire and medical evidence submitted with it, she also considered my ESA85 and ESA85a reports from 2010, 2012 and 2014 when I was last on ESA. I ended my claim in 2014 before reapplying earlier this year when my health deteriorated and I had to stop work. In 2010, I was granted an ESA award and placed in the WRAG after a face-to-face assessment. At renewal, both in 2012 and 2014, my ESA award continued in the WRAG, as before, but after paper based assessments. The descriptors I scored points for then are no different from the descriptors I would have expected to score points for this time round. My illness diagnosis/health condition was the same then, as it is this time with the same difficulties.

The Maximus assessor does not explicitly state that she relies on regulation 29 or 35 - just used the form of words I quoted, which I suppose implies it. But, I am relieved to know the lack of reference to any points being scored in my ESA85a should have no bearing on my current PIP review assessment.