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TOPIC: Confused re: ESA at assessment rate pending appeal

Confused re: ESA at assessment rate pending appeal 3 weeks 1 day ago #205336

I want to try to clear up exactly what the rules are regarding being approved for ESA at assessment rate. Having claimed it myself, it seems to be a highly complicated issue.

Here's some background: I recently managed to get a backdated fit note to the date of my cancellation of ESA. It was a real struggle and in the meantime I had to sign on to JSA for a bit, until I got my confirmation of appeal letter, which was a problem in itself. From my understanding, unless you get a fit note backdated all the way you won't get ESA at assessment rate, unless you have been signing on for JSA and can get a fit note up to the date of your most recent JSA payment, although apparently, even that can be hit and miss.

HOWEVER, I know of a friend's relative who only signed on JSA for about a week and didn't even get paid because they put in an assessment rate claim with a fit note dated from before the JSA claim (thus cancelling it out) but NOT backdated all the way to ESA cancellation (the doctor refused even though the DWP allow it). And they are also now on the assessment rate. I have seen all the evidence of their case. I would like to spread the word on this as JSA is an extremely stressful benefit, but I don't know if my friend's cousin was just lucky...?

So to clear up this confusing issue for future claimants can any of the mods give a clear explanation on the rules for assessment rate pending appeal and also link to the actual DWP guidelines concerning this. For example, if a claimant wants to avoid the stress of claiming JSA, and can manage to survive financially until the appeal letter arrives BUT doesn't manage to get a fit note from the date of cancellation - only from the date of the letter, say; what are the chances of getting ESA at assessment rate?

Thanks in advance

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Confused re: ESA at assessment rate pending appeal 2 weeks 6 days ago #205372

JustAde


OK, so the ESA Assessment rate is not available during the MR.

To receive it during an appeal;

- You must be appealing a Fit for WOrk Decision, not a failure to attend or return the ESA50.
- It must be your first FfW Decision or the first since you had an ESA award.
- You cannot claim until the DWP have received written notice of your appeal from the Tribunal Service.
- You must have a valid Fit Note in place for payment of the Assessment Rate to be done,
- If the Fit Note covers the claimant from the day after their ESA claim was closed then they should receive back payment of the Assessment rate from that date minus any other benefits they have claimed in the interim such as JSA.
- If the Fit Note does not cover from the day after then I think they will only be paid from the date that it does start. Any missed payment will be covered as part of the appeal if the receive an award.

See 42790 onwards

www.gov.uk/government/uploads/system/upl...e/658287/dmgch42.pdf

Gordon

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

Confused re: ESA at assessment rate pending appeal 2 weeks 5 days ago #205547

Thanks for the reply and link Gordon. But I have to admit, when it comes to a fit note that's not fully backdated, I'm none the wiser what the actual rules are. And even in your reply, you seemed sure of all points but that one. Maybe I'm just being thick and someone else can work out the rules from the DWPspeak in your link, I couldn't.

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Confused re: ESA at assessment rate pending appeal 2 weeks 5 days ago #205563

JustAde

There are several issues with Fit Notes in this situation.

GPs are not required to issue a retrospective Fit Note if they have not seen the patient during the period they are being asked to cover.

If this was a new claim for ESA, then the DWP will normally write to the GP advising them that they do not need to provide further Fit Notes unless the claimant is appealing the Decision.

The ESA payment system will not allow a payment of the Assessment rate unless their is an active Fit Note on the system.

Gordon

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

Confused re: ESA at assessment rate pending appeal 2 weeks 3 days ago #205773

Gordon wrote: GPs are not required to issue a retrospective Fit Note if they have not seen the patient during the period they are being asked to cover.


But this is again a confusing issue as it seems the DWP have allowed some scope for GP's to backdate even if they haven't seen the patient during the cancellation (or any other) period?

www.gov.uk/government/uploads/system/upl...ote-gps-guidance.pdf (pg 19)

I phoned the ESA dept of the DWP trying to get clarity on fit-note backdating even if there had been no assessment and they seemed to think that a sick note could be issued in those circumstances. They wouldn't commit 100% to that information though.

It is impossible for all claimants with cancelled benefit to be expected to be able to get a fully backdated fit note to qualify for ESA appeal rate if it has to be done on surgery visit/assessment at date of cancellation - or just before/after.

So it must be okay for a claimant to either get a backdated note from the GP without assessment OR/AND to submit a fit note from a date later than cancellation and still be entitled to assessment rate ESA?

I know a lot of DWP rules are complex but I can't help thinking they are clouding the issue here on purpose because they want people to claim JSA instead even though there's no difference in the amount of payment. Thank God my claim went through.

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Confused re: ESA at assessment rate pending appeal 2 weeks 3 days ago #205778

I've been trying to find one of the most confusing bits of info I've seen on the net about ESA pending appeal and here it is:

"It is also important to ensure that the DWP has medical certificates (‘fit notes’) which are current and cover the period of the MR, as this is a condition of entitlement for payment of ESA during a dispute. If there are delays in getting ESA restored and the claimant is in financial hardship, s/he could request a short-term benefit advance."

As posted on this website

www.cpag.org.uk/content/benefit-during-e...rt-allowance-dispute

and copied to many others. Again, I could be mis-reading and please tell me if I am Gordon or others but it implies the fit-note must be backdated to cancellation or ESA pending appeal will not be granted. I first came across it posted on a website late last year and then back-tracked it down to the cpag page dated 2014. If you cut and paste the para you'll find it on loads of forums. People re-posting info like this (which I'm guessing is outdated now) really doesn't help and is another reason why I hoped we could get a clear and definite answer on this. Ah well....

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