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ESA/PIP confusion

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5 years 7 months ago #217418 by Shemarie
ESA/PIP confusion was created by Shemarie
Apologies in advance- I’m afraid this is a bit lengthy.
I was assessed for PIP and was awarded standard rate for both mobility and daily living until 1 January 2021, with 10 points for mobility and 11 for daily living.
I had been receiving indefinite DLA with higher rate mobility and middle rate care. This runs until 12 September when the PIP rates begin.
On 24 August I received a letter from the DWP stating that my current rate of ESA will end on the 11 September “due to a change of money coming in.” It didn’t mention the amount I’ll receive after that date.
On 30 August I called the DWP intending to ask them about this and also to ask for clarification about eligibility for disability premiums and to request a copy of my last ESA85a. I was last reassessed (on paper) in August 2017.
However, I didn’t get a chance to inquire about the last two- the lady I spoke to said she couldn’t find the ESA85a in the system. She’d have to look into it and get back to me.
The next day, 31 August, I received a call from the DWP saying that they couldn’t send the ESA85a because there was nothing in the system from Maximus except a note saying that they would need to carry out a home assessment. However, no home assessment had taken place.
I felt so upset at the prospect of going through the whole assessment rigmarole yet again that I just burst into tears.
The lady who called assured me that I didn’t have anything to worry about and that I didn’t have to do anything. She said that it was just down to Maximus updating the system so that the ESA85a could be sent. She was categorical that I wouldn’t need to be reassessed.
However, if the last update in the DWP’s system referred to a home assessment that never actually took place, where does that leave me? Could they ask for a home assessment a year after receiving the paper part of the reassessment? Could they demand a full reassessment on the basis of Maximus not updating their paperwork?
My last ESA payment went into my account the same day as this call, and was labelled LP (Last Payment?). Today I received a replica of the ESA letter I received on 24 August. Again, no mention of how much I’ll be receiving after 11 September. Could they just stop my payments altogether until Maximus send an update?
Would I in any case be eligible for the disability premium? I live alone, don’t have a carer and was awarded standard rate PIP in both categories.
I had been intending to ask for my PIP award to be looked at again, and think I have good reason for this. It would need to be done by the 16 September, but I’m too apprehensive go ahead with it in case I’m hit with another ESA assessment at the same time. I just don’t have it in me to juggle both.
Advice very much appreciated.

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5 years 7 months ago #217422 by Gordon
Replied by Gordon on topic ESA/PIP confusion
Shemarie

I would not worry about the report or another assessment at the moment, you need to understand why your ESA is stopping!

My best guess is that the assessment last year moved you from the Support Group to the WRAG and that you are/were receiving Contribution Based ESA and that has been time-limited by the 365-day rule. The dates are consistent with this if your last assessment was in August of last year.

However, this is just an educated guess and you need the DWP to confirm if this is the case before you can take any further action.

If your ESA(CB) has been stopped because you are no longer in the SG then the DWP should have assessed you for Income Related ESA, your post suggests that this has not happened as your payments should have continued if you were eligible for ESA(IR).

Any eligibility for the Premiums is dependant on your receiving ESA(IR).

Gordon

Nothing on this board constitutes legal advice - always consult a professional about specific problems
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5 years 7 months ago #217429 by Shemarie
Replied by Shemarie on topic ESA/PIP confusion
Thanks for your reply, Gordon.

I receive IR ESA and am in the SG. This has been the case since 2013, so the 365-day rule does not apply. Apologies for not making that clear.

The date given (11 September) coincides with the end of my DLA and the start of my PIP award. I will receive DLA until 12 September and then the first PIP payment on the 8 October.

I had assumed that the "change in money coming in" referred to the amount I'll be receiving for PIP. As I have been awarded standard rate for both daily living and mobility, the amount is a fair bit lower than I was receiving for DLA (middle rate for care and high rate for mobility).

I thought that this meant that the DLA severe disability premium would be automatically removed as a result, and that I would now have to apply for the disability premium, provided I am eligible.

Thanks

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5 years 7 months ago #217441 by Gordon
Replied by Gordon on topic ESA/PIP confusion
Shemarie

There is nothing in your post that would link your DLA or your PIP to your ESA.

Your post states that the DWP have written to you saying that your ESA is stopping, you need to contact the DWP to find out why this has happened, if you are receiving Income Related ESA then there is no reason why your ESA would have been stopped.

Gordon

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

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5 years 7 months ago #217516 by Shemarie
Replied by Shemarie on topic ESA/PIP confusion
Hi Gordon,
I called the DWP first thing Friday, after yet another sleepless night.
As I stated in my post, I had received two letters confirming my current ESA payments until 11 September with no indication of payments being made after that date. My DLA was due to end on 11 September and PIP begin on 12 September.
Thankfully, these payments are not stopping, and will continue to be paid at exactly the same rate from 12 September. The LP acronym on my last payment stands for Like Payment.
Yes, the “change of money” subject heading does refer to the change from DLA to PIP and another letter will be sent on 12 September confirming this. Yes, the disability premium has automatically been added and does not require a separate application.
Apparently, all this is just standard procedure. So far so good, but so very stressful.
I now need to decide whether to challenge the PIP decision or not. The deadline is looming. On one hand, I’m just relieved and don’t want to rock the boat. On the other hand, the assessor/decision maker completely ignores or contradicts solid medical evidence sent. I’m deeply uncomfortable about just leaving this on my file. There is also new medical information since the application/decision relating to a significant deterioration in one of my conditions.
Yes, I know only I can decide this, but would appreciate some information about MCs:
• Are MCs and “looking at your claim again” the same thing? Is the same form and procedure used?
• I understand that over half of MCs are successful, but is there any specific data relating to awards being lowered or removed entirely at MC stage?
• Is the assessor obliged to look at all the evidence provided with the original claim? It seems that they haven’t even glanced at mine.
• Do they look at the entire claim again, or just the points being challenged?

Thanks

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5 years 7 months ago #217524 by Gordon
Replied by Gordon on topic ESA/PIP confusion
Shemarie

So your ESA is continuing? This is definitely not the standard process for moving from DLA to PIP.

- Yes, MRs (MCs) and looking at your claim again are the same thing.

- I'm not sure where you have heard that more than half of MRs are successful, the figure is only about 10%, you may be confusing it with appeals where the figure is in excess of 70%.

- The DWP will look at all of the award when they do an MR, it is very rare that we hear of them reducing the points awarded but it does happen.

Gordon

Nothing on this board constitutes legal advice - always consult a professional about specific problems
The following user(s) said Thank You: TheMerlin486

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