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PIP Mandatory Reconsideration

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6 years 10 months ago #190970 by James
PIP Mandatory Reconsideration was created by James
Hi

After exhaustive and inconclusive research I've decided to come to the forum for some guidance.

I recently had my DLA to PIP claim rejected with zero points awarded. I have Fibromyalgia with all the associated pain and fatigue symptoms including cognitive difficulties.

The nature of the beast is that there is much variability and despite having a slight limp when I walked into my ATOS assessment I presented quite well and this was well documented almost to the exclusion of everything else.

I even stated on the day that I was having a 7-8 out of 10 day. I also had taken some caffeine tablets to help me cognitively. The downside to that is that it hyped me up. So, I was very engaging, good eye contact, natural rapport, all according to the report. No signs of anxiety, distress, etc. You’re damned if you do and you’re damned if you don’t!

Anyway, I need help in understanding a key sentence in the decision letter:

“The reported frequency of your relapses and bad days means that they are not the majority of days.”

The above sentence is repeated and echoed throughout the decision letter.

Here is what I reported and my own calculations:

Periods of most need - 4 relapses per year (1 month duration)
Other times of equal need - 2-3 days a week


If 1 month = 30 days and they are using the stated 2 days a week for the remaining 8 months (32 weeks) then that totals = 184 days.

If the same calculation is made using the stated 3 days a week then the total becomes = 216 days.

In both calculations I have met the 50 percent rule, if such a rule even exists, and I’m confused as to why they came to that conclusion. Does this not make it the ‘majority of days’?

Please can someone explain in this sort of circumstance, when a range of days is given, ie, 2-3 days, which number do they pick - 2 or 3?

Is there a known calculation that I have overlooked that will explain all of this?

Many thanks in advance.

James

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6 years 10 months ago #191020 by Gordon
Replied by Gordon on topic PIP Mandatory Reconsideration
James

I read your post multiple times and really struggled to understand that you met the requirement for the majority of days, even after I had worked through your maths it still took me several goes to understand the point that you were making.

If I had these problems then I think it likely that the DM did as well! My first thought was to take the statement "4 relapses per year" as meaning that you were not affected at all for 8 months of the year. I don't know whether it was recorded or not in the report but your statement on the day of the F2F the you were "7 out of 8" probably did not help either.

Whilst you certainly need to clarify what you meant in the form I think you should consider explaining it differently and more simply.

The first stage to challenging a Decision is for you to request a Mandatory Reconsideration, this needs to be done in writing to the DWP, within one month of the Decision, to the office that dealt with your claim, have a look at our PIP MR & Appeal guide for details of the process, the PIP area also has template letters that you can use to make the request with.

www.benefitsandwork.co.uk/help-for-claimants/pip

You should contact the DWP for a copy of the assessment report if you have not already done so, I would phone them but again follow up the request in writing. Once you have the assessment report you will have a better understanding of how the DWP Decision Maker has come to their conclusions and will then be able to argue against them.

Your primary task is to show that you meet the criteria, there are many reasons you may have failed, you need to address each of these but don't get bogged down in criticising the assessment report unless you can clearly show that it is incorrect, it is a lot easier to argue the facts of the situation;

"the assessor recorded that I walked 50m, I did but they have failed to document that I had to stop every 10m for a rest due to breathlessness"

than their opinions

"based on my observations of the claimant walking I believe that they can reliably walk more than 200m.

When you have a better idea of the issues with your claim, come back to the forum 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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6 years 10 months ago #191035 by James
Replied by James on topic PIP Mandatory Reconsideration
Hi Gordon

Thanks for the reply and sorry if my question appears complicated.

I think you misread one sentence I wrote. On the day of the F2F I was asked what kind of day I was having so I stated honestly that I was 7 or 8 out of 10. I was having a better day. That didn't seem complicated to me but then like everything else she recorded it is very subjective. What is a ten to one person would be different to another.

I already have the ATOS report and am waiting for the MR to be sent to me. In summary, I have about 4 relapses per year which last about one month. For every other week throughout the year, I struggle about 3 days out of 7.

As I can't really break it down any more than I have then can you at least address my query of if there is such a thing as a 50 percent rule? How does the DWP define the 'majority of days'?

I met with a Disability Advisor this morning and she stated that she's hearing of 75 percent being their guide for that description.

In fact, if I have simply answered the questions presented to me in the forms and at the F2F and the DM couldn't understand the answers then doesn't that just go to show that the system is really not fit for purpose?

Those calculations in my first post were for the benefit of whoever was replying and wasn't laid out in the paperwork like that.

James

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6 years 10 months ago #191056 by Gordon
Replied by Gordon on topic PIP Mandatory Reconsideration
James
The phrase "majority of days" is defined in the legislation and should be taken literally, so 4 days a week, 16 days a month, 27 weeks a year, 7 months a year, etc.

However, you also need to consider variability and how this might be seen as affecting the period affected, so as a general rule; 5 days a week will be seen as a stronger statement than 4 days and so on.

Stay away from percentages, for example you would need to be affected for 58% of the time to meet the 4 days a week requirement.

f your condition varies explain how; using your example from a previous post, how are you affected on the 150+ days that are not covered by your 4 x month and 2-3 days? Are you fully functional and perfectly healthy, I would guess not, so how are you affected. Remember you must also be able to complete the PIP activities reliably. So as an example; a claimant might be unable to stand and move more than 1m on four days a week, able to move 10m 2 days a week and up to but not more than 20m on the remaining day.

Gordon

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

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6 years 10 months ago #191081 by gixxacath
Replied by gixxacath on topic PIP Mandatory Reconsideration
i ended up with o points in my letter ,the hp told lies he didnt put anything i told him properly in the decisions letter,i have osteoarthiritis in neck lumber region,ankles and off work as its in my knees and my doctor said i will have to have my knees done in my 60s if ime lucky to last that long ,i have been to cab and no rushing off them ,i rang up for help for someone to come wit me if it gets to a tribunal but no they cant do that ,i am willing to pay

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6 years 10 months ago #191245 by James
Replied by James on topic PIP Mandatory Reconsideration

Gordon wrote: James
The phrase "majority of days" is defined in the legislation and should be taken literally, so 4 days a week, 16 days a month, 27 weeks a year, 7 months a year, etc.

However, you also need to consider variability and how this might be seen as affecting the period affected, so as a general rule; 5 days a week will be seen as a stronger statement than 4 days and so on.

Stay away from percentages, for example you would need to be affected for 58% of the time to meet the 4 days a week requirement.

f your condition varies explain how; using your example from a previous post, how are you affected on the 150+ days that are not covered by your 4 x month and 2-3 days? Are you fully functional and perfectly healthy, I would guess not, so how are you affected. Remember you must also be able to complete the PIP activities reliably. So as an example; a claimant might be unable to stand and move more than 1m on four days a week, able to move 10m 2 days a week and up to but not more than 20m on the remaining day.

Gordon


Hi Gordon

Thanks for your advice.

I'm really struggling to keep this going as I have very little fight left in me and that's quite unusual for me.

There's a chance I have underestimated my level of need in terms of variability. However, as I had no more supporting evidence to provide DWP the mandatory reconsideration will now go ahead and likely will return the same decision. My deadline for it was today.

If I'm to start retrospectively altering what I've already reported in the claim form and at the F2F will that not make me look like I'm just making it up as I go along just to get the decision I want? What could I possibly say to the tribunal panel that isn't going to paint myself in a bad light?

Using your example, could I perhaps say that I hadn't been asked about the remainder of the days and that I was also thinking in terms of worst case scenario instead of every day life? It's certainly true that I'm not perfectly healthy every day and do have symptoms. It's just how to convey this at such a late stage without appearing dishonest.

James

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