PIP and ESA appeal

Hi Tinkerbell

If you haven't already - you need to ask for a copy of the assessment report - it's called a PA4 (if you had a telephone assessment) It normally takes 7 - 10 days to arrive. If you had a paper-based assessment, it is called a PA5, but we are finding that a lot of people are being told a report hasn't been written. You get the report from the DWP.

If you do get hold of a report it should give more reasons why you didn't score any points. I'm assuming that the Mandatory Reconsideration didn't tell you very much. There is no point in appealing or making a new claim if you don't understand why they think you do not meet the criteria for a PIP award.

If you put in an Appeal which you need to do within four weeks of the date on the MR decision letter. An appeal can take up to a year to be heard.

If you decide to put in a new claim - they will be aware that you have been turned down for one - so you will have to consider what you need to tell them this time to increase your chances of success. I don't know whether you used our guide for your previous application.

BIS

Hi Tinkerbell,
If you continue with the existing claim then you will get backdated benefit from the date of claim if you succeed at MR or appeal. This could easily amount to a few hundred pounds so is worth having!
As BIS said, if you have been refused on the initial claim, it is highly likely that you will be refused for the second claim. And, almost certainly you will have to have another assessment.
If the new claim succeeds brnegit can only start from the date of claim.
I often advise people who ask for help when they have failed at their claim. A chat with them normally reveals that they have forgotten to mention things, or haven't been clear enough. When I write the MR letter I explain that the claimant has now sought specialist advice and hence the differing information.
Do you have the assessment report for ESA? If not it might be helpful. Compare the two reports. Now (as DWP will clearly tell you,) PIP and ESA aren't the same benefits so the reports will of course say different things. Hmmmm true, but there is a lot of crossover. If for example the ESA report confirms you have leg pain and can only walk 50m, that is clearly relevant to PIP mobility, more so if the PIP report says you have no walking problems. Similarly if ESA acknowledge you lack grip and can't use a pen etc, or maybe can't lift something, that shows you have limited arm movements which could link with problems with washing or dressing etc etc. Look for similar activities or discrepancies in movements, ability to speak or socialise etc.
If there are relevant comparisons/discrepancies, then given that you have had recent reports for both benefits, you have a strong argument to say that the PIP report is inadequate.
On a spare page write down 4 or 5 major criticisms of the PIP report. Formulate these into bullet points. Give examples. The discrepancies between reports could be a further bullet point.
Have another look at the Guides and decide what level of points you should get. Remember that you need to do activities safely, repeatedly, in a reasonable time and to an acceptable standard. All 4 conditions must be satisfied.
Repeatedly means across the whole day as many times as reasonably required.
Pain and breathlessness could comprise not being acceptable so bear this in mind too.
(The 4 criteria is set down in PIP Regs 2013 Reg4(2A) )

In addition remember that you need to consider what happens for the majority of days. A few better days won't preclude benefit. If 2 or more descriptors within the same set apply equally, then the higher value is the correct one. (Reg 7)
Now you can start your letter. Head it with your name and NI number (put this on all pages ) and the PIP Mandatory Reconsideration Letter.
I normally write a couple of paragraphs about general health background, diagnosis etc
Then you can write your bullet points and examples.
Then go through each descriptor agreeing/disagreeing with the points awarded. Say why. You can now make more specific criticism of the PIP report and contrast with the ESA if relevant. Contrast also with you own medical report. If the assessor says you take a basic medicine or low dose- check this. (Google the pills on NHS website and normal doses will be apparent.) If you can't take other meds say so.
Include the correct points taking into account Regs 4(2A) & 7.
You normally have a month, but if you need longer, as long as you can explain this as a reasonable excuse it is very unlikely that DWP will refuse.
Good luck.
Let us know how you get on.
LL26