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MR fail

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1 day 16 hours ago #299808 by Jayf
MR fail was created by Jayf
Hi

I recently requested a MR to increase my PIP to enhance, even though I know I qualify for enhanced they have refused on the grounds that the information I have sent in is new information concerning new conditions, medication and deterioration of my health since my review was sent in and when their last decision was made. The DWP have said that I would have request another change of circumstances review. Should I appeal their MR or put in for a new review?

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19 hours 25 minutes ago #299849 by LL26
Replied by LL26 on topic MR fail
Hi Jayf,
So...DWP think the fresh medical reports are for new conditions. If you wish to proceed to an appeal you will need to ensure that the tribunal do not take a similar view.
When you claim PIP or make a renewal claim, DWP will only look at 'circumstances pertaining at the time this is the legal requirement- basically, DWP won't consider disabilities occurring after the claim is put in, and decided upon.
However if eg you have osteoarthritis the MR scan and associated consultant report created 5 mths after the last decision could still be relevant.
First it shows an ongoing health concern rather than a temporary one.
Second, conditions like osteoarthritis take a while to develop, it is very unlikely if severe damage is shown/described that this will have occurred many months or years ago, hence although the medical report is new, it is confirming a condition you have had for a while as described in your claim form.
Another scenario exists - g perhaps you have had ongoing leg pain that precludes various PIP activities. GP hasn't worked out exactly what's going on...things become suddenly worse and further tests in hospital reveal a severely herniated disc in the neck, causing severe pain. The doctors now realise the leg pain was in fact caused by the damaged neck. Again the neck problem would not be a new condition, and the surgery now needed is still an extension of the original, not properly diagnosed leg problem.
Medical reports or other evidence fitting the scenarios described above can always be used to support an MR based on original disabilities from the claim form. On this basis there is no reason why you couldn't appeal. By appealing now, you would ensure that if successful, your award will be backdated to the initial decision leading to the MR, or indeed the start of the claim, if this is a new claim.
If you ask DWP for a further review, then any resultant award can only be backdated until either the date the review is initiated or maybe an earlier date if you have good evidence to show when deterioration occurred. The latter is often quite difficult to prove.
If you wish to appeal, ordinarily the appeal should be lodged within 1 mth of the MR decision date. If you can show good reason a late appeal can be lodged - eg illness, bereavement awaiting further evidence could all comprise a good reason. Absolute time limit is 13 mths late.
You can lodged an appeal via tge online form- if you Google 'SSCS1 online' this should take you to the appeal application form.
What I usually do is to set out the actual grounds of appeal as a separate document. For some reason there us a formatting glitch on the form, and large amounts if text come out as a huge paragraph with no gaps. Difficult to read!
I normally set out the reason in the first paragraph.
Eg DWP have ignored the true extent of my disabilities I was awarded standard level of the Daily Living component. I am appealing as I should have been awarded Enhanced Rate of Daily Living.

Then include a paragraph or so explaining the background of your illness/disabilities- diagnosis, general overview of what you can't do etc.
Explain the medical reports and the new ones. Explain that DWP were incorrect to ignore these as they don't deal with new conditions because....
You can then criticise the HCP report if you need to.
I normally condense the major criticisms into 4 or 5 bullet points. Give examples of the worse. (Don't try and not pick every single repetion or grammatical error as this will water down the very valid points you need to make in an overlengthy essay, which DWP will not have time to read!)
Then go through the descriptors, what points should be awarded, you can have a more detailed criticism of the assessment report or decision maker here, and you can cross reference/contrast with your own evidence or medical reports. You can briefly repeat how the new information is important and DWP should not have ignored this. You may wishbto refer back to the Members Guides for further clarification of the individual descriptors and their associated legal tests.
Please make sure you keep a copy of any information you send in or the SSCS1- this is particularly important if you do not use the online version.
Good luck with any appeal.
Please let us know how you get on.
I hope this helps.
LL26

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

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