PIP/ESA Problems, Challenges and Appeals Receiving The Decision • Decisions on entitlement to benefit are made by a DWP Decision Maker (called Case Managers in PIP). They are not medically trained, and do not specialise in any particular condition. • To decide on a claim they use all the evidence available – the claim form you filled in – the assessment report – any reports from your doctors/nurses the DWP may have requested – any extra evidence that you might have supplied • You will be notified of any decision in writing, although a decision maker may phone you to explain the decision before its is sent out. How Many Appeals Are Successful? Tribunal statistics (2011–2012) • There were 380,000 benefit appeals made in the year 2011 – 2012 • 83,000 DLA appeals • 41% of DLA appeals were overturned in client’s favour • 181,000 ESA appeals • 42% of ESA appeals were overturned in client’s favour • 793,000 ‘fit for work/not entitled to ESA’ decisions were made from October 2008 to February 2012 • Almost 17% of those decisions have been successfully overturned by the claimant What Do I do If I Disagree? • Ask for further information. If you get an explanation of why they made their decision you may realise that the DWP are missing an important piece of evidence • Ask the DWP to reconsider their decision. Send them any extra evidence you have. Make sure you explain how the evidence relates to the qualifying conditions of the benefit you are applying for • APPEAL • SEEK ADVICE Appealing Against an ESA Decision • If your application has been rejected by the DWP, or you disagree with their decision about your capability for work, you can appeal. • There are now 3 levels of appeal. • The timeframe for appeal is very short, you need to process your appeal very quickly. I would suggest that when you send in your ESA application, you start to prepare your case for appeal – evidence (preferably new evidence) is essential. Appealing Against an ESA Decision • Details of how to appeal will be included with the decision letter you receive from the DWP. • First Level of Appeal – Reconsideration. • Write to the DWP and request a reconsideration of the Decision Maker’s ‘Decision’. • You should provide additional evidence at this stage, particularly if you omitted anything in your original application. • KEEP COPIES OF EVERYTHING! Send your letter by Recorded Delivery so you can show that you appealed within the 1 month limit! Appealing Against an ESA Decision • Reconsiderations can take up to 11 weeks, possibly even more. • You will get a letter from the DWP saying they are reconsidering your application. • Assume the reconsideration will fail – start to assemble a body of evidence to take to the First Tier Appeal – you won’t get a better opportunity to do this. Appealing Against an ESA Decision • SECOND LEVEL OF APPEAL – First Tier Tribunal • If you wish to against the DWP’S Reconsideration rejection: • Write to the DWP and within one month – allow for postal delays – DWP uses 2nd Class Mail – up to 5 days. • You will receive a GL24 appeal form. Once you have returned the completed GL24 + evidence you will receive further information about the appeal. Appealing Against an ESA Decision • To be able to appeal through this route, you will need to examine minutely the ‘Descriptors’ in your original application to see how they apply to your condition, and provide concrete evidence to support this. • First Tier Tribunal appeals mean that you will have a tribunal hearing. The tribunal will include a doctor and a judge (barrister or solicitor). You may receive the decision on the day, or they may write to you with the decision. Appealing Against an ESA Decision • Third Level of Appeal – the upper tribunal. • This level of appeal only applies if there is evidence that the first tier tribunal made an ‘error of law’ when considering your appeal. • An example would be that the first tier tribunal had, or did not make use of, an evidential basis for its decision. • At this stage you cannot ask for additional evidence to be considered. • There is no other legal avenue left to you.