<edited on 5th September 2011, because the criteria and scoring system have changed since I wrote this, and I don't have the up-to-date list of the scoring criteria. Also please bare in mind during the whole post that it was written a year ago so the system might not have changed completely, but I'm sure some of it has>
Originally Posted by Emz
i've written my appeal letter but I'm just so worried they're going to leave me without money for months :( I'm panicking so much.
I have experience here, and also a little bit of inside information. The first is from a friend who works at the CAB and for a long time now they've been giving A LOT of people who're perfectly entitled to the benefit (you need over 15 points to qualify<edit - not sure about this now under the new criteria>
) ZERO on assessment, so you are most definitely not alone
The first thing I'm puzzled about is that they've stopped your money. In my experience when you have told them of your intention to appeal the decision they must
continue to pay you until the decision is made. If they ultimately find you aren't entitled the back-pay is simply changed to JSA. Have you not told them yet? If not I suggest ringing them ASAP
and telling them. And get that appeal letter off ASAP too, I believe they need it within a certain time-frame.
I too wrote an extremely detailed letter of appeal, but no matter what you write I believe they will turn it down unless
you have extra supporting medical evidence to back-up your claim. That said I think it's certainly a good idea to write your full letter, just, as I said, get it to them within the time they've asked for it! If there's any problem that causes a delay just let them know.
Sick notes from the doctor are necessary for the benefit but don't assist whatsoever in actually being judged entitled to it.
Another piece of insider info is that the assessment doctors are glorified pen pushers. If they were any good at healthcare why wouldn't they be out there helping people??!! In my opinion they are inept.
More importantly, my insider (who I'll get to in a bit) knows the system inside out and says that these 'doctors' know and understand little
whatsoever about mental health issues.
Assuming you don't provide additional medical evidence, whatever you put in your appeal letter I believe you will then have the option go to an independent tribunal - do so!! There will be a doctor there who will ask you similar questions to the medical, but he or she will be much more experienced. The tribunal will also have seen hundreds if not thousands of cases like yours, and know that people are being given zero points when they are perfectly entitled to this benefit. I read on BBC news (I think) that 40%
of tribunal decisions are found in favour of people like us - i.e. against the medical assessment!
Because I did not provide any extra medical evidence at the appeal stage - only my vehement and extremely detailed letter - I had to go to tribunal. If you want any more information about that stage, if it gets that far, then please send me a private message and I will reply on this thread. There are so many posts here and threads that just in one night's posting (tonight) I have lost which threads I've posted in and need to follow. But I want to help here
Going to tribunal took more than six months (they have such a backlog of cases, because they are turning everybody down!) In the meantime they continued to pay me.
Regarding medical evidence.
Are you under an NHS psychiatrist for your condition? This is how I got my medical evidence. Through my psychiatrist's practice, by explaining what I needed, I was put in touch with the benefits adviser. (He's my 'insider' - he deals with these situations all the time.) He went through the official checklist with me, and then spoke to my psychiatrist who agreed that I was entitled to the benefit. The advisor drew up the letter of medical evidence from my psychiatrist (being an expert in the system, while she is not) and she signed it. They gave me 30 points but arguably they could have given me more, and they felt that was enough - but firm medical evidence like that is irrefutable by the tribunal or (of course) even the appeals section.
It may be too late to arrange this evidence for the appeals stage - do not worry!
You will have many months until the tribunal to get this in place
If there is no benefits adviser (I cannot believe there wouldn't be) then approach your psychiatrist directly.
If you are not under the psychiatrist yet then push your GP - you should be!!
If you don't get that far (or want to get that far, but if you're applying for ESA you should probably be under an expert) then your GP needs to provide the evidence himself!!
I believe that any medical evidence from people who know your situation and are treating you directly, and who say that you are unfit to work and entitled to ESA under the criteria will get you a positive result
There is much more I could write, but this is long enough, so just a few more points!!
- Many people won't have seen the exact list of criteria they judge the points from. This is not
the questionnaire. This is probably not something they will have given you or shown you. I have a copy, I will send you a copy if you want. The letter from my psychiatrist started something like 'I am aware of the points system used to evaluate ESA and my patient scores as follows'. If you cannot get as far as an adviser or a psychiatrist it's your GP's job to look at this and provide the medical evidence on your behalf.
- That said, I think you should be under the psychiatrist in the condition you're in - you deserve to be, and it will support your claim even more strongly. Insist to your GP to refer you!
- For goodness sakes, in future if you haven't felt able to leave the house for months, don't do so for a medical!!! You have to remember that there are a lot of liars and cheats out there. You said at the medical it was your first time out of home for months, but how was he or she to know that? And they will take every opportunity they can to mark you down on your points. They will come to your home if you explain the situation. I had a home visit even though I was able to drive to a support group every day 10 miles away, because I (rightly) told them that I was only able to make that trip because I knew I was going to a completely
supportive environment that I knew well. I believe the home visit's why I was given 6 points at the medical rather than the typical 0. Well, that's done now for you, but if you get to the tribunal stage they will support your travel expenses. I phoned up and explained that I was unable to use public transport to get there and would require a taxi, which they agreed to pay for. At the tribunal they asked how I was able to make it there if I was almost totally homebound at the time (which is a very fair question - thankfully I am much better now). I explained that I had almost had to ask the taxi to turn around at some points to take me home. I had also written to the tribunal in advance to explain that there was a good chance I might not be able to make it, submitting my main points in writing and asking them to consider those if I was absent, and also requesting the chance to speak to them by phone if I couldn't attend.
- All of this supported my case I'm certain, but as my adviser said afterwards 'you had firm medical evidence, that was all
you needed, if they hadn't accepted that I would've given them hell to pay' and I believe this is true - the medical evidence is all you need. However mine (30 points) did beg the questions 'how were you able to come here?' etc and all of these I was able to answer with cast-iron supporting evidence.
- With the taxi and all the other steps I took, I took a lot of the pressure off myself for the tribunal. Please, please do the same. It would have been even better if I'd been accompanied (for my condition, which is after all what I was there about!)
I'm sorry I've written a lot, I hope it helps. Please do get in touch by private message if I can help more. Having been through this awful system myself I know how depressing it is, which is why I've spent so long tonight trying to help. Even though I beat myself up and my anxiety spiralled out of control over this, looking back, once I had the medical evidence I was home and dry. They're threatening me with a medical again and I spoke to my adviser and he will prepare a new letter from my psychiatrist to have with me then, so it shouldn't (hopefully!) get as far as me even having to appeal next time
And, even though I'm much better than I was and able to get out locally most days I'm still not up to travelling to a new and strange place for a stressful medical with some incompetent baboon, so they will have to visit me at home again.
Please let me know how you get on?
All the best
(saving now as my computer keeps crashing - will continue writing and editing in a bit)