1.2. Stages of Claim before Appeal
Claimants are asked to list their healthcare professionals on the form, and are given the instructions:
Claimants will be paid the assessment rate of ESA (£57.90/week for those aged <25 and £73.10/week for those aged 25+) the first 13 weeks of their claim. After the 13th week, claimants are either paid the WRAG or Support Group rate if they were found to have limited capability for work/work and WRA respectively, or payment would stop if they were found to be fit for work. If the assessment process takes longer than 13 weeks, the assessment rate would stop, but any benefit would be backdated to the 14th week.
There is no assessment rate of PIP – PIP is only paid when a successful decision has been made, and then is backdated to the date of the claim/end of the previous award (of DLA or PIP).
Assessors produce a report following assessment, and these reports carry great weight with the DWP, who describe them as “objective and impartial”. The reports have also been strongly criticised for their inaccuracy, and most of our clients dispute the findings in their assessor’s report.
Mandatory reconsideration (MR)
A second DWP Decision-Maker will review the original decision, and write to the claimant with their Mandatory Reconsideration, which details if the original claim is upheld or revised. Following the release of information obtained in an FOI request, the DWP was widely criticised for their use of a target that 80% of original decisions should be upheld. Figures suggest that target is exceeded, with the latest statistics showing that 88% of original decisions were upheld, leading to accusations that the original decisions are merely “rubber-stamped”. The target was dropped in December 2017.
There is no mechanism to be paid ESA during the MR process (but see next section), and a claimants’ only financial option to bridge this phrase is to claim JSA or Income Support if they meet the relevant eligibility criteria.
Again, PIP cannot be paid during the MR phase, but it can be backdated following a successful tribunal decision.
Lodging the appeal (SSCS1 form)
“ESA pending appeal”, paid at the assessment rate, can be claimed once an appeal has been lodged. The claimant must take their appeal acknowledgment letter and a fit note from their doctor to a Jobcentre and request ESA pending appeal – it is not automatically granted. Providing the fit note covers the whole period, ESA pending appeal can be backdated to cover the MR phase as well (though not if they have been claiming JSA or Income Support during the MR phase).
Again, PIP cannot be paid during the appeal phase, but it can be backdated following a successful tribunal decision.
DWP response to the appeal (“the Bundle”)
It is very rare, but the DWP can revise a decision when they are informed that an appeal has been lodged, or at any time up until the hearing (e.g. following submission of further evidence by the claimant.)
Last updated on February 20th, 2019 at 11:39 am