1. Introduction

An overview of the claims and appeal process for ESA and PIP, as well as practical details of how to prepare before the client meeting. 

The Claims Process

Phone application

If a client needs to make a new claim for ESA or PIP, they first have to contact the DWP to check general eligibility and to provide basic details.  If a client is already in receipt of ESA or PIP, they are invited to be reassessed rather than having to make a fresh claim at the end of their existing award. 

PIP2 or ESA50 form

When a client has either made a new claim or been invited to be reassessed for ESA or PIP, they will be asked to fill out a health questionnaire. The answers they provide form the basis of what the health care professional asks them about during their assessment. 

Assessment

Assessments are contracted out by the DWP and run by private companies: Atos, Capita and Maximus. The way the assessments have been conducted has been widely criticised by MPs, disability rights organisations, the press and claimants, with criticisms that the questioning can be insensitive and insufficiently detailed and targeted to draw out the detail of a claimant’s impairments.

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.

Original decision
Decisions are made by a “Decision-Maker” at the DWP, using the assessor’s report and any other information. This may on occasion include forms sent to the claimant’s GP asking for details of their conditions and impairments, but does not include any other medical records unless submitted by the claimant.
Mandatory Reconsideration (MR)
If a claimant disagrees with the original decision, they have 13 months in order to request a Mandatory Reconsideration. Though claimants may do this by phone or in writing, Z2K and other advice agencies advise sending in a letter, detailing the points they disagree with in the original decision.

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.

Lodge appeal (SSCS1 form)
If a claimant disagrees with the MR decision, they have 13 months in order to lodge an appeal with HMCTS. To do this they must fill in an SSCS1 form and post it to HMCTS, complete with a copy of their MR notice. HMCTS then informs the DWP.

“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")
The DWP’s produces a response to the appeal. Prefaced with a mostly pro-forma statement of their position upholding the original decision, it includes copies of all the documents relating to the claim so far, including the PIP2/ESA50 form, the original decision, the MR request letter, the MR decision, the SSCS1 form, and any medical evidence held by the DWP. It is the DWP’s responsibility to send copies of the Bundle to the Tribunal, the Appellant and to the Appellant’s representative if one is listed on the SSCS1 form.

 

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.)

Tribunal hearing

Clients are invited to attend a tribunal hearing, where an independent panel decide afresh whether the DWP’s original decision was correct or not. Z2K provide representation to attend with clients, and in 2018, we won 87% of our disability benefits appeals and secured nearly £2.7 million in resulting payments to our clients.

Before the meeting

When arranging an appointment to help a client with an ESA50 or PIP2 form, you need to remember to ask the client about the following things:

The deadline

The form must be sent back within 28 days of being sent to the client by the DWP. Check when that date is, and if the meeting will not be in time, the client needs to ring the DWP and ask for an extension.

Documents for the client to bring

Remind your client to bring the following with them:

    • Details of their GP
    • Details of hospital or other treatment
    • Details of medication
    • Any medical reports or letters they may have

Language issues

Is the client’s English sufficient for the meeting? If not, can they bring a friend or family member to interpret. If they have no one to interpret, talk to Z2K staff about arranging an interpreter.

Accessibility Issues

Many of Z2K’s clients have mobility problems and need level access. Make sure to check if your client can use stairs, and if not arrange a suitable meeting space with level access.

Practical details

The client will have been sent a paper copy of the ESA50 form (or the Universal Credit version, the UC50 form, is exactly the same). Alternatively the form can be filled in online and then printed and posted. PIP2 forms have unique reference numbers, and the form sent in must be the one sent to the client.  You can make copies of any medical reports/letters that the client brings in and send them in with the ESA50 – just make sure they are relevant and support the client’s case.

Last updated on February 20th, 2019 at 04:08 pm