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