ATOS say fit for work. Since then I've been in hospital. HELP!

[BlurredFX]

Hi Guys,

 

I am quite a awkward "stick" and was hoping for some help.

 

In brief, I attended an ATOS Medical and a couple of months later I received a letter from DWP saying ESA has been stopped. That was towards the end of July. I was getting worse by this point.

 

Two weeks ago, I was admitted to hospital with the symptoms I had been suffering from - and have been there ever since. (I have managed to escape for a couple of hours today (escorted of course)).

 

It turns out I have been previously misdiagnosed, and having had a number of CT scans and what not I am being treated for a far more serious illness.

 

Am I correct in thinking that I need to get the GL24 back as soon as possible? Is it possible to make the appeal over the 'phone?

 

What type of info do I need to put on the GL24? Do I need to reference it to every question in the "Limited capability for work questionnaire"? Does my in-patient status have much of a bearing on these things?

 

I have done my best to read around these forums (prior to admission and also today), so please do forgive me if I have missed something, but my faculties are not at their best.

 

Thanks for any help,

 

Blurred:)

[ErikaPNP]

An appeal has to be in writing. However, being in hospital is usually good cause for submitting a late appeal. You don't need to go over everything on the GL24, it results in a quicker overturn if you can. But as long as you can give basic grounds for why you disagree, they will accept it as duly made and log it, putting your ESA back into payment pending the outcome (assuming you were turned down because the result of the assessment said you had no limited capacity for work).

[Nystagmite]

Your appeal is only relevant as to what you were like at the time of the medical.

[ANDYANDFLO]

The above post is correct. Your appeal is about how you were at the time that you failed the assessment.

 

Whatever has happened since is of no concern to the appeal or to the DWP or even the Tribunal.

If you were found fit for work then the argument is that on that date, the DWP got it wrong.

 

If things have taken a nosedive healthwise since then, you can apply for a review or maybe even close down the original claim and submit another claim with the new info. However you might have another ATOS medical.

 

I had a similar situation and ended up in hospital for a a month and a half. I closed down my original claim that I failed as I was finding the appealing bit too stressful. I made a fresh claim, had another ATOS assessment and was put in the support group.

Edited August 21, 2011 by ANDYANDFLO

[ErikaPNP]

Any deterioriation or change in illness since the date of the decision to refuse you ESA will not be taken into consideration by the appeal. However if you have obtained supporting evidence from medical diagnostic testing after the decision which shows the illness you had at the time of the decision was misdiagnosed, this is very relevent information which will be considered.

 

There is a difference between having a different illness/suffering worse symptoms and a misdiagnosis.

[ANDYANDFLO]

I didn't know that!

 

One of my conditions, the one that makes walking almost impossible, was diagnosed as arthritis and old age by my GP. Nearly a year later, after being taken into A&E it was found that I had been suffering from Periphial Vascular Disease, and had emergency surgery to remove three bloods clots in one leg, hoping that that would solve the problem, if not the right leg at the hip would have had to come off.

 

I was put in the support group for my other problems, but if they had have diagnosed the leg problems properly, my original claim would have had a different result.

[Nystagmite]

But the diagnosis is irrelevant - it's based on what you can and can't do.

[ErikaPNP]

The diagnosis makes a difference if it's a terminal illness with a limited life expectancy. It's not clear from the OP whether or not that is the case.

[ANDYANDFLO]

Well Erika above seems to think that a misdiagnosis is important in an ESA claim.

It's nothing to do with what you can and can't do it seems - that's how I saw it. No different to being told that you have a chesty cough for 6 months only to find out that is actually lung cancer and have 4 months to live.

 

The diagnosis is different but the abilities still remain the same, yet for lung cancer with life expected under 6 months, you would go straight into the support group.

 

Sorry Erika, I didn't see your reply - and we were both on the same wavelenth it seems - wierd!

[BlurredFX]

Hi Guys,

 

Managed to sneek out to McDonalds in order to check up. Thanks for all the feedback - my major concern is the fact that I also receive Mortgage Interest Support - and if I lose that, it is a major blow!!

 

I understand that the appeal must relate to the time of the ATOS medical, so I will avoid going on about what has happened since too much.

 

(assuming you were turned down because the result of the assessment said you had no limited capacity for work).

your assumption is correct

 

However if you have obtained supporting evidence from medical diagnostic testing after the decision which shows the illness you had at the time of the decision was misdiagnosed, this is very relevent information which will be considered.

 

There is a difference between having a different illness/suffering worse symptoms and a misdiagnosis.

Supporting evidence at this stage is a little hopeful, though I am sure it will be forthcoming in the next couple of weeks. How do you suggest I bring the mis-diagnosis into the letter?

 

How about if I was to write something along the lines of "at the time of my medical, I was diagnosed with XXX, however, more thorough investigation (as a hospital inpatient) has since diagnosed me with YYYYY. The relevance of this is that the tiredness, lack of energy, inability to focus, hold a conversation, or even walk for 200m was a minor side effect of my pain killers. (reasons to change my responses to questions??).

 

I suppose I will have to go through the GL24 and see how I would have answered had i been aware of my condition?? Is that the correct course of action?

 

Thanks everybody for your help on this, I am slowly getting an idea of the way to progress!!

 

Blurred:)

[BlurredFX]

The diagnosis makes a difference if it's a terminal illness with a limited life expectancy. It's not clear from the OP whether or not that is the case.

 

Thanks for your concern, but thankfully, as far as I know, I am not dying!!!!

[speedfreek]

@ Erica & Nyst; The initial diagnosis is looked up in the DWP handbook of medical stuff.

 

This gives them a very general opinion of how your condition fits into the ESA frame work i.e. if you meet any of the special rules, where you are likely to meet descriptors and if further assessment is needed.

 

A change in diagnosis may shift the goalposts giving some of your arguments more weight and others less in their eyes. It may also as Erica says give you eligibility for one of the special groups which give automatic qualification to ESA.

 

Sorry I could be talking complete gubbins here but it's hard to simplify.

 

@ Original posting

 

Surely this should be a case of appealing the original decision then chucking in a new claim/change of circumstances for the deterioration/new condition?

 

Hospitalisation = an automatic LCW decision for the duration of the stay http://www.newcastle.gov.uk/core.nsf/a/wr_esalimitedcap

 

So whilst the OP may win the appeal and may be able to use the misdiagnosis to their advantage. Surely the fact that they now would be automatically considered eligible for ESA needs reporting and a new judgement by the DWP made based on the current facts - the new diagnosis + deterioration + hospitalisation?

 

The appeal against the 1st decision will be ongoing until it's decided. Whilst the new evidence would require a new 2nd decision separate to the 1st. If successful in the 2nd decision you would get awarded ESA and also continue with the appeal against the 1st decision. Whilst if it was unsuccessful the 1st appeal would continue as is. You could also appeal the 2nd decision but I think the 6 month rule before a new claim could be submitted would be reset to 6 months from the date of the 2nd decision?

 

That's what I've read but I could be wrong?

[ANDYANDFLO]

Phew!! I know less now. Why do things have to be so damn complicated?

I never knew about the hospital bit - automatically being treated as not fit for work.

[speedfreek]

Phew!! I know less now. Why do things have to be so damn complicated?

I never knew about the hospital bit - automatically being treated as not fit for work.

 

Things are only as complicated as you perceive them to be.

 

In reality very complex things when broken down/explained in their individual parts are really a miss mash of extremely simple entities!

 

Have you recovered from last year?

 

Whilst your multiple logins/personalities did highlight some glaring issues with ESA etc! It had rather a bad effect on those who struggle through their illnesses to help others on this board!

[ErikaPNP]

Speedfreak is spot on

[BlurredFX]

Many thanks one and all for the feedback, it is providing much info and relieving a good amount of stress!!

 

Surely this should be a case of appealing the original decision then chucking in a new claim/change of circumstances for the deterioration/new condition?

 

I have never heard of "a new claim/change of circumstances for the deterioration/new condition?". Where would I get one of these? If someone lets me know the form ID, I will download it. This form seems the most sensible, though clearly I have no experience of such. I was having nightmares about getting so far, then having to restart the claim, and then whether I would get the MIS I have been getting!

 

@speedfreak, the link you provided goes to the Newcastle search page. Is there another way you could post it? Ta.

 

What does LCW mean? Internet searches are no help...

 

So, my plan of action is to fill in the appeal form and get that off asap (money running out fast - well friends and family money!!).

 

Then I will consider the change of circumstances for deterioration form, if we think that is the best idea?!?!?

 

Thanks guys, help is much appreciated.

 

Does my plan seem sensible??

 

Blurred:)

[Nystagmite]

LCW = limited capability for work.

 

I think what Speedfreek is trying to say (using the link) is:

 

ESA will have far fewer exemptions - for patients undergoing certain types of chemotherapy, pregnant women where there is a risk to health, who are in the later stage of pregnancy or who have recently given birth, carriers of certain infectious diseases or hospital in-patients.

 

http://www.communitycare.co.uk/Articles/2008/07/24/108915/Employment-and-Support-Allowance-how-it-will-work.htm

 

The Newscastle Gov site is being odd with me too.

[speedfreek]

Thanks Nyst the Newcastle site seams to be undergoing some reorganisation since I posted that link.

 

There's a box for hospitalisation on the ESA50 form see here http://www.nawra.org.uk/Documents/Cardiff_Mar_10/Fit%20for%20Purpose%20%20A%20Guide%20to%20Completing%20the%20ESA50.pdf

 

That's a pre April 20i1 form so some questions have changed on the new ESA50 forms but most of it stands.

 

@ Blurred yes that plan seams very sensible.

 

Get the appeal on the 1st decision in, then make a new 2nd application for ESA citing the deterioration/change of condition/hospitalisation. (Apply in the normal way as you did the 1st either by telephone or form)

 

Basically in order for them to consider your new circumstances you have to put in a new claim. This claim will kick off a new round of assessment based on the new information.

 

See here for what I'm talking about

 

http://www.cpag.org.uk/cro/wrb/wrb216/ESA_appeals.htm

 

Other changes and clarifications

 

DWP guidance states that where a claimant is already being paid ESA, any new claim for ESA will be refused, unless the claimant has a new or deteriorating condition, in which case a new assessment phase will begin and the claimant will be subject to the WCA again.[Footnote 7] Where a claimant who is being paid ESA pending appeal experiences a change of circumstances which means they can be treated as having limited capability for work (e.g. as a hospital inpatient), a new assessment phase will begin.

 

A lot people think that their current appeal will consider facts after the original decision and during the period from that date until the appeal is heard at tribunal. That's wrong. They may consider something if you can convince them it was relevant on or before the date of that decision. That's a big may! So whilst Erikas' suggestion on the change of diagnosis may get accepted for your current appeal and be of benefit. Nothing else will be considered until you put in a new claim.

[BlurredFX]

Thanks guys, I'm still in hospital and have been out of the game for a couple of weeks - having various holes put in me, and the usual type of stuff! It's amazing how it takes it out of you

 

I will get on with appeal 1 over the weekend - my only concern about the above is that I am currently receiving MIS (Mortgage Interest Support) which is covering my mortgage. If I start a new claim, will I have to wait again (3 or 9 months) for the MIS to start coming through again??

 

I will have a read of those links - they look very useful at first glance!

 

I will certainly try the mis-diagnosis as being relevant - it explains a whole load of problems, so it is worth a try at least!

 

Thanks for your on-going support everyone! I will post back next week with an update!

[honeybee13]

Hello, nice to hear from you again. I hope you feel better soon.

 

My best, HB

[BlurredFX]

Right, well, I have sent a letter off, explaining the situation asking for permission to appeal. If I am given permission, I will send them more details...

 

But in the mean time, I am filling in a new claim form, and will be enclosing notes from the hospitals I have been in to verify the story.

 

I think this is the best course of action - if anyone thinks different, let me know, so I have time to possibly correct it!

[Nystagmite]

You also need to carry on sending in fit notes to receive ESA.

[BlurredFX]

You also need to carry on sending in fit notes to receive ESA.

Good point!

 

Right, I have got that form off, and now I need to start the new application, starting from when I went into Hospital. What do I need to put on this form?

 

Someone mentioned that as I am applying for ESA having just been kicked off ESA (by ATOS), there must be good reason. How do I go about demonstrating such good reason? Is simply being admitted to hospital sufficient?

 

Many thanks

 

Blurred:)

[BlurredFX]

Bump!!!

 

Thank you everyone!

 

Blurred:)

[BlurredFX]

Bump!!!

 

Thank you everyone!

 

Blurred:)