esa support group payment and group income protection

[honeybee13]

Lovely, thank you. Reputation duly enhanced.

 

HB

[**Margaret**]

:moving on:

 

Now we know for certain that you're off sick, rather than retired from your job on health grounds, thanx to :estellyn: for her help. It's the argument I'd use as well, cos treating health insurance as pension should only apply to ex employees.

 

https://www.gov.uk/government/publications/decision-makers-guide-vols-8-and-9-employment-and-support-allowance-staff-guide

(Chapter 44, section 44700)

 

And the legislation;

 

http://www.legislation.gov.uk/uksi/2008/794/regulation/72/made

 

Well that's the theory, but I think it very unlikely that you'll successfully argue your cause over the phone. Experience tells me that every call will be a repeat performance of starting from scratch with the issue and erroneous explanations of why you're not entitled to employment n support without deductions. Also, Jobcentreplus are unlikely to accept anything you say about the insurance payments, without written proof from your employer or the insurance company.

 

So please, pretty please, try to stay off the phone.

 

Written argument with references to the guidance/legislation.

Not relevant to this argument, but enclose confirmation of the insurance so Jobcentreplus can check.

And ask Jobcentreplus to explain why you're not entitled to employment n support without deductions for income.

 

I've never been involved in this particular debate, but among my self help group we've used the strategy to overturn several incorrect deductions for pension income. If you've problems with wording a letter or physically writing it, you may be able to get help from, for example, a hospital social worker, a support group for your condition, or (if you're a member) a trade union.

 

Best wishes, Margaret.

 

 

(If your insurance income is high enough for you to pay national insurance and tax, you're unlikely to qualify for short term help.)

 

 

 

 

[moving on]

Thanks to you all for the advice and help,would it be best to write in first instance to ask for confirmation of what part of regulations or legislation they are using and then try to gather all the information that I can to try and overturn their decision.

 

Or should I phone,ask for local office to return call and then,keeping conversation brief and to the point,request reason,ask for written confirmation and also if possible, an email address for correspondance.

 

Then if need be approach employer and ask could they (or I) contact insurance company to confirm the official name of policy,and what affect,if any,it would have on an ongoing ESA contributions based support group payment of over thirteen months duration.

 

After all ESA is deducted automatically from payment by insurance company for first twelve months so therefore insurance company must assume you are able to be in receipt of both ?.

 

Recall some mention last Thursday that they were looking into investigation further,not she though as I had a lot going on at time of call,so have not given up hope yet.

 

I am in a union-UNITE-so hopefully if this all becomes too much,and needs challenging, I will be assisted with my appeal.

 

Will keep you all posted of any updates,

Again,thanks for all your help,

 

Moving on.

.

[estellyn]

As Margaret said, you need to write, requesting a mandatory reconsideration of their decision, arguing that the payments are in fact sickness pay.

 

 

And yes, the payments take into account ESA, because you are able to have sickness pay and ESA once your SSP has ended. I assume that your employer completed an SSP1 form, which you provided to the DWP?

[moving on]

Thanks estellyn,

 

An SSP1 was completed and sent to me by wages,albeit two weeks late,I then completed my part and asked wages what do with form.Answer was,submit to DWP to claim benefit for ESA,as ESA amount was to be deducted from monthly group income protection payment for one year.

 

Claimed ESA via phone,when asked about "received or waiting to receive any income from pension, permanent health insurance, or compensation payment?" my answer was No,as the only paperwork I had referred to payment as Group Income Protection Scheme.

 

Received Tax claim for ESA money last year.

 

February this year received form to fill out from ESA enquiring about "my part time or voulantery work" part 16 asked "Is your employer paying you any sick pay or maternity pay,as well as SSP,instead of SSP,or when an employee cannot get SSP?

 

To this I answered No.

 

I then added a note in reference to answer, No,stating,my payment each month is off my employer, my employer receives it from a policy they have and it is passed onto me as a continuation of my salary.All forms I have in relation to the policy have been titled Group Income Protection.I have no details of the policy".

 

I submitted a number of recent pay slips and also the address of the wages department, and a letter sent to me by the insurance company requesting a medical report.The letter was titled "Group Income Protection Scheme".

 

After giving them all this information they appear to be discounting it and putting ESA claim under whatever title they feel like, just to decline benefit payment.

 

With all this in mind,would it be wise to base appeal on the grounds that payment is sick pay,or carry on with the only paper proof that I have,which is,payment is from a policy that my employer has,it is passed onto me as a continuation of my salary,it is titled Group Income Protection, I am still employed by the company,I am off work on long term sick and I am still in receipt of sick notes,and have been for the whole time I have been claiming ESA.

[estellyn]

The paper evidence you have and the argument that it is sick pay is one in the same. Your employer takes out insurance so that they are able to pay sick pay to their employees. The payments take into account that ESA is payable at the same time. Whoever is making the decision on the claim evidently doesn't understand the type of scheme and needs it explaining as 'sick pay'. How your employer can afford to pay you extended sick pay is not really anything to do with you, you don't pay for the scheme, it is not your insurance and should not be treated as such.

 

 

It really needs to be sent for a mandatory reconsideration to a more experienced decision maker, who will hopefully have more understanding and come to the correct decision.

[moving on]

Thanks again for your replies.

 

Update: e-mailed employer on Friday,employer contacted insurance broker who in turn called me back.I explained my situation to him and he seemed quite certain that there had been a mistake,misinterpretation, on the part of the DWP/Jobcentreplus.As many of the advisors had thought in responding to this thread.

 

As far as he was concerned (that's if regulations have not recently changed) my payment is from a Group Income Protection Scheme,and as such should have no impact or affect on any ESA payment that I was in receipt of (not including WRAG 365 day limit,told him I was in support group so that wouldn't be applicable).

 

He has offered to speak to whoever is doing the investigation-that's if authorisation is granted-to explain the policies Terms and Conditions, who owns policy,who pays for it,how I receive payment etc,etc.

He has also requested that I scan and send all letters,communications that I have had or sent to DWP prior to him hopefully speaking to them.If a telephone explanation is not acceptable then I am hopeful they will let him write to them.

 

From what he has advised,I have requested a call back for Monday the 27th from DWP.

I hope to obtain a name,telephone number,office address,and although not mentioned by broker,the DWP regulations being used and - if the decision has been looked at again already-a request for a "mandatory reconsideration" appeal.

 

I think I have covered all the points and areas that I need to identify or confirm,but if any knowledgeable people can give me any advice or guidance it would be greatly appreciated.

 

I will post any developments (favourable I hope)as soon as I have them.

 

Yours,

Moving on.

[estellyn]

The most important thing is to ask for the reconsideration - up until that point all they are doing is explaining their decision, you want them to look at the decision again.

[moving on]

Thanks estellyn,

 

I will formally request a mandatory reconsideration, either over the phone,if they return the promised call back,or by the way of a letter, hand delivered to the office dealing with this case.

 

If I am not well,or able enough,to do it myself tomorrow, then I will ask a family member to hand deliver it and get confirmation of delivery by getting a signed and dated signature off the person who takes receipt of the letter.

 

Many thanks,

Yours,

Moving on.

[nicolee2931]

Another case of the DWP misinterpreting the situation and the rules to benefit themselves. Its instances such as this which makes me question whether the DWP is actually here to hinder or help, my personal belief being to hinder.

 

I would write to them stating you disagree with their decision and give them the authority to deal with the insurance provider or ask your provider to provide a written statement of the facts outlining the terms and conditions, otherwise its off to a tribunal which in my opinion is unessacary if the DWP would only deal with the facts of the matter instead of purposely trying to misunderstand the facts for their benefit.

[TayWimp1959]

Hi

I read with great sympathy your problems with your ESA. Like you the DWP are calling a halt to my ESA due to my being in receipt of Group Income Protection payments through my Company. These were allowed under Incapacity Benefit rules (I go back over ten years) so I am learning by experience. Since Unum are deducting the ESA benefit from any payment they must be confident that it is allowable to have the two income sources or they would have to make up the shortfall. I agree that the Jobcentre/DWP seem to not know what they are doing on this matter since they told me to fill in a permitted work form!!

 

 

I wish you a good outcome as I tread wearily in your footsteps.

[flowergirl01]

Hi Moving on and everyone else, I wondered how you got on with dealing with this? I too am paid PHI from my employer and have been on long term sick since jan 2010. I never paid the premium for the phi my employer did and I was never going to claim ESA but it was deducted from the PHI claim so I did. I was awarded ESA contribution based and received it ever since. Over the years I have googled to see if I was eligible for esa as I did worry that I had PHI too but I never found any info about PHI being deducted from ESA, only pensions. This year a friend said something to me so I googled again and saw a paragraph that said 'sometimes' PHI is deducted from esa. I went round and round in circles trying to find the correct info online and in the end I gave up and contacted the benefits office, they would surely know and be able to help, right? WRONG! I went round in circles with them too, one lady even told me I had nothing to worry about it would be classed as income from an employer so not deductible, another lady told me I wasn't due esa as got PHI etc etc..I sent a copy of my wage slip in 3 months ago and been waiting for an answer ever since. Then finally I get a letter from the Benefits office, the incorrect letter telling me I failed to work(!) nothing to do with my phi query. So I rang them to see what was going on, basically wrong letter sent out to me but as I have PHI I was never due any ESA. So the ESA has been stopped and what they paid me in error has been written off as it was their error as I declared everything to them. But I am still at a loss as to how my PHI paid thru my employer should be treated, salary income, phi, pension. I know this makes a difference to whether I can get esa or not, can anyone help me in pointing me to the correct legislation or something? Or even let me know what your outcome was in your situation. Where do I start? I want to be able to understand this properly and make sure Benefits have dealt with it properly.

Thank you

Edited November 13, 2014 by flowergirl01

[flowergirl01]

Hi Moving on,

 

I have read your posts on here re PHI and ESA. I am in exactly the same situation as you and I wondered if you had got this matter resolved, if so I hope you don't mind me asking if it was in your favour or not. I added a post to the end of your thread so you will be able to read a bit more about my situation.

Thank you for your time.

Thanks again for your replies.

 

Update: e-mailed employer on Friday,employer contacted insurance broker who in turn called me back.I explained my situation to him and he seemed quite certain that there had been a mistake,misinterpretation, on the part of the DWP/Jobcentreplus.As many of the advisors had thought in responding to this thread.

 

As far as he was concerned (that's if regulations have not recently changed) my payment is from a Group Income Protection Scheme,and as such should have no impact or affect on any ESA payment that I was in receipt of (not including WRAG 365 day limit,told him I was in support group so that wouldn't be applicable).

 

He has offered to speak to whoever is doing the investigation-that's if authorisation is granted-to explain the policies Terms and Conditions, who owns policy,who pays for it,how I receive payment etc,etc.

He has also requested that I scan and send all letters,communications that I have had or sent to DWP prior to him hopefully speaking to them.If a telephone explanation is not acceptable then I am hopeful they will let him write to them.

 

From what he has advised,I have requested a call back for Monday the 27th from DWP.

I hope to obtain a name,telephone number,office address,and although not mentioned by broker,the DWP regulations being used and - if the decision has been looked at again already-a request for a "mandatory reconsideration" appeal.

 

I think I have covered all the points and areas that I need to identify or confirm,but if any knowledgeable people can give me any advice or guidance it would be greatly appreciated.

 

I will post any developments (favourable I hope)as soon as I have them.

 

Yours,

Moving on.

[estellyn]

Best to ask for your own thread to be started, a mod can help with this.

 

But as a first step, request a mandatory reconsideration regarding the decision a stop your ESA and another one if they notify you of an overpayment.

[flowergirl01]

Thank you estellyn, I have put in a request for a mandatory reconsideration. I will post a new thread when I get a reply.

Best to ask for your own thread to be started, a mod can help with this.

 

But as a first step, request a mandatory reconsideration regarding the decision a stop your ESA and another one if they notify you of an overpayment.