Aids & Appliances

The new legislation that came into effect at the end of January 2013 states that if an aid or appliance can be used and the claimant could be reasonably expected to use it, then they will be assessed as using it.

The following is taken from a memo to Decision Makers, which you can see in full here: http://www.dwp.gov.uk/docs/m-24-12.pdf

Aid or Appliance Prescribed or Advised

7 The Decision Maker should establish whether the claimant normally uses an aid or appliance, and if not, whether the use of it has been prescribed or advised.

8 If the claimant does not have an aid or appliance which they have been

prescribed or advised to use, the Decision Maker should establish

i. whether it would help the claimant

ii. why they are not using one

iii. whether the explanation is reasonable.

Example 1

Billy has been advised by his GP to use a walking stick to help with balance problems when walking and standing. He states that he doesn’t like the idea of a walking stick because it makes him look old. The Decision Maker considers that it would be reasonable to expect Billy to use a walking stick, and assesses LCW as if he is using it.

Example 2

Annie lives in a one bedroom apartment on the upper storey of a two storey block. There is no lift. She has been advised by her GP that a wheelchair would help her to mobilise over longer distances and that a wheelchair could be provided on request. Annie states that she could not get a wheelchair into her apartment, and could not store a wheelchair, either in her apartment or elsewhere. The Decision Maker considers that it would not be reasonable to expect Annie to use a wheelchair, and assesses LCW without it.

Aid or Appliance Not Prescribed or Advised

9 The Decision Maker must consider all the circumstances in order to determine whether it would be reasonable to assess the claimant as using an aid or appliance that has not been prescribed or that they have not been advised to use.

10 Factors include whether

i. the claimant possesses the aid or appliance

ii. the claimant was given specific medical advice about managing their condition, and it is reasonable for them to continue following that advice

iii. the claimant would be advised to use an aid or appliance if they raised it with the appropriate authority such as a GP or occupational therapist (advice may only be given on request)

iv. it is medically reasonable for them to use an aid or appliance

v. the health condition or disability is likely to be of short duration

vi. an aid or appliance is widely available

vii. an aid or appliance is affordable in the claimant’s circumstances (people are not routinely required to buy equipment where it can be prescribed.)

viii. the claimant is able to use and store the aid or appliance

ix. the claimant is unable to use an aid or appliance due to their physical or mental health condition, for example they are unable to use a walking stick or manual wheelchair due to a cardiac, respiratory, upper body or mental health condition.

Example 1

Miranda has significantly reduced mobility due to arthritis of the right hip and is on the waiting list for a hip replacement. She uses a walking stick to help with balance, but this does not enable her to walk any further than 200 metres before she experiences pain. She has not been advised to use a wheelchair. The HCP advises that she has no other health problems, and in their opinion based on clinical experience, would be provided with a manual wheelchair if she asked her consultant about this. If she had a wheelchair, she would be able to mobilise over longer distances. The Decision Maker decides that it would be reasonable, having considered all relevant factors, for Miranda to use a manual wheelchair, and that none of the Activity 1 descriptors apply.

Example 2

Gary has problems standing due to a condition which affects his balance. He would normally be helped by the use of a walking stick. However, the HCP advises that due to arthritis of the hands, Gary would have difficulty using a stick because he has reduced grip. The Decision Maker determines that it would not be reasonable to assess Gary taking a walking stick into account.

11 Where it is considered that the claimant should be assessed using an aid or appliance they do not have, the Decision Maker must give a clear explanation of how it could help the claimant. In the majority of cases the HCP will give advice on their use in the medical report. If not, or if the advice is not clear, the Decision Maker should seek further advice as to how reasonable it is to expect the claimant to use or benefit from the aid or appliance.

12 The aid or appliance must be relevant to the activity being assessed. For example, when assessing activity 5, manual dexterity, it is not appropriate to consider the use of devices, such as a grabber, which substitute for the hands, other than prosthetic hands.

13 DMs are additionally reminded that some activities and descriptors specify that the person must be assessed without the help of another person.

M.E. and Fibromyalgia are such complicated and neglected conditions, that while there may be many aids or appliances available to help us, firstly we probably don't know about them, and secondly we're likely to be unable to use them due to another facet of our condition.

For example,

A decision maker may consider that because I have a back issue, and that other people with similar back issues are helped with a walking stick, that I should use a walking stick. They would also need to take into consideration the fact that my hands are frequently too painful to grip the handle of the stick, due to the pain of Fibromyalgia.

Where we are aware of aids or appliances that are available to help with symptoms and issues that we have. If we do not have those aids or appliances or cannot use them, for whatever reason, we must state it clearly on our ESA50 form.

I will populate the end of this blog post with examples of this as they occur to me, simply because I find it very unfair that a Decision Maker can assess us as using an aid or appliance when we do not even know they exist. If you have any suggestions, please leave a comment below.

Supporting Evidence

One of the first things I usually ask people when I'm helping them, is whether they have their supporting evidence in place yet. It can often take weeks to get letters from doctors or other professionals. As such, I generally advise to get as much supporting evidence together before even requesting the ESA50 from the DWP. Of course, if you're being moved from Incapacity Benefit, or being re-assessed, you don't have that luxury.

Your case will go before a Decision Maker for a decision to be made. The three things they will look at are:

• the result of your WCA (Work Capability Assessment)
• your application form (ESA50)
• your supporting evidence

The Work Capability Assessment

As the result of the WCA the person who assessed you makes a recommendation as to what the result of your ESA application should be. Previously, Decision Makers were found to be using primarily the Assessor's recommendation upon which to base their decision. They were and are supposed to use all three sources evenly.

The WCA is essentially someone who is qualified in health, observing factors about your abilities, your body, and your appearance, and ticking boxes on a computer. I presume that the boxes probably add up to give a number, which they may compare to the score from your ESA50. We do know that the tick boxes have very specific answers, and that the assessors prefer to try and pigeon hole you than type in their own answers. Your job is try to get them to make a report that does actually represent you.

The experience of the assessment itself, what to expect, etc, will be covered in another post.

The Application Form

The Decision Maker will go through your application form (ESA50) using the descriptors (which you can find here, and here). This gives your application a score. The score from your form can determine the outcome of your application if you have no other evidence.

Supporting Evidence

Supporting Evidence can come in many forms. It is far from limited to the following:

• letter from your GP
• letters from any of your specialists (eg, physiotherapists, psychologists, counsellors, neurologists, endocrinologists, etc).
• letter from an Occupational Therapist
• letter from non NHS specialists (eg, opticians, osteopaths, accupuncturists, etc)
• copies of blood tests
• copies of scans (eg, MRIs, CT-Scans, X-rays, ultra-sounds, etc)
• letter from a carer
• letters from family or friends who see you on a day to day basis. (I've even heard of letters from Reverands and MPs being submitted).

Medical evidence carries the most weight. Blood tests, and scans are irrefutable. Of course, with M.E. there's not much you can show with a scan, though blood tests that could be helpful include:

• Vitamin B
• Vitamin D
• Thyroid
• Diabetes
• Gluten intolerance
• Ferritin
• Iron
• Antibody levels

(There is only any use in providing the results of these blood tests if they show an irregularity).

If you are requesting a letter from a medical professional:

1. Make them aware of regulations 29 and 35 if you believe they may apply to you.
2. Ask them to give you the letter, rather than have them send it straight to the DWP.
3. Preferably have someone who is familiar with the DWP, check through the letter. Ask the person who wrote the letter to make any changes required, before using it. (You are most likely paying for the letter after all, so you want it to help you rather than be used against you).

When sending in additional evidence with your form:

• Keep a copy of every piece of evidence you send.
• Put your name, your date of birth, and most importantly your National Insurance number somewhere clearly visible, on every piece of evidence.
• On page 20 of your ESA50 tick the box to state that you are including medical reports, and list in the box what evidence you are including with it. If you know you will have more to send on afterwards, list it there too.

You don't have to send all your additional evidence with the form. You can send it late, but it's best to get it to them as soon as possible, because you want it to be with your form when the Decision Maker looks at your case. When you send in late evidence:

• Keep a copy of every piece you send.
• Put your name, your date of birth, and most importantly your National Insurance number somewhere clearly visible, on every piece of evidence.
• Include a request for them to verify that they have received this information and placed it with your case. You could a self address envelope (they don't tend to use them). You could simply send it recorded delivery to start with. Or you can phone them to check it's been received.

Getting Supporting Letters Right

 

Medical Professionals

When writing supporting letters, people (doctor's in particular) need to make statements of their own observations, rather than flaky sentences. Some examples:

Bad: "Ms Jones has told me that she has M.E.."
Good: "Ms Jones is diagnosed with M.E.."
Better: "Exploratory tests have proved inconculsive for Ms Jones, but her symptoms are consistent with M.E.."

Bad: "I think Ms Jones is affected by severe anxiety."
Good: "Ms Jones suffers with anxiety."
Better: "Ms Jone's medical records show a history of anxiety attacks. She is being treated using Sertraline 50mg/day"

Bad: "Ms Jones cannot work most of the time, but sometimes she can."
Good: "It is my assessment that my patient would not manage a full time job."

(It isn't actually your GPs responsibility assess whether you can work or not, so unless they are saying you cannot work at all, it's best to ask them to remove any reference to your work-ability from the letter).

This is one of the reasons it's so important to see your GP regularly, even if you don't have any new problems. You need your medical records to be kept up to date; and you definitely need them to state that you do have M.E.. Think of it this way; if the DWP write to your surgery requesting information about you, but your personal GP is away on holiday, what sort of picture is another GP going to build of you from what they find on your records?

Another issue: Most surgeries are now requesting that people pay for supporting letters, because of the rising number in people asking for them. (Nb, the number of requests rising is because of the DWP insisting upon them, rather than the number of people applying for ESA rising). The Decision Maker has a responsibility to request information from any medical professionals you list on your ESA50, if you have not sent evidence from them already. If they fail to do this, it is grounds for appeal in itself.

As such, even if you cannot afford the surgeries charges for a supporting letter, it is still advisible to have an appointment with your GP (and write to any specialists you list) about the application. Make sure they are up to date on your condition. It can be worth talking specifically about what you need them to say to the DWP, and give them a copy of Regulations 29 and 35.

 

Friends and Family

Letters from people who are not medical professionals are not given anywhere near as much weight, but the useful thing about them is that they can give the Decision Maker an insight into your every day life. Friends and family often make observations that we are so familiar with ourselves that we don't notice them any longer. Some examples that surprised me from my boyfriend's supporting letter:

"She has recently taken to bringing a childhood toy to bed"
"Her sleep is extremely poor anyway, [..] she spends all night tossing and turning."

"It is extremely obvious to me when the pain killers wear off. (She becomes very irritable)" (I hadn't personally made this connection).

"she walks like a crab"

"making her cry for days on end (which then causes migraines)" (I hadn't made this connection either).

As with medical professionals, you need to be certain what your friends and family say won't do you more harm than good. Where a medical professional can speak with authority though, your friends and family cannot. It is best if they don't specifically comment on your diagnoses, but that they work to make clear the difficulties you struggle with.

Some of the things it can help for them to explore:

• difficulties with getting out of bed
• difficulties with washing and or dressing
• difficulties with preparing meals
• difficulties with eating meals
• difficulties with continence
• difficulties with walking
• difficultires with using stairs

(Basically go through the questions from the form and see if they have any comments to make).

When asking someone to write you a supporting letter I advise against leading them. You want a totally unbiased account of your abilities. Once they've written it you can ask them to tweak it if you're not happy with it, but do not ask anyone to write anything that is not true.

Assessment Centre's

When the DWP invite you for your Work Capability Assessment, they will tell you which assessment centre your assessment will take place at. Normally it will tell you which floor the assessment takes place on, too, but if your letter does not tell you this, and you do have access requirements, I suggest you contact the DWP using the phone number from your letter, to ask which floor your assessment will be on.

Using Google Maps, and the post code for the assessment centre, you will be able to have a look at the assessment centre and the surrounding area. You are looking to see how accessible it is:

• is there parking outside?
• is there parking nearby?
• is it in a no stopping zone?
• is it in a pedestrianized area?

If for whatever reason, the building looks inappropriate, explore the other centre's that you may be able to get to, in the same way until you find one you feel is suitable for your needs. You can use this document to identify other centres.

Once you have identified a centre that you would prefer, contact the DWP to make the request. A DWP telephonist may be helpful, but if they are not, make the request in writing. A letter from your GP agreeing with you that the centre is not suitable for you will be helpful.

What to expect from the Work Capability Assessment

When you apply for ESA, you may have to undergo what a lot of people colloquially refer to as 'the medical'.

The DWP call it the Work Capability Assessment (WCA). That's exactly what it's doing; assessing how capable you are of work, not assessing how ill or disabled you are.

Naively, when I first underwent this in 2003 I believed that they had my interest at heart (that our government looks after us), that they wanted to assess how ill I was, as opposed to how capable of work I was, and that when they referred to 'work' they were referring to the job I used to do. This is why I failed. Lack of understanding. So I advise to be prepared, and know what you're expecting and what is expected of you.

You will be sent a letter inviting you to attend the WCA. It will give you the date of the assessment, and the location. You may well find that the assessment centre they expect you to attend is over an hour's journey for you. They may have included a route for you to use to get there, using public transport, too.

If the assessment centre does appear to be in an unreasonable location for you, contact the DWP to discuss it. There may be one that isn't any nearer, but is more convenient for you to get to; the assessment may be able to be rearranged for you. You can view a list of assessment centres here.

If the date they have scheduled your assessment for is inconvenient, again, contact them to reschedule it.

If you are given a morning appointment, and you find morning's impossible to function (as many people with M.E. do), you might want to contact them and ask for an afternoon appointment. Make it clear why you are rescheduling. Then when you get to the actual assessment, again, make it clear, so that it is noted that you cannot function in the morning. On the other hand though; if an assessor can see how badly you function in the morning, it may help you to score more points on the assessment.

The public transport itineraries they send people are usually totally ridiculous. The one they sent me would have taken six hours, with a 40 minute wait at one station, and a walk across a city. None of it was at all possible. The public transport agenda is essentially their first way of tripping people up. A lot of assumptions are made if you are able to use public transport, for example that you have planning skills, you do not suffer from social phobia or anxiety, you can deal appropriately with people you do not know, etc.

Ideally you will arrange for someone to drive you to the assessment centre. The assessment centre may offer to pay a little towards the fuel. Otherwise you may be able to agree with the assessment centre for them to pay a portion of a taxi fee. If neither of these are possible for you, some areas have voluntary drivers; your Citizens Advice Bureau is most likely to have this list.

Of course, if you can drive, then you may drive yourself there. Again, the assessment centre may pay a little towards the fuel. There are a few things to consider in doing so though:

• Do you normally need to rest before and after driving that distance? - it will be assumed that you do not.
• Are you able to drive the same distance every day? - it will be assumed that you can.
• Are you able to fill your car with fuel, or does someone else usually do that for you? - it will be assumed that you have the manual dexterity and strength to lift the fuel pump nozzle.

Joyce Drummond, who worked for Atos for a while, has given a very insightful account of what to expect from the WCA. I highly recommend reading it for further observations that I may not have made here.

In Joyce's account she states that at the centre she worked in they did not use security cameras to assess people as they approached the assessment centre. However, we've heard so many accounts of people believing this has happened, that it's best to assume they do.

The assessor will ask you where you parked. Your answer will be used, in part, to assess your mobility (how far you can walk). Most centre's do not have parking available nearby. I personally choose to be dropped off outside - even if there are double yellow (or red) lines there. I cannot walk far reliably, repeatedly or safely, so I don't want to mislead them into thinking that I can.

The buildings vary, but most of them do not have the assessment centre on the ground floor. One of my experiences was thus:

I arrived at the assessment centre. Two security guards watched me get out of my partners car. One made notes. After I had reached the door and presented my papers I was asked whether I could use the stairs. I said that I could not, and asked to use the lift. I was told that if I could not use the stairs then I could not go up to the assessment centre in case there was a fire. I started to panic, so the other security guard rephrased, asking whether I'd be able to push myself to use the stairs in case of a fire. So that I could get to the centre, I said that if there was a fire I'd have no choice, even if it meant going down on my bum. I was assessed as being able to use stairs, on the basis of that conversation.

That was a dirty trick. At the time I knew no better. If anyone plays a trick like that on you, don't fall for it. If you can use the stairs fair enough, but if you can't, don't be forced to put yourself in a position that causes you pain and/or discomfort. If they prevent you from going upstairs, they are forfeiting the assessment, not you. If you've mentioned on your ESA50 that you have a problem using stairs then they should not have scheduled you to be assessed at a centre that is inaccessible to people who cannot use stairs. What I should have done was ask my partner if he could go up to the centre and explain the situation. I believe I could have insisted upon an assessment downstairs, even if that meant rescheduling it for another date and location.

And that is one of the keys for the whole of the assessment; don't do anything that causes you pain or discomfort. As soon as you feel anything tell them - because they cannot know if you don't do so.

Once you arrive at the assessment centre you need to go to reception to book yourself in and prove you are who you say you are. At my last assessment they played another dirty trick here; three receptionists sat behind the desk giggling and gossipping while a queue built up. I sat on the floor to start with (if you have Orthostatic Intolerance too, you'll understand why), but moved to some chairs after five minutes, to lie down.

If there is a queue when you arrive, I recommend you take a photo of your watch, or preferably a clock on their wall; a screen print of your phone if necessary. The reason I suggest this is because that half an hours queue at the reception desk made me late for the assessment. They later used this as an excuse to send me home without the assessment. Not turning up for an assessment can result in your benefit being revoked.

At the desk they ask you for three forms of ID. I totally forgot to take any one time, so just emptied my entire purse at the lady, which she accepted. So I believe that several things with your name on will be fine. If you usually have trouble remaining standing, you can request a seat while you're at the desk.

If you accept the expenses form, bare in mind that they will be assessing your manual dexterity when you fill it in, and how legible your handwriting is. If you have to submit it in another room, they'll also be assessing your mobility. As such, if your condition is fluctuating, make sure that the assessor knows (once you meet them) what the difference is between these actions and how they would be when you've become fatigued.

Everything you do and say is being watched. From the moment you step into the assessment centre the type of chair you choose to sit in is noted, how you sit in it, whether you fidget, rock, talk to yourself, etc, is all being noted. If you stand or pace, your mobility is assessed. If you use your phone or have brought a book to read, or a book of puzzles, your manual dexterity and concentration are being assessed. Judgements are made according to what you are wearing, and how well groomed you are (not particularly correctly in my experience). Joyce Drummond mentioned that they even make note of whether someone's eyebrows are waxed. I couldn't help wondering how they know.

For most people it isn't particularly unfair that their actions in the waiting room are assessed. The problem for people with M.E. and similar conditions is the fact that our conditions fluctuate. For some of us they fluctuate on a hour by hour basis, others it can be month by month. So, until we actually speak to the assessor to explain where we are in our fluctuations, judgements really should not be made. I've heard of people's assessments not taking place though, because of observations that have been made in the waiting room. (To be fair, though, in these cases the decision has gone in the claimant's favour).

Usually you will be expected to wait a while before you meet your assessor. You may be assessed by a nurse, a physiotherapist or a doctor. Technically speaking the rules state that neurological conditions should be assessed by a doctor. Despite NICE and WHO recognising M.E. as being a neurological condition, the DWP and Atos do not. If your personal condition has been recognised as being neurological you can therefore insist upon being assessed by a doctor. Personally, since we're not seeking treatment from these people, I don't really see that it makes a difference.

The assessor will come to the waiting room and call you by name. They will be assessing, at first, how well you hear them, then they'll assess whether you make eye contact and to some extent your manual dexterity and social behaviour when they offer to shake you by the hand. As you walk with them to the assessment room they are assessing your mobility from whether you walk straight, stumble, bump into doorways, etc.

If you usually use a walking aid or wheelchair, take it with you. The assessor may ask you if they were prescribed or if you bought them. Whichever is your answer, make sure you explain clearly what your reasons are for using it. If there are other aids or appliances you use at home that you believe may help the decision, you could bring them in, or take a photograph to add to the evidence.

You can take someone in to the assessment with you. This person can make notes on the assessment, provided that you allow the assessor to make a photocopy of these notes before you leave. You can have the assessment recorded by prior arrangement. If you want your assessment recorded, you simply phone the DWP and request it. There are not many recorders available throughout Atos as an organisation, so making this request can cause the date of your assessment to be postponed. You can also have home assessments recorded, again, by prior arrangement.

Once you're in the assessment you will be invited to sit down. If the type of chair you are given to sit in is one you are normally uncomfortable in, make sure you mention this to the assessor. If they offer you another chair, don't be fooled into carrying it across the room if it will cause you any discomfort or pain, whether that would be immediate or later.

To every question you are asked, understand that they are making various judgements. For example:

• how much do you need to move around for whatever the question was in reference to.
• how much do you need to move your hands?
• how much do you need to walk?
• how much responsibility does it require?
• how much prior organisation?
• how much social interaction does it require?
• how much social interaction with strangers?

For example, they ask you whether you have any pets. If you simply answer 'yes', it will be assumed that you have a cat or a dog. From that they assume that the animal is fed on the ground, so you must be able to squat (bend the knees) and open a tin (manual dexterity). They will also assume you walk the dog daily. Even if you specify that your pet is not a cat or dog, an amount of responsibility and organisation is assumed, since you will assumably be feeding and watering the animal every day. They do not ask you how many pets you've accidentally maimed or killed. As such, if you have a pet in your household, which you are not responsible for, either do not tell them that it is your pet, or tell them who takes care of it.

You can find a list of the questions you 

may be asked at the assessment, here.

There is also a physical section to the assessment. You will be asked to perform certain movements, some of which you will need to get up onto a couch for. If anything the assessor asks you to do, including climbing on to the couch, causes you discomfort or pain, or usually would, make it absolutely clear to them. If you know that something will cause you discomfort or pain, you can refuse to do it. If they try to talk over you (as one of my assessor's did continuously), say it to them again afterwards.

Once the assessment is over, you should hear what the result is within 4 to 6 weeks. If it seems to be taking forever, phone the DWP to find out what is why. 

Under some circumstances you may be able to arrange for the medical assessment to take place in your home, usually by a visiting doctor. The two scenarios I know of this happening are:

1. By submitting a letter from your GP or a specialist stating that attending the WCA will be detrimental to your health, or that of someone else.
2. When the medical assessment has been cancelled at your detriment, they may offer you a home assessment instead. (This happened to me).

Getting the DWP to agree to a Work Capability Assessment at home is infamously difficult. Simply requesting one yourself rarely works, no matter how hard you state your case. To illustrate how difficult it is; a close friend of mine was in hospital in a neurological unit when she was called for re-assessment. The DWP refused to give her a home/hospital assessment, so she was taken to the assessment centre in an ambulance, and carried in on a stretcher.

The home assessment is very similar to that performed in the assessment centre's. You are asked very similar questions. You are still asked to perform certain movements. The main difference is that the assessor can see for themselves the evidence around your home as to your state.

Useful Links

A comprehensive look at the WCA questions and how to answer them, written by Michelle.

A list of the questions you'll be asked in the WCA.

Questions You May Be Asked (from dwpexamination)

dwpexamination is a fantastic website for any benefit related problems you may have. There are a lot of useful posts, but also their forum is based in Iceland, so our government has no jurisdiction over it at all. I'll let you ponder the implications of that yourself. 

Meanwhile, I am copying here a very useful post, which outlines some of the questions you may be faced with in the Work Capability Assessment. It was originally written in reference to Incapacity Benefit, which is why it refers to the IB50 instead of the ESA50. It still totally relevant now though. I was planning to rewrite it, but I don't think they'll mind me copying it outright if it helps just one person.

 

Here are some of the questions you may be asked during your medical interrogation  ’examination’.

Mental Health

Completion of tasks
Can he or she answer the telephone and reliably take a message?
When referring to ‘telephone’ the ‘Doctor’ will deduce you have and can operate a mobile phone, which you use for texting, chatting, making arrangements and for emergencies. the term ‘Mobile phone’ will not actually be used. That you can and do answer the phone when it rings, your motor and memory functions are normal and that you are not depressed among many other possible ‘stock answers’ he is allowed to use in his / her report. Apparently, answering yes or no to any of the questions you are asked gives the alleged ‘Doctor’ the freedom to be creative in their answer.

How do they know you have one?

Does he or she sit for hours doing nothing?
From this question the alleged ‘Doctor’ will assume you can sit comfortably for longer than the period you have stated on your IB50, incidentally, if you stand up at regular intervals during your examination due to the discomfort you are feeling, he reports this as being able to stand for (and he times you here) for however long without discomfort. You can not win. He /she will also link this with travelling to the examination, either driving, being driven, bus etc despite the fact that you will have stopped several times during your journey due to the discomfort you were feeling during the trip. All from answering yes or no to this question? 

Can he or she concentrate to read a magazine article or follow a radio or television programme?
They are still looking to trip you up here if you have said you cant sit for long periods, despite the fact that you lie in bed to read, watch TV or listen to the radio! They also deduce that you can read, which means to them you can manage your own finances, bills etc, letters, and mail in general, that your eye sight and concentration levels are excellent and in one email I received last night, that you can operate a computer without difficulty? Where on earth does it mention finances, computers or concentration in the question?

Can he or she use a telephone book or other directory to find a number?
Please note, a telephone directory can be heavier than a carton of milk, its another method of covert assessment, curiously as well as proving you can read it also includes the use of computers, management of finances, and the mobile phone again? Be careful and specific when you answer these questions yes or no can be dangerous. Personally I don’t read at all now, and have not done so for years, and when I need a number from the phone book I ask my partner to look it up as I find I usually end up straining to see the small print in the directory.

Heavier than a pint of milk?

Does the mental condition prevent him or her from undertaking leisure activities previously enjoyed?
This one is a beauty, the alleged ‘Doctor’ is trying to trip you up again. If you say you are suffering from depression and yet still follow your local football team then this proves you are not depressed. If you say you sometimes get to the allotment to see to your pigeons, then you are fit enough to travel to work. These questions are geared to prove everything you have entered on your IB50 form is false and can be medically debunked by your own answer. I don’t know about you, but my disability  prevents me from pursuing any of my previous hobbies, full stop.

Does he or she overlook or forget the risks posed by domestic appliances or other common hazards due to poor concentration?
This question disproves the following question (before you even answer it!) relating to serious accidents or to whether or not you can cook for yourself, from your answer the alleged ‘Doctor’ will deduce that you have not had any ‘serious’ accidents lately (I wonder if this includes slips, trips or falls?) you can use a computer? you can drive without difficulty? have excellent concentration skills? can use a mobile phone, deal with you finances, correspondence, can read and write, do your own shopping?

Has agitation, confusion or forgetfulness resulted in any potentially dangerous accidents in the last 3 months?
From your answer the alleged ‘Doctor’ will deduce that you have not had any ‘serious’ accidents lately including slips, trips or falls? you can use a computer? you can drive without difficulty? have excellent concentration skills? can use a mobile phone, computer, deal with you finances, correspondence, can read and write, do your own shopping? you have an excellent memory, your coordination and orientation are normal and you were not confused, agitated or forgetful during the ‘examination’?

Can his or her concentration only be sustained by prompting?
Again, this question is linked to the previous questions and is asked this far in to prove your concentration is good enough to continue answering questions under pressure? So anything you have said relating to poor concentration in your IB50 is immediately called into question?From this and previous answers the alleged ‘Doctor’ will deduce that you can (yes you guessed it) use a computer? you can drive without difficulty? have excellent concentration skills? can use a mobile phone, deal with you finances, correspondence, can read and write, do your own shopping? you have an excellent memory, your coordination and orientation are normal and you were not confused, agitated or forgetful during the ‘examination’?

Daily living

Does he or she need encouragement to get up and dress?
Your Healthcare professional will comment that you have no difficulty getting in and out of bed and can dress yourself without difficulty. This means anything you have said relating to pain when moving is immediately called into question. This also means you are not depressed, can cope easily with everyday functions and can climb stairs curiously enough?

Does he or she need alcohol before midday?
This is to prove you have or do not have a drink /alcohol problem. Notice the use of the word NEED in the question. Everyone (including alcoholics) will rarely admit to NEEDING alcohol at all? Therefore, if you are in the unfortunate position of being an alcoholic, your own pride prevents you from answering honestly. Sad isn’t it?

Do you really NEED this?

Is he or she frequently distressed at some time of the day due to fluctuation of mood?
This question relates to mood swings, sudden changes in temperament. Your alleged ‘Doctor’ will say you did not suffer a mood swing during your examination which means you are not depressed, stressed, or suffer mood swings. Are we to assume then, as long as he /she does not witness you having a mood swing they can say you do not have them?

Does he or she care about his or her appearance and living conditions?
If you are relatively well dressed and appear to be clean during the examination the alleged ‘Doctor’ will deduce that you are capable of dressing appropriately, caring for your self, have good living conditions, are not depressed, stressed and have good coordination. This is despite the fact you may have had help in washing, dressing and that your family or friends help you look after yourself and your home?

Do sleep problems interfere with his or her daytime activities?
Be careful when answering this question! as from your answer the alleged ‘Doctor’ will decide if you have sleep problems which affect your concentration, which in turn may debunk any answers given to previous questions relating to concentration. I refer you to questions 3, 6,7 and 8 previously asked in the Mental Health section.

Coping with pressure

Was mental stress a factor in making him or her stop work? This question is used to debunk any information you put on your IB50 relating to stress as being the main reason or contributory reason you stopped working. The ‘Healthcare professional’ should say so here, if the main reason was anything else, this should also appear here. I.E. The main reason for leaving work was mental stress, physical health, depression etc.

Does he or she frequently feel scared or panicky for no obvious reason?
Unless you actually have a panic attack during your ‘examination’ the alleged ‘Doctor’ is at liberty to assume you do not have panic attacks and therefore anything you have entered onto your IB50 is utter lies. The usual comment is; Does not experience panic attacks,  Appeared relaxed, Not anxious on examination

Does he or she avoid carrying out routine activities because he or she is convinced they will prove too tiring or stressful?
This question has already been asked in the mental health section and I refer you to question 5. The alleged ‘Doctor’ will deduce the following from your answer. You have and can operate a mobile phone, which you use for texting, chatting, making arrangements and for emergencies. Can drive a car without significant difficulty, can deal with your own finances and correspondence effectively and are able to make long journeys without significant difficulty?

Is he or she able to cope with changes in daily routine?
This answer to this question has already been gleaned from the previous questions asked. Take a look at the questions in the two previous sections and tell me I am wrong, The alleged ‘Doctor’ arrived at the following opinion from my answers. Had an appropriate level of concern because of coming here today, normal concentration on examination, not anxious on examination, does not suffer panic attacks and oddly, has a mobile phone, which you use for texting, chatting, making arrangements and for emergencies.

Does he or she frequently find that there are so many things to do that he or she gives up because of fatigue, apathy or disinterest?
Its interesting to note that the answer to this question appeared to have already been gleaned from section 1 questions 1,3,4,5,6 and 7. Section 2 questions1,3 and 4. Section 3 Questions 1,2,3 and 4. You can see this clearly from the alleged ‘Doctors’ answers this question. Dont forget the question about your past hobbies in particular?

Is he or she scared or anxious that work would bring back or worsen their illness?
As with every one of the previous questions, when I was asked this question it was worded differently, the alleged ‘Doctor’ asked;  “What would you do if “they” offered you a job now?”. I gave a positive answer by saying I was eager to return to work once I recovered from my ailment. The alleged ‘Doctor’ inserted the following stock answer. Feels very negative about being able to cope with work?  What planet are these people on? What on earth will the decision maker conclude from that? Worse still, how can I defend this if I need to? The mind boggles.

Interaction with other people

Can he or she look after himself or herself without help from others?
Beware?You have already been asked this question in sections one and two, from this question your alleged ‘Doctor’ will deduce that you have a mobile phone and use it for texting, chatting, making arrangements and emergencies, can deal with your own finances and correspondence without difficulty, can use a computer and have normal intellectual functioning?

Does he or she get so upset by ordinary events that it results in disruptive behavioural problems?
Caution! this has already been assessed in question 3, Daily living section.

Do mental problems impair his or her ability to communicate with other people?
Already assessed in question 1 section 1.Curiously, the alleged ‘Doctor’ deduced the following; Yes you guessed it, has a mobile phone and use it for texting, chatting, making arrangements and emergencies, Behaved normally, normal rapport?

Does he or she get irritated by things that would not have bothered him or her before becoming ill?
Beware! this has already been assessed at section 1 question 5, section 2 question 3 and section 3 question 3. The alleged ‘Doctor’ will comment on your present state of agitation, i.e Had a clam nature, He or she appeared agitated.

Does he or she prefer to sit alone six or more hours a day?
It didn’t seem to matter when I told the alleged ‘Doctor’ that I regularly spend long periods of time alone as my partner works alternating shifts, the stock answers entered were. Sees family every day, Behaved normally, not depressed on examination?

Is he or she too frightened to go out alone?
I was asked How I got to the examination centre? was I accompanied? did I drive there myself?  The answers I gave to these questions (which were entirely supplementary, and not part of the official list of questions I have reproduced here) did not appear on my medical report, neither did I understand their significance until I saw the medical report. The stock answers included; Goes out alone, Does not experience panic attacks, Not anxious on examination, can drive a car without significant difficulty, Appeared relaxed, Able to make Long journeys without significant difficulty.

Work Capability Assessment Centres

The following two documents contain a list of the UK assessment centres, as of April 2013.

The spreadsheet you can sort in order to find the centre you're looking for more easily.

The PDF contains more information.

Excel Spreadsheet.

PDF.

 

Work Capability Assessment List of Questions

Below you will find a list of questions that you may be asked during your Work Capability Assessment. It is unlikely that you will actually be asked all of them.

When you look at each question consider what they are assessing, and consider what your thorough answer will be.

They will be looking to make judgements on:

• how much the activity in the question requires you to walk.
• whether you might need to go up or down stairs for the activity.
• whether you may have to reach your arms to perform the activity.
• what kind of weight you can lift.
• how much manual dexterity is required.
• how well you cope in social situations.
• how well you communicate with other people.
• how well you understand other people.
• how safe you are when unattended.
• whether continence problems restrict your abilities.
• how good your cognitive skills are.
• how well you cope with change to routine.
• how well you cope with unexpected changes.

It's very easy to give yes and no answers, but doing so does not give the assessor a proper picture of your situation, and is more than likely to lead to scoring zero points, and therefore not succeeding in your application for Employment & Support Allowance.

A couple of examples of thorough answers:

Question: Do you use the wheelchair every day?

Bad Answer: No.

Thorough Answer: No, because I am usually in too much pain to get out of bed. And my partner cannot push the wheelchair, so I can only go out if we have another person to push it. I do always use it to go out.

Question: Who helps you with the depression? Are you under a psychiatrist or a GP?

Bad Answer: GP. (Atos, in their wisdom, assess any condition for which you do not see a specialist, as less severe than if you do see a specialist).

Thorough Answer: I see my GP fortnightly at the moment because we're changing my anti-depressant medication. I'm on the waiting list to see a counsellor because my GP is very worried about my state of mind.

Question: Do you live in a house or a bungalow?

Bad Answer: A house.

Thorough Answer: I live in a three story house, but I only use two rooms. When I have to I go downstairs on my bottom, and crawl up the stairs, pausing for breaks usually twice.

Asks who diagnosed the problems and whether I was under a specialist or just a GP?

Do you use the wheelchair every day?

Do you use the wheelchair indoors?

Are you able to propel the wheelchair yourself?

How long have you had depression?

Does your mood vary?

Do you have good weeks and bad weeks with this?

Would you say that you are mostly down then?

Who helps you with the depression? Are you under a psychiatrist or a GP?

Do you drink alcohol?

Have you ever self harmed or attempted suicide?

Do you get suicidal thoughts now?

How long have you had IBS?

What symptoms do you get with the IBS?

Do you get to the toilet in time?

Do you have to wear incontinence pads?

Have you brought a list of your medication?

Goes through all medications I’m taking.

Do you get any side effects with what you are taking?

How did you get here today?

How long did that take you from your house?

Who has accompanied you today?

Who lives in your house with you?

Is it a house or bungalow?

When did you last work?

And you’re not studying or working at the moment?

What is your sleep pattern like?

Do you find you get a disturbed sleep?

Is this due to not being able to switch off or pain?

What time do you normally get up in the morning?

Does your son get himself up and ready now he is older?

How do you manage to get washed and dressed?

Have you got a shower or bath?

Can you wash your hair?

How much assistance do you need to get dressed?

Can you pull your top over your head?

Can you manage buttons?

Do you have assistance with getting your lower garments on?

Have you got a stair lift?

Have you a bathroom upstairs as well as downstairs?

Have you a toilet downstairs?

How do you manage in the kitchen making yourself tea and coffee and snacks?

Can you manage to make yourself a cup of tea?

When did you last make yourself a cup of tea?

Who see’s to the housework?

Do you do any housework?

Do you drive at all?

When did you last drive?

What stopped you driving?

What was the cause of the blackout?

Were you unconscious during the blackout?

These episodes of vagueness you’ve had since then do you go unconscious or is it just your speech is affected?

Where do you go to do your shopping normally?

Do you have assistance to go around the house?

How many minutes can you walk for?

Do you walk outside?

Have you any hobbies or interests?

What do you do during the day?

How far away do you live (this is directed to my father)?

How often do you come and visit (again this is directed to my father)?

Do both your parents come every day?

How do you get to your father’s house?

Does your son make his own way home from school?

What’s your routine in the evening what do you tend to do?

Does your son help you with the evening meal?

Does your son come with you to your parent’s house?

Have you got friends locally that pop in and visit?

Have you got any other family members that come to visit?

Do you keep in touch with other family members on the phone?

How far is the GP surgery from you?

Are you OK making appointments with them when you need to?

Do you have to phone them in the morning?

Do you wear glasses all the time?

Do you wear any hearing aids?

Now she checks limb movements.
Are you able to look up to the ceiling for me?

Are you able to look down to the floor?

Are you able to look over to your father and then look the other way towards the filing cabinet?

Are your neck movements OK?

Can you bring your ear down to each shoulder?

Can you bring your arms out straight?

Turn your arms over and then back again?

Can you bring your arms up to your shoulders?

Can you bring your arm up and behind your head?

Where’s the pain when you do that?

Have you got pins and needles in this hand at the moment?

Can you close your eyes I’m going to get a tissue and touch different parts of your hand and you tell me when you can feel it?

Can you stand up and do a forward flex?

Where would that hurt you?

Could you squat to pick something up off the floor?

Are you able to get on the couch to do some limb movements? Or do you wish to do them in the chair?

Would you be able to get on the couch or would you find it difficult?

Can you bend your left knee and bring it up to your chest?

What pain does that cause you?

Can you straighten you leg and bring it up?

Where does that hurt you?

Can you do the same with the right leg?

Can you get your arm behind your back at all?

What about the other arm?

Challenging a Decision

The DWP seem to either turn people down, or give them a lower award than is appropriate. For example, putting someone who should be in the ESA Work Related Activity Group when they should be in the Support Group, or awarding someone Low Rate Care for DLA when they should be on High Rate Care.

It's been explained by some people as a test to see if people are really legitimate. The theory being that if they truly deserved the benefit they applied for, or a high award than they were given, they would fight for it. This does not stand to reason, as they do not then take the benefit away from people who don't fight for higher awards. As such, I can only presume that this is a last ditch attempt to save a few pennies.

If you do not agree with the award they give you, or you are turned down, do not let it lie. Do not be afraid to confront the DWP. 

I pretty much expect the DWP to mess everyone around. As such, I prefer you to be ready for it.

Whether it was ESA, DLA, or PIP you have applied for, the process, if you disagree with their decision, is the same.

Wait until you are calm, because writing in anger does no one any good.

They give you a time limit within which you must respond. You have two choices:

- request a reconsideration

- request an appeal

If you request a reconsideration, your case will be placed before a Decision Maker again (when you made your original application, a Decision Maker looked at all your evidence, and made the decision which you just received). It will not be the same Decision Maker as the first time. (You can check this; the decision document has the Decision Maker's name at the end of it. You will receive another such document after the Reconsideration, which will also have the Decision Maker's name at the end of it. The two should not be the same). This Decision Maker will look at your evidence again, anything new you have submitted, and your reasons for requesting a Reconsideration. They will then send you another decision document.

If you decide to Appeal a decision, you are asking to go to tribunal. As part of the Appeal process, your case will be Reconsidered (as described above), before going to tribunal. (It saves them money if your case does not go to tribunal). If the decision is not over-turned by the Decision Maker you will go before a tribunal panel. It can take anywhere between 3 and 18 months to be seen by the tribunal panel (depending upon where in the country you live). 

Going to tribunal means you go before a panel to whom you can state your case. You can take someone with you, who may or may not be allowed to speak on your behalf. It is just you, whomever you take with you, and the tribunal panel in the room; it is not a public court. The tribunal panel consists of three people; usually it will be a medical professional, a legal professional, and an independent witness from the disabled community. They will ask you questions about how your illnesses affect various things. You can point them to specific bits within the evidence that the Decision Makers may have over-looked. 

You may be able to submit further evidence at the Tribunal, but it's advisable to submit it as early as possible; they can argue that they are assessing you as you were when you made the original application for benefit, so any later evidence is not applicable.

As many as 70% of cases are over-turned by the Tribunal panel. So, going for Tribunal is not to be overly feared. It is very stressful though, so it really is better to state your case clearly and concisely from the beginning.

One of the overwhelming messages from people with M.E. and Fibro being seen by the tribunal panel is that it is usually the disabled person on the panel who gives them the worst reaction. This is most likely because M.E. & Fibro are not visible, as their condition may be. As such, it is imperative to paint a very clear picture of how you are affected. You cannot ignore one person's attitude, as all three are in the position of judging your case.

My advice, usually, is to go straight for an Appeal. The reason being that your case will be seen by a Decision Maker, and possibly over-turned at that point. If it is not you are automatically placed in the queue for the tribunal panel.

However, there are cases where I have not advised this. Using myself as the example is easiest. I received the decision documents for DLA in August. The date I was given to challenge their decision by, was the beginning of September. I had a various medical tests lined up on September 10th and 16th, which could provide further evidence for my case. As such, by requesting a Reconsideration (which I assumed would turn my case down again), I was delaying my request for an Appeal, so that I could add any new evidence to the Appeal request form.

How to Challenge the Decision!

To challenge a decision, use the GL24 form, which you can download here or here

(Though, to be honest, I totally forgot to use the form, and they still accepted my request for reconsideration).

You will have been sent a list of reasons as to why your case was turned down. These lists usually read like they are referring to someone else, and often feel as if someone is telling lies about you. It's perfectly normal for it to seem that way, don't worry.

You need to challenge these reasons, either by referring to the evidence you already submitted to the DWP, or by referring to the new evidence you will be submitting with the GL24. The GL24 only provides a tiny box in which for you to write. Do not be lulled into thinking that filling that box will be sufficient. If you use the Word version of the GL24, you can type as much as you want to. If you use the PDF, you will have to staple further sheets of paper to it.

It's far easier to show you than to explain how to challenge them, so I am copying a section from my request for reconsideration. This is how I've approached just one of the statements from the Decision Document. You can view the whole document here.

It has been stated that:

I don’t need help to use a cooker, use kitchen tools, carry and lift safely, plan a meal, or motivate myself.

·         I would like to refer you to the ESA Medical Report Form written by Dr ######:

•  Page 4: “Struggles to wash hair and body due to pain.
•  Page 4: “Can’t do buttons”
•  Page 4: “Unable to cook”
•  Page 4: “ May need meat cutting up”
•  Page 4: “Unkempt. Very unkempt room and house”
•  Page 8: “All reduced movements due to pain, weakness, stiffness”
•  Page 12: “Reduced power grip – point weakness” (nb, I drop things)
•  Page 12: “Reduced power both arms – point weakness”
•  Page 29: “Severe functional disability seems likely with mobilising”

·         I would like to refer you to my DLA Application Form:

• Page 14: “My concentration is poor”
• Page 17: “I need a lot of encouraging and prompting to get out of bed as I am constantly exhausted.
• Page 17: “I need reminding it is time to go to bed.”
• Page 17: “Most days I don’t get up until between 11 and noon” [if I get up].
• Page 17: “I wear the same clothes for days at a time as it is too exhausting for me to dress.”
• Page 17: “I often wear my nightclothes or wear my day clothes to sleep in.”
• Page 22: “My muscles are weak, I am in constant pain”
• Page 23: “Somedays I cannot cut up food as my fingers are so weak and my wrists are painful.”
• Page 23: “I need constant reminding to eat and drink as [..] it is too much effort.”
• Page 24: “I cannot open blister packs / medicines due to pain and my fingers and wrists.” {And I cut my tongue on one yesterday).
• Page 24: “I need reminding to take my medication as I am very confused by fatigue.”
• Page 28: “I am too fatigued to cook.”
• Page 28: “My concentration is very reduced and I forget I am cooking and burn food.”
• Page 28: “ I cannot lift hot pans due to weak muscles and carpel tunnel.”

So, you use your evidence (including your application form) to bring the Decision Maker's attention to the exact pieces of information that challenge each statement that has been made about you. It is easiest for the Decision Maker to find the right information if you present it to them this way. 

It can take a long time to do this, as it means looking through you evidence over and over again to find the exact quotes required to challenge their statements, but it is worth it. The whole process of applying for benefits can be extremely stressful, but once you've got them, you can breathe easy for a while.