Document for requesting a reconsideration

Below you will find an example document for requesting a reconsideration. This was my own document when requesting reconsideration for DLA. It's exactly the same format I would use for ESA (I just don't have my ESA one available to copy). 

When you receive the decision on your ESA, you should receive a document with it called the ESA85 - the 'explanation of reasons'. If you do not receive this, contact the DWP and request it as soon as you can. Once you receive this document:

• Try not to let it get to you. Remember you're just a statistic to them, it's not meant personally. If it makes you emotional, leave it a day to come back to it.
• Go through with a pen, marking each point you disagree with.
• Create a document, type each point you disagreed with into it.
• Go through your evidence, one piece at a time, checking against the points you disagreed with.
• On the document, create a list of evidential statements, that disagree with the points you copied into the document previously. Name the piece of evidence, and quote the part or parts that disagree with their conclusion. (See my example below to understand this better).
• Try to treat it as a business matter. Remain professional. Inserting emotion tends to rub them up the wrong way; what the outcome of the document is, is of no consequence to them, so appeal to them by making it as simple and easy as possible.

Address
Address
Address
Address

National Insurance No.: XX111111X


Date



To whom it may concern,

I’d like to bring a few points to your attention before I present you with my reasons for requesting a reconsideration:
1)    The Decision Maker who spoke to myself and my partner, told my partner that she had not looked at my evidence before making the decision. As such I would like to be sure that the Decision Maker who revisits my case does actually look at the accompanying evidence, please, particularly at the report written by Dr ### ####### whom performed the home medical for ESA.
2)    The ESA medical assessment (from which you have some evidence) was recorded; you are very welcome to have a copy of the recording to use as additional evidence should you believe this to be helpful – please contact me if so. Similarly, both my counsellor and case worker are independent witnesses whom are happy for you to contact them.
3)    This document has been dictated to my partner.

It was been stated that:
I can walk over 50 metres, slowly, in a reasonable manner.
•    I would like to refer you to the ESA Medical Report Form written by Dr ### #######:

• Page 3: “Suffers with Orthostatic Intolerance – where standing or sitting up causes blood pressure to drop. Passes out due to this.”
• Page 4: “Feels knackered on little exertion”
• Page 4: “Seemed tired, exhausted”
• Page 8: “Stood up with physical help”
• Page 8: “Jerky body movements – said felt dizzy and unsteady”
• Page 8: “ Walked few steps with unsteady gait”
• Page 8: “Unable to stand still with eyes closed”
• Page 8: “All reduced movements due to pain, weakness, stiffness”
• Page 29: “Severe functional disability seems likely with mobilising”

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

• Page 10: “Often bed bound and unable to go out”
• Page 11: “Very slow: less than 40 metres a minute.”
•  
• Page 11: “I walk very slowly due to severe, significant, pain in my knees, pelvis, hips. I also have poor balance so unless I walk slowly I fall. I often use a wheelchair when outdoors due to severe fatigue.
• Page 12: “I cannot walk without physical support.”
• Page 12: “I would fall without physical support.”
• Page 12: “I would injure myself without physical support.”
• Page 12: “If I am well enough to go out without using the wheelchair I have to use a walking stick or link arms with another person”.
• Page 12: “I would fall and hurt myself without support.”
• Page 21: “Out in the community I am usually in a wheelchair”
• Page 22: “My muscles are weak, I am in constant pain, my co-ordination is very poor due to constant severe fatigue.”
• Page 22: “I cannot weight bear due to pain, fatigue, and carpel tunnel syndrome in my wrists.”
• Page 22: “My last fall [before filling in the form] was April 25th.” (Please note, that is the date the form was submitted – I fall nearly every day).

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.”

It has been stated that:
I do not need help getting in and out of bed, to wash and dry myself, to use a bath or shower, to dress or undress, to get up and down stairs, to move about indoors, to eat and drink, to take part in social activities, or to communicate.
•    I would like to refer you to the ESA Medical Report Form written by Dr ### ######:

• Page 3: “has speech impediment at times.”
• Page 3: “has difficulty in crowded rooms”
• Page 3: “sound sensitive, light sensitive”
• Page 3: “Does not get washed and dressed if not going out.”
• Page 3: “Has shower sitting on ground – due to low blood pressure – a day before going out.”
• Page 4: “Struggles to wash hair and body due to pain.”
• Page 4: “Needs help to get dressed.”
• Page 4: “Wears loose fitting clothes.”
• Page 4: “Can’t do buttons.”
• Page 4: “May need meat cutting up.”
• Page 4: “Copes to move indoors holding furniture.”
• Page 4: “Copes to go downstairs on her bottom.”
• Page 4: “Copes to stand up once a day.”
• Page 8: “Stood up with physical help.” [from bed].
• Page 34: “Severe functional disability seems likely with mobilising.”

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

• Page 10: “Wheelchair: cannot self propel due to severe debilitating fatigue.”
• Page 12: “Even if I am well enough to go out without using my wheelchair I have to use a walking stick and link arms with another person. I would fall and hurt myself without support.”
• Page 14: “I suffer from anxiety and need someone with me outdoors as I get distressed.
• Page 14: “My concentration is poor and I can be in danger crossing roads.”
• 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: “My body clock is very confused.”
• Page 17: “Due to pain I need physical help to get into and out of bed.”
• Page 17: “Most days I don’t get up until between 11 and noon” [if I get up].
• Page 17: “I am in too much pain to often brush my hair.”
• 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 21: “I am often unable to move about indoors at all due to severe fatigue and pain.”
• Page 21: “I am often unable to use the stairs at home.”
• Page 21: “I avoid stairs as I have fallen.”
• Page 21: “I need help to get into and out of my wheelchair due to pain and fatigue and being unable to weight bear.”
• 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 I cannot bring myself to eat / drink as it is too much effort.”
• Page 25: “I have panic attacks and cannot answer the telephone or deal with strangers.”

It has been stated that:
I am aware of common dangers, not at risk or harming myself, not at risk of aggressive or anti social behaviour, not at risk of falling, not at risk of neglecting myself, and not at risk of danger from dizzy spells or blackouts.
•    I would like to refer you to the ESA Medical Report Form written by Dr  ### ######:

• Page 3: “Suffers with Orthostatic Intolerance – where standing or sitting up causes blood pressure to drop. Passes out due to this.”
• Page 8: “Jerky body movements – said felt dizzy and unsteady.”
• Page 8: “Declined squat – due to feeling unsteady and weak”
• Page 34: “Severe functional disability seems likely with mobilising”

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

• Page 11: “I also have poor balance so unless I walk slowly I fall.”
• Page 12: “I would fall and hurt myself without support.”
• Page 13: “Yes, I fall and stumble when walking outdoors.”
• Page 13: “Poor balance, severe extreme debilitating fatigue and pain.” [cause me to fall and stumble].
• Page 13: “I stumble constantly, and have a ‘proper fall’ every 1 – 2 weeks.”
• Page 13: [I need help after a fall because] “I am disorientated, unsteady, and in significant pain.”

It has been stated that:
“I do not need help to sleep comfortably or to adjust bed covers”
•    I would like to refer you to the ESA Medical Report Form written by Dr  ### ######:

• Page 4: “Can’t do buttons”
• Page 4: “Unkempt. Very unkempt room and house”
• Page 4: “Feels knackered on little exertion”
• 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 22: “My muscles are weak, I am in constant pain”

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

• Page 29: “I awake in pain and cannot get comfortable.”
• Page 29: “I get distressed during the night and ruminate on post issues of abuse in my life.”

•    I would like to mention that while none of the evidence says I need help to sleep comfortably, I never do sleep comfortably. Even sleeping medication and night pain meds (which you’ll find listed on the form and the ESA medical report) do not help me sleep properly.

It has been stated that:
“I am aware of common dangers, not at risk of harming myself and not at risk of anti social behaviour”
•    I would like to refer you to the ESA Medical Report Form written by Dr  ### ######:

• Page 8: “ Walked few steps with unsteady gait”
• Page 8: “Unable to stand still with eyes closed”

•    I would also like to refer you to the letter from Simon Painter, of MIND:

• “The consequences of these traumatic events left Ms ##### terrified for her life and suicidal.”
• “[..] severe and frequent panic attacks where she lost all sense of reality.”
• “During these panic  attacks Ms ##### would self-harm; scratching, biting, and hitting herself: she would hide and frequently regain awareness in unfamiliar locations.” Note: Mr %%%%% has personally seen the wounds from these attacks.
• “[..] feels at times that she ‘doesn’t want to be here anymore.’.”

•    She hasn’t mentioned it in her supporting letter, but I would like to suggest you call my case worker, ???? ??????, from DIAL, and ask her what happened the first time we met. I am not proud of such moments, but they happen with increasing frequency.

I hope you do not mind me asking that you do not telephone me this time. I am telephobic, as such receiving unexpected phone calls can cause an anxiety attack. This is mentioned on Page 25 of the DLA Application Form. I am currently left alone in the house during the day, which leaves me at risk of anxiety attacks if anything unexpected happens. If the phone call with the previous Decision Maker had been recorded, you would be able to hear a panic attack starting; unfortunately I’m told that no such recording exists. If you do wish to speak to someone who knows me, both ???? ??????? and %%%% %%%%%%% are willing to take a phone call from you.

Kind regards,



Name

What is ESA?

ESA is Employment & Support Allowance. It was introduced in 2008 as a replacement for:

• Incapacity Benefit
• Invalidity and Sickness Benefit
• Income Support claimed on grounds of sickness

It has been rolled out slowly, gradually reassessing those who have been claiming those benefits name above. If you are claiming one of those, you will be reassessed at some point, so it would be wise to be prepared.

Employment & Support Allowance is intended for people who are unable to work due to sickness or ill health. There are different types of ESA. It can be quite daunting trying to understand which to apply for.

 

ESA - Contributions Based

• In order to claim Contributions Based ESA you need to have had an employer pay your National Insurance (Class 1 contributions) for the whole of the previous year. 
• If you were in full time employment before becoming ill, this is the type of ESA you should apply for.
• If you are in the WRAG (Work Related Activity Group - see below), on Contributions Based ESA, you will only receive it for a year. You can then apply for Income Related ESA (see below).
• If you are in the Support Group (see below), on Contributions Based ESA, you are not time limited to the year.

ESA - Income Related

• Income Related ESA is means tested. If you haven't been employed (do not have Class 1 contributions) this is the one you need to apply for.
• The means testing takes into account your income, your savings, and any income and savings of a partner if you live with one.
• It does not take into account your out goings.
• Income Related ESA is not limited to a year.

 

WRAG (Work Related Activity Group)

There are a lot of misunderstandings over what the Work Related Activity Group is.

• The Work Related Activity Group is for those who are expected to be able to return to work within a given time period.
• If you are placed in the WRAG you will be expected to seek and partake in 'activity' that progresses your situation to being able to work again in the future.
• This activity may be voluntary work, but it may also be attending therapy or specialist appointments - it depends upon how open and understanding the Job Centre Plus employee you work with, is.
• It is imperative that the 'activity' you undertake does not cause your health to decline. You can use letters from your GP to guide them in how much they push you.
• One of the useful bits of being in the WRAG is that having regular appointments with a DWP employee means there is a regular record if your health is declining.

It is NOT:

• A group. You do not sit in a circle with other people as if you were in group therapy.
• The Work Program.
• Forced unpaid labour.

The Support Group

The Support Group is for people considered too ill to be likely to return to work in the near future.

Rates

The rates paid to those on ESA have changed since it was introduced, but I believe they have been frozen for the next few years.

• £56.80pw is the introductory rate for under 25s.
• £71.70pw is the introductory rate for over 25s.
• £100.15 is the rate for the WRAG.
• £106.50 is the rate for the Support Group.

Officially the introductory rate is only for 13 weeks. In reality the assessment process often takes a lot longer. When you are eventually placed in WRAG or the Support Group you should get payment at the appropriate rate, back-dated to the 13th week.

If you do not have appropriate National Insurance Contributions, and your household income is too high to place you on Income Related ESA, you will receive no payments - £0.00pw - but they will still pay your National Insurance Credits. (Credits and Contributions are not the same thing).

 

The Process Outlined

If you are employed, and become severely ill:

• you can self certify yourself as ill for one week.
• a doctor can then sign you off work for as long as they consider you need to be off work.
• you send the the sick note (called a 'fit note' since 2010) you are given by the doctor to the DWP in order to receive Statutory Sick Pay from the government. (Statutory Sick Pay is £86.70).
• you can claim Statutory Sick Pay for 28 weeks 
• the DWP may ask you to complete the ESA1 when you send in your first sick note. You don't have to (until 28 weeks); basic rate ESA is less than Statutory Sick Pay.

You do not have to leave work because of sickness. Some employers will create an agreement with you whereby your position is held open for you should you be able to return to work in the future. You will no longer receive payment from your work place, but will receive ESA payments from the government, whilst still holding a contract with your work place. You are in a more secure position if you can make this arrangement with your employment, than if you resign.

If you have been severely ill for a few years, but haven't claimed ESA yet:

• you can also submit sick notes from your GP to the DWP for 28 weeks, as described above,
• or you can telephone the DWP and fill in an ESA1 form over the phone.

Once you have completed the ESA1:

• You will be sent the ESA50 form to complete.
• When you receive the ESA50 you will be given a three or four week time limit in which it must be returned. It is advisable to be prepared for this form before you receive it, and have evidence lined up to send with it.
• Once your form and evidence has been returned, it will be briefly assessed as to whether you require a Work Capability Assessment (the WCA - otherwise known as "the medical").
• Most people are invited to the WCA, but some are placed either in the WRAG or the Support Group on the strength of their form and evidence.
• If you are invited to the WCA and do not attend, your application for ESA will be declined.
• In the WCA you will be assessed by a doctor, a physiotherapist or a nurse. They will make a recommendation as to what they believe the decision on your case should be.
• A Decision Maker will then look at your form, the evidence you submitted with it, and the data collected in your WCA, and make a decision over which group you should be placed in, if you should receive ESA at all.
• You will receive a document from them informing you of the decision. You should then start to receive the higher rate of pay, and any back pay that has accumulated.
• If you disagree with the decision you can either request a Reconsideration or go straight to Appeal.
• If you request a reconsideration another Decision Maker will look at all your evidence again.You can write to them explaining why you disagree with the decision, but you do not have to.
• If you ask to go to Appeal, another Decision Maker will look at your case (Reconsideration) anyway.
• If the decision is not over turned at this point, you will eventually go before a tribunal panel to plead your case.