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How to Appeal PIP: Gain Confidence With These 12 Invaluable Tips

 

So continuing on from Part 1 of this mini-series, which covered how to navigate the PIP appeal process, here is Many Lemons’ Top 12 tips to read before embarking on the PIP appeal process (yeah, 12 not 10, I’m not conforming).

Number 1: Bear in mind the deadlines of each phase:

REQUEST A MANDATORY RECONSIDERATION:

 the DWP must receive your request within one calendar month of the date on the decision letter you received

APPEAL TO THE TRIBUNAL:

the tribunal must receive your request for appeal within 1 month of the date of the Mandatory Reconsideration Notice.

It is possible that you can still appeal past these deadlines but it’ll be a lot harder and you’ll have to argue as to why you missed the deadline. But, if you are in this boat, as always, don’t let this put you off, you can always give it a good go. Go for it.

Number 2: Be aware of and use phrases that apply to you

If it applies to you, be aware of and repeatedly use the phrases:

“most of the time”, “majority of the day”, “more than 50% of the time”

“I can manage this BUT I suffer with pain / fatigue / exhaustion / numbness / tremors / weakness afterwards and have to rest/take pain medication as a result and it affects me afterwards in that <insert your experience here> for the rest of the day / days afterwards”

“I cannot do this safely/reliably/repeatedly/within a reasonable time/whenever I need to”

“I can sometimes do this on a good day, but these days are rare / occasional / happen less than half the week”

“It takes me a long time to do <activity> because I have to keep resting / it causes me pain”

“If I do <activity> repeatedly, I suffer pain / exhaustion / severe discomfort / tremors / numbness / weakness / problems with grip”

This is key if you have a condition that fluctuates by the minute / hour / day / week / month and/or you have invisible symptoms. In 2013 the Countess of Mar and members of Professor Malcolm Harrington’s Fluctuating Conditions Group succeeded in getting the DWP to amend PIP regulations to take into account fluctuating conditions and invisible symptoms. So if it applies to you, use this amendment by using the phrases! Further details of how to explain your condition in PIP-friendly terms will be coming up soon in a future blog post.

Number 3: At any stage of the tribunal  appeal process, you can put the brakes on and say ‘stop’!

This is a very handy piece of knowledge to have because it can alleviate the incredibly high anxiety most of us feel about the whole process. Just receiving a DWP letter through the letterbox can fill us with panic, but knowing you can stop at any time, means in your head you can say ‘well, I’m not going to do anything, I’m just going to see how this goes out of curiosity’.

Number 4: PAPER TRAIL PAPER TRAIL PAPER TRAIL!!!

Photocopy any paperwork before you send it off to the DWP or to the tribunal service. Also, make a note of any phone calls you make with the DWP and always follow up with a written, dated and signed letter which details what was discussed along with the date and time it was discussed, and send this letter to the DWP recorded delivery. There have been many cases where the DWP has denied phone calls were made to them and also denied mandatory reconsideration requests by claimants were ever made. Cover yourself.

On the flip side, bear in mind that whatever you say during a phone call could be used later on (it’s very rare to be recorded, bu the assessor may make notes). So it’s worth keeping a pad of paper by the phone in case you get a call. In this way, you can make your own notes of what was said and contest anything later on if needed. If you are not prepared for the call, for example you are feeling very fatigued or in a lot of pain, don’t hesitate to let them know and finish the call, planning one with them at a later date and time. Also, do not feel rushed! Take your time and ask the caller to repeat themselves if you need clarification or some time to absorb the information. Look after yourself guys! It’s your right, your phone, your time.

Number 5: Your current points are not protected

It is important to understand that the appeal of your award can result in you gaining more points, but the tribunal also has the power to take them away. So if you have standard rate and wish to appeal as you believe you should get higher rate, bear in mind that you may end up even worse off after the appeal process. However, it is a power that the tribunal exercise extremely sparingly. Unless a glaring error has been made previously your existing points will usually be safe.

I have a duty to let you know of this possibility, but also I’d like to put it into context. The decision to appeal your award is a very loaded decision for us, because it’s not ‘just’ about the money – there is a lot at stake.  The difference between getting higher rate versus standard rate mobility award is the difference between getting access to the motability scheme or not. This is the difference between being able to get out of the house, and not. I mean, if your bus stop is more than 20m away, the distance cut-off for gaining higher rate from the ‘how you get around’ descriptor, you’re kinda screwed. In addition, to automatically qualify for a blue badge, you need to have been awarded points indicating you cannot walk 50m or more. You can still apply for a Blue Badge if you have not qualified for these points, but there’s no guarantee you’ll get a badge.

So you may decide an appeal is essential, or that, given this very small but real chance of losing points, that it’s too risky. To decide, I’d recommend taking a look at whether the points you have so far gained for the PIP activities are sturdy in terms of being accurate or not. Again, ask for advice if you are unsure.

Number 6: Be aware that DWP decisions are being overturned left right and centre!

The success rate of both PIP and ESA appeals has been largely steadily increasing. During the period April-June 2014 when PIP was first introduced, 26% of claimants won their appeals. In the period April – June 2015 claimant wins had climbed to 47%. In January 2016, claimants had a 61% success rate.  That’s 3 in 5 claimants overturning the DWP’s decision. Nice odds. And these numbers include claimants who did not have professional representatives, so if you get a representative, your odds will probably be higher. The discrepancy between initial DWP decisions on disability benefits and independent party’s rulings on the same laws is illustrated wonderfully by the fact that 95% of DWP ‘fit for work’ decisions imposed on 200 applicants were overturned by a group of Law students from Bristol. The national average for overturns of this type of benefit ruling during the Law Student’s work in September 2015 was 59%, indicating that when the law is imposed properly by trained representatives, the DwP failings are evident and quite incredible.

So, in my opinion, the default setting if you have a disability which has invisible symptoms and you are not ‘severely disabled’ seems to be to err on the side of the lowest points they can get away with. The government are using a process with ATOS which in effect enforces quotas in the number of people who are ‘allowed’ into the Support Group for ESA. It would not surprise me if a similar process is being used that effectively results in quotas for PIP awards. In addition, the Public Accounts Committee recently concluded that too many PIP and ESA assessments do not meet the required standard, and highlighted specific concerns over the level of service for claimants with fluctuating and mental health conditions. So getting to appeal is, unfortunately, the only way for the law to be applied fairly in a lot of cases. 

Number 7: You can get hold of DWP’s records on you

If you decide to appeal, the tribunal service will request a copy of all your PIP records be sent to both them and you. This means you will have full access to the assessor’s notes plus the defence of the points you were awarded by the awarder. From this, you can see and note carefully if anything from the assessment, application form or submitted evidence was either ignored completely or misrepresented by the assessor.

Number 8: 1st Tier Tribunals are relatively informal

In many cases, the DWP does not send a ‘presenting officer’ to attend the hearing. It does depend on the region, and occasionally they do show up, so you should prepare yourself with that possibility, but please do not let this put you off as it is not certain by any means.

The judge is joined by a doctor (usually a GP) and a ‘Disability Qualified Member’ (DQM), and together they will hear your case, each having the opportunity to ask questions. Although formally the tribunal members are of equal status, it is the judge who makes the record of proceedings, advises or directs the others on issues of law, is responsible for writing the statement of reasons if one is required…and is paid the most! In practice It is solely the call of the judge as to whether you should be awarded more (or fewer) points. So, in practice, the judge is by some distance first among equals and the one you most want on your side.

Finally, the hearing will have considerably less formality than a court and often takes place around a table in a simple room (so you can’t pretend you’re in an episode of The Good Wife), but in some places magistrates’ court buildings are used (and then you can!…ish).

 

Number 9: Get more, specific evidence if you can

If you can get hold of more evidence and more specific evidence, do it do it do it. MS Nurses and/or GP’s can be gold in these situations because they are the people who most likely see, hear and understand how your disability affects you. See if you can have a chat with them about how your disability affects your average day and whether they’d be willing to write a letter summarising this. If you have invisible symptoms, ask your healthcare professional whether they can emphasise these in the letter. Similarly, if you have had any referrals for symptoms or difficulties associated with your disability or mental health, ask your healthcare professional whether they can emphasise these in the letter, including an explanation of why the referrals were requested.

Number 10: Keep it simple

If occasionally, you CAN walk more than 20m without exhaustion (for example), do not offer this information unless asked. In terms of the application, it is inconsequential, because what matters is how you feel for the majority of the time, not occasionally. And it may well affect your assessor or judge subconsciously. I am NOT saying to lie about your condition, in no way am I saying to lie. What I am saying is to bear in mind that your job is to stress what your experience is the majority of the time. I would interpret the questions as meaning ‘the majority of the time’ and make sure you answer in terms of how you are affected the majority of the time, using variations of the example phrases in point 2.

The other point to keeping it simple is, if your condition has not worsened dramatically but you are instead experiencing a normal exacerbation of  your symptoms which you considered during your application,  do not be tempted to say that your condition has worsened since application. Again, this is down to interpretation – if your fluctuation has already been accounted for in your application, then to all intents and purposes, your condition is the same. If you state that it has worsened, the case will be thrown out and you will be asked to reapply for PIP with your new worsened condition.

Number 11: Do NOT use ‘My Worst Day’ language

There has been an increase of well-meaning but ultimately destructive advice being given, which is to state your symptoms on ‘your worst day’. This is not what PIP is based on and it could, in fact, be used against you. PIP is for how your symptoms affect you the majority of the time.

Most of us play down our bad days, or bad hours, or relapses and recoveries in our heads in order to maintain an optimistic outlook on life. Because of this, you may well need to consider your worse days in order to be more realistic when working on your case. So by all means consider your worst days, hours, or months when working out how your symptoms affect the majority of your time –  – but do not centre your whole appeal around your ‘worst day’ – again, consider the majority of your time or 50% of your time.

Number 12: Do not submit conflicting info

Ensure you are not conflicting with any information you have already sent to the DWP or offered during your assessment. Remember, though, that there may be cases where you can offer a different statement in your appeal.

You can offer a different statement in your appeal if, during the assessment, you answered with something that is not true the majority of the time but the answer has been either (i) taken out of context, or  (ii) incorrectly assumed to apply for the majority of the time. In this case, it is ok to offer a different statement if your newly-submitted statement does apply the majority of the time. Ensure, though, that you explicitly state that your answer during the assessment applied to something you are able to do occasionally, rarely, or at the least not the majority of the time, or alternatively that your answer was taken out of context.

For further reading

The CAB is my first go-to for brief information and tips on benefits and appeals.

For more detailed guidance, I highly recommend the Benefits and Work website and their guides. The website requires a £19.95 yearly subscription payment to gain access to their guides, but they are absolute gold; so, so detailed. The guides include examples all the way from writing your initial application, to writing letters for mandatory reconsideration, to 50 ways to challenge a PIP medical report. (Hand on heart, I’m not on commission!). From time-to-time they offer a 20% discount so it’s worth keeping your eyes open for that – you can sign up for free to their newsletter which will inform you if there’s a deal.

To submit an appeal to the Tribunals Service, you’ll need to fill out an SSCS1 appeal form. The Tribunal Service also supply a booklet (SSC1A) titled ‘How to Appeal against a decision’. The Tribunal Service website is www.justice.gov.uk.

If I haven’t mentioned any resources that you’ve used during this process and found helpful,  please do share. I’d love to hear of more and add these to my Useful Guides Collection (to be created soon!). Different people assimilate information in different ways, so it’s nice to have a selection for all of us to choose from.

As always, if you’d like to be notified when a new blog post becomes available on manylemons.com, pop your email address into the box at the bottom of this page and click ‘Notify Me’.

Image courtesy of unsplash.com

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26 Comments

  • Reply Debbie April 29, 2016 at 8:30 am

    Brilliant read and it has given me more knowledge, thank you.

    • Reply Many Lemons April 29, 2016 at 12:19 pm

      Wonderful to hear you found it useful Debbie, many thanks for your feedback.

  • Reply Nazia Ahmed April 29, 2016 at 8:52 am

    Great read Mel, this will really help anyone going through MR/Appeal!

  • Reply Debbie R May 13, 2016 at 3:46 am

    I was scared about the whole process and what to expect but now I am going to stop worrying. You have made my stress levels a lot lower now and I know stress does not help MS sufferers.

    Thank you for being honest and making your information so easy to understand.

  • Reply Sammy Holland May 15, 2016 at 8:38 am

    Fantastic advice, and so helpful in this recorded format, especially for dyslexic people like me. A real confidence boost. Thx you

    • Reply Many Lemons May 16, 2016 at 7:12 pm

      Thanks Sammy for your feedback, especially about the use of audio – I’m so glad you’re finding the audio is making the content accessible.

  • Reply Denise Clarke May 17, 2016 at 3:26 pm

    Hi thanks that’s great advice. The most important part of the process is to get the form ‘right’ I had my form completed by Fightback4justice who asked for a small suggested donation as they are a unfunded CIC organisation. They have specialist lawyers in the benefits field who can also help with appeals, Buddy service etc. I went straight through to support group without a medical and was awarded Pip enhanced for both..hope this helps. you can also find them on Facebook.

  • Reply Christine Maloney August 9, 2016 at 10:31 pm

    I have sent back my appeal letter for PIP in March as I was receiving the highest rate for both components and then dropped to the lowest rate mobility and lost the other rate.
    That was the second reply to them and I haven’t received nothing back.
    I had to have major knee surgery and couldn’t walk again for 12 weeks without 2 crutches.
    Now I’m waiting to have major knee surgery on the other knee and I may not walk for over 6 months without crutches/frame etc
    They have fobbed me off I think.

  • Reply Amelia November 7, 2016 at 4:13 pm

    A great article, I just wish I had found it earlier. I am an unpaid carer for my friend who has helped me in my time of need when no one else did. He has schizophrenia, depression and plantar fibrosis lumps on both feet making it extremely painful to walk which has escalated his depression. He was on DLA for 13 years which they stopped as he notified them of his lumps in his change of circumstances in June 2015, he was awarded 0 points on his pip application & his reconsideration only today Nov 2016 he had a telephone tribunal he was interrogated like it was a criminal case for an hour bombarding him with questions when it was already highlighted he gets confused, upset and frustrated, I never felt so helpless in my life and the judge could hear me in the background and said I was prompting him!!! He is the most depressed I have ever seen now, it’s breaking my heart and to add insult to it all he is also a veteran.

    • Reply Many Lemons November 9, 2016 at 6:01 pm

      I’m so sorry to hear of this Amelia. I would recommend you approach the CAB or another service such as the Law Centres Network to see if anything can be done. I wish you all the best.

  • Reply lauren November 11, 2016 at 11:50 am

    Great advice, for people who feel this is too much they can get the claim forms, mandatory reconsiderations and appeals done through CAB and have representation at appeals from most CAB’s or other local welfare rights orgs.

  • Reply Sarah lizzy scott November 13, 2016 at 2:39 pm

    This website has relaxed me a lot I am just waiting for the next available date for my tribunal. The department of work and pensions have stopped my middle rate care and higher mobility and given me nothing. I have 21 years as an MS sufferer.

  • Reply Sarah Scott November 13, 2016 at 11:55 pm

    That is such a tragic occurance I am so scared of the tribunal this is all so wrong, I’m losing faith very quickly

  • Reply Pamela allman November 24, 2016 at 11:42 pm

    This is good advice. In process of a mandatory reconsideration for pip. Awarded standard rate for mobility so will lose my motorbility car. I can barely walk and every step causes pain and exhaustion. My atos assessor unfortunately wrote the opposite of my walking ability saying I could walk 50 yards to my daughters home with a stop on the way. There is nowhere to ‘rest’ on the way – it’s a straight bit of road. I certainly did not say I could walk that far. I was very shocked to see it in my award letter. It was mentioned that during my assessment I ran my hands through my hair! I cannot believe this was a negative against me!

    • Reply Sarah Scott December 19, 2016 at 12:02 pm

      I have to go to court soon for my tribunal and I don’t no what to do what do I need to take with me and should I take some body with me?

  • Reply Margaret Collinge January 13, 2017 at 2:04 am

    Read this post often. I don’t have ms but have me. I am going for my appeal on the 25th Jan. I lost my mobility car but got standard rate mobility and full care. I have been on dla for 24 years and had first mobility dla. Then a year later claimed care. I was on higher rate for both. The change to pip was a shock, the former and the assessment seemed endless. I feel more prepared for the appeal after reading your blog. Fingers and toes crossed the appeal goes well. I also feel my age is against me for the mobility component (66)

    • Reply Margaret Collinge January 29, 2017 at 8:52 pm

      Hi, Update on appeal. Thanks to this blog and to the help I received from C. A.B, I have been awarded the highest rate for mobility. I get to keep my Car!!. So very happy after the stress of the last 4 months I can relax. Six years before I need to go through it again.

  • Reply T. S January 29, 2017 at 2:58 pm

    Found this most useful, was awarded DLA for life nearly 30 years ago, l am 68 and have had to go through a 40 page form and face to face assessment despite being registered 100% disabled more than 35 years ago as have lifetime total spinal fusion and much else, have retained my Motability and some cash but am going to Tribunal as so much rubbish written about me by ATOS assessor, seem to have been discriminated against because hobbies reading and listening to music!! I feel guilty about asking for more money but really annoyed about what was written and the whole process has caused me untold stress….sorry to winge

  • Reply julia Sampel February 28, 2017 at 12:34 pm

    I am in the process of trying to get a mandatory reconsideration. I have been marked down because I was wearing makeup (I actually wasn’t) The assessor also stated that my mental state was stable (I didn’t realise that she was a qualified psychiatrist…..) she also said I could move parts 70% this way and other parts 20% etc etc, and yet not once did she actually measure my abilities scientifically. Also, she said she didn’t think that I had anxiety problems as I was very articulate and made eye contact. She concluded that I could plan a complicated route and complete it alone. Really?!!! Firstly my pain levels go through the roof when I’m anxious. I suffer extreme anxiety in public and always have someone I trust with me. The last time my anxiety went through the roof, I had a seizure. Basically she negated most of the application form. All of these things were based on me having a “good day” when she arrived. This woman say I paint and draw as a focus, I actually said, one of the few things I can physically do these days is painting or drawing (When I’m up to it) and it helps me to focus away from the constant pain i’m in. Her words on all comments altered the tone of the assessment. I don’t usually rant like this but This has been such a huge knock. I feel like I’ve been downgraded to enable pennies to be saved. EVERYTHING in her report was worded to change the tone of my assessment. I’ve received the write up of my assessment, but nothing to enable me to launch my appeal. What do I do? sorry, sorry, sorry to rant. I just don’t know where to turn.

    • Reply Many Lemons March 1, 2017 at 10:58 am

      Hi, sorry to hear of the distortions of your assessment. Please take some comfort that your experience is not unusual at all and many people have overturned their original assessments, you’ve got a few stages to reverse these decisions.
      When you say you haven’t received anything to enable to launch your appeal, do you mean the mandatory reconsideration, or have you done the reconsideration and are wanted to take it to the next step of appealing via the tribunal service?
      As always, I’d highly recommend getting in touch with someone like the CAB to help you through the tribunal stage, at least. If you haven’t yet requested a mandatory reconsideration, then all you need to do at this point is make sure that you have requested a mandatory reconsideration from the DwP within a month of receiving your original award result – give them a ring, and then make sure you send your letter requesting your mandatory reconsideration to them recorded delivery (proof is important!) within a month of when you received your original decision letter.
      In terms of content, what you have written here is content you can use in your request for a mandatory reconsideration, or for a request for an appeal at tribunal – you can contest all the points that you have stated. Just a few pointers in the meantime:
      The fact that you suffer from pain and anxiety during activities and which worsen during an activity is crucial and something you must keep stressing. Did you for example suffer pain during her assessment of your movements? Did she ask you this?
      Did you originally submit any evidence to support your anxiety or pain, for example prescription meds, services you’ve used…
      Finally, keep stressing that you can do x or y only on a good day, but these days only happen x times a week / a few hours a day etc.
      I wish you all the best, Melly

  • Reply Hermione May 26, 2017 at 3:41 pm

    Thank you very informative. Do you have any information on what it means that a PIP Tribunal decision hasn’t been given on the day? Is this a bad omen? My partner just had his tribunal, after being awarded 0 for everything by DWP, having been on middle rate care and higher rate dla for his MS. I thought our nightmare would be over today, but seems we have to wait a bit longer to find out.

    • Reply Many Lemons June 7, 2017 at 8:34 pm

      Hermione, apologies for the late reply – I guess you know the decision by now? But no, it’s not a bad omen at all, often the tribunal will delay giving a decision on the day solely due to workload, it’s not uncommon at all, so please don’t fret.

  • Reply Steven Gascoyne May 27, 2017 at 9:02 am

    Thank you so much for this post, especially recommending the Benefits and Work site. Their ‘Ways to Challenge a PIP Medical Report’ is invaluable and highlighted to me several key grounds for challenging that I would not have considered.

    I am an incomplete C6 tetraplegic, so be the very medical definition I have impacts to my upper and lower limbs including reduced motor control and pain/temp sensation. I use a wheelchair the majority of the time and crutches at all other times, but still I did not receive the higher rate for mobility.

    The list of errors and omissions in the report was almost comical, including the no acknowledgement of grip/dexterity impacts, loss of pain sensation, tendency to fall and difficulty in getting up. Best of all ‘observed to remain seated for the majority of the assessment’ when I actually arrived and left in my chair and was never asked to attempt to get out of it at any time.

    Personally I am certain that between these errors and the support of my spinal consultant, I will get the right outcome, but I worry deeply for others who may have a case which is less clear or whom may not feel so confident in tackling the process, especially with the levels of worry and stress it causes.

    I would love to to see a class action for the distress and possible costs for all those who have successfully overturned what were clearly flawed decisions.

  • Reply M Youngs July 27, 2017 at 1:06 am

    Thanks for your advice.
    I’ve had epilepsy since i was a teenager, now 39 and has lately become a lot worse along with bad tiredness through the day with headaches that can last up to a full day.
    Was sacked from work for having too much time off so now decided the only way forward is benefits, i have a family of 2 children and me and my partner have a mortgage so we’re really trying for any financial help.
    Any other advice would be appreciated.

  • Reply patrick burke October 25, 2017 at 6:37 pm

    If you are sending any correspondence I have been advised to keep a copy plus send it by registered delivery

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