Esa Mental Nov 11
Esa Mental Nov 11
Esa Mental Nov 11
claims for
INDEX
Introduction - why this guide is so big .................................................................................... 3 Who is this guide for?............................................................................................................ 4 How to start your claim for ESA............................................................................................. 5 Three ways to get into the work-related activity group ........................................................... 8 1 Should you be in the work-related activity group on exemption grounds?........................... 9 2 Should you score enough points to get into the work-related activity group? ....................11 3 Should you be in the work-related activity group because of exceptional circumstances? 12 Three ways to get into the support group .............................................................................14 1 Should you be in the support group on exemption grounds? ............................................15 2 Should you be in the support group because a descriptor applies to you?........................16 3 Should you be in the support group because of exceptional circumstances? ...................18 Completing the ESA50 questionnaire ...................................................................................19 How to show you score points even if you can actually do an activity...................................21 How to complete pages 1-6..................................................................................................23 Completing Part 2 Mental, cognitive and intellectual functions...........................................26 How to explain problems with: 11. Learning how to do tasks................................................28 How to explain problems with: 12. Awareness of hazard or danger .....................................34 How to explain problems with: 13. Initiating actions.............................................................40 How to explain problems with: 14. Coping with change .......................................................45 How to explain problems with: 15. Going out.......................................................................49 How to explain problems with: 16. Coping with social situations..........................................53 17. Behaving appropriately with other people ......................................................................57 Providing Other information ................................................................................................61 Signing the Declaration.......................................................................................................61 Completing page 20 .............................................................................................................61 Supporting evidence means more chance of success ..........................................................63 Medical examination will you have to have one? ...............................................................66 Preparing for a medical examination ....................................................................................67 What happens at your LiMA computer controlled medical ....................................................69 Questions you are likely to be asked at your medical ...........................................................72 How the decision is made and what to do when you get it....................................................74 Where to look for help with claims and appeals....................................................................77
Disclaimer. Every care has been taken to ensure that the content of this work is accurate and that legislation and caselaw used is current at the time of writing. However, no responsibility for loss occasioned to any person acting or refraining from action as a result of any statement in this work can be accepted by the authors. Copyright 2009-2011 Steve Donnison and Holiday Whitehead. All rights reserved. No part of this work may be reproduced or transmitted in any form or by any means (photocopying, electronic, recording or otherwise), without the prior written permission of the authors. Crown copyright material is reproduced with the permission of the Controller of HMSO and the Queen's Printer for Scotland.
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We publish a separate guide for people who have a physical health condition. It covers the most recent work capability assessment which came into force on 28 March 2011.
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Assessment phase
The assessment phase is intended to last for 13 weeks, from when you first make a claim for ESA to when a decision is made about your entitlement. In reality it often lasts for many months more than this. The test to decide whether you are eligible for ESA and, if so, at what rate is called the Work Capability Assessment (WCA).
ESA50 questionnaire
If you are not placed in the support group at this stage, you will be sent an ESA50 questionnaire to complete. Most of this guide is about completing that questionnaire. -6-
Once your completed questionnaire is returned you may be placed in the support group or the work-related activity group. But in most cases you will be asked to attend a medical before a decision is made about which group, if either, you should go into. At the medical the Atos health professional will assess what points they think you should score and create a medical report about you using LiMA computer software. This will be passed to the decision maker.
The decision
The decision maker will decide supposedly based on all the evidence whether: 1 You have failed the work capability assessment and will have to claim jobseekers allowance. 2 You have passed the limited capability for work assessment and are eligible to join the main phase of ESA in the work-related activity group. You will get an additional work-related activity component. 3 You have passed both the limited capability for work assessment and the limited capability for work-related activity assessment and are eligible to join the higher paying support group. You will get an additional support component. If you are not happy with the decision you can appeal.
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Exemptions
You will be treated as having limited capability for work if any of the following circumstances apply: (a) you are terminally ill, i.e. you are suffering from a progressive disease and your death in consequence of that disease can reasonably be expected within 6 months. (b) You are receiving, or recovering from receiving, intravenous, intraperitoneal or intrathecal chemotherapy or you are likely to receive such treatment in the next six months and the Secretary of State is satisfied that the you should be treated as having limited capability for work. (c) you have, or have been in contact with, a notifiable disease; (d) you are pregnant and there is a serious risk of damage to your health or to the health of your unborn child if you do not refrain from work (e) you are pregnant and within the maternity allowance period and entitled to maternity allowance (f) you are pregnant and within either six weeks of giving birth or have given birth in the last two weeks and you are not entitled to maternity allowance or statutory maternity pay. If you think that any of these exemptions may apply to you, inform the DWP office dealing with your claim and give them details of your GP or other health professional who can provide supporting evidence. -9-
Hospital treatment
You will be treated as having limited capability for work on any days in which you are an inpatient in hospital or recovering from in-patient treatment. The same applies if you are attending residential rehabilitation for the treatment of drug or alcohol addiction. This does not need to be medical treatment. It could, for example, be a residential centre run by a religious organisation. There is a space on page 5 of the ESA50 form to give details of hospital treatment and on page 6 to give details of residential rehabilitation.
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2 Should you score enough points to get into the workrelated activity group?
The limited capability for work assessment is divided into 17 activities: 10 physical and 7 which assess mental health and learning difficulties. We only deal with the mental health and learning difficulties activities in this guide, theres a separate guide for physical health. Each of these activities is divided into a number of descriptors and each of these descriptors has points attached to it, ranging from 15 down to zero. You need to score a total of 15 points in order to pass the limited capability for work assessment. If you have a physical health problem as well you can add together your physical and mental health points and, if the combined total adds up to 15, you will have passed. You can only score points for one descriptor from each activity the highest one. So, for example, if 11(b) applies you get 9 points, but you cant also have 6 points for 11(c) because they are both the same activity. But you can have 9 points for 13(b), if that applies, because thats a separate activity. In this case you would have 18 points and, provided the decision maker agreed with this assessment, you would be eligible to join the work-related activity group. Youll find much more detail about points and how to give evidence about what you consider you should score as we work our way through completing the form further on in this guide.
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Substantial risk
The second regulation says that you will be found to have limited capability for work if: (b) you suffer from some specific disease or bodily or mental disablement and, by reasons of such disease or disablement, there would be a substantial risk to the mental or physical health of any person if you were found not to have limited capability for work. For this exceptional circumstance regulation to apply you need to show firstly that you have a specific disease or disablement. This could be anything at all, for example: anxiety, depression, bipolar disorder, schizophrenia. Then you need to show that there would be a substantial risk either to you or to someone else if you were found not to have limited capability for work. - 12 -
So, if you were found not to have limited capability for work, you would have to sign on for Jobseekers Allowance or not get an income replacement benefit at all. You would need to meet your jobseekers agreement and eventually start doing paid work. How might this pose a substantial risk? For example, might your condition deteriorate seriously? Might you attempt to harm yourself? Would you be unable to leave your home to sign on and attend interviews. In this case would you be left without any money to buy food and pay for heating and lighting with the result that you would become ill? Would you find attending job interviews or work very distressing and might you be liable to lash out in fear and possibly physically injure someone else? If you believe that this exceptional circumstance applies to you, include information with your questionnaire and try to obtain supporting medical evidence. It is likely that if this exceptional circumstance applies to you that you will also be covered by a similar regulation which will allow you to be placed in the support group.
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14. Appropriateness of behaviour with other people, due to cognitive impairment or mental disorder Has, on a daily basis, uncontrollable episodes of aggressive or disinhibited behaviour that would be unreasonable in any workplace. [These final two activities have both physical health descriptors and mental health/learning difficulties descriptors.] 15. Conveying food or drink to the mouth. (a) Cannot convey food or drink to the claimants own mouth without receiving physical assistance from someone else; (b) Cannot convey food or drink to the claimants own mouth without repeatedly stopping, experiencing breathlessness or severe discomfort; (c) Cannot convey food or drink to the claimants own mouth without receiving regular prompting given by someone else in the claimants physical presence; or (d) Owing to a severe disorder of mood or behaviour, fails to convey food or drink to the claimants own mouth without receiving (i) physical assistance from someone else; or (ii) regular prompting given by someone else in the claimants presence. 16. Chewing or swallowing food or drink (a) Cannot chew or swallow food or drink; (b) Cannot chew or swallow food or drink without repeatedly stopping, experiencing breathlessness or severe discomfort; (c) Cannot chew or swallow food or drink without repeatedly receiving regular prompting given by someone else in the claimants presence; or (d) Owing to a severe disorder of mood or behaviour, fails to (i) chew or swallow food or drink; or (ii) chew or swallow food or drink without regular prompting given by another person in the physical presence of the claimant. As well as physical issues, conditions including learning difficulties and severe anorexia may be relevant to 15 and 16 (c) and (d). The WCA Handbook states that: When considering mental function, you should look for evidence to confirm a severe disorder of mood, for example requirement for hospital admission for a claimant with anorexia who refuses to drink as well as eat. Someone with a lesser degree of depression associated with reduced appetite, who requires occasional encouragement to maintain nutrition, would not fall into the Support Group in this category.
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Missed deadline
If youve missed the deadline, return the form as quickly as possible along with a letter explaining why you are late doing so. If the decision maker decides you have good cause for sending your form in late they can still accept it, otherwise you will be treated as capable of work Obviously this is a serious matter, so if youve been ill, away from home or have some other reason why you are late, explain in as much detail as possible. If the decision maker refuses to accept your late claim, get advice from one of the agencies listed at the end of this guide as quickly as possible as you may be able to appeal this decision as well as making a fresh claim.
Keep a copy
We strongly advise that, if at all possible, you keep a copy of your completed questionnaire and any additional sheets. Its far from unknown for Atos and the DWP to lose documents sent to them. It will also be useful for you to be able to review your evidence before you have a medical, if you are called for one.
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In addition, you are likely to receive another ESA50 questionnaire to complete at least once a year and possibly even more frequently, so its worth keeping a copy for reference. Though clearly you must ensure that the information you give on each new form is accurate and upto-date.
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How to show you score points even if you can actually do an activity
In relation to physical health, it is accepted even by the DWP and Atos that just because you can carry out an activity that doesnt mean you are prevented from scoring points for being unable to do it. So, if you can perform an activity but it causes you problems such as: severe discomfort, pain, breathlessness; extreme fatigue;
or if you could do it once but couldnt repeat it within a reasonable space of time or with reasonable regularity or safely then that may count as being unable to do it. For example, you may be able to walk or wheel your wheelchair 100 metres but you are actually in severe discomfort after only 50 metres, then you should argue that 50 metres is the limit of your ability. Or perhaps you can stand for 10 minutes without help from another person. But because of your ME/CFS you would be so exhausted at the end of that period that you would have to go and lay down for hours and might not be able to stand again for any length of time for hours. In that case you should argue that you are not able to stand for 10 minutes because you cannot do it with reasonable repeatability.
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If you have indicated on your ESA50 form that your condition is variable and this issue is not addressed by the health professional if you have a medical, that will be grounds for challenging the reliability of the report if you need to appeal. Or you may sometimes be able to do an activity and sometimes not, without any way of being able to predict which will be the case. This is less an issue of your condition being variable and more about being unable to rely on your ability to do a specific activity on any given occasion. We would argue that in this case you should count as not being able to do it, at least for the majority of the time, because you can never predict whether you can do it or not. In addition, if you could do an activity but it would not be safe for you to do it, then you should be assessed as being unable to do it. So, if you could go to unfamiliar places but because you are not safe near traffic or because you approach strangers inappropriately you would not be safe doing so, then we would argue that you are unable to do so. In completing the questionnaire, the important thing is to include as much information as possible about the difficulties you face and then, if you are not happy with the decision, consider appealing.
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Face-to-face assessment
These were previously called medical assessments on the form. But it seems they no longer want to raise expectations by implying that the WCA resembles a proper medical as we know it. Atos call centre does not seem to have a high reputation for politeness and good customer service amongst some claimants. If, because of a mental health condition, for example, you would find it difficult to speak to someone on the phone to arrange an appointment, then consider not giving a phone number and instead explaining in the box that, because of your mental health condition you need them to write to you rather than phone. Be prepared though: if they already have your phone number they may just ring you anyway or they may send you a letter asking you to phone them within 48 hours. In some circumstances phoning you when you have asked not to be telephoned may be a breach of the Equality Act (formerly the Disability Discrimination Act).
If you do not understand English, or cannot talk easily in English, do you need an interpreter?
If you do not understand English, or cannot talk easily in English, do you need an interpreter. This may apply if English is not your first language. If you need a signer, see the box below.
Tell us about any help you would need if you have to go for a face-to-face assessment.
The form lists problems with stairs, travelling, including using public transport or if you need a British Sign Language signer. Beware! Some Atos medical centres are not accessible to wheelchair users or even to people who have problems with stairs. Make sure you give full details of your access requirements here. You may wish to tell them about any problems you would have with waiting in a public area amongst strangers or if you need access to a lavatory at all times because of continence issues. You can ask for a home visit, but they are very reluctant to provide these and you will need medical support to show your need for a home visit.
Tell us about any times or dates in the next 3 months when you cannot go to a face-to-face assessment.
If you are bringing someone with you to the medical, make sure you give their unavailable dates as well. If there are times of the day when it would be particularly hard for you to attend, give information about this too.
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You might want to leave this box until you have done the rest of the form, so that you can include anything here that hasnt been covered elsewhere but dont forget to come back and do it. You need to say: What conditions you have and, if you know, when they began. Dates of events such as episodes of serious self-harm including overdoses or a serious deterioration in your condition. How your life is limited by your condition. You might be able to write about the things you used to do that you are no longer able to do, for example, the help you get from other people, what the future is likely to hold for you. Anything else that might make the decision maker understand just how much your life is affected by you illness or disability.
About your GP
This section asks for details of your GP. If they have little involvement in your health care it is worth making a note on the form saying so. Bear in mind that the DWP may well contact your GP even if you say you seldom see them. So, seriously consider making an appointment with your GP and updating them on your condition because inaccurate and unhelpful information from your GP can seriously damage your claim.
If there is more than one person, give details of others on page 18 or on an additional sheet. It is important that you do this as the decision maker should ensure that they have sufficient evidence to make a decision on, rather than solely relying on an Atos medical report. So, if you ask them to contact specific health professionals and they fail to do so, this may be an issue you will want to raise if your claim is not successful and you lodge an appeal. Because there is no guarantee that the DWP will contact your health professionals you may need to approach them yourself and ask them if they are willing to provide evidence. See
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Supporting evidence means more chance of success later in this guide for more on the importance of supporting medical evidence.
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The descriptors: what the law says you score points for
For each activity we list the descriptors and the points that they score. Even though these descriptors and points arent listed on the ESA50 form, the entire purpose of the questionnaire is to see how you score yourself. If necessary you will then have a medical so that an Atos health professional can decide what they think you should score. So, its vital that you know how the scores work for each activity.
In plain English
The descriptors are sometimes complex, so this is where we try to explain the whole activity in just a few simple sentences.
DLA alert
Some of the activities or descriptors are very similar to some of the grounds for getting disability living allowance (DLA). We know that medical reports for ESA are used to assess DLA claims. So its really important that you are warned about activities which could have a particularly marked effect on any DLA award you have. In the end, any evidence in your form or from your medical could have a bearing on your DLA these are just the most closely overlapping areas.
Also consider
Here we alert you when we think that if you score points for one activity in this test theres a good chance you could also score points for another or you could qualify via the exceptional circumstances regulations.
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Sample answer
For every activity we give at least one sample answer, so that you can see how the step-bystep system works for that activity.
And finally . . .
We know this is a lot of information and there may be a temptation to stop using the guide once youve managed to assess yourself as scoring 15 points. But please dont. The doctor and the decision maker may very well not agree with your choice of descriptors in some cases but accept them in others. The more descriptors you can accurately identify as applying to you the better.
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Support group
If 11 (a) is accepted by the decision maker as applying to you, then you will be placed in the support group.
So: If you cant learn a simple task like how to set an alarm clock tick No and, if this is accepted you should be awarded 15 points and placed in the support group. If you can learn a simple task but cant learn a more complex task like operating a washing machine tick Yes for the first question and No for the second. If this is accepted you should be awarded 9 points. If you can learn a moderately complex task like operating a washing machine but could not do something more complex, then you have to tick Yes for both questions. However, if it is accepted that you cannot learn anything beyond a moderately complex task then you will be awarded 6 points. But there is no tick box for this descriptor. All you can do is put a note next to the tick boxes saying please see below and then explain explain in the Use this space box that you cannot do anything beyond a moderately complex task. A more complex task than using a washing machine might be something like driving a car.
Sample answers
Please note: these are just examples of the kinds of information you may wish to give they arent correct answers of any sort. But it is vital that you give detailed evidence rather than just ticking boxes. You dont need to put the numbers in thats just to show how the system works. Learning difficulties 1 Because of learning difficulties. 2 I have problems with simple and more complex tasks. For example, I have never learnt how to set an alarm clock to go off at a given time and I have had to be shown repeatedly how to make a cup of tea with milk. 3 I have problems with both learning how to do things and remembering how to do them at a later date.
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4 Even for simple tasks I need to be shown how to do them many times before I can understand the sequence and repeat it myself and this process may take days or weeks, depending on the task. But even after getting it right, by the next day if no-one is helping me I forget the right order and do things like put the tea bag in the cup but forget to put any water in the kettle before I turn it on. Or I put the water and milk in the cup and forget the tea bag. 5 My condition affects me like this all the time. Brain injury 1 Because of a brain injury which has affected my ability to process sound, my concentration and my short-term memory 2 I have problems with moderately complex tasks. 3 I have problems both with understanding and remembering instructions. 4 For example, I need to have tasks such as using a washing machine or sending an email explained but I will repeatedly ask questions about something I have just been told because I hear the wrong words or they get drowned out by background noise. So, I have to be physically shown how each step works as well to help me process the information. I also dont follow sequences of directions well and need them broken down into very small steps or I will miss parts of the explanation and then do it wrong.5 Even after learning things like using a washing machine if I try to do it again the next day without anyone there to help I will do things like forget to put the soap in or put it in the conditioner slot. 5 My condition affects me like this all the time.
The WCA Handbook states that health professionals should take into account: The length of time taken to learn a task and the ability to retain the information. If the person needs to be shown how to do a task again they have not learnt it. If a person learns a task on one day but is unable to repeat it the next day, they have not learnt the task. If a person takes a very long time to learn a task, for example takes 2 years to learn how to wash and dress themselves, they do not have the ability to learn the task.
The WCA Handbook tells health professionals that a simple task may only involve one or two steps while a moderately complex task may involve 3 or 4. They are advised to collect evidence about the following sorts of daily activity in relation to simple tasks: Brushing teeth. This would involve remembering to put toothpaste onto a brush and brushing all areas of teeth. - 30 -
Washing. This would involve the ability to use soap/shower gel and wash their body Brushing hair Turning on the television/ using basic functions on the TV remote control Getting a glass of water
In relation to moderately complex tasks, health professionals are told to look at things like: Using a microwave oven Making a cup of tea including filling kettle, putting tea bags in teapot, pouring into cup and adding milk and sugar Playing CDs on a stereo Using a Playstation Using a computer for basic activities such as playing a game tasks learned during training driving
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If youre supposed to be washing woollens and you set the machine to wash synthetics or forget to put the conditioner in then, we would argue, you havent completed the task successfully. If it takes you twenty minutes to set the alarm or put the washing on, we would argue that you have not learnt how to do it because you are unable to do it in a reasonable amount of time.
Beyond
For (b) and (c) the test is not whether you can do a simple or moderately complex task, but whether you can do anything more complicated. If you cant then you get the points. So, if you can do a simple task like setting an alarm clock but cannot do anything beyond that, then you should get 9 points. The issue then is, what is a task beyond setting an alarm clock. The DWP would presumably argue that it is a moderately complex task like operating a washing machine. If you can operate a washing machine but not do anything beyond that, then you should get 6 points. The only hint that the WCA Handbook gives about what is an activity beyond operating a washing machine is that: More complex tasks should also be considered such as driving should be detailed and any previous tasks learned in training and employment should be considered. We have a strong suspicion that claimants will be wrongly assessed for this activity, scoring 0 points if they can use a washing machine instead of looking beyond that.
Simple task
The example given of a simple task is setting an alarm clock. The DWP seem to believe that this just involves learning how to push the buttons on the alarm clock. However, we think that this task at the very least involves you being able to read numbers and being able to tell the time. So for example, if someone said to you Im going to show you how to set the alarm for half past seven, this would involve moving the hands or setting the alarm time to 7.30 and then moving the alarm switch or button to the on position. (The law doesnt specify what type of alarm clock whether a digital one or one with hands). What if you can set an alarm clock but couldnt do similar tasks, should you score points? For example, it may have taken you a very long time months or years of being shown before you learnt how to set an alarm clock. But if you had to learn a new task of similar complexity would you be able to learn or understand it just by being given a demonstration? If not, we would argue you should score the points because you should be able to learn simple tasks in a reasonable period of time, such as the time that an employer might be prepared to devote to training you. We would definitely explain which simple tasks you cant do and then be prepared to consider an appeal if youre unhappy with the decision.
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Sorting the clothes by colour, colour fastness and type of material, e.g. wool or synthetic. Reading labels to check what temperature wash and type of spin each item of clothing requires and to ensure that they are not dry clean only. (The DWP may argue that these first steps arent included, but we would disagree). Making sure there are not too many or too few items for the capacity of the machine. Selecting the correct wash cycle, which will involve being able to read the instructions on the machine and turn the knobs or push the buttons as appropriate. Adding the correct amount of the correct sort of washing powder. Adding the correct amount of conditioner. Staring the machine and understanding why it may not start, such as the plug at the wall being switched off or the door not being properly closed. Knowing how to tell if the machine has completed its wash and rinse cycle. Opening the door and removing the clothes.
If you cant reliably learn how to do all these tasks we would argue that you have not learnt how to operate a washing machine.
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You score points depending on how much of the time you require supervision.
Support group
If 12(a) is accepted by the decision maker as applying to you, then you will be placed in the support group.
DLA alert
If you are getting DLA on supervision grounds and you think that this activity applies to you then take great care to make sure you give accurate evidence because a medical report for this assessment can be used to look again at your DLA award.
capability for work and possibly also limited capability for work-related activity (support group). Indeed, the WCA Handbook says that the substantial risk issue should be considered where 12(b) applies, but in our opinion this does not go far enough as even an occasional risk if the danger is severe enough should be sufficient. See Should you be in the work-related activity group because of exceptional circumstances? above for more details on giving evidence on this.
Activity 15
If you lack awareness of danger from traffic then it may be that you cannot get to specified or unspecified places without being accompanied by another person.
Do you need supervision (someone to stay with you) to keep yourself safe?
Usually Sometimes It varies. Warning need supervision! Before you choose a box, bear in mind that the regulations talk about whether you require supervision, not whether you receive it. If you dont get supervision, but have accidents, hurt yourself or others, damage property or have near misses, then it may be that you do reasonably require supervision even though you dont actually receive it. Warning damage to property! The question above fails to ask about whether youd be a danger to other people or whether you are liable to damage property, so its really important that you give details in the Use this space box. Tick Usually if supervision is required for the majority of the time. Sometime and It varies are both extremely imprecise. To score 9 points, supervision needs to be frequent and occasionally for 6 points. If you need supervision, but for less than the majority of the time we would suggest you choose sometimes and give details in the Use this space box.
Sample answers
Please note: these are just examples of the kinds of information you may wish to give they arent correct answers of any sort. But it is vital that you give detailed evidence rather than just ticking boxes. You dont need to put the numbers in thats just to show how the system works. Depression 1 I have problems with this activity because of severe depression and because I selfmedicate with alcohol. 2 As a result of the effects of prescription drugs and alcohol I am frequently confused, have poor concentration and do not realise when I am putting myself in danger. 3 I have fallen down stairs and cracked a rib, nearly been hit by cars, taken accidental overdoses of prescription medication leading to hospitalisation and burnt myself with hot drinks and hot pans. I frequently leave the iron, cooker or electric fire on and fall asleep with cigarettes burning. Its really only by luck that the house hasnt burnt down. 5 My flatmate keeps an eye on me most of the time. 6 I have accidents or near misses on most days. Dementia 1 Because of my dementia 2 I lack awareness that some situations could be dangerous and have very poor concentration. 3 Its not safe for me to cross roads alone as I often dont think to look for traffic. I dont remember whether I have taken my medication and so would sometimes fail to take it and sometimes take it several times if I wasnt supervised. It is not safe for me to cook, use knives or make hot drinks unsupervised anymore because I forget that I have a sharp knife or hot kettle in my hand. My partner always runs the bath for me because I have forgotten to turn it off and also made it much too hot and then attempted to get in. I cannot choose appropriate clothes to wear for the weather and would go out without a coat even on freezing, wet days. 4 My partner never leaves me on my own for more than a few minutes at most because it would not be safe to do so. 5 I have better and worse days, but no days on which I could be left unsupervised.
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They are told that it applies where there is a lack of understanding that something is dangerous. It also applies where claimants do not realise that it may be dangerous for them to attempt an activity, such as a person with dementia attempting to cook. In relation to 12(a), however, the WCA Handbook confusingly says that: Those with simple concentration problems would not be considered in this area as they should normally have the insight to realise they have poor memory/concentration and therefore should avoid hazardous situations. However, if you are found capable of work then you will not be able to avoid potentially hazardous situations, without risking losing your benefits. Health professionals are told that daily living activities that they should ask the claimant about in relation to this activity include: Ability to cope with road safety awareness Driving Ability in the kitchen Awareness of electrical safety Responsibility for children/pets
They are also told to consider whether the claimant could be safely left alone to manage basic daily life.
Reduced awareness
You need to show that you dont fully realise the hazards you are facing, rather than that you deliberately or knowingly take risks or harm yourself or damage things. Reduced awareness could be caused by, for example: confusion caused by dementia distraction caused by hearing voices learning difficulties extreme fatigue overwhelming anger or frustration substance misuse confusion or poor concentration caused by medication
Everyday hazards
Everyday hazards would be things you are likely to come into contact with at home or outdoors. These could be things like, for example: boiling water cooker rings dressing inappropriately for the weather electric appliances fire - 37 -
taking medication hazardous substances such as bleach food past its sell by date heights medication running water sharp objects traffic
It may be worth arguing that reduced awareness of the risk posed by a just one or two everyday hazards should count. So, if you are only unaware of the risks of fire and electricity, for example, but safe around other things you should give details. Inappropriate behaviour with strangers, such as allowing strangers into your home or behaviour that appears to be sexually provocative or aggressive may also be relevant. Ultimately, if the DWP disagree, it would be up to a tribunal to decide whether strangers constitute an everyday hazard. Failure to maintain personal hygiene, such as not washing your hands after using the lavatory, because of a lack of awareness of the danger of germs might also be relevant. Again, it would be up to tribunals to decide if health hazards such as germs and bacteria are an everyday hazard.
Supervision
The level and type of supervision is not specified. Does it mean someone being present in the room with you or would just listening out from another room and checking on you from time to time be sufficient? We would argue that supervision may include such things as checking rooms to see if there are any hazards present and then regularly checking back to see if you are safe. As we said above, if you dont get supervision, but have accidents, hurt yourself or others, damage property or have near misses, then it may be that you do reasonably require supervision even though you dont actually receive it.
Frequently
Frequently, in this context, should mean less than a majority of the time - so may mean less than four days a week or less than half of the day. As stated above, the WCA Handbook advises that Frequently would represent several times a week.
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In the absence of a clear definition of frequently, try to give the clearest possible idea of how often you are at risk or have accidents.
as well as more serious harm such as being hit by a vehicle or serious burns.
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Support group
If 13 (a) is accepted by the decision maker as applying to you, then you will be placed in the support group.
DLA alert
Your DLA claim may be based in part on being unable to motivate yourself to carry out everyday activities. If this is so, take great care to make sure you give accurate evidence for this activity, because a medical report for this assessment can be used to look again at your DLA award.
It varies. If you can start and complete tasks, but it takes you great deal longer than it would take other people, then we consider that this should count as being unable to do that task. If you start tasks and then forget what you are doing and start something else this should count as not being able to do them. If you can start and complete tasks, but only if someone prompts or encourages you to do so, then we would argue that this counts as not being able to do the tasks. If you have a relative or carer who encourages or cajoles you, think about how you would manage if they were not there and give details in the Use this space box. If you tick Never you are assessing yourself as scoring 15 points and as being eligible for the support group. If you tick Sometimes this could relate to 13(b) or 13(c), so you will need to give more details in the Use this space box about whether this is for the majority of the time or frequently. It varies is extremely imprecise and is unlikely, as evidence on its own, to allow points to be scored.
Sample answers
Please note: these are just examples of the kinds of information you may wish to give they arent correct answers of any sort. But it is vital that you give detailed evidence rather than just ticking boxes. You dont need to put the numbers in thats just to show how the system works. Depression 1 Because of my severe depression 2 I have problems motivating myself to start doing things and frequently give up after starting through apathy and fatigue. 3 If my partner is at home he encourages me to do things. He has to keep on reminding and hassling me until I do things. 4 For example, if he is not around I dont bother to get out of bed until lunchtime and then I cant get myself to have a proper wash. Often I wont bother to get dressed at all because I cant see the point. But if hes there he reminds and encourages me over and over again - 41 -
until I do get washed and dressed. I would never bother buying proper food or cooking a meal unless he was with me and kept encouraging me. 5 I have worse days when nothing even he says makes any difference, but for the rest of the time I can do things with enough prompting and encouragement. CFS/ME 1 Because of my CFS/ME 2 I get very foggy and confused so that I forget to do things and cant concentrate when I do attempt to do things. I very often start things and then dont finish them because of poor concentration. 3 I need prompting or reminding in person, by phone and by using notes and alarms. 4 I have a pill dispenser with a timer which my wife fills and sets for me every morning. My wife also writes on a pad on the fridge anything I need to remember for that day, such as bringing the wheelie bin in or being home for a delivery. We have an arrangement that my wife will ring me from work several times a day to remind me to do things like let the dog into the garden. My wife comes home to find piles of clothes where I have started to sort some washing and then forgotten about it. I often leave washing out in the rain because I forget it is there. I frequently find that it is the middle of the afternoon before I remember to eat, dress or bathe. I can no longer drive a car because my concentration is much too poor for me to be able to do so. If I was left by myself I would not be able to cope. 5 I am like this on the majority of days although I have some better days and I have days when I am so bad I cant even get out of bed except to go to the toilet. Obsessive compulsive disorder 1 Because of my OCD 2 I can do everyday tasks but it takes me a very long time to do most things. 3 With many tasks prompting or encouraging will not help. 4 I usually spend over an hour washing in the bathroom on a morning because I have to wash myself in a certain order and clean each part of my body a certain number of times and if I am not sure I have done it right I have to start again. Preparing even simple food such as a sandwich usually takes at least 20 minutes because I have to be very careful that I dont touch certain things in the kitchen and that different things dont touch each other. If I do touch them or get too close to them I have to wash myself very carefully and start again. I frequently have to stop whatever I am doing to check that all my books are there and in the right order. This means that whatever task I am doing can take a very long time because I have to keep stopping and checking. Leaving the house also takes half an hour to an hour because I have to make sure that everything is switched off and that all the doors and windows are locked before I go out. I usually have to check everything at least half a dozen times before I can find the courage to go out. 5 I am always like this.
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understand how to co-ordinate actions in the correct sequence such that they successfully complete any personal actions in a logical order for example washing before dressing. However, the law refers to planning, organisation, problem solving, prioritising or switching tasks and we do not consider that washing before dressing something that is done routinely and habitually - requires the ability to solve problems, prioritise, switch tasks or, in any real sense, plan or organise. Health professionals are told that they must take into account whether a person can repeatedly and reliably complete tasks and that there has to be evidence that they can do so: For example, someone with OCD may initiate many actions, but due to rituals they may not actually be able to complete them and therefore should be considered not capable of personal action. Similarly, if a person perhaps with bipolar illness manages to wash and dress but then goes out and spends all their money on non essential activities, giving no consideration to issues such as bills, rent, food etc, they would not be considered to be initiating effective personal action. Health professionals are told that severe concentration or memory problems would affect this activity and that the kind of conditions that are relevant include: psychosis obsessive compulsive disorder (OCD) autism learning disability severe depression
They are told that personal action may include: ability to plan and organise a simple meal ability to get up, washed, dressed and ready for work in the morning ability to cope with simple household tasks e.g. sorting laundry and using a washing machine dealing with finances arranging GP appointments, picking up prescriptions, taking medication
Health professional are told that daily living activities that they should ask the claimant about include: Making travel arrangements Writing shopping lists Organising finances Planning a simple meal Getting washed and dressed Ironing clothes for the next day Caring for children: preparing clothing, lunches etc.
Finally, it is worth noting that the Work Capability Internal Assessment Review which made the changes to the WCA made it clear that the intention was to amalgamate three of the activities from the original WCA into this one. The three activities were: Memory and concentration Execution of tasks Initiating and sustaining personal action
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Sequential
In relation to this activity, reliably completing 2 sequential personal actions would, according to the DWP, be things like remembering to shower before getting dressed rather than the other way round. Although only 13(a) refers to sequential personal actions it seems likely that sequential is implied in 13(b) and 13(c). As completing sequential actions is a more demanding activity because you have to get them in the right order you may wish to assume this is the case.
personal action (which means planning, organisation, problem solving, prioritising or switching tasks).
Guidance issued with the first version of the test that used the phrase personal action stated very clearly that this activity does not refer to the ability to self-care or maintain an acceptable level of personal hygiene. Guidance given to doctors carrying out the original pilots of the test said that it is designed to reflect those who struggle with their affairs such as bills or finances, such that the person may require an appointee or have input from a support worker or homemaker. However, whilst the law hasnt changed, the guidance given to doctors has been changed in order to make it much harder to score points. So, if you have problems with simple everyday tasks then you should certainly give details. But even if you can manage everyday activities but cant manage more complex ones then you should also give details. Possible relevant activities might include: Making and keeping a doctors appointment. Ensuring that your car has an up-to-date MOT Choosing and purchasing car insurance or home insurance Checking the estimated reading on a utility bill and arranging for the bill to be paid
Frequently
For 16(c) frequently must mean less than a majority of the time, so probably less than four days a week. In the absence of a definition of frequent, try to give the clearest possible idea of how often you have problems.
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Support group
If 14 (a) is accepted by the decision maker as applying to you, then you will be placed in the support group.
Yes It varies. This question appears to relate to 14(c).If you have difficulties for less than the majority of the time you are less likely to score points. If you cannot cope with small unexpected changes for the majority of the time, your answer should be No. You can give details of any variability in the Use this space box. Cannot cope in this context means that it becomes significantly more difficult for you to do everyday tasks. If you tick it varies, make sure you give full details of the variability in the Use this space box. You should be assessed on how you are for the majority of the time.
Sample answer
Please note: these are just examples of the kinds of information you may wish to give they arent correct answers of any sort. But it is vital that you give detailed evidence rather than just ticking boxes. You dont need to put the numbers in thats just to show how the system works. Autism 1 Due to my autism 2 I have great difficulty with any changes, whether expected or not. 3 I am unable to carry on with any everyday activities if my routine is changed. 4 For example, I always eat toast and Asda strawberry jam for breakfast at 7 oclock. If there is no bread or just blackcurrant jam I will become very distressed and may start to rock or repeat the same word, refusing to do anything else until I have been given the right breakfast. This affects nearly all everyday activities including the time I leave the house, how I travel to destinations and the route taken. Even the programs I watch on television need to be scheduled at least a week in advance so that I know what to expect and if a show is late starting I will become very stressed until it starts. Christmas is incredibly upsetting for me because so many things happen that are different to my usual routine, even if I have been prepared for the change I will still react badly and rock almost constantly until my routines are back in place. 5 I am like this all the time.
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Health professionals are told that daily living activities that they should ask the claimant about include: Use of public transport Shopping Dealing with appointments at hospital, GP or Jobcentre Plus Coping with children and their out of school activities
Health professionals are given the examples of: A claimant with a severe form of mental disablement who may become so distressed by the supermarket being out of stock of their usual brand of breakfast cereal that they cannot continue with other activities or complete the rest of their shopping. A claimant who would be unable to cope with the train being cancelled and would return home rather than wait for the next train.
The Handbook also suggests that anyone who attends for a medical alone is unlikely to score points for this activity.
Cannot cope
Cannot cope may mean things such as becoming extremely distressed, having panic attacks, shutting yourself in your room or similar behaviour. Whatever your response it would have to affect your ability to carry on ordinary life.
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Cannot be managed
Even if you can do the activities above, can you do them successfully? So, for example, do you get up at a reasonable hour? Do you wash or bathe properly every morning? Do you put on clean clothes that are appropriate to the occasion and weather? Do you shop regularly, so that there is food in the cupboards and fridge? Do you cook and eat properly or just have sandwiches and microwave meals? Is your house reasonably clean and tidy? Do you get out and meet people? Do you undress and go to bed at a reasonable hour? Do you personally successfully manage these things or are most of them done by, or with the help and encouragement of, a partner or carer? Even if you live alone and manage to get by that doesnt mean that someone observing you from outside would agree that you successfully manage day to day life. So your inability to cope with any change needs to result in your being unable to do at least some of the activities above successfully in order to score points for 14(a).
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Support group
None of the descriptors for this activity will qualify you for the support group.
DLA alert
If you are getting the lower rate of the mobility component, this activity may apply to you. If this is so, take great care to make sure you give accurate evidence, because a medical report for this assessment can be used to look again at your DLA award.
Activity 16
If the reason that you cant get to familiar or unfamiliar places is about fear of meeting people then you may also score points for activity 16, Coping with social situations.
Can you leave home and go out to places you know if someone goes with you? No. Yes It varies If you are unable to go to places you know, even if someone comes with you, for the majority of the time, tick No. You can give details of any variability in the Use this space box. If you can manage it most of the time you are less likely to score points for this activity. If you tick it varies, make sure you give full details of the variability in the Use this space box. You should be assessed on how you are for the majority of the time. Can you leave home on your own and go to places you dont know? Usually. Not very often. It varies. If you are unable to go to places you dont know, even if someone comes with you, for the majority of the time, tick No. You can give details of any variability in the Use this space box. If you can manage it most of the time you are less likely to score points for this activity. If you tick it varies, make sure you give full details of the variability in the Use this space box. You should be assessed on how you are for the majority of the time.
Sample answers
Please note: these are just examples of the kinds of information you may wish to give they arent correct answers of any sort. But it is vital that you give detailed evidence rather than just ticking boxes. You dont need to put the numbers in thats just to show how the system works. Agoraphobia 1 Because of my agoraphobia 2 I cannot go anywhere on my own and just thinking about doing so makes me very anxious indeed. If I even leave my front garden I start shaking uncontrollably, my chest gets tight and I believe Im going to stop breathing, my heart races and I break out in a sweat. The only way to control the panic is to go back inside my house. 3 Even if someone accompanies me I can only go as far as the corner shop (approx 200 yards) and sometimes I cannot go into the shop because I am so scared that I will get - 50 -
trapped, particularly if there are other customers inside that could block the door. Often I am so scared of the thought of having a panic attack in public that I will not even go out with supervision. My doctor visits me at home because I cannot go to the surgery and I have not seen a dentist for 3 years. I do all my shopping online or get friends and family to pick things (e.g. medication) up for me. 4 I am always like this. Learning difficulties 1 Because of my learning difficulties 2 I can only go out on my own to very nearby places such as the local shops. I often react adversely when in public places as I find crowds and loud noises distressing. I am highly impulsive and impatient so if I have to wait in a queue or the bus is late my behaviour will become unpredictable, I may start to flap my hands, repeat a particular word over and over or even be verbally aggressive. The more anxious I am the more I struggle to communicate my needs, which makes me even more anxious. I also find traffic noise disorientating as I cannot shut it out and tend to over react to sudden bangs or shouts. This combined with my poor spatial skills and short-term memory problems means that I get lost easily even if the route is familiar. 3 If someone is with me they can calm me down when I get anxious and make sure I dont get confused and lost. 4 I always have these problems with going out alone.
They are told that it is not about lesser degrees of anxiety about going out. They are also told it is not about problems with planning and timekeeping and that how you travel is not relevant: For example, individuals who are unable to use public transport but are able to arrive at their destination by other means will not score on this activity. Health professionals are told that daily living activities that they should ask the claimant about include: Shopping Attending the chemist Attending hospital or GP appointments Walking the dog Supervising children outdoors
Health professionals are also told that general safety awareness and abilities in the kitchen may be relevant and that there should be evidence of severe anxiety.
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Cannot get to
15(a) relates to someone who is unable to get to familiar places even if someone is with them. This may apply to people with severe agoraphobia or anxiety conditions. The law says get to but doesnt say how. We think, but we cant be certain, that what is important is that it has to be you thats doing the getting to. So if you could walk or use public transport that may count as being able to get to. But if you can only get there by taxi or if someone else drives you there, we would argue that this doesnt count as being able to get to because someone else is taking you there you havent got there under your own steam.
Is unable to get to
15(b) and 15(c) use Is unable to get to rather Cannot to get to, but there seems no obvious reason for this change of wording. Once again, get to is not defined, and again we would argue it is about whether you can walk or use public transport rather than using a taxi or getting a lift.
Any specified place / A specified place with which the claimant is familiar
Any specified place in 15(a) may mean that if someone selected any place at all that you know the doctors, the supermarket, the park - you would be unable to get to any of them. A specified place in 15(b) and 15(c) could mean that there is just one place that you cannot get to, though it seems unlikely that this is what the DWP intends. But it may mean that if there are some places you can get to and some that you cant 15(b) and 15(c) may still apply. If in doubt, include as much detail as possible about where you cant get to and, if youre unhappy with the decision, consider appealing.
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Support group
If 16 (a) is accepted by the decision maker as applying to you, then you will be placed in the support group.
Yes It varies Once again, please note, this activity is about difficulty relating to other people as well as becoming scared or anxious. If you are Always unable to meet with people you dont know for social engagements then the answer is No. You should also tick No if this is the case for the majority of the time, which would relate to descriptor (16)(c). It varies is unlikely to score points.
Sample answers
Please note: these are just examples of the kinds of information you may wish to give they arent correct answers of any sort. But it is vital that you give detailed evidence rather than just ticking boxes. You dont need to put the numbers in thats just to show how the system works. Depression 1 Because of my depression. 2 I have become very isolated and see people as little as possible. 3 I try to go out only very early in the morning or after it gets dark so that there is less chance of bumping into neighbours and having to say hello. Even having to speak to an assistant in places like the chemist, health food shop or library makes me feel very anxious and I try only to go to supermarkets because you dont have to speak to people there. If anyone in a shop does try to strike up a conversation with me I avoid going there again. I virtually never go to new places and would not dream of going to any sort of social event. Just setting foot outside my door makes my heart beat very fast and I have to fight back the panic. If I felt that I had to attend some sort of social occasion, such as a funeral I would be frightened for days and days beforehand. I wouldnt eat properly for days because I would feel so sick and anxious that people would try to talk to me. I would be very tempted to have a few drinks before going and be very worried that I would drink too much and make a fool of myself. I would probably end up not going, but if I did go I would be terrified and would sweat and shake and mix my words when anyone acknowledged me or spoke to me. Afterwards I would feel ashamed and hate myself. 4 I am always like this and have been for a long time.
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Post-traumatic stress disorder 1 Because of post-traumatic stress disorder 2 I have found it increasingly difficult to be in any social situations or to meet new people. 3. I avoid going out as much as possible and if I do have to go out I always have someone with me. I no longer have a social life or see any of my former work colleagues. At home I can no longer have friends round as then I cannot get away if it all gets too much and I start to panic. Now the very possibility of being around people other than my direct family can set off an anxiety attack where I tremble, my heart races, I struggle to breathe and break out in a sweat. 4 I am like this for the majority of the time now and it seems to be getting worse.
It suggests that for people with conditions like anxiety, panic disorder or agoraphobia there would need to be evidence that the condition was severe. For example, evidence of psychiatric input or medication. Health professional are told that daily living activities that they should ask the claimant about include: Use of public transport Shopping Talking to neighbours Use of phone Hobbies and interests Social interaction with family
Health professionals are told that, if this activity applies, it is likely that the claimant would need to have a companion with them in order to attend the medical.
Precluded
This probably just has its ordinary meaning of prevented.
Significant distress
This is a very imprecise term. It may mean things like trembling, being unable to speak, having panic attacks, being unable to sleep at the thought of meeting people.
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Support group
If 17 (a) is accepted by the decision maker as applying to you, then you will be placed in the support group.
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3 Can you give examples of your behaviour and what effect it has had on other people who were there at the time.? 4 Is it easy to predict when you are likely to have an outburst and can you control it? 5 Roughly how often do these outbursts happen?
Sample answers
Please note: these are just examples of the kinds of information you may wish to give they arent correct answers of any sort. But it is vital that you give detailed evidence rather than just ticking boxes. You dont need to put the numbers in thats just to show how the system works. Learning difficulties 1 Because of my learning difficulties 2 I often behave in ways that other people find strange or alarming. 3 For example, if a see a strange male with long hair I try to go and stroke it if I am not restrained. This makes some men very nervous and others very angry and aggressive. Sometimes I get very excited for no obvious reason and start to clap and laugh out loud which makes people around me stare and move away anxiously. 4 These outbursts can happen at any time without warning. 5 They happen most days of the week. ADHD 1 Because of my ADHD 2 I find it very difficult to control my temper. I get irritated and angry very easily and for quite minor reasons. 3 For example my wife asked me recently if I had used her hairbrush, because she couldnt find it, and I exploded. I was already frustrated because I couldnt find my house keys so I over reacted and spent the next few minutes shouting and verbally attacking her until she was in tears and visibly frightened. Similar instances occur in various situations like waiting in queues or an item being out of stock in the shop. 4 My over-reactions often cause people to move away from me or stop serving me or talking to me. Sometimes I will be asked to leave a caf, shop or doctors waiting room. 5 Incidents like the ones above happen at least once a week, often more frequently.
Atos health professionals are told that it applies to conditions where there are occasional episodes of relapse, such as some psychotic conditions, as well as conditions which cause - 58 -
consistently abnormal behaviour. But the Handbook adds that it does not apply to aggressive behaviour or anger management issues where there is no underlying mental health issue. The Handbook states that: The descriptors relate to behaviour that would be considered in an average workplace such as a call centre as this provides a more general concept rather than applying reasonable to one persons standards as this may be subject to considerable variability. It is likely that the behaviour would extend beyond verbal aggression for the descriptors to apply. We think that this is absolutely wrong as there are very few workplaces where verbal aggression would be seen as anything other than unreasonable. Health professionals are told to consider circumstances where criticism might occur, such as: Previous occupational history Shopping Childcare Parents nights at school Relationships with neighbours Ability to cope at appointments: GP/ Hospital etc. Ability to cope with bills and on the phone Dealing with finances and bills at the post office Appointments with official persons such as the Bank Manager/ Social Worker/ Benefits Personnel
Uncontrollable episodes
If your episodes can be controlled then they may not count. However, if they happen without warning or they cannot be controlled once they begin then they should be taken into account.
on a daily basis
This would probably have to be on every, or almost every, day.
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Frequently
There is no legal definition of frequently in this context. If the episodes are on a less than daily basis, all you can do is give detailed information and, if you are unhappy with the result of your claim, consider including this issue in your appeal.
Occasionally
As for frequently above.
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These are only examples. The safest rule is, if in doubt, tell the DWP. And, please, do it in writing and keep a copy because if you do it by phone they may deny the call ever happened and you could end up facing a huge repayment and even accusations of fraud.
Completing page 20
For people filling in this questionnaire for someone else.
If someone else is helping you to fill in the form but you are going to sign it yourself then we would say that it is up to you whether this part is completed or not. However, the DWP seem often to be suspicious about evidence given by claimants themselves, particularly where a mental health condition is involved. So, if you get help from a social worker, housing worker, health professional or someone similar, it may actually be to your advantage for them to complete this section.
What to do next
If you have any additional evidence, particularly medical evidence, you want to submit, send copies (not the originals) with this form as well as taking them along if you have to have a medical. Tick the box to say you are including them.
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And finally . . .
Well done for sticking with it youve reached the end of what is probably the most unfit for purpose form the DWP have ever managed to produce. Were sure it hasnt been easy. But if youve followed our guidelines you can at least reassure yourself that youve given yourself the best possible chance of getting the right decision. Please do remember to take a copy before you send the form off, if you possibly can. And also either post it recorded delivery or get a free certificate of posting from the post office, so that if it does get lost you can prove that you sent it within the deadline.
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If you write to someone asking for evidence, its really important that you keep a copy of the letter you sent them. If you have to go to an appeal hearing the tribunal may insist on having a copy of any letter you wrote to your GP or other health professional asking for evidence. If you dont provide it they may adjourn the hearing in order to allow you to contact your doctor and get a copy. The reason they do this is to see how much of the information the doctor provides is simply taken from the letter you wrote, rather than based on the doctors prior knowledge. However, it may then be three months or more before the hearing gets relisted. If you wish to avoid having to submit letters you wrote asking for evidence, then simply dont write any. Instead, make an appointment to see your health professional or go and visit or telephone friends or relatives and explain to them in person what it is you require. Take a copy of the descriptors with you and discuss which ones you think apply to you and why, if necessary. If you do have to attend a hearing you will have to say that this is what you did if you are asked.
Non-medical evidence
Decision makers have to take into account all relevant evidence. This includes any letters from friends, relatives, carers, neighbours and support workers such as social workers and housing workers. If you live with someone, a partner or family member for example, they may be able to provide very detailed evidence about the way your condition affects you.
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It can be very upsetting asking people to write about you in this way, try to ensure that you have someone to give you support, or possibly to approach people for evidence on your behalf.
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Give very careful consideration to how you travel to the medical, because you will be asked about how you did so and enormous assumptions may be made on the basis of your being able to use public transport on your own, for example. It may be assumed that you can initiate personal action, execute tasks, cope with change, go out alone, cope with social situations and so on. If you do have to use public transport and it is painful or distressing for you, make sure you explain this to the doctor who assesses you.
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The health professional has to choose one answer from each of the four sets of options. The computer will then construct a sentence such as: Always likes to deal with own finances efficiently. Similarly, in the box on the next page, the doctor will choose options which will allow the computer to create a sentence such as: Always likes to do housework for 2 hours.
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The computer will then paste these sentence repeatedly throughout the report to justify awarding or not awarding points for activities. For example, in relation to the Learning how to do tasks activity, the computer may say that no points should be awarded because the claimant: Always likes to deal with own finances efficiently. Always likes to do housework for 2 hours. In addition, in relation to the Initiating actions activity, the computer may also say that no points should be awarded because the claimant: Always likes to deal with own finances efficiently. Always likes to do housework for 2 hours.
If the doctor or nurse considered that the claimant couldnt do housework then he might use the dialogue box above to allow the computer to create a sentence such as: - 70 -
Usually is unable to do housework due to apathy. The computer might then use this as justification for deciding that 9 points should be awarded for: 13(b) Cannot, due impaired mental function, reliably initiate or complete at least 2 sequential personal actions for the majority of the time. It is possible for the health professional to type in their own evidence rather than using the multiple choice answers. However, if they do so the computer cannot copy and paste these answers into different bits of the report because it doesnt have any way of understanding what the doctor has written. This means that the health professional will have to do the copying and pasting themselves which obviously takes more time and effort. The doctor or nurse may thus be reluctant to choose any option that is not already loaded into the software bearing in mind that, for people being paid per medical, time is money.
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Cooking, housework and shopping Do you do your own cooking? What kind of cooking do you do? Can you follow a simple recipe? Are you safe around electricity and gas? Have you had any accidents recently? Do you keep your home tidy? Do you do shopping? Do you go to the supermarket or the local shop? Do you walk or drive to the shops? How long do you shop for? How often do you go? Hobbies and social life What do you do all day? Do you have any hobbies or interests? Do you watch TV? What do you watch? Do you use a computer? Do you have friends? Do you have a social life? Do you like to spend time with friends or family? D you go to pubs or night clubs? Do you drink alcohol? Do you use any street drugs? Pets Do you have a pet? Do you feed your pet? Communicating Do you have a telephone? Do you have problems with phone calls or doorbells? Do you phone your friends or family? Do you deal with you own letters and bills? Did you fill in the incapacity questionnaire yourself? Temperament How is your temper? How is your mood? Do you have problems with anxiety or panic attacks? Did you get anxious or lose sleep thinking about coming here today?
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In the past, decision makers generally went along with whatever descriptors the Atos health professional chose, disagreeing in only 2% of cases. However, since accepting in 2011 recommendations in the first Harrington report, the DWP should now ensure that decision makers take into account all the available evidence and reach their own conclusions.
Delayed assessment
If by the end of week 13 a decision has not been made on eligibility, for example because you have been too ill to be assessed or because there is an enormous backlog, the assessment phase can be extended. Where this happens, when the decision as to which group you belong to is made, any back payments of an additional component owed from week 14 onwards will be made.
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Many people have no hesitation about appealing, as they consider that they have no choice but to do so. For other people, the emotional demands of preparing a case and possibly appearing before a tribunal are extremely daunting and they may find it very hard to come to a decision. If you do decide to go ahead, a separate, detailed guide to the appeals process is available from www.benefitsandwork.co.uk.
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Advice agencies:
These are agencies whose main job is providing advice and information they should be able to offer help with enquiries about any benefit. Many employ welfare benefits specialists. You can usually find numbers for advice agencies in your local Yellow Pages in one or more of the following sections: disability information and services; information services; social service and welfare organisations; counselling and advice. Advice Northern Ireland To find your local independent advice centre in Northern Ireland, visit www.adviceni.net Citizens Advice Bureaux (CAB) There are over 750 bureaux in mainland Britain. Look under Citizens Advice Bureau in your phone book or visit the Citizens Advice website at: www.citizensadvice.org.uk Citizens Advice Scotland To find your nearest bureau, look under Citizens Advice Bureau in your phone book or visit the CAS website at: www.cas.org.uk Community Legal Advice (CLA) helpline and website CLA are a government body and their helpline is run by a private sector company. However, many of the agencies funded by CLA are voluntary sector agencies, such as citizens advice bureaux. If you are eligible for Legal Help, CLA provide free advice on a range of subjects, including welfare benefits, from their helpline on 0845 345 4 345. You can also get information about your nearest community legal advice funded advice providers by visiting the CLA website at www.communitylegaladvice.org.uk Disability Information Advice Line There are over 140 local DIALs, all staffed by disabled people and all offering telephone advice. If you have a local line it should be listed in your telephone directory under DIAL UK. Alternatively, call the national office on 01302 310 123 or visit their website at www.dialuk.org.uk where you can find a directory of DIAL offices. Shelter Shelter offers help with benefits, but generally only in relation to housing or if your home is at risk because of your benefits problems. For help call the Shelter helpline on 0808 800 4444 or visit their website at www.shelter.org.uk for details of your nearest Shelter Housing Aid Centre.
Law Centres
Contact details of your nearest Law Centre, where you may be able to get free advice and representation at appeals, are available from the Law Centres Federation website at www.lawcentres.org.uk
organisations have helplines where trained staff can help with some benefits queries and some employ a benefits specialist. In addition, there are often local groups with members who have claimed benefits and are prepared to share their experiences or accompany you to a medical or to a tribunal. Some mental health organisations, such as MIND, have advocacy projects with staff who will accompany you to medicals and hearings. To find out about any groups dealing with your health condition, visit the websites below. Contact a family www.cafamily.org.uk Although this is a site for families with disabled children it also contains a great deal of information that is of value to adults. The conditions index contains information on over 1,000 conditions along with details of support groups. NetDoctor www.netdoctor.co.uk This site features a support groups index with contact details for groups covering a very wide range of conditions.. UK Self-Help groups www.ukselfhelp.info Details of about 800 self-help groups, including many relating to different health conditions.
Solicitors
Be very cautious about engaging the services of a solicitor. Solicitors may charge you for help with benefits claims and will always charge you for representation at a hearing. Before getting a solicitor to do any work for you, always ask them whether you are eligible for free help under the Legal Help scheme. If you are not, you could face a bill running into thousands of pounds for help with a benefits claim.
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