Appealing PIP and ESA decisions
Claiming Personal Independence Payment (PIP) or Employment and Support Allowance (ESA), is not always a straightforward process. Here, our charity partner Turn2us helps you decide when you should challenge a decision and how to do it.
PIP is only awarded to about half of the people that claim it and nearly 40 per cent of all ESA claimants are told that they are fit for work. Lots of people have to challenge the decision to refuse their benefits and then appeal to Tribunal to get what they are entitled to.
It’s not easy to deal with a decision that you’re not entitled to benefits. It can leave you feeling stressed, disbelieved and unsupported. It can also affect your health, especially when it leaves you worse off financially.
1. The Decision Letter
When you are refused PIP or ESA, you will receive a letter from the Department for Work and Pensions (DWP) confirming the decision. This is called the ‘decision letter’. You usually have one month from the date of the decision letter to ask the DWP to change their decision.
If you’re not sure whether the decision is right, you may want to check the rules for PIP or ESA and whether you qualify. These are helpful websites for checking if you qualify:
www.c-app.org.uk has easy-to-use questionnaires for PIP and ESA. When you have completed the questionnaire, it tells you whether you are likely to qualify, and which answers are important. You can use the checklist of important answers to see if the DWP has considered all of those facts.www.benefitsandwork.co.uk has self tests for PIP and ESA. When the DWP assesses your entitlement to PIP or ESA, they award points for each activity listed in the rules. The Benefits and Work self tests tell you how many points you may score for each activity. You can use the results to compare how many points you think you score against how many points the DWP awarded you.
2. Mandatory Reconsideration Request
To ask the DWP to look at their decision again, you must request a ‘Mandatory Reconsideration’.
If you think the DWP made the wrong decision, you have to ask them for a Mandatory Reconsideration within one month of the date on your decision letter. If you ask for a Mandatory Reconsideration later, the DWP will not look at their decision again unless they accept that you have a good reason for the delay.
The best way to ask for a Mandatory Reconsideration is to write to the DWP at the address on your decision letter.
Make sure you include:
- ‘Mandatory Reconsideration Request’ at the top
- Your National Insurance number
- Today’s date
- Date of the decision
- Why your request is late (if it is)
- Which part of their decision is wrong and why
You can request mandatory reconsideration over the phone, but a letter is the best way of making sure your request is processed. You may be able to get help to write the letter from a local benefits adviser, which you can find on advicefinder.turn2us.org.uk.
Your letter does not have to be detailed. A short letter is better than no letter.
If you can, include more detail in your letter. For example, if you think the DWP did not award you enough points for a particular activity, tell them how many points you think you should have received. You can give details about what happens when you do that activity or try to do it. You can give them evidence to prove what you say, for example medical letters or records, or a letter from someone who helps you.
The DWP tries to deal with Mandatory Reconsideration requests within two weeks of receiving them. If you don’t hear anything after two weeks, you may want to call them to check they have received it. Remember to keep a record of your call. When the DWP looks again at their decision, if they think that the decision was right, they will try to telephone you to see if you have anything else to tell them. If they can’t get through to you or what you tell them doesn’t change their mind, they will not change the decision. If you tell them that you have more evidence to send to them, they will give you more time to submit it before they look at the decision again.
3. Mandatory Reconsideration Notice
The Mandatory Reconsideration Notice confirms whether the DWP has changed their decision. Once the DWP has considered all of the information they have, they will issue a Mandatory Reconsideration Notice. You will receive two copies.
Don’t be put off if the DWP does not change their decision at this stage. The DWP only changes a small proportion of challenged decisions themselves (13 per cent for PIP and 10 per cent for ESA).
If you are still unhappy with the DWP’s decision, you can appeal to Tribunal. Success rates at the appeal stage are much higher. Over 60 per cent of appealed PIP decisions and 58 per cent of appealed ESA decisions are changed by the Tribunal.
You cannot appeal to Tribunal until you have received your Mandatory Reconsideration Notice.
4. Appeal to Tribunal
The Tribunal is independent of the DWP. They will look at all of the information the DWP has and everything that you tell them and then decide whether the DWP’s decision is correct according to the rules.
The appeal form is an SSCS1 form. The easiest way to get a copy of the form is to do an internet search for ‘SSCS1’ and download the form from the justice.gov.uk website. You could also get a copy from your local Citizens Advice Bureau or another benefits adviser or charity.
You have to submit your appeal form within one month of the date on your Mandatory Reconsideration Notice. If you submit your appeal later, the Tribunal will only consider it if you have very good reasons for the delay and your appeal is submitted within 13 months of the date on the Mandatory Reconsideration Notice.
Submit your appeal by posting your completed SCCS1 form to the Appeals Centre using the address on the form. They will send you a letter to confirm they have received your form. This letter will have your Tribunal Reference number on it. You can check the progress of your appeal by calling 0300 123 1142. A copy of your appeal will be sent to the DWP by the Tribunal Service.
Within four weeks of receiving a copy of your appeal, the DWP will send you and the Tribunal all the paperwork about your claim. This is their evidence. It is a good idea to read their evidence, if you can, and make a note of anything that you do not agree with.
You can submit evidence too. It is best to send it with your appeal form but you can send it later. Put your Tribunal Reference number on any papers you send to the Tribunal separately to your appeal form. Good evidence to submit includes:
- Sick notes and prescriptions
- Medical records from your GP
- Letter from friends or family who help you saying how they help you, how often and what would happen if they didn’t
When the Tribunal decide your entitlement to PIP or ESA, they award points for each activity listed in the rules. Documents which show how much help you need to carry out the activities are the best evidence to prove that you should be awarded more points.
You will receive a letter from the Tribunal Service at least two weeks before the hearing confirming the date, time and place.
You can take someone with you to the hearing, and if you have any more evidence, you can take that too.
When you arrive, the clerk will greet you and explain what happens next.
When you go into the Tribunal, you will see a panel of two people for an ESA appeal or three people for a PIP appeal. They will introduce themselves and explain what happens next. Each of the panel takes turns to ask you questions about your health and how it affects your ability to do things for yourself. Remember to tell them about your worst days as well as your best days.
You can take a break at any time during the hearing. At the end of the hearing, you will be asked if there is anything else you want the panel to know before they make a decision. You may want to tell them about things you disagree with in the DWP’s evidence.
You will be told the Tribunal’s decision on the day of the hearing unless the panel think it will take a long time to make a decision. Whether they make the decision on the day, or later, you will receive the decision in the post. A copy of the Tribunal’s decision will also be sent to the DWP.
If you have been refused PIP or ESA, it could be harder for you to make ends meet. You may have to make do on less money unless or until your appeal is successful. Make sure you visit the Turn2us website turn2us.org.uk to find out about other help.
Turn2us can help you to find:
- Benefits adviser near you to help challenge a PIP or ESA decision. Use advicefinder.turn2us.org.uk
- Other benefits you may be entitled to. Use the Benefits Calculator on phauk.org
- Charities that can help you with grants that you don’t have to pay back. Use the Grants Search on phauk.org
- Immediate help for people who are really struggling. Search turn2us.org.uk for “Emergency Assistance”
Turn2us is a charity that is passionate about fighting UK poverty. Find out more about their work at turn2us.org.uk, or on Facebook or Twitter @turn2us _org.