(ESA) or Disability Living Allowance (DLA) before 28th October 2013.
You disagree with Housing Benefit decisions made by your local authority.
For all other benefits appeal processes (including Personal Independence Payments (PIP) and Universal Credit (UC)) please see our factsheet on: ‘Welfare Benefits: Mandatory Reconsiderations and Appeals’.
This factsheet aims to provide information about what do to if the Department for Work and Pensions (DWP) or your Local Authority (LA) make a decision about your benefits that you don‟t agree with. This factsheet covers the revisions and appeals process. It also covers how to prepare your own case and represent yourself at tribunal.
This factsheet covers –
1. Challenging a Council Tax Support Decision
2. Challenging a Decision from the DWP/LA
3. I‟m out of time is there anything I can do?
4. The appeals process
5. Preparing your Appeal
6. Attending your Hearing
7. Tips for self-representation
8. Sample Letters
Whenever the DWP or LA makes a decision about your benefit they will inform you in writing. If you don‟t agree, you have one month in which to either ask for a revision or appeal. Some examples of the types of decisions you may disagree with are –
You have been found capable of work and therefore refused Employment and Support Allowance (ESA).
You have been placed in the Work Related Activity Group (WRAG) of ESA but you think you should be in the Support Group (or vice versa).
You have been refused Disability Living Allowance (DLA).
You have been awarded DLA but not the rate or component you believe you are entitled to.
You want to challenge a decision made about your Housing Benefit.
You disagree with the amount of Council Tax that you have been asked to pay.
If you‟re not sure what the decision letter means or the reasons why the DWP/LA have made the decision you can call them and ask for a verbal explanation or you can write to them and ask for a written statement of reasons.
1. Challenging a Council Tax Support Decision
The government has decided to give LAs the power to set Council Tax levels in their area. As a result LAs will need to set up their own system for appeals and there will no longer be a centralised system. This means that
The Welfare Benefits system is currently undergoing significant reform. This factsheet is correct at time of publication. However the factsheet will be reviewed regularly and updated with further information as soon as it becomes available. If you have received information that differs from the content of this factsheet, please contact us.
the appeals process for Council Tax Support is likely to vary from area to area.
As a result it is difficult to give an overview of the appeals process for Council Tax Support Decisions. We would recommend that you contact your LA and ask them for a copy of their appeals forms and the procedure that needs to be followed.
In general you are likely to need to get evidence such as bank statements, proof that people are living at other addresses, invoices and receipts that show money has been spent on essential items or any other evidence that proves the decision they have made about you is incorrect.
We would always recommend making you appeal in writing and keeping copies of any letters or paper work you send. Make sure that you stick to the time limits for appealing the Council Tax Support Decision, which are set by your LA.
Other LA administered benefits decisions, such as Housing Benefits, can still be challenged following the standard procedure, set out below.
2. Challenging a Decision from the DWP/LA
If you disagree with the DWP/LA‟s decision about your benefit you have the right to ask the DWP/LA to look at it again.
Currently you can choose whether or not to ask for a revision of the DWPs decision, if you disagree with a decision made about ESA or DLA before 28th October 2013. You can choose to ask for a revision and then appeal to the tribunal or appeal to the tribunal directly.
If you are appealing a decision made about your claim after this date, or if you want to appeal a decision made about PIP or UC you will need to follow a different procedure. This is set out in our factsheet ‘Welfare Benefits- Mandatory Reconsideration and Appeals’. It is available to download at http://www.rethink.org/factsheets or by ringing 0300 5000 927.
When you request a revision you are asking the DWP/LA to look at their decision again and change it. We would advise you to request a revision in writing, keep a copy and either send it recorded delivery or get proof of postage. This way you know it has been received within the strict 1 month time limit and you have a copy of what you have asked for.
If you have asked the DWP for a written statement of reasons the time limit is extended by 14 days as long as they send you the reasons within the month.
If you have asked the LA for a written statement of reasons the rules are different. The days in-between you asking for the reasons and the day they are provided are ignored when calculating the 1 month time limit.
The letter you send them should explain why you think the decision is wrong. If you have any evidence to back up your opinion you should send that too.
Someone from the DWP/LA who has not looked at your claim before will then review the decision that has been made. The DWP/LA will then look at all the information you have given them and decide whether to stick with their original decision or change it. They will then write to you with their amended decision. If they have changed their minds, any change in benefit should be backdated to the date of the original decision.
It is important to send in medical evidence to support your claim, as the DWP are more likely to reverse their earlier decision if they have evidence that shows that the original decision was wrong.
If the DWP/LA look at the decision again but decide to stick with it and you still disagree with them, you can appeal the decision to a tribunal. This is explained in more detail later on in this factsheet. You have one month from receiving the DWP‟s revision to lodge an appeal.
Example
John made a claim for ESA but this was refused. The decision maker at the DWP said he only scored 6 points (but he needed 15 to qualify). They sent him a letter on the 1st February. John wrote a letter within the 1 month time limit to the DWP asking them to look at this decision again. He explained he felt it was incorrect because he has great difficulty in coping with change. He sent in a letter from his psychiatrist which confirmed this.
A different decision maker at the DWP looked at all the information about John‟s claim again. They looked at his original questionnaire, the medical report from the DWP doctor and also the information given by John and his psychiatrist in the revision letter.
The DWP wrote to John with a new decision on the 8th March. They decided that he did qualify for ESA and was to be placed in the Work Related Activity Group.
John was given the extra „work related activity component‟ money backdated to the 1st February.
3. I’m out of time is there anything I can do?
The DWP/LA may accept a request for a revision after 1 month if they think it is reasonable, there could be a prospect of success and the delay in asking for the revision was due to special circumstances. Not knowing the law or the time limits is not enough. If you were very unwell and in hospital for example, this could be a good enough reason. You should make the request in writing as usual but also explain why you are asking outside of the 1 month time limit.
You can only ask for a late revision up to 13 months after the original decision. The later your request for a revision or reconsideration is, after the 1 month time limit, the more compelling your reasons will have to be.
4. The appeals process
What are the time limits?
If you disagree with a decision you can either appeal within 1 month of the decision being sent or, if you have first asked for a revision, within 1 month of the revised decision being sent.
If you are outside of the 1 month time limit but there were special circumstances why you missed the deadline, then you can ask the DWP/LA to consider still taking the appeal. Special circumstances could be that you or your partner was seriously ill. As with revisions, any late appeal must be within 13 months of the original decision.
How do I submit an appeal?
If you decide to appeal after asking for a revision, or if you decide to make an appeal as soon as you receive the decision, the appeal must be in writing. There is a form known as a GL24, it is also called „If you think our decision is wrong‟, which you can use for appealing decisions made by the DWP. You can ask for this at your local Jobcentre Plus office or view it on-line at the following web address.
If you want to appeal a decision made by the LA, you can ask them for their own appeals form.
You can appeal just by writing a letter, however if you use the specific appeals forms you can be sure you are giving the DWP/LA all the information they need. Again, we would advise keeping a copy and ensuring you get proof of postage or send it recorded delivery.
If you lodge an appeal it is automatically treated as a request for a revision first. The decision is reviewed locally and is passed to a different decision maker to look at the case again. Unless you are providing evidence as to why the original decision was wrong then the decision is unlikely to be changed at this stage. The case will then be passed to the tribunal service for a full appeal
What happens to my benefits whilst I am appealing?
Due to the number of appeals currently being processed by the Tribunals Service it can take 12 monthsi from the date that the appeal is submitted for the case to be heard. If the original decision is not changed, at the point of revision, by the DWP you could be living off reduced income or having to make further outgoing payments for quite some time.
If you are appealing an ESA decision that you are „fit for work‟ then you will be paid ESA at the assessment rate. See our factsheet on „Employment and Support Allowance’ for more information.
If you are appealing an ESA decision that you have been placed in the WRAG when you feel you should have been placed in the Support Group you may have already been referred to Jobcentre Plus or a Work Programme provider for work focussed interviews and to engage in work related activity. If you want to get the money you receive for being in the WRAG then you will need to attend the work focussed interviews and abide by the requirements of the work provider.
If you do not take part in the activities required of you by the Jobcentre Plus or the Work Programme provider you may have part of your ESA stopped. This is known as having your benefits sanctioned. The DWP have the power to sanction part of, or the whole of the basic allowance of ESA. This sanction is made if you cannot provide a good reason for why you have not taken part in the activities asked of you.
If you appeal before you are referred to the Work Programme, you should not be referred to the Work Programme whilst your appeal is ongoing.
How can I find support for my appeal hearing?
You could try and get help from a specialist welfare rights adviser at your local Citizens Advice Bureau, independent advice agency or Local Authority Welfare Rights Service to help you with your appeal.
You can usually find details of local services in the telephone book, Yellow Pages or on the internet.
What if I have to represent myself?
Due to cuts in funding for voluntary sector services and changes to legal aid, many people are struggling to find a local organisation that can help with an appeal and provide representation at the hearing.
You may, therefore, need to consider either preparing the appeal yourself or getting help from a friend or family member to prepare the appeal with you. Many people find the thought of preparing the appeal and representing themselves daunting however it is possible.
Whilst it is helpful to have representation, if this is not possible, it is important to remember the tribunal system was set up so that people could represent themselves. Many people without representation successfully represent themselves every day. You can improve your chances of being successful at appeal by being well prepared and knowing what to expect from the process.
5. Preparing your Appeal
Getting Supporting Evidence
It can be very helpful to get medical evidence to support your appeal. It is worth attempting to get supporting evidence if you can.
You can submit evidence along with your appeal form. However don‟t worry if you can‟t get the evidence in time, you can always send it later. You are also able to submit evidence on the day of the hearing, at the tribunal venue. However if you submit a lot of evidence, this may delay the hearing, as the tribunal panel will need time to read it.
The tribunal will not write to medical professionals (e.g. your GP, psychiatrist or social worker) to ask for evidence. You will need to speak to the medical professionals involved in your care and ask them if they are prepared to support your request for a revision or appeal and if they would provide a letter/report that backs up your claim. You should be aware that some GP‟s may try to charge you for this. It is important to state from the outset that you are not in a position to pay if this would cause you hardship.
Rethink Mental Illness has drafted some letters that could be sent to your medical professionals in relation to benefits appeals to request the necessary supporting information. These can be found at the end at this factsheet in the „Sample Letters‟ section.
If a carer or relative has important information about your condition then we recommend that they make a written statement about your needs and condition(s) and submit this in advance to the tribunal.
It is important to make copies of the medical evidence that you send to the tribunal so that you can refer to it during the hearing.
Making arguments to counter the DWP/LA’s decision
Once you have gathered all the medical evidence that you want or have been able to get and have sent back all the forms, the next step is to consider writing a submission which sums up your arguments. It is not a requirement to do this but it is something that most welfare rights advisers do, as it can help to focus the tribunal on the matters that are important to you in the appeal.
In order to be successful at your hearing you need to show the tribunal that you meet the assessment criteria for the benefit. Written submissions are a good way of explaining which parts of the DWP/LA decision you disagree with and countering the DWP/LAs arguments by explaining how you meet the assessment criteria and how your evidence backs up your appeal. You can also highlight important information that you would like the tribunal to consider.
It is important not to use your written submission as an opportunity to criticise the DWP/LA or Atos. You will not be successful at appeal by simply critisising an earlier decision. Instead you should stick to facts and explain why the decision is wrong.
When writing your submissions, do not feel that you have to complete them in one go. Splitting the submission into issues and focusing on one at a time can help.
Due to the legal rules that govern the tribunal, the tribunal panel are only able to consider facts and examples about your condition that were true at the time that the decision about your benefit was made. So for example if your hearing takes place in June 2013, but the original decision about your benefit was made in September 2012 the tribunal can only consider evidence about your condition, as it was in September 2012.
If your condition has deteriorated or improved since the decision about your benefit was made, you will have to give examples and evidence based on your condition as it was previously. It may be difficult for you to remember what you condition was like. Therefore it is advisable that you spend some time thinking about this. You may also find it useful to ask friends or family to remind you, if you cannot remember.
Tips for writing your submission
Look at the paper work sent to you by the DWP/LA. There should be reasons given for why your benefit claim was not allowed.
Look at the eligibility criteria for the benefit you are applying for. See Rethink Mental Illness‟s factsheets on ‘Disability Living Allowance (DLA)’, ‘Employment and Support Allowance (ESA)’ and ‘Work Capability Assessment (WCA)’ for more information on the eligibility criteria for these different benefits.
If you disagree with the way that you have been assessed and the decision that the DWP/LA has reached, you need to explain what you disagree with and why.
Deal with each point of disagreement individually.
Refer to medical evidence and evidence from carers or family that backs up your argument.
Example Submission: Limited Capability for Work and Work Related Activity
The DWP has stated that I was awarded 0 points when assessed on my awareness of hazards or danger. Therefore I was assessed as not needing supervision to keep myself safe.
This is inaccurate. I need supervision to keep myself safe the majority of the time. For example, I always need to be supervised when taking my medication as I would always take the wrong amounts, if I was not supervised.
This is evidenced by the letter from my GP, Dr Roberts, dated 12th April 2013, which I attach to this submission. In the letter Dr Roberts confirms my need for supervision when taking medication.
Furthermore, the statement made by my partner Ms Jane Smith, dated 10th April 2013, which I attach to this submission, confirms that she has to supervise me when I take medication every morning and evening.
Therefore, I contend that I should have been awarded 15 points when assessed on my awareness of hazards or danger.
You are not required to write submissions and you can simply go to the tribunal hearing and give your evidence orally.
If you decide not to make written submissions we would recommend making notes in the days before the appeal hearing and taking them with you so that you remember everything you want to say. It can be easy to forget something important due to the stress and strain of a hearing and this is your last opportunity to mention it.
Making Arrangements for the Tribunal
If you have any communication needs, such as requiring a translator to understand proceedings, it is important that you let the Tribunal know in good time, so that one can be arranged. Family members are unlikely to be allowed to act as your translator during the hearing.
If you would like someone to accompany you to the hearing you should ask them, in good time, whether they are willing to accompany you and available on the date of your hearing.
It is also important to plan how you will get to the tribunal. Make sure you know where the venue is and you have worked out how you will get there.
6. Attending your hearing
What happens when I arrive at the tribunal building?
It is important that you arrive at the tribunal in good time. The buildings
that are used for hearings vary throughout the country. When you arrive at
the building it is important to go to the right place. The location of your hearing should be stated in the letter you received telling you about the date of your hearing. You should report to reception to let them know that you have arrived.
It is likely that you will then be directed to a waiting room. The panel involved in the tribunal will try and make sure that hearings run to time. However in some situations there may be delays. You may want to bring along something to read. You may also consider bringing along a drink and some snacks, as refreshment facilities may be limited.
A tribunal clerk will come and ask you if you have any last minute evidence (such as medical reports) that you want to submit to the panel. This is also an opportunity to ask any questions you have about procedures for the tribunal.
What is the appeal hearing like?
Your appeal hearing will take the form of a tribunal. It is important to remember that attending a tribunal is not like going to court and is without the majority of formality you would associate with court.
For appeals regarding Disability Living Allowance, the hearing will be in front of a judge, a doctor and a „disability member‟ (this is someone who has an understanding of disabilities but is not a medical practitioner, they could be a social worker, nurse or occupational therapist for example).
For Employment and Support Allowance or Incapacity Benefit appeals it will be in front of a judge and a doctor.
For appeals in relation to Housing Benefit it will be in front of a judge only.
The people deciding your case will be wearing suits, not robes or wigs. The tribunal will not take place in a court room and there will be no witness box or jury. Instead the tribunal will take place around a table. The tribunal panel will make notes on what questions they ask you and what you say in response. There may be computers on the table that the panel will use. There may also be a tribunal clerk who sits at the back of the room. The clerk may carry out administrative duties, related to the hearing.
The style of proceedings is “inquisitorial”. This means that the panel will ask you questions in order to get a better understanding of your condition and the process should be co-operative. This is unlike cases in criminal courts where the style is “adversarial” and lawyers seek to discredit the other side. The panel is trying to work out the facts and should not act aggressively or make accusations against you.
The DWP may also send a representative to the hearing, although this is happening much less often at present. They are known as a presenting officer and their job is to represent the DWP and put their case across. They have the right to ask you questions about your condition, illnesses or situation and you will be expected to answer them. They can also make legal arguments to the tribunal.
How long will my hearing last?
The hearing will last around 30 to 40 minutes. The tribunal will be conducted in plain English and there should not be unnecessary use of legal jargon or reference to the law. The tribunal will be based on the facts of your claim. You do not need to know the law in order to represent yourself.
When will I know what the decision of the tribunal is?
Usually the same day. They may ask you to step outside the room for a few moments whilst they decide. If they cannot make a decision straightaway they will send the decision to you by first class post. If you still disagree with their decision you should ask for a written statement of reasons. Decisions made by the tribunal can only be changed in limited circumstances. You should always seek specialist welfare benefits advice.
You can search for a local welfare rights adviser, who may be able to help with an appeal, by contacting Civil Legal Advice on 0845 345 4 345 or by doing a search on their website – http://legaladviserfinder.justice.gov.uk/AdviserSearch.do
7. Tips for self-representation
Take your time when answering questions and ask for additional clarification or a short break if needed.
The panel will ask you questions about your medical condition and about what you can and cannot do. It is important that you take your time when answering. If you do not understand the question that is being asked do not be afraid to ask them to repeat themselves or to phrase the question in a different way.
It is important to be polite to the panel. If you feel that you are finding it difficult to stay calm or you are becoming upset you can ask the panel to allow you to take a short break.
Answer the panel’s questions as fully as you can and honestly
When giving your answers it is best to be as open and honest as possible. It is often hard to talk about medical problems and the help that you need.
If you think it is likely that you will be asked about something you find difficult to speak about, you may want to plan what you want to say before hand and practice saying it out loud. Alternatively you may want to write it down in your written submission and then refer to your written submission, instead of speaking directly about it.
Give relevant examples
Mentioning relevant examples of how your condition affects you is a good way of explaining the impact your condition has on you. It may be helpful to take some written notes of practical examples so you don‟t forget what you want to say. If you found it difficult to get to the venue and needed help and support to do this, you could mention this.
You will often be asked to describe your typical day. It can be hard to describe a „typical‟ day if you have mental health problems as your mood or health could vary from day to day- try to explain this to the panel. Let them know what you can do on a good day but also how you manage on a bad day and how often you tend to have bad days.
Consider taking along a friend or relative
You are entitled to take along a friend, care or relative for support. They can also help you during the tribunal by asking you questions, to prompt you to mention facts that you may have forgotten.
Whoever you take with you will not be expected to speak on your behalf as you are expected to answer the questions put to you by the tribunal yourself. If a representative or someone providing support attempts to give evidence to the tribunal on your behalf then they are likely to be stopped by the tribunal chair and not allowed to continue. This person can however ask you questions about things that you may have missed or are important to the case. You could then provide evidence by answering these questions. They would usually be able to ask their questions when the panel have finished asking questions. Your friend or relative may find it useful to bring a pen and paper with them, so they can write down points that they would like to ask you questions about.
8. Sample Letters
Example letter requesting supporting evidence from a health care professional for challenging Limited Capability for Work and Limited Capability for Work Related Activity decisions
To: (add name of professional)
Address: (add address of professional)
Date: (add date)
Dear Sir/madam (delete as applicable)
Re: Name: (add your details)
Address:
D.o.B:
I am currently appealing a decision regarding an Employment Support Allowance (ESA) claim and I am writing to ask if you would provide some evidence which may help my case.
It has been established that evidence from medical professionals involved with the diagnosis, care and treatment of a patient can be extremely useful in helping decision makers at the Department for Work and Pensions (DWP) to make decisions that are appropriate to the patient‟s needs and conditions.
I would be very grateful if you could answer all the questions that you think are relevant to my condition from the list below and return them to me in the envelope provided. Please be aware that I am not in a position to pay for any report or information.
Please note that the appeal is in respect of a decision made in (add date mm/yy) so I would be grateful if you could provide information based on my condition at that time.
I have downloaded this letter from Rethink Mental illness. The information contained therefore focuses on mental rather than physical health needs. If there is information regarding my physical health needs in addition to my mental health needs that you think is relevant, then please include this at the end of the form.
Yours sincerely
1. Please state what condition(s) I suffer from and what medication(s) and treatment(s) have been prescribed.
2. How is my ability to learn simple tasks (e.g. setting an alarm clock or operating a washing machine) affected by my medical condition(s)?
3. How is my awareness of everyday hazards, (e.g. Boiling water or sharp objects), affected by my medical condition(s)? Does this pose a significant risk to my safety or other‟s?
4. How is my ability to initiate and complete personal tasks affected by my medical condition(s)?
5. How is my ability to initiate and cope with change affected by my medical condition(s)? Does this affect my ability to manage my day to day life?
6. How is my ability to get to places affected by my medical condition(s)? Do I need supervision to get to familiar or unfamiliar places?
7. How is my ability to cope with social engagement affected by my medical condition(s)? Am I caused distress by social engagement and does this preclude social engagement?
8. How is my behavior affected by my medical condition(s)? Do I show signs of aggressive, uncontrolled or disinhibited behavior? And could this be considered unreasonable in a workplace?
9. If I am required to attend work focused interviews or job programs. Would this have a detrimental affect on my health? If yes, how would I be affected?
10. Is there any other information that you think is relevant?
Signature Date Hospital/Surgery Stamp
Thank you very much, in advance for any help you can provide towards my appeal
Example letter requesting supporting evidence from a health care professional for DLA Appeals and Revisions
To: (add name of professional)
Address: (add address of professional)
Date: (add date)
Dear Sir/madam (delete as applicable)
Re: Name: (add your details)
Address:
D.o.B:
I am currently appealing a decision regarding a Disability Living Allowance (DLA) claim and I am writing to ask if you could provide some evidence which may help my case.
It has been established that evidence from medical professionals involved with the diagnosis, care and treatment of a patient can be extremely useful in helping decision makers at the Department for Work and Pensions (DWP) to make decisions that are appropriate to the patient‟s needs and conditions.
I would be very grateful if you could answer all the questions that you think are relevant to my condition from the list below and return them to me in the envelope provided. Please be aware that I am not in a position to pay for any report or information.
Please note that the appeal is in respect of a decision made in (add date mm/yyyy) so I would be grateful if you could provide information based on my condition at that time.
Yours sincerely
1. Please state what condition(s) I suffer from and what medication(s) and treatment(s) have been prescribed.
2. To what extent do my condition(s) physically affect my ability to walk outdoors?
3. Do I require guidance and supervision whilst outdoors in connection with my medical condition(s)? If yes, what support is needed?
4. To what extent do my condition(s) affect my ability to care for myself at home? E.g. wash, dress and bathe, prepare and cook a main meal, remember to take my medication, dress myself appropriately or keep my self safe?
5. Do I need someone with me throughout the day to provide supervision, for example in order to keep me safe or to provide me with support and reassurance due to my medical condition(s)?
6. Do I have any history of falls or seizures? If yes, how does this affect me and how often do they happen?
© Rethink Mental Illness 2013
Last updated April 2013
Next update April 2014
