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Thread: PIP - preparing for reconsideration - one thing I can't get my around

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  1. #1

    PIP - preparing for reconsideration - one thing I can't get my around

    Hello there,

    Firstly I'd just like to say how helpful this site is - I've been reading through previous posts and guidance and it's really helped me to focus on what I need to do next with respect to my PIP claim (I've received my decision back 0 points, and now I'm preparing to write to the DWP to request that they reconsider).

    There's one thing that I can't quite get my head around though (and I think this may have been part of my problem during the second of my interviews with a health professional) and that is the question of "how often" my problems affect me.

    I'll give a bit of background:

    I suffered a breakdown about 6 years ago as a result of a terrible job I had at the time - since then I've suffered what I could best describe as mix of social anxiety and nausea - certain situations will set me off (usually involving formal or restrictive situations or not having access to a toilet when I feel sick). Since I started to feel this way, I've reorganised my life accordingly, for example I left my job and now I work from home - the whole of my life now is split into three parts - the stuff I can do, the stuff I can do while experiencing discomfort, and the stuff I'd never dream of doing, because even the idea makes me nervous.

    So, where do I fit in with PIP? I avoid 90% of the things that cause my anxiety to trigger - does that mean I don't have a problem?

    To me it seams like I'm avoiding a huge part of my life, and that everything I might or might not do has to be looked at through the lens of "will this set me off?", but the way the PIP assessment is set up, none of this matters, because I'm not regularly experiencing a problem (because I'm avoiding it).

    I had a meeting with a health professional last year, and I felt that I really got to explain this in the interview - giving lots of examples of situations I struggled with, how distressing it was etc the interview was really thorough and I felt that I was in good hands. Six months later whilst chasing Capita, the lad on the phone said there was no record of my initial report on the system and they booked me another appointment (a long story) this second appointment seemed to fly by, and I don't think the HP took into account the fact that my condition was situational. She seemed to just look at me and say "he looks alright" and wizzed through the categories without giving me a chance to say within what kinds of context I'd have a problem.

    So, it feels like if I lock myseld in the house, never speak to anyone, never go anywhere and never do anything, I'm not eligible for PIP. And likewise, if I want to fill my claim form with lots of examples of how horrible it feels to be suffering an attack of anxiety/nausea, I need to start hunting down horrible situations to put myself in - this just seems grim.

    I suppose what I'm getting to is the 50% of the time fluctuating condition criteria - I'm not suffering 50% of the time because I avoid triggers - if I had to do my old job, I'm pretty sure I'd have a problem with that a lot more than 50% of the time - in fact, I'd probably have to quit my job and work from home - which is exactly what I've done!

    I feel like I'm going around in circles and waffling on a bit here, but each time I try to assess my condition based on the points criteria I find the same kind of issues - how do I define "manage" does running out of a building sweating count as managing? What about locking myself in the toilet on the train? Or carryig a sickbag everywhere I go? is this managing? What counts as overwhelming psychological distress? Can I communicate with someone face to face? Yes. Can I communicate with someone face to face when I'm having a panic attack? No.

    My answer to each questions seems to be "yes but no, some of the time, but not at other times", and I feel like when they conducted my assessment, they only heard the yes, and then stopped listening.

    I'm sorry for having such a moan, but I feel like the report came back saying there's nothing wrong with me - when I applied for PIP I felt that I was being reasonable, but I didn't know whether I'd be eligible or not. Now I've received the comments back from the assessment, it feels like they've not really taken my case into consideration - the person described on the report doesn't sound like me, and doesn't have any of the problems I know I have.

    So there it is - I actually came on here for some guidence, and to ask some questions, but as soon as I started writing, I guess I felt a need to rant and rave (sorry).

    Still, I'm kind of stuck in a limbo of how to restate my case for the reconsideration - I'm worried that I'm just going to write yes but no again, and they're going to read the yes.

    Any advice anyone?

  2. #2
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    Sorry you got turned down for these types of problems. I did too although a mixture of mental and physical. I have also asked for a mandatory reconsideration and its being looked into now but its not a question of yes and no answers. I personally just wrote a 7 page letter stating my conditions and the affects they have me and have no idea if this will work as it seems that the assessor who assessed me (I did not receive my report back until last week) actually agreed that I should be granted PIP and it seems what she has written is similar to what I have written in my letter. (The decision maker actually disagreed with her though although did award me some points). If this is the case then I am just hoping that I have now persuaded the decision maker to side with us both.

    I think someone with more knowledge will come along and help but just wanted to say good luck.

  3. #3
    Thanks Karen, I appreciate it.

    I'm hoping that having a chance to put something down in writing will help - I don't think I did myself any favours in my recent assessment - I kind of let myself get shepherded through the process, and after the assessor had left, I didn't feel like I'd really told my side of the story, or succeeded in getting my isues onto the report.

  4. #4
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    Its often the case with mental health. We don't know how to express things at the right time and in the right detail for legal matters of the PIP descriptors maybe. I had my report back and was surprised at the descriptors the assessor had ticked and the ones the decision took away due to legality I assume. Its a minefield actually claiming anything and when your head Is full to the brim its even harder.

  5. #5
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    Period over which the assessment is made

    Quote Originally Posted by IanSouthWales View Post
    So, where do I fit in with PIP? I avoid 90% of the things that cause my anxiety to trigger - does that mean I don't have a problem?

    To me it seams like I'm avoiding a huge part of my life, and that everything I might or might not do has to be looked at through the lens of "will this set me off?", but the way the PIP assessment is set up, none of this matters, because I'm not regularly experiencing a problem (because I'm avoiding it).
    These two paragraphs are key to the answer.


    The law is found in Regulation 7 of The Social Security (Personal Independence Payment) Regulations 2013 (SI 2013/377) ('the PIP regulations') read in conjunction with the definition of "prescribed date" in Regulation 14(a).

    That is not the easiest piece of law to assimilate, so I'll put it together for you.


    You cannot be paid PIP until you have had the disabling problem(s) for three months - this is what Regulation 14(a) is about. If you have had the disabling problem(s) for three months on the day you claim, the day you claim is the "prescribed date", otherwise the "prescribed date" is the day you have had the problems for three months.

    Your problems have been going on for far longer than three months, so it's almost certain that the "prescribed date" is your case is the day you phoned to claim PIP.


    Regulation 7(3) sets the period over which the scoring is done as starting three months before the "prescribed date" and ending nine months after it.


    In other words, it is your problems during the year that starts three months before the day you claimed PIP that are being scored. This means that you must make your arguments in relation to your life now, not when you were working from an office in your previous job. PIP is paid in relation to the difficulties you currently face, not in relation to the effect those difficulties had on your former life.

    It is important to distinguish between "this cannot occur because I have completely removed that trigger from my life and will not face it again without a change of lifestyle", which doesn't count and "my current life should still contain this, but I can't go through with it" which, depending on the activity and descriptor you have in mind, may well still count.


    Definition of terms, especially "overwhelming psychological distress"

    You brought up the definition of terms in the descriptors and activities. Some are given a formal definition in schedule 1 to the PIP regulations. Those words and phrases not defined there take their ordinary meaning unless defined further by case law (which really does not exist in relation to the PIP regulations yet - the last time I checked PIP was still too new for there to be any reported Upper Tribunal decisions, which would act as case law).

    The PIP Assessment Guide is the official guidance from DWP to the assessment providers and their staff. It does not have the force of law, but is likely to be followed unless the specific point you are looking at has been overridden by developing case law or changes to the regulations.


    Psychological distress is defined in schedule 1 as "distress related to an enduring mental health condition or an intellectual or cognitive impairment", which seems to be satisfied in your case.

    Overwhelming is not defined in the PIP regulations, and the PIP Assessment Guide offers no further guidance on this point, so the usual rules of statutory interpretation apply. In almost all cases, it will take its ordinary, literal meaning. Lawyers typically look to the Oxford English Dictionary for definitions of words, so I looked up overwhelming there and found the definition "so powerful as to overcome utterly". I'd say an inability to cope without leaving the building because you are having a panic attack is "overwhelming psychological distress".


    It's probably most helpful to brainstorm the triggers you face in your life today, how common those triggers are and how they affect you. Could you engage with someone that came to the door? Could you engage with people doing ordinary, everyday things such as taking a walk, sitting in a doctor's waiting room or buying groceries?

    I hope this helps to steer you onto the correct lines.

  6. #6
    Thank you Flymo.

    You've given me some food for thought, and together with some of the advice you've previously given on the forum, I feel I've got something to work with over the next couple of weeks while I prepare a written statement to go along with my request for a reconsideration (I've already ready your notes on how to deal with the call from the DWP and to make sure they don't reconsider without my having had the chance to add a written statement for them to include in the reassessment).

    It strikes me as rather astounding how poor this system is - it's not that I was turned down that upsets me, but rather that I'm having to try so hard to have my case assessed on what I feel is a thorough and accurate representation of who I am and how I live my life. If they'd asked me, I could've told them, but instead, 11 months after I made the initial phone call, I feel that we've generated a fair bit of paperwork, but haven't got an inch closer to acheiving a fair and thorough assessment.

    Anyway, at least for the time being the ball is back in my court.

    Thank you again.

  7. #7
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    Flymo, its so wrong that they expect us to know the law on wording.

    Surely if someone does not go out but DID go out there is something not right regardless of whether they avoid going out (removed the tigger) or can't go out because of stress. All these legal phases should not apply to the claimant really. I know I need help. I feel I am not normal, I need people and feel extremely lonely at times but I know that being among people is mentally draining to me.

    I don't go out, I used to go out, I got ill and although my desire to go out is missing now because I have lived like this for so long so I no longer try, I still KNOW that its not normal. I know deep down I want to socialise and be among people but something holds me back and I don't but rely on medical professionals to tell me why? How would you define that one? Mine was a mixture of mental and physical?

  8. #8
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    Also lots of people (people with aspergers for instance) can put on an act of mirroring just for a time of sitting in a doctors, greeting someone that comes to the door, going into a shop but if they are put in front of people for a longer length of time, they would not be able to engage perhaps. I can engage to some extent but I know that over a long period of time I would be exhausted and overwhelmed and my mind would shut down and I would want to get home quick to safety. I would be out of my comfort zone as I have a limit.

  9. #9
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    There is, unfortunately, a fundamental paradox in any assessment based system, in that functional impairment can only be assessed if it is obvious to the assessor, or articulated (in writing or orally) for or on behalf of the claimant. Those who cannot convey the full range of their impairment unaided and who cannot access advice and support to help them convey a full picture will be under assessed and may well finish up with less than they deserve.

    Relatively few functional impairments are obvious to the assessor. If you take complete blindness (able to see nothing at all, not even light or dark), the immediate effects are fairly easy to understand, but the functional impairment will depend on how well adapted the person is to their blindness, any aids they use and their lifestyle. Someone who was blind from birth, is confident with their guide dog and has good hearing is unlikely to be as impaired by their blindness as someone who recently became blind, who has no hearing either and has not learned to use any aids.

    For many conditions, including the majority of mental health conditions, the immediate effects are unlikely to be obvious even to someone with some medical training and experience.


    This means that in most cases, it is the way the functional impairment(s) are explained that is crucial. The loss of Legal Aid funding for most benefits matters in April 2013 was a bitter blow on top of the general squeeze on funding from charitable sources and discretionary council grants. The upshot is limited access to advice at the time major changes in the benefits system starts. I am dismayed and furious at how many are suffering because they can't get access to good quality advice in relation to the benefits system.

    I take Karen's point that explaining your case is often difficult for most people with mental health problems, but it can be equally difficult for those with physical health problems.


    Usually, the problems experienced in obtaining disability benefits are with explaining the relevant points in a way the assessor and decision maker can understand. It is rather less common for the law to be misapplied to a full and accurate explanation of the relevant issues, so in that sense, it is less important for claimants to understand the nuances in the law. However, this rapidly reaches a "chicken and egg" scenario - how do you know what is relevant if you don't understand the regulations?

    PIP certainly isn't perfect, but the regulations are arguably easier to understand than DLA, which used much more abstract legal tests that required a fair amount of case law to define more fully. One thing I find frustrating with PIP is that many web sites and other resources reproduce the activities, descriptors and points from Schedule 1 of the PIP regulations but omit the definitions at the start of that schedule, which are so important to understanding the activities and descriptors.

  10. #10
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    I made a remark in my mandatory reconsideration. It was about when my face was completely paralysed on one side that I actually felt better when out with my family that people could see I was not right and it actually reflected how I felt most of the time anyway so was easier to explain if needed and people generally avoid talking to you when like that anyway. I don't wish it upon myself though, not really but it was visible that I was maimed in some way. I can look good again (although I still see a wonky face when tired as my eye droops still), I can "act" OK to a point for a short time but most of the time I am alone and lonely and really cannot do anything about it because of my mind and my fatigue.

    I don't know for definite what is wrong with me "medically". I know something took a lot of my life and I thought I could overcome it. Like I say, I let the professionals tell me or I am trying to. (On going for years).

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