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Thread: ESA & PIP claims - consultant letter stating I cannot work

  1. #1

    ESA & PIP claims - consultant letter stating I cannot work

    Hi everyone

    I am totally new to these forums and to claiming benefits so apologies if there has been a question like mine before. I have googled and googled but can’t seem to find the answer.

    I’m 37 years of age, and a single parent who has always been reasonably fit and healthy and always worked full time. However, last August I fell extremely ill and ended up in hospital with Sepsis shock. I was told by the time I reached hospital my organs had started to shut down and they didn’t think i’d survive overnight. Thankfully I did, but if i’d left it 3-4 hours longer then I wouldn’t be here.

    Unfortunately, the infection damaged one of my heart valves and I was diagnosed with a condition called endocarditis. For this, I spent 5 weeks in hospital being treated with antibiotics but unfortunately it wasn’t enough and my aortic valve is severely damaged and I need open heart surgery to replace this with a mechanical valve.

    My symptoms that are caused by this include severe breathlessness and chronic fatigue. I have been told by cardiologists than I am to stop whatever I am doing immediately when i get out of breath, yet I can get out of breath just sitting down or standing. I suffer with palpitations and the occasional chest pain and have a irregular heartbeat and signs of heart failure. I could also sleep all day! The littlest of activities wears me out.

    I met with my consultant cardiothoracic surgeon last week and am now finally on a waiting list for surgery, but this list is very long and I am expected to wait months. For financial reasons even though I don’t feel up to it, I asked about returning to work in the interim as my sick pay is coming to an end and I’m panicking. Without hesitation, my surgeon said definitely not, I cannot work. My heart is enlarged and under immense pressure with severe aortic regurgitation and if I don’t have surgery for a new heart valve my heart will stop within the next two years because that’s how bad it is. I am to be under no pressure or stress.

    So I have now applied for PIP and ESA totally stressed that I will have no income and cannot work due to no fault of my own. Because I can wash and dress myself (albeit much slower than before) I don’t hold out much hope for PIP, but my question to you is this - if I have a letter from my consultant clearly stating I cannot currently work as it is a danger to my health, will that be enough to get ESA? Would I still need a face to face assessment do you think, or would I be automatically awarded it? I am just worried that these assessments are going to cause me anxiety on top of the anxiety I’m already feeling. Everyone says I look well, but that’s not how I feel and not what my doctors tell me. I’ve heard horror stories about the assessments! Also, because I’m due to have surgery would they expect me to be fit and we’ll afterwards and then only award me payments (if successful) for a short period of time? My symptoms should improve after surgery but we don’t know by how much yet and I will be on warfarin for the rest of my life.

    I’m sorry for such a long post and thank you if you’ve stuck with me. Any information or knowledge would be gratefully received.

    Cath

  2. #2
    Senior Member nukecad's Avatar
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    Hi Cath,

    ESA first.
    A letter from your consultant saying that work would be a danger to your health should definitely get you ESA.
    (I assume you have been paying NI contributions whilst working so this would still be ESA not Universal Credit).

    To start with once you make your claim you will start being paid at the assessment rate (£73.10 /week for a single person over 25).
    You will be sent a questionaire (called a ESA50) to fill in and send back.
    They will decide from this if they need to see you face to face or if they can assess on the paperwork only.
    (If they do want to see you then a letter from your consultant/GP saying it would be harmful to attend their office should get then to visit you at home, or change their minds about having to see you).
    Once you have been assessed then you will be awarded a group and your payments will increase.
    ESA is an ongoing benefit, it does not have an end date. It does have dates for when they will reassess to see if you have become fit-for-work.
    But basically once awarded ESA then you are on it until a new (face to face) assessment finds that you are fit again.

    PIP is a bit different.
    PIP is not about working, it is about how you can cope with your daily life.
    Again once you claim you will be sent a questionaire (called a PIP2) to fill in and send back, etc.
    You won't get paid any PIP until a decision is made, but it is backdated to the date you made the claim.
    PIP is awarded for a set time. It is awarded for a number of years and then you have reapply using a shorter version of the questionaire.

    With both benefits any future surgery is not taken into account, they are assessing your condition as it is at the time.
    The only affect it could have is the length of time before you need to be reassessed.
    Of course if you are no better after the surgery and recovery time then the ESA would continue, and a new PIP award would be made.

    I hope that's explained the basics of making your claims, I'm sure you will have more questions and the members here are always willing to help with experience, support, and even some legal bits.

    You may also want to try using one of the online benefit calculators at this stage.
    I usually prefer this one: https://www.entitledto.co.uk/
    Just enter your details and it will tell you just what you could/should be claiming. Obviously ESA and PIP, but also Child Credits, Housing Benefit, etc., etc.
    Last edited by nukecad; 02-02-2018 at 07:25 AM.
    I don't know everything. - But I'm good at searching for, and finding, stuff.

    Migration from ESA to Universal Credit- Click here for information.

  3. #3
    Hi Nukecad

    Thank you so much for your detailed reply, it’s a a great help for me.

    I will certainly look at the benefit calculator. I find it all so confusing at times as every benefit seems to have such different rules! Yes I believe I have paid enough national insurance for ESA.

    I am glad they don’t take into account future surgery as I was worried they would think I’ll be fine after my new valve and not award anything.

    I’m finding it all very hard to deal with at the moment as whilst I am trying to get my head round my health problems and prepare for a big op, I’m worried sick that my sick pay is coming to an end and I have no income coming in! I’m pretty sure it’s having a detrimental effect on my health and certainly not helping. Some things are certainly sent to try us.

    Again, thank you for the information and the time you’ve taken to reply.

  4. #4
    They tend to have a problem if it's to do with medication their software says will cure you which you aren't taking - I cannot have anti depressants or anti psychotics for medical reasons, that always gets flagged up as me refusing medical treatment. When I first applied (when it was incapacity benefit) I was sent to multiple appointments at the jobcentre where I'd meet someone who would give me a list of medication to ask my dr for so I could get back to work. The last time the person showed me it was to do with what was on the system - despite me putting every condition on the form and why I cannot take meds the person who did the data inputting only put mental illness and refusing meds on the system.

    I've had experience of being told I just need to ask for joint replacement as well (again medically not possible).

    I suggest when you get your form you put the information on it regarding your operation and if you can enclose a letter with it (you may not have time to do this though).

    I can sympathise with your situation it's been years since my diagnosis and issues began and I still feel overwhealmed with it sometimes, be kind to yourself. It's a big change. Claiming benefits is difficult and stressful but necessary. This is on the whole a supportive forum with people who are willing to help, it may take awhile for people to reply but they will when they can.

  5. #5
    Hi Bekki,

    Thanks so much for your reply and for sympathising! I can’t believe they would say You’ve refused medication when you simply cannot take it. That’s totally different to refusing it!

    I will put down that I am waiting for surgery, thanks. It’s the only way I have a chance of getting better. I’m also currently on ramipril and thyroxine and can provide a copy of my prescription if necessary. I’m also hoping to have my letter from my consultant stating I cannot work soon, so I can include a copy of that too.

    I hope that your issues have now resolved and they changed their details on the system. I can imagine the extra stress this could have caused you having to attend multiple appointments. How frustrating.

  6. #6
    Sorry to here about your illness it really come as a shock, one minute you are ok and bang a life changing event. I my humble opinion I can see no reason for them to refuse your award. I suffered a brain injury.

    As getting dressed, that is only a minor point, we struggled on for 12 years on dla lower rate we were to embarrassed to ask for help, it was only last year when one of my specialist inquire are you getting any help, it open our eyes, an in depth medical report and I was awarded 24 points mobility and 24 points care and we get a career allowance. The system is designed particularly for people with your needs.

  7. #7
    Senior Member
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    Hello Cath123

    Sorry to hear you have been so poorly.

    You say you have applied for PIP and ESA already, so it sounds like you have completed the forms (small books) and await to hear if you will need to have a face to face assessment.

    As hopefully you will now be aware qualifying for PIP is scoring points in the listed descriptors. You mention about your difficulties with getting breathless just getting dressed. I can only imagine how you may have to sit down in between putting each item on in order to get your breath back and as for socks you may have to wait a good while before you can attempt to put them on given the bending involved.

    I would recommend describing this in detail to your assessor should you need an assessment.

    Does it not take you longer to bathe or shower too given how much slower pace you must do most things nowadays? Do you use any aids to help you wash yourself, or would using one help you do you think?

    Cooking? Do you need to sit on a stool as an aid to enable you to chop vegetables for your meals?

    Walking, is the distance you can manage to walk been effected?

    Good luck with your application, please come back to the forum to let us know how you get on.

  8. #8
    I have some very supportive letters from two specialists, one being one of the top experts in his field which I had to fight through my mp to see and have to travel two hours to see, and I also have tons of medical evidence stating my disability; yet my very first ESA assessment still failed me and I won at MR. I have also failed one pip assessment before, even though at the time I was about to me moved into adapted and assisted housing and had the evidence etc for that. I lost at MR but they then decided to award me before tribunal.

  9. #9
    So nothing is a guarantee I am afraid, but it would definitely help to provide it regardless!

  10. #10
    Hi Oscarmax

    Thank you very much. I’ve always considered myself to have very good friends and family but since finding myself in this position I realise how alone I am. This is something only I can deal with. Not sure if you felt the same?

    I’m really pleased to hear you were awarded enough points and now getting the help you’re entitled to. Can I ask how you went about getting an in-depth medical report?

    I asked at my GP surgery and was told a copy of my medical records would cost me £50 and it’s a waste of time as it doesn’t make any difference to my claim. So I didn’t bother! The only thing I have is a letter from my consultant to my surgeon explainingmy condition and it mentions heart failure and my diagnosis. I have today received a letter from my surgeon which I requested and it mentions my symptoms and that they consider my request for ESA in a sympathetic manner and that he thinks I would struggle to cope with work. I’m not sure if this is enough evidence but I don’t have anything else. I’ve told my GP I’m feeling down and asked for something to help with anxiety but he won’t prescribe anything due to my heart condition. I’m not even sure he writes on my records about my symptoms and how I’m feeling so I fear my records just state my condition and not how it affects me personally.

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