Forum Home → Discussion → Disability benefits → Thread
Agoraphobia - unable to get to ATOS PIP assessment. Doctor charging £20 for letter. Any other options?
We are driven to ask for medical evidence when faced with a poor assessments and a DM at DWP who is adhering to the conclusions like glue.
...(combined, probably, with learned articles via google setting out the usual results of the relevant medical condition).
...
I have never thought of doing that, have you had any success with researched materials being sent?
I respectfully remain wholly unconvinced that medical evidence is the “only” counter. It is one tool amongst many and the evidence for its effectiveness is at best debateable.
We don’t see the many claims which succeed without us and without medical evidence. We do see lots of cases where the standard of reporting is abysmal but perhaps we confuse “only” with “quickest” and “traditional”. Most of the time with ESA and PIP reports we pick them apart routinely from what we know of the condition and the client. We rarely seek medical evidence to help us pick them apart. We and the client do it perfectly well with no medical input. If we can and do do that then what’s the extra value from medical evidence?
We know most of what helps us pick stuff apart from our interviews with the client. Relaying that information in full via MR or appeal is most times more than enough. I suspect the reality is that because clients wrongly put so much weight on medical evidence “... my doctor says…” that many of us see attending a hearing without medical evidence as a risk in the sense that if we do lose we risk the client or a tribunal turning on us saying “... but why didn’t you get such and such.”
I agree with your other points in general Claire i.e. these reports are terrible and people are not trained to do them properly and there is a very serious issue around medical professionals on appeal tribunals. However, I think those issues are distinct from why we request medical evidence and all the anecdotal evidence in the world of cases succeeding with “strong” medical evidence does not mean that was why the claim succeeded. We can continue to convince ourselves that correlation absolutely equals causation but actually there’s no research been done by DWP to suggest that is the case. Their own stats. suggest less than half of cases which succeed without professional input have additional medical evidence.
I recently had a PIP case where we had four pages of excellent consultant evidence. After winning the appeal the client asked the tribunal and the PO why the DM had disregarded the letter from the start. Judge explained bluntly that the letter gave a diagnosis. That was not needed for PIP and was not in dispute. It gave a history. That was interesting but they would have asked about it anyway and the client was capable of detailing that without help from a consultant. It gave a prognosis, which was the only relevant bit in terms of award but it was a degenerative condition so it would have been an ongoing award anyway. PO nodded their head.
JAS1 - yes the information should have been uploaded into the system they access prior to the face to face. Anecdotally I seem to recall DNS and a few blogs running stories from whistle blowers saying that often times it didn’t upload; or they skim read it and pre-populated answers based on guess work.
Undoubtedly I should have said this earlier but agoraphobia is a great example of how you can proceed without medical evidence, putting aside the HV aspect. A client history of how it started will often include some fairly traumatic incidents and when supplemented with anecdote of subsequent examples and stuff from family it’s pretty hard to dispute.
I shall duck my head down at this point and pretend I was not one of the two people running cases in 1994 which successfully argued for the first time that DLA lower rate mobility could be awarded for agoraphobia :)
[ Edited: 9 May 2017 at 10:07 am by Mike Hughes ]mmm
aye, but when there are also plenty of reports of tribunals/DM’s relying on the HCP report and wholly ignoring the wholly supportive/appropriate medical evidence from elsewhere (consultants etc)
It will, of course, depend on the individual case as to how much extra actual medical evidence will assist, but we’ve all seen reports/cases where actual evidence from actual treating teams has assisted substantially (if only once the case is at UT ....)
I wonder if I have been over emphasising the importance of evidence myself. I just always remember a client that got all Mob award taken away, got a print out from the Dr. On the print out it stated something to the effect that his exercise is limited to 20 yards/metres. I sent that in with a letter highlighting it and he was straight back on the ER Mob. It’s true that there is no proof that this was the reason though. Also that is probably an outlier too, fairly often I find the medical evidence doesn’t actually provide much further evidence.
Is there maybe value in just having a second piece of documentation backing up what the client is saying so that it is not just their word against the DM?
... aye, but when there are also plenty of reports of tribunals/DM’s relying on the HCP report and wholly ignoring the wholly supportive/appropriate medical evidence from elsewhere (consultants etc)
There are plenty of threads on here with ridiculous HCP outcomes. The fact we tend to refute with medical evidence does not mean that medical evidence was what was needed. In most cases almost anything will refute a HCP report.
In one thread on here there was recent reference to a hearing impaired client not awarded 8 points because their hearing could improve! A fine example of ineptitude of the sort we’re all familiar with. If we want to refute that beyond reasonable doubt we go for medical evidence. If we remember that we only need to work with the balance of probabilities we simply repeat the diagnosis; detail whether or not there is a cure and ask the DM to identify the specific piece of evidence they and the HCP relied upon to determine there was the possibility of improvement. The matter usually ends there in my experience. Writing to the GP or consultant to confirm the obvious would have antagonised both of the latter; introduced a delay and possibly have cost also.
Easy to confuse correlation and cause. Of course medical evidence would turn round such a stupid decision. The better question is whether it could be turned round anyway without any medical input.
i’m probably in a fairly unusual yet fortunate position evidence wise.
my clients are primarily people with learning disabilities and they often wont see any medical professionals at all and if they do it will typically be for a different condition. not much can be done medically with a learning disability.
where i am fortunate is most of my referrals come from other professionals such as supported employment staff, advocacy agencies, social care agencies etc. This means i have professionals who are generally more willing to provide evidence and as they usually work regularly with our service they see the value in what we do so take advice from me on what a tribunal actually wants to know i.e. “on the job they struggled with the till, to read written instructions…” or “they have a care package where we help them with….”.
I am doing pretty good in getting the 4 points for the need for a person “trained in communication support” this way.
Where i am less fortunate is that many of my clients struggle to explain their situation on the day of a hearing or will tell a tribunal what they think the tribunal will want to hear. I have some ways around this in the way i ask questions on the day but as always you are limited in what you can “fix” once your client has said it.
I think mike is right in that there can be an assumption from clients and advisers that evidence is needed when its always about the actual quality of the evidence in what it tells the tribunal in relation to the criteria. I tend to be quite focused with clients that their evidence on the day of the hearing will usually be the biggest determining factor as that is my experience.
It can sometimes be difficult to get a client out of the “but my doctor says” line of thinking to this is about “getting the tribunal to accept x”.
interesting post Steve.
One thing I get stuck with is when medical evidence contradicts what the client believes is true.
This is pretty common in MH diagnoses. Sometimes 3 different psychiatrists have given 3 different diagnoses and the client believes they actually have a 4th diagnosis that fits them better. I find that kind of thing tricky when it comes to deciding what to submit.
interesting post Steve.
One thing I get stuck with is when medical evidence contradicts what the client believes is true.
This is pretty common in MH diagnoses. Sometimes 3 different psychiatrists have given 3 different diagnoses and the client believes they actually have a 4th diagnosis that fits them better. I find that kind of thing tricky when it comes to deciding what to submit.
I’m sure plenty of us will have had exactly that issue across a lot more than mental health. My most recent one? Was it CFS? Was it Lupus? Was it both? Lots of contradictory evidence from professionals and the client. I take the view that in such circumstances I front it up and put it all in. I present the truth of where we’re up to diagnostically but focus the tribunal on the fact that legally no diagnosis is needed and practically none of the medical professionals are saying that the symptoms are not real. Ultimately it only matters if DWP dispute the diagnosis not if the professionals either disagree amongst themselves or are still engaged in differential diagnosis.
interesting post Steve.
One thing I get stuck with is when medical evidence contradicts what the client believes is true.
This is pretty common in MH diagnoses. Sometimes 3 different psychiatrists have given 3 different diagnoses and the client believes they actually have a 4th diagnosis that fits them better. I find that kind of thing tricky when it comes to deciding what to submit.
A diagnosis; especially in mental health, is a very moveable feast. A patient might present one set of symptoms; fitting one diagnosis at one assessment, then different symptoms meriting a different diagnosis at a second. People make recoveries then relapse into different symptomatology. Labels are of limited utility. At the same time, as differing symptoms are observed the diagnosis might evolve from, say, bipolar to a personality disorder.
Whether the assessing clinician follows ICD10 or DSM V is also an issue as on occasion the same presentation will merit different diagnoses depending what school the clinician trained at.
I’ve heard it said by a psychiatrist that although at times symptomatically close to each other; whether an individual was diagnosed with schizophrenia or bipolar disorder was indicated by their socioeconomic status as much as their symptomatic presentation, the rationale being that someone in a decent social situation is more likely to return to a good level of function between periods of ill health whereas someone with ongoing social stressors might not have the space to make a full recovery.
In the sprit of mental health month… labels are for jars, not people. Sometimes it is useful to explain that to clients.
Where’s the Like button. Excellent post Dan.
Thanks Dan and Mike. That’s very helpful (and I agree with the good points re mental health). I don’t do Appeal level work at the moment so it’s useful to get insight in to the more detailed points such as diagnoses not being a legal necessity and so on.
We are driven to ask for medical evidence when faced with a poor assessments and a DM at DWP who is adhering to the conclusions like glue.
...(combined, probably, with learned articles via google setting out the usual results of the relevant medical condition).
...I have never thought of doing that, have you had any success with researched materials being sent?
I do it all the time, accompanied by a written submission highlighting the specific thing I want a tribunal to pull from it as no-one wants to read the totality of anything nowadays. Generally works fine. Had no objections but equally I couldn’t say for certain that it was that which won the appeal. Often times it’s just simple stuff not even deep research. It just gives irrefutable background.
So, for example, always useful to put something in on sight impairment cases to explain that visual acuity is not the same as visual impairment. Standard DM submission for unregistered appellants equates mild visual acuity with mild visual impairment. Not the same at all.
Just putting one in in the next week talking about how the vestibular system interacts with eyes and walking to provide background to the argument that the exertion required to walk can include the extra effort of using limited vision and headaches/migraines caused by that effort are a serious deterioration in health.
We are driven to ask for medical evidence when faced with a poor assessments and a DM at DWP who is adhering to the conclusions like glue.
...(combined, probably, with learned articles via google setting out the usual results of the relevant medical condition).
...I have never thought of doing that, have you had any success with researched materials being sent?
who can tell?
but worth it, i would have thought, especially as it’s likely to be clear from DWP submissions what misconceptions they have about the condition in question. and if the HCP has wholly misunderstood even more so…. since you’d be able to show that the HCP medical was worthless….
as with so many things, it’s going to depend on the case.
[/quote] since you’d be able to show that the HCP medical was worthless….
as with so many things, it’s going to depend on the case.[/quote]
I always wonder when challenging DWP at recon stage how much to talk about the actual HCP assessment and their report . Whether to focus just on the client’s health issues and care needs or to also include the inaccuracies/errors from the HCP, or a bit of both. I tend to do a bit of both without letting it degenerate in to a complaint about the HCP as often the client will have a lot to say about their opinion on the HCP!
Depends what you’re trying to achieve with the MR. If you’re looking to actually change the decision and believe that possible then you do what you need to do. If you accept that an MR isn’t going to change the decision and you just need to get it to appeal then I wouldn’t give it a great deal of thought. As Nick Lowe was once quoted. “Bang it down and tart it up!”.
FWIW I tend to steer clients away from their thoughts on HCPs. My line tends to be that there is nothing they can tell me about their HCP appointment which will be anything new or surprising. I emphasise that you can destroy a bad HCP report with minimal effort but, after you’ve done that, so what? It still doesn’t explain how you qualify for the benefit. That’s where the effort needs to be focused, whether at MR or appeal.