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Forum Home  →  Discussion  →  Work capability issues and ESA  →  Thread

ESA and surgery? Regs??

benefitsadviser
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Sunderland West Advice Project

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Joined: 22 June 2010

Hi folks. I think ive asked something like this before however im still struggling.
I know that one main purpose of Jobcentre plus regarding ESA is to determine whether a claimant has or has not Limited capability for work (or work related activity) and i believe that if a client is to shortly undergo surgery then they should perhaps be classed as having a LCFW.
Can anyone confirm that this is the case, and if so are there any regs (other than 29 or 35) that would back this up?
I have a client who (against my advice) refused to undertake a WCA as apparently someone at medical services told her she didnt have to as she had an operation due in a few weeks. She had an argument with the Atos assessor and refused to partake due to the surgery thing, even though he told her she still had to be assessed. This put his back up straightaway and i think he will inform JC+ that she simply refused to partake without good cause. Muggins here will now have to try and show good cause to appeal this, but i need to know if i can use the upcoming surgery as automatically classifying the client as having LCFW, therefore negating the need for a WCA.
Any help would, as always, be greatly appreciated

1964
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Deputy Manager, Reading Community Welfare Rights Unit

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Nope- upcoming surgery doesn’t exempt client from undergoing WCA or give them an automatic LCW. All roads lead to negative WCA decision and as client refused to attend medical her ESA payments won’t be reinstated even if she appeals (and won’t be reinstated unless/until she attends further medical).

I think she needs to backtrack pronto and see if ATOS will arrange a further appointment for her.

benefitsadviser
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Sunderland West Advice Project

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Thanks. I know that she has blown it and will have to claim JSA as no ESA payments can be made due to failure to attend without good cause. I suspect the Medical services employee may do a bit of backtracking and deny she advised client not to attend. C’est la Vie and all that.

1964
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Deputy Manager, Reading Community Welfare Rights Unit

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Don’t suppose she knows who she spoke to or has itemised phone bill confirming call to ATOS was made? Would be useful for the good cause for non attendance appeal.

benefitsadviser
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Sunderland West Advice Project

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I advised her last week (as i do with most clients) that if they ever get a call from DWP,JC+ or Atos then make a note of time, date, subject and name of person involved, which she has. The Medical service person now has this down as a “misunderstanding between both parties” and is trying to arrange another WCA at short notice. She has said that this mornings WCA report has already been submitted so my gut instincts are there will be a sanction. Although we can prove contact with Atos we cant back up what was said, unless of course the calls are always recorded.

Ariadne
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Social policy coordinator, CAB, Basingstoke

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There used indeed to be a provision for treating someone as incapable of work for incapacity benefit purposes if they were expecting to undergo major surgery within three months, but that didn’t carry over into ESA and I think vanished from IB before 2008 anyway.