The availability of benefits is an important issue to many people suffering CRPS or other chronic pain conditions. In an earlier article we considered the difficulties often encountered by CRPS sufferers in satisfying the qualifying criteria for Personal Independence Payment (PIP) and Employment and Support Allowance (ESA).
In this article we consider the experiences of two of our clients who applied for PIP and ESA. Their names have been changed.
Mark was a self-employed landscape gardener. In 2014 he developed CRPS in his dominant right upper limb after being struck by a motorcycle on a pedestrian crossing. As a result of his CRPS he was unable to use his dominant arm and hand, developed stress, anxiety and fatigue, as well as issues with his balance. He was unable to work or drive and required considerable assistance around the home from his partner.
Shortly after the accident Mark applied for ESA and after a Work Capability Assessment he was awarded both the Contributory Component (since he satisfied the National Insurance payment requirements) and also Income Based ESA. Because it was agreed that his injury was likely to affect him for the foreseeable future he was placed in the Support Group as opposed to the Work-Related Activity Group, which entitled him to both components of ESA for 3 years.
His initial application for PIP was made once his injuries became chronic. Mark supported his application with letters from two treating medical consultants, as well as extracts from his medical records. He was then assessed by a “health professional” who decided that Mark was entitled to the Daily Living Component of PIP at the standard rate only and was not entitled at all to the Mobility Component.
Not a person to be beaten, Mark refused to accept this finding. Utilising funds from an interim payment in his claim, he paid for consultations with, and letters from, two further medical consultants and a home assessment with an occupational therapist. These were provided to the Department for Work and Pensions with his request that the decision in relation to PIP be reconsidered. The decision was reconsidered but upheld.
Mark therefore appealed the decision and persuaded the occupational therapist (who was shocked by the decision) to accompany him to the tribunal hearing. There Mark argued that the initial assessment with the “health professional” provided only a snapshot of his capabilities and the observation evidence of the various medical practitioners and the occupational therapist had clearly not received proper consideration. Having heard from Mark and the occupational therapist and having considered the documents, the tribunal awarded him the higher rate of both the Daily Living and Mobility Components.
Clearly, Mark’s eventual success came down solely to his persistence and determination and a not inconsiderable outlay in fees to medical practitioners and an occupational therapist. This case illustrates clearly the huge hurdles to be overcome in obtaining benefits by those with disability in general and those suffering CRPS in particular.
We have only recently been instructed by Julie. She suffered a leg injury at work when a large drum of cooking oil fell from a stack. As a result of her leg injury, Julie developed CRPS. In addition, she now suffers from depression, anxiety and agoraphobia, as well as regular panic attacks. She mobilises on crutches around the home and on the rare occasions that she ventures out, uses a wheelchair. However, she is largely housebound.
On her initial application, Julie was awarded the higher rate of ESA. However, when she applied for PIP, although she was awarded the Daily Living and Mobility Components, both were at the standard rate. She asked for the decision to be reconsidered and provided evidence of her condition from her treating medical consultants, but the decision was upheld. She appealed.
What happened next is a sobering reminder that by appealing a decision, the entire decision is open to be reconsidered.
At the appeal hearing the nature of the tribunal’s questions indicated that they had little if any knowledge of CRPS. Despite that, and without any evidence to support their findings, they concluded that Julie had exaggerated the effects of her CRPS and therefore reduced the Mobility Component of her PIP to the standard rate and ordered that she was not entitled to the Daily Living Component at all!
As if that was not harsh enough, Julie’s ESA was also reduced as a result of the tribunal’s finding that she was more able than she claimed.