Can I appeal a medical decision which affects my benefits?

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Q. I have been claiming Employment and Support Allowance for three years and I have always been in the Support Group.

But I went for a medical recently and I have just been informed that I will be put in the Work Related Activity Group.

I am not happy about this and I would like to go back into the Support Group. What can I do?

A. When claiming Employment and Support Allowance you will continue to be sent for Work Capability Assessments to determine whether or not you still have Limited Capability for Work.

If you are found to be fit for work then your benefit would stop.

In your case you have been found to have Limited Capability for Work, but not Limited Capability for Work Related Activity, which is the test to be placed in the Support Group. 
Whether you have Limited Capability for Work Related Activity is assessed as part of your medical, but against a separate list of activities.

It includes, among other things, not being able to walk 50 metres, not being able to raise one arm to the top pocket of a jacket, and not being able to turn the pages of a book.

You need to meet one of these criteria to be placed in the Support Group. 
If you disagree with the decision then you can request a Mandatory Reconsideration of the decision by phoning or writing to Jobcentre Plus within one month from the date on the decision letter.

If that is not successful then you can appeal to the Tribunal Service by completing an SSCS1 form.

Q. I have applied for Employment and Support Allowance due to breaking my leg and not being able to work, but I have been told that I do not qualify for Employment and Support Allowance because my partner is working part-time and I have not paid enough National Insurance Contributions. Can I appeal this decision?

A. Employment and Support Allowance is based on standard rates of entitlement which are set each year.

If your partner’s income has been assessed correctly and is over that threshold, there would be little point in appealing the decision.

However, if they have taken the wrong income into account, or assessed it as weekly rather than monthly, for example, then you should request a Mandatory Reconsideration.
You may still be entitled to other benefits such as Housing Benefit and Council Tax Reduction, or in full service Universal Credit areas you may be entitled to a joint claim for Universal Credit – so it is worth getting a full benefit check.

Q. I am on maternity leave and I am getting Statutory Maternity Pay (SMP) through my employer.

I do not have any family who are able to help with child care, so I have been thinking about taking another year off work, so that I don’t have to put my child into nursery/childcare.

But would I have to pay back the maternity pay I have been receiving?

A. If you have only been receiving Statutory Maternity Pay (SMP) then you would not have to pay that back if you do not return to work.

However, if you had been receiving Contractual Maternity Pay then it would depend on the terms of your contract.

Some employers state that if you do not return to work for a set time, then some of the maternity pay is repayable.