Employment and Support Allowance

Confused with ESA? Your at the right place!

This fact-sheet has been designed by benefits advisor’s and covers all aspect of ESA from making the claim, appearing at a medical to appealing the decision.

Introduction

Employment and Support Allowance (ESA) is a benefit paid to people whose ability to work is limited by ill health or disability. It was introduced on 27 October 2008 and replaced claims for Incapacity Benefit (IB), Severe Disablement Allowance (SDA) and Income Support (IS) paid on illness or disability grounds.

People who were already on IS, SDA or IB were initially unaffected by the changes – they could continue to getting these benefits. However Jobcentre Plus has now begun the process of reassessing existing claimants for ESA – this started in February 2011 and is expected to be completed by Spring 2014.

ESA has complex rules and processes so many people find claiming and navigating their way through the system confusing. This factsheet aims to help you understand:

• the ESA rules and guide you through the various stages of the claims process
• what to do if things go wrong and where to get further help and advice if you need it
• what to expect if your IB, IS or SDA claim is being reassessed for ESA.

There are also lots of practical hints and tips which we hope will give you the best possible chance of making a successful claim.

This factsheet is in 5 parts:

Part 1. Claiming Employment and Support Allowance – including:

• Completing the Medical Questionnaire (ESA50)
• Work Focused Interviews
• The Medical
• If you have a learning disability or mental health condition
• The Decision
• Impact on other benefits
• Exceptional circumstances
• Jobseeker’s Allowance

Part 2. Revisions and Appeals

Part 3. Reassessment of Incapacity Benefits ­a step by step guide

Part 4. Where to get advice

Part 5. Useful Links and information
Links

Part 1: Employment and Support Allowance – a guide

Introduction

You may get Employment and Support Allowance (ESA) if:

• you are aged at least I 6 and under pension age;

• your ability to work is limited and you pass a test (called the Work Capability Assessment) which assesses this – see the next section on ‘The Medical Questionnaire’;

• you have paid enough national insurance contributions for contribution-based ESA. But special rules allow young people under 20 or sometimes 25 to claim without contributions; or

• your income (including savings) is low enough for income-related ESA.

Note: some people can claim income – related ESA on top of their contributory ESA.

ESA has two levels:

The support group – for people with very severe disabilities who are judged to be too disabled or unwell to be expected to work; and

The work-related activity group – for people who may be able to work in the future provided they are supported into employment.

Most successful claims fall into the work-related activity group.

It normally takes at least 13 weeks for Jobcentre Plus to assess your claim. During this period (known as the assessment phase), you will be asked to provide medical certificates from your doctor. You will normally receive £53.45* a week (if you are under 25) or £67.50* (if you are over 25). If you qualify for income-related ESA, extra amounts may be included depending on your circumstances. For example if you have a partner, is a carer or get Disability Living Allowance highest rate care component.

*Rates normally change in April each year.

Contact Jobcentre Plus to make a telephone claim on 0800 055 6688 (textphone 0800 023 4888).  Claims can be backdated for up to 3 months.

The Medical Questionnaire ­ESA50 (around Day 30 of claim)

After about a month, you are normally sent a medical questionnaire to complete called an ESA50 to assess how your condition affects your ability to work. You normally have six weeks to complete and return it. If it is not returned within this period you will be treated as being capable of work unless you have good cause for not returning the questionnaire.  But see this section if you are affected by a mental health condition or learning disability.

The ESA50 is used to decide if you need to attend a medical called a Work Capability Assessment. Many people find the form difficult to fill in so it’s important to get advice if you need it before completing it.

There is a series of tick box questions about how any physical and or mental health conditions affect your ability to carry out various everyday activities or functions.

Each activity or function is worth points (0, 6, 9 or 15 points). You need a total score of 15 to pass the test.

Examples of physical activities include:

• walking and moving around

• standing/sitting

• reaching

• speech/hearing and seeing

• manual dexterity.

Examples of mental and cognitive functions include:

• memory and concentration

• learning and understanding

• coping with social situations

• awareness of danger.

 

The ‘Benefits and Work’ website includes useful tips and guides to help you fill in the questionnaire.  Plus there is an online test to help you decide if you may be able to get ESA – see Part 5 ‘Useful Links’ for contact details (or if you would like a copy of the  descriptors used to assess if you have limited capability for work).

Important: when you send the questionnaire, it is worth including copies of any recent medical reports that you have or letters from doctors, so that as much information as possible is available when a decision is made on your claim.

Are you exempt?

Some people are exempt from the Work Capability Assessment, so if Jobcentre Plus agrees, will automatically be entitled to ESA. This includes:

• people who are terminally ill and death can be reasonably expected within 6 months;

• people receiving certain types of chemotherapy;

• pregnant women within 6 weeks of their due date or who are entitled to Maternity Allowance;

• pregnant women where there is a risk to the health of the unborn child if the mother does not stop work;

• people who can show that because of their illness, there would be a serious risk to them or to any other person if they were found fit for work (see the ‘Exceptional Circumstances’ section for more on this).

 

Work Focused Interviews (around Week 8 of claim)

When you claim ESA you normally have to attend a series of interviews to discuss work and training opportunities. Your first interview will be carried out by Jobcentre Plus and will normally take place eight weeks after your claim begins (so for many people the interview will take place before their medical). After this, five further interviews will be carried out (usually monthly).

You must participate in the interviews and notify them if you are unable to attend. Failure to do this may result in your benefit being reduced – get advice. The interview can sometimes be postponed (for example due to illness or following a bereavement or relationship breakdown) so it is important to contact them to explain why you cannot attend.

The Medical

Most people will need to have a medical assessment before a decision is made on their ESA claim. But you should not be called in for a medical if you have a very severe disability and there is enough information to show that you should be in the support group. Your doctor will be contacted if necessary.

The medical examinations are carried out by ATOS Healthcare on behalf of the DWP and generally take place in Croydon. You will normally be given at least 7 days notice of the date of the medical (unless they agree to a shorter period).

It is important not to ignore the letters.

In some circumstances, the medical can be postponed. If you cannot attend, you must inform the office that arranged the medical without delay.  If you fail to attend, your benefit payments will stop and you will be treated as being capable of work unless you can show you had a good reason for not attending (known as ‘good cause’) – get advice.

The medical is carried out using a computer – based assessment.  At the medical, you are likely to be asked questions about how you travelled to Croydon and how you intend to travel back.  Note that conclusions may be drawn from your response. It is important to explain any difficulties you had with the Journey.

There may be a delay before the examination begins.  When the health care professional is ready to see you, they will come to the waiting area to get you and lead you into the examination room.  Please note also that this allows them to observe how you manage to rise from a chair and your walking ability.  Remember to tell them about any difficulties you had while in the waiting area.

It is important to tell the healthcare professional about your abilities.  If your condition or ability varies from day to day – remember to say so.  If you can only perform an activity with pain or it causes tiredness either that day or in the following days, remember to mention this.  It is the effect of your condition over time, not just on the day of your assessment, that should be taken into account.

The healthcare professional should also consider other disabilities/conditions that may apply to you, including a mental health condition or learning disability. They should ask how your condition affects your:

  • ability to perform normal day to day activities (such as: going to the shops, cooking, travelling);
  • understanding;
  • memory and concentration;
  • ability to interact with other people.

Many people find the idea of a medical worrying. Remember that you don’t have to go alone. You can take someone with you

(such as a representative, carer, friend or relative) who could help fill in any gaps in what you tell the healthcare professional.

If you bring along additional medical evidence, the healthcare professional must accept this from you and make copies and forward it to Jobcentre Plus.

Don’t hand in your only copy of any report ­- remember to get a copy beforehand.

Help with travel costs

You can reclaim your travelling expenses (and for a companion if you need one). If you cannot travel by public transport, you can claim for taxi fares, but will need a doctor’s letter confirming that this is necessary. You will need to request an expenses form at the medical. Your expenses claim will take around two weeks to be processed and will be paid direct into your bank account – cash payments cannot be made.

Home Visits

A home visit can only be made if there is medical evidence from your doctor or consultant that this is necessary.

Appointees

If Jobcentre Plus/ ATOS know that you have an appointee, they will try to avoid calling you in for a medical.  They will talk to your appointee to try to obtain the evidence they need.

If you have a comment or complaint about your medical

ATOS has its own complaints procedure which you can use if you have a comment or complaint about the way your medical assessment has been conducted. All complaints are logged. Contact ATOS Customer Relations for a copy of their customer care booklet on 0113 230 9175 or email: customer-relations@atoshealthcare.com

If you have a learning disability or mental health condition

You may find the ESA claims process particularly challenging if you have a learning disability or a mental health condition. There are some safeguards built into the system to protect you and make your claim process a little easier. For example, remember that:

  • you should not be disadvantaged if have failed to return your ESA50 form due to a learning disability or mental health condition – you should still be called in
  • for a medical;
  • you may not have to undergo the medical assessment if there is evidence that you have a severe disability due to a mental health condition;
  • if you do not score enough points to pass the ESA test, you can still get ESA if you can show that because of your illness, there would be a serious risk to you or to any other person if you were found fit for work (see this section for more on ‘Exceptional Circumstances’);
  • you should provide as much supporting evidence as possible. Jobcentre Plus are very keen to receive any supporting evidence and may even write to you to request it. If you provide further evidence at the medical, ATOS must accept it, take copies and send it on to Jobcentre Plus.

Further information: Rethink is a national mental health charity that works to help everyone affected by severe mental illness recover a better quality of life. They have a website and produce useful information, including a free ESA factsheet focusing on mental health issues. The Benefits and Work website also includes a similar factsheet for paid subscribers.

The Decision (from around week 13)

Once enough information has been collected, a decision maker will decide if you qualify for ESA and you will receive a written decision. This brings the assessment phase to an end. If your claim is successful you will move into ‘main phase’ ESA and your payments will increase (see the if your claim is refused section). You will also find out which group you will be placed in – the work-related activity group or the support group.

The Work-Related Activity Group

Most successful claimants who have been awarded 15 points or more will be placed in this group. You will receive £26.75* extra a week. You will still have to attend Work Focused Interviews and your benefit may be affected if you fail to attend or participate – see the medical. You will normally be reassessed every year and will have to complete the ESA50 questionnaire again (although you may not necessarily have to attend another medical).

The Support Group

If you have been placed in the support group you will receive £32.35* extra a week. If you are on income-related ESA you will also automatically get an extra amount called an enhanced disability premium. This is currently worth £ 14.05* for single people and £20.25* for couples. You will not have to attend Work Focused Interviews or have any further conditions imposed on you, but your award may be reassessed periodically.

*Rates normally increase in April each year

Impact of ESA on other benefits

If you start getting ESA it is important to notify the office/s that pay your benefits. How ESA affects your other entitlements depends on whether you are getting income-related or contributory ESA and which other benefits you are receiving.

If you or your partner gets income-related ESA you will automatically be entitled to full help towards your rent and council tax. If you have dependent children, you will also get full Child Tax Credit.

If you or your partner get Housing Benefit and/or Council Tax Benefit. and are awarded contributory ESA, this will reduce the amount of help that you get. Make sure you notify Greenwich Advice and Benefits Service about changes in your income straight away to ensure you are paid the correct amount. Telephone

020 8921 4900 (or I 800 I 020 8921 4900 for textphone users).

If you get tax credits your award may be reduced if you start getting cESA. This is because cESA increases your yearly taxable income that is used to assess your tax credits. However, you don’t need to immediately declare a change in income as currently increases of up to £10,000 are ignored. But you may get less help when your award is renewed the next year.

If your claim is refused or you are unhappy with the decision

If you are found not to have limited capability for work – always get advice. There may be a range of options available to you. You may be able to get another benefit such as

Income Support or Carer’s Allowance, or you may even be able to re-claim ESA.

Remember: the fact that you have been found not to have limited capability for work does not mean that all is lost and you cannot get ESA. You ask for the decision to be looked again or you can appeal.

See Part 2 ‘Revisions and Appeals’.

Exceptional Circumstances

Even if you are found not to have limited capability for work, and are not exempt from the test, you can still get ESA if there is evidence that exceptional circumstances apply. For example, if you can show that because of your illness, there would be a serious risk to you or to any other person if you were found not to have limited capability for work.

The decision maker will consider the evidence supplied by the medical examiner. It is worth getting separate evidence from your doctor about this. The DWP should consider the most reliable evidence available.

Claiming Jobseeker’s Allowance

The Government expects that of those who are found fit for work, around half will then claim Jobseeker’s Allowance USA). JSA is a benefit for people who are available for work and are looking for work. If you are claiming JSA and have additional needs due to ill health or disability it is important to arrange to see a Disability Employment Adviser (DEA) in Jobcentre Plus so that they are aware of your health problems. You will still need to be available for and actively seeking work, but this will give JCP information about how your condition affects you and any barriers to employment you face.

Part 2: Revisions and Appeals

The fact that you have been found not to have limited capability for work does not mean that all is lost and you cannot get ESA. You can ask for the decision to be looked at again (called a revision) or you can appeal.  You must usually request this within one month of the date of the decision letter. However if you miss the one month deadline, you can still appeal after this in some circumstances – get advice.

You can also dispute other decisions made during the Work Capability Assessment, including that:

  • you do not have good cause for failing to return the medical questionnaire (ESA50);
  • the exceptional circumstances rules do not apply to your situation.

Tip: always appeal instead of asking for a revision.  The decision is always automatically looked at again where an appeal has been lodged so there is no real advantage to opting for a revision.

Although the appeals process can be stressful and can take a long time, it is worth considering. At least 4 out of 10 people who appeal are successful – with many going from zero points to 15 or more points at appeal. Tribunal hearings themselves are informal affairs and the panel will try their best to put you at your ease so that it is not an ordeal for you.

Make sure you get advice or information at an early stage about this. See part 4 ‘Where to get advice’ for details of organisations that may be able to help and Part 5 ‘Useful Links’.

Benefits while you are appealing

While you are appealing, you have two options:

• continue to claim ESA (at the basic assessment phase rate – see page 2). You will need to keep submitting medical certificates until a decision is made on your appeal. You will also need to complete and return a GL24 form or submit an appeal letter as soon as possible otherwise your payments will stop;

• claim Jobseeker’s Allowance (see page 6). If you decide to claim JSA, this should not prejudice your appeal.

How to appeal

You or your representative will need to appeal in writing (on a GL24 form) or in a letter. If you appeal in a letter it must include:

  • your details (name, address, national insurance number and date of birth);
  • details of your representative if you have one;
  • details of the benefit being appealed and your grounds for appeal.

jobcentre Plus should contact you to ask if you have any further evidence you would like to submit.

Important tips – remember:

  • Ask jobcentre Plus for a copy of the health care professional’s medical report so you can see which areas you might need to clarify or dispute.
  • Always ask for a hearing in person ­called an oral hearing. This will improve your chances of success. You will be sent a pre-enquiry form asking if you want an oral or paper hearing. Make sure you complete and return this within 14 days otherwise The Appeals Service may assume you do not wish to continue with your appeal.
  • There are strict time limits for challenging decisions – make sure you know all the deadlines and stick to them carefully to ensure that you don’t miss out.
  • Provide further supporting evidence if possible (medical and non-medical).
  • Prepare your case and get advice from a specialist organisation – see Part 4 and Part 5.
  • Attend your appeal!

Part 3: Reassessment of incapacity benefits

Between February 2011 and Spring 2014 most claimants who receive Incapacity Benefit (IB), Severe Disablement Allowance (SDA) and Income Support (paid on illness or disability grounds) will be reassessed for Employment and Support Allowance (ESA). The ESA rules are much tougher than the old test and fewer people are expected to

qualify. People who do not meet the rules for ESA will have to claim jobseeker’s Allowance instead. People who qualify for ESA will not see a reduction in their benefit at the point of change.

We understand that this is a very worrying time for claimants, so we hope this information will help you to understand what the process involves and what to expect, and how to get help and support if you need it.

Who is not affected?

The reassessment process will not affect the following groups:

• people who are due to reach state pension age by 6 April 2014 and are currently receiving IS, IB or SDA

• people who qualify for Income Support on other grounds – such as because they are a carer or have children under age 7 (or under 5 from October 2011).

When will Jobcentre Plus contact you?

The reassessment process started on a limited scale from 28 February 2011. It will be rolled out nationally to most people between April 2011 and 2014.

If you are affected by a mental health condition or learning disability

People affected by a mental health condition or learning disability are expected to find this process particularly challenging so it is vital that you are aware of the changes and how they are likely to affect you. Some important safeguards have been built into the system to help make the claims process a little easier for you – please see page 5 for details.

If you have a severe mental health condition and also get Disability Living Allowance highest rate care component, under the old rules you were exempt from the assessment process. This will not be the case under the ESA test (the Work Capability Assessment). Part 1 for more on this.

‘Rethink’ produces a useful ESA factsheet specifically for people affected by mental ill health that will help guide you through the reassessment process. Visit www.mentalhealthshop.org/factsheetsaz.html and select Employment and Support Allowance to download your free copy.

If you need to reclaim benefits after a period in work

The old rules which allowed people to reclaim IB, SDA or IS in specific circumstances were abolished on 31 January 2011. Previously special rules protected entitlement to these benefits for some people. For example, some previous claimants whose benefits stopped because they started work or training could return to the same rate of benefit if they had to stop work and reclaim within two years due to ill health or disability (this was known as the Welfare to Work Beneficiary Scheme). After 31st January, people in this situation have to claim ESA.

You do not need to contact jobcentre Plus or do anything until they write to you. Since benefits are being reassessed up to 2014, it may be some time before they contact you about the change. Until then, you will continue getting your current benefit (as long as you continue to satisfy the rules for the benefit).

In the next section is a step by step guide to the reassessment process.

ESA: The Reassessment Process – a step-by-step guide

Step 1:

At some point starting from February 2011 to 2014, you will receive a letter (or notice) advising about the changes that are about to take place and advising you what to do next. It will also confirm that your award will be converted to ESA if you meet the rules for the benefit and that it will end if not. The letter asks you to provide a contact telephone number to enable future contact.

Step 2:

jobcentre Plus will telephone you to provide further information, answer any questions you may have and identify if you need extra help or support through the process.

This is a good opportunity to raise any additional support needs you may have – such as if you are affected by a mental health condition, learning disability, sensory impairment or have literacy problems.  You may be able to get face-to-face support if necessary. Please also see sections in Part 1 and Part 3 that relate to mental health or leaning disabilities.

Step 3:

You will receive a medical questionnaire to complete (called an ESA50) to assess how your condition affects your ability to work (known as the Work Capability Assessment). Please see Part 1: the Medical Questionnaire for more about this and tips on how to fill it in.

Step 4:

You will receive a call from ATOS Healthcare to arrange your medical (or Work Capability Assessment). They will send you a letter confirming your appointment details and directions to the examination centre in Croydon. Most people will have to attend the medical (but there are exceptions). Now see the section on the Work Focussed Interviews for important information about what you can expect at the medical and what to do if you cannot attend.

Step 5

You attend the medical.

Step 6

jobcentre Plus will contact you if they need any further information and to explain the next steps.

Step 7

jobcentre Plus will decide if you meet the ESA conditions of entitlement.

Step 8 :Jobcentre Plus decide you are entitled to ESA

Go to step 9 if Jobcentre Plus decide you are not entitled to ESA.

• You will receive a call confirming you are entitled to ESA and the next step.

• You will receive a written decision confirming that your award can be converted and how much benefit you will receive. It will also confirm if you will be expected to undertake ‘Work Related Activity’ in order to continue to get ESA. Most ESA claimants will be expected to do this, but some claimants with very severe disabilities (for example, people who are terminally ill) can get ESA without following an action plan. See page 5 for more information.

• If you have been placed in the Work Related Activity Group you will be contacted to arrange a Work Focused Interview – Part 1 for more on this.

Your benefit is converted to ESA and the previous award ends. This should normally happen within two to four weeks of the date of the decision.  If you were previously getting IB or SDA, your benefit will be converted to

contribution-based ESA.  You will not see a reduction in the level of your benefit at the point of change.  Your ESA will be topped up if there is a shortfall between your previous rate of benefit and ESA

Impact on tax credits and other benefits

Tax Credits – if you were previously getting Invalidity Benefit (IVB) and are transferred to contributory ESA (cESA), your tax credits award may be reduced.  This is because unlike IVB, (which is non-taxable), cESA increases your yearly taxable income that is used to assess your tax credits. However, you don’t need to immediately declare a change in income as currently increases of up to £. 10,000 are ignored. But you may get less help when your award is renewed the next year

Please see page 6 for more information about how getting ESA may affect other benefits.

 

Step 9:  Jobcentre Plus decide you are not entitled to ESA

  • You will receive a call from jobcentre Plus confirming the decision and why they believe you are not entitled. If you have any additional information you feel should be taken into account.  This should be considered.
  • You will be advised about your options – to claim jobseeker’s Allowance JSA) and/or appeal against the decision (see below).
  • If you wish to claim jSA, you will be transferred to someone who will take your claim over the phone.
  • You will receive a letter confirming the ESA decision.
  • Appeals – there is a right of appeal against any aspect of the conversion decision

-   including that you do not have ‘limited capability for work’.

  • If you appeal against the decision, you will continue getting ESA until your appeal is determined. You will need to appeal in writing. jobcentre Plus will firstly look at the original decision again. This will involve a long call to you to confirm you have provided all the information needed.

 

Now turn to the section If your claim is refused or you are unhappy with the decision for more information about appeals.

 

For more information about the incapacity benefit reassessment process please visit www.direct.gov.uk/ibchanges.
Links

Part 4: Where to get advice

For advice and advocacy

Citezens advice Bureau  http://www.adviceguide.org.uk/index/your_money/benefits.htm

Part 5: Useful Links and information

Benefits and Work www.benefitsandwork.co.uk

This site offers detailed practical includes useful information, tips and benefit guides for claimants and professionals on benefit issues including ESA. The website includes factsheets and guides and lots of practical tips and hints to give you the best possible chance of making a successful claim. You will need to subscribe to download the more detailed information and guides, but there are also lots of free resources available to people who have registered with the site.

Rethink – www.rethink.org

National voluntary sector provider of a range of mental health services. Provides useful factsheets.

DWP­www.dwp.gov.uk/adviser/updates/ib-reassessing-claims/

The DWP have produced a range of information to help advisers support customers who are being reassessed for ESA. These include:

  • a factsheet for customers explaining the reassessment
  • a factsheet explaining what support is available for customers with additional needs
  • a guide for advisers to the reassessment process

• DirectGov – www.direct.gov.uk

Directgov Includes general information about ESA and a guide to the incapacity benefits reassessment process.