Employment and Support Allowance
ESA is the replacement for two benefits:
Income Support for unfit-to-work reason (that is, Income Support with the disability premium)
It started on 27th October 2008. It currently applies to new claimants only, although existing claimants will be migrated onto it someday.
Why claim it?
It is worth £26.75 per week extra more than JSA or Income Support (2011/12 figures).
Claim it by phoning 0800 055 6688. They send you out the initial form to complete.
You will need to send in a sick note from your G.P. when you claim this.
You then have to fill in the main form, ESA50. That is similar to DLA form for filling in. Takes one full hour to complete, just like DLA (and that’s moving fast!). For new advisors, have the completed forms kept back and read over and corrected by someone more experienced before posting them out.
For the first 13 weeks of your claim, you are paid only the standard JSA rates. Thereafter you are paid the extra ESA rate.
Claim DLA too (call 0800 88 22 00)
Note that due to the tough criteria for getting ESA, many people on ESA will be entitled to DLA also. So ask your client if they are already getting DLA, and if not, call up the DLA disability benefits claim line immediately, to ask for a new claim form to be sent out. Don’t download the form from the internet or wait for later to phone them. Why? Because the DLA money will be backdated to the day you made the call – as long as you return the form within 6 weeks. The number to call is 0800 88 22 00.
However some GPs may be more reluctant to support their patients DLA claims than ESA claims. And without support from your GP, a DLA claim is unlikely to succeed.
There are similarities between the forms, so make sure to keep photocopies and refer to them when doing the other form. The DWP also compare both forms when doing their medicals and so on, so aim to be consistent in each. For DLA you have to emphasise more the care and assistance and support you need to do tasks.
DLA can involve serious money (below are the 2011/12 figures) and it is less hassle (fewer interviews) than the ESA claim, so there is no sense is not trying for it:
DLA Care component
Highest rate £73.60
Middle rate £49.30
Lowest rate £19.55
DLA Mobility component
Higher rate £51.40
Lower rate £19.55
Substantial extra amounts will be paid to income based ESA if you have specific disability related conditions. See these course notes for details.
Filling in the EA50 Form:
Page 2 – For someone else? Yes adviser should complete this part, as it can help get the claim treated a little more seriously. But be especially careful then not to write down anything that your client has not either said to you or agrees with. That means reading what you have written back to the client at each page, giving them a chance to stop you. The reason for that is that if the DWP get a claimant to say some part of their claim form is wrong, that their advisor just made that bit up, then the truth of the whole claim is cast in doubt, which you don’t want happening at especially an appeal.
Page 2 – Phone number. Claimants’ telephone number should not be given on the DLA form, because the DWP have a habit of phoning at awkward times and conducting a telephone interview. Better to let DLA issues all be handled in writing (although it’s ok to give out other peoples phone numbers e.g. doctors and carers). But here, for ESA, there are so many interviews and medicals to go to, that unfortunately giving out a phone number probably is a good idea.
Page 4 – Illness. Spell out the impact on day to day tasks here, as well as in the rest of the form. Continue on page 25 and then separate sheets if necessary. Every separate illness or condition should be listed separately, even those that are (to us) obviously closely related or symptoms of one another. Spell out the effect of each illness on day to day tasks – don’t assume that saying “rheumatoid arthritis” means that the reader will realise that causes “severe pain in legs, arms, and fingers making it difficult to move or
Page 7 – Drugs/alcohol – always worth listing if there is serious abuse of these. Spell out all the effects they have – e.g. fits or spasms for severe alcoholics, say “exacerbates mental health issues” and so on.
Page 8 onwards – phrases include “severe pain and discomfort”, “danger to myself and others”, “I have tried this in the past and…”. Similar to DLA, where there would also be “I need support and assistance to …”. You will find that repeating the exact same phrases over and over again in the different pages.
You need to draw clients out – a lot of people minimise their suffering, which is a great positive approach to life normally, but is deadly for an ESA form. So ask clients things like “What is it like on your worst days?”. “Have you ever found that…?”
Page 18 onwards – the ESA points system means your mental state has to be serious before you will qualify. Talk up all the mental health issues. Note that a whole load of mental health issues often go together, so if your client has one find out if he (even partially) has some of the others:
Thoughts of self harm / planning for self harm / attempts of self harm
You can list them all separately and repeat over and over on each page.
The Medical (‘Work Capability Assessment’)
The doctor or nurse carrying out the medical is working to and filling out form WFHRA0907 as they go. It’s questions are pretty loaded – trying to elbow the claimant into slipping up and admitting they are or could become capable of working.
One way to counter that is to adopt the “politicians answer” technique. That’s where, whatever the question is, there is only one answer. Politicians, trade union officials, and campaign spokespersons get trained in that as part of their media handling. You can watch it in action on news interviews and so on. A media savvy politician will acknowledge the interviewers basic point, whatever that is, but then quickly move on to talk about their particular talking point of the day, and will do so over and over almost regardless of the questions thrown. In a medical like this, that means emphasising over and over again the severity of the health conditions, the impossibility of becoming capable of work, and the likely futility of any remedial action. And doing so in response to every question from the medical examiner.
Outcome of Medical, either:
ESA claim rejected (you should appeal this)
ESA claim accepted and placed in work activity related group (you can appeal to be placed in support group)
ESA claim accepted and placed in support group
The Support Group
Best group to be in because:
You get paid £5 a week more, so £89.50 rather than £84.50.
You get paid even more than that if you have sufficient National Insurance Contributions - £102.10 per week rather than £89.50 per week. If you are under 20 or have been a carer you can be credited with the National Insurance contributions even though you haven’t been working for an employer, and so get the extra money also.
You don’t have to go to the five further monthly work focussed interviews
But difficult to get in to this group because has to be severe illness. You can appeal the group you are placed in.
Your clients also need to know
At the end of the interview remind clients of things like:
You have to turn up at the various work focussed interviews and medicals, otherwise they will sanction you, loosing half the extra money for four weeks and thereafter loose all the extra money. If you have good cause – medical appointment, serious illness – let them know as soon as possibly, preferably in advance.
Your interviews and medicals start as you approach the building. The DWP can watch you in security cameras walking towards the building and use that against you. They can time how long you can sit in the chair in the reception waiting room. They can watch how easily you get up from a chair in the waiting room and in the interview room. They will look at your general appearance – so not shaving or washing or changing your clothes for a while beforehand might be worth doing.
Don’t let medicals or interviewers lead you into agreeing things about how your health might improve in the future. Stick to your line about how bad your health is and how impossible it will be for you to cope with a working environment, just as your EA50 form says. If the medicals and interviewers don’t like the bare truth because they have targets to meet in failing people like you – well, that’s just tough.
You are allowed to bring someone else with you to the medical (especially important) and the interviews (less important). Your companion will be allowed to speak at the medical and clarify your answers and give more detail.
It is always worth submitting an appeal. That way an independent and often more sympathetic tribunal gets to over-rule the DWP. A lot of cases pretty much always need to go to appeal to get an award. You can (and should) bring someone with you to the appeal tribunal. Often the appeal is heard and decided by just one person, or sometimes there is a doctor there as well.
Quick Guide to Employment Support Allowance (ESA)
ESA comes into force on 27th October 2008. It:
replaces Incapacity Benefit for new claimants; and
replaces Income Support on the basis of being unfit for work (only)
for new claimants as of 27th October 2008.
So note this makes it important to appeal if rejected for IB or IS unfit to work before the 27th October - because if you win your appeal you will be backdated onto the old benefit.
Remember only 28 days time is normally allowed to lodge an appeal.
will still be able to claim Income Support?
Income support will still be available for single parents and for carers.
There are two types of ESA
Contribution based ESA (= old Incapacity Benefit)
Income based ESA (= old Income Support unfit for work)
Contribution based ESA can be topped up with income based ESA (which is normally higher).
A claimant needs to satisfy all the basic conditions:
Have a limited capability to work
be at least 16 years of age
be under pension age
be in Great Britain
not be entitled to income support - so if you would qualify for income support as a lone parent or as a carer, then those would take precedence and you wouldn’t get ESA. That may mean in some circumstances it would be better to keep quiet about carers duties you are performing.
not be entitled to jobseekers allowance - including even just being a member of a joint claim JSA couple
contribution based ESA conditions
For contribution based ESA, you must also satisfy the contribution conditions:
class 1 or class 2 for one of the last three complete tax years;
or been credited with class 1 or class 2 contributions in the last
two complete tax years;
You qualify via the relaxation in the first qualifying condition (regulation 8(2) - which especially lets carers qualify.
Additional income related ESA conditions:
Your income must be less than your applicable amount, which is what the law says you need to live on.
Your capital is not over limit of £16,000
You are not entitled to pension credit
Neither you or your partner (if you have one) are engaged in renumerative work - although ‘permitted work’ and voluntary work is allowed. Note that you can keep all permitted work income, rather than just £20 per week as in the old income support rules.
Not in full time education
Not subject to immigration control
ESA Initial Period
The first 13 weeks of your claim are the ‘initial period’ assesment phase.
Paid ESA at basic rate only (£67.50 if aged 25 or over, £53.45 if under 25, for 2011/12)
You must attend a work focused interview
You must undergo a work capability assessment
That assessment decides if you qualify for ESA (appealable) and if so which of the two ESA groups you fit into (also appealable).
You are exempted from the ESA initial period if you are:
terminally ill; or
your claim is linked to an earlier ESA claim
An ESA claim requires you to complete an EA50 form. This is like the old IB50 form, except is much bigger
The initial Work Focused Interview during assessment phase:
Is carried out by a ‘personal adviser’ - who could be DWP staff or could be contracted out to a private agency
He assesses your work prospects
And identifies activities to assist with work - these will often be compulsory, just like in JSA, either do them (or convincingly pretend to do them) or face sanctions of benefit reductions
The WFI can be waived or deferred.
Work Capability Assessment during assessment phase:
Test is for ‘limited capability for work’
Is carried out by a ‘health care professional’, which is a:
registered medical practitioner (doctor); or
registered nurse; or
occupational therapist; or
Is similar to the old personal capability assessment - but is
Changes from old personal capability assessment are:
fewer exemptions than in old IB50
no more 3 point tests
mental health test altered
15 point threshold for each test, rather than just 10 points
simplified combination of points
The points system
You must obtain a total score of 15 points either by a single activity or through a combination of descriptors.
You are assessed as if wearing any prosthesis that you are fitted with, or other aids or appliances that are normally used.
Where more than one descriptor applies to you, only the descriptor with the highest score in respect of each activity applies.
There are now three grades of severity only - 6, 9, or 15 points. The old 3 points scores are gone.
The old ’sitting’, ‘rising from sitting’, and ’standing’ activities have been merged into one.
The ‘walking up and down stairs’ activity has been removed.
There are three sets of descriptors for continence.
The wording of the descriptors has been changed.
Replacement of four sets of activities with ten.
New activities include ‘initiating and sustaining personal action’, ‘disproportionate reactions to events or criticism’, ‘ability to visit new places or engage in social contact’.
You will be automatically counted as having limited capability to work if:
you are pregnant and there is serious risk to your health or the health of your unborn child; or
you are entitled to maternity allowance and you are within your maternity allowance period; or
you are between the sixth week before date of confinement and the fourteenth day after the date of confinement; or
You are being treated as an in-patient in hospital, or recovering from such treatment; or
you are terminally ill; or
you are otherwise suffering from some severe disease, disablement or undergoing major treatment (for example, chemotherapy).
If the assessment phase rules that you do not have limited capability for work, then you would cease to receive ESA and would instead make a claim for jobseekers allowance, or income support for lone parents, or income support for carers.
You can (and should) appeal that decision, within 28 days.
If instead the assessment decides that you do have limited capability for work then it will also to decide to place you into the
support group (good); or the
work related activity group (less good)
You can also appeal that decision, again within 28 days.
Excerpt DWP guidelines to healthcare practitioners on ESA medicals: “If possible, you should meet the claimant and accompany them from the waiting room. This positive initial point of contact will help put the claimant at ease and is a natural courtesy. From your point of view, it provides an opportunity to observe the claimant outside the examination room, and extends the time spent in contact with them. Most importantly, it initiates the rapport between HCP and claimant which is so essential to an effective interview.”
ESA Handbook Section 18.104.22.168 Page 36
1. Make an initial claim for ESA over the telephone using an 0800 number.
2. You are sent a printed Customer Statement to check, sign and return. You may be asked to provide other evidence, such as proof of savings and income as well as a medical certificate.
3. Some claimants may be given ‘early entry’ to the work capability assessment, allowing them to be placed in the support group or work-related activity group without needing to attend a medical or complete a questionnaire. This may be, for example, because:
- you are terminally ill
- you are exempt because, for example, you are having certain types of chemotherapy
- you have a very severe illness or disability and it is clear you qualify for the support group.
The DWP may contact your GP or another health professional for further evidence if they consider you may be eligible for early entry.
4. By day 11 your claim should be processed and you should receive your first payment on the due pay day.
5. By day 30 you should be sent a an ESA50 questionnaire. You will have six weeks to complete and return the questionnaire
6. If you are allocated to the support group or work-related activity group on the basis of your questionnaire and any supporting evidence, you should receive a decision letter informing you of this. If you have been placed in the work-related activity group you will still have to attend a work-focused health-related assessment at a Medical Examination Centre.
7. If you are not allocated to the support group or work-related activity group on the basis of the evidence already received, you will get an appointment for your medical examination, which will include a work-focused health-related assessment. You should be sent notice in writing of a medical examination at least 7 days in advance unless you agreed to accept a shorter period of notice in writing or otherwise. In practice Atos Healthcare will generally try to arrange medicals by telephone and may leave misleading messages warning you that your benefit may be affected if you do not return their calls.
8. You attend your examination at around day 43 of your claim, though this seems to be based on your returning the IB50 questionnaire within a few days.
9. You should receive a letter giving you a date to attend a work-focused interview. This interview may be as early as week eight of your claim, unless it is waived or deferred. For many people, the work-focused interview may take place before their medical. If you have already been allocated to the support group you won’t have to have a work-focused interview. If you haven’t yet been allocated to the support group but it is considered likely that you will be, your interview will be deferred until a decision has been made.
10. You receive your outcome letter for the work capability assessment and a copy of your work-focused health related activity report. If you are found capable of work you can challenge the decision via revision and appeal. Whilst awaiting an appeal you can claim ESA at the assessment phase rate.
11. After 13 weeks, if you passed the work capability assessment, you will enter the main phase of ESA as a member of either the work-related activity group or the support group.
12. If by the end of 13 weeks a decision has not been made on eligibility, for example because you have been too ill to be assessed, the assessment phase can be extended. Where this happens, when the decision as to which group the you belong to is made, any back payments of an additional component owed from week 14 onwards will be made.
13. Claimants in the work-related activity group will have a further five work-focused interviews. Your benefits may be sanctioned if you fail to attend and take part in these interviews.
14. Claimants in the work-related activity group will be subject to at least one work-focused interview each time you have a further work capability assessment. It is intended that assessments will take place annually, though it may not always be necessary for claimants to attend further medicals. Claimants in the support group may have their eligibility reassessed from time to time.
For more detailed information, see: