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ESA is the most complicated, unfair and badly designed benefit. The claim form is long, complex and often confusing. The medical is carried out using a computer. It’s often rushed and it may not even be a doctor that assesses you. The appeal system is very complicated and confusing.
We are very concerned that as all members on Incapacity Benefit (IB) are transferred over to ESA, our Benefits Advisor is likely to be overwhelmed with requests for help with claims. With that in mind we have written these notes to give an overview of the benefit and will provide a detailed guide to all claimants on request, to enable you to handle the claim yourself. The benefits Advisor is still more than willing to assist those who find the process too difficult or to give a little help or advice to other members but we do expect members to do some preparatory work and at least read the guides we can send (if you are able), as he simply won’t have time to deal with all claims from start to finish. Furthermore, if our Advisor is to do anything to support you with your benefit problems then he needs to know about them at the earliest possible moment, not 12 hours before your application form needs to be returned to the DWP. Please help us to help you and let the Support Team Manager or your STC know in good time if you would like help with any benefit.
When will the transfer from IB take place?
Claimants will be assessed when their next personal capability assessment is due. Claimants who are exempt from the personal capability assessment (PCA) and those with no review date (people with ‘in the longer term’ on their prognosis) are being assessed at the beginning of the process. The intention is that everyone will begin to be assessed, on a random basis from March 2013.
Is there anyone this won’t affect?
If you are due to reach pensionable age by March 2014 then you will not be reassessed, because the DWP say they don’t want people to have to change benefits twice in such a short period of time.
How will I know the transfer process has started for me?
You will get a letter from the DWP telling you that you are about to be subject to the work capability assessment (WCA). You will also get a confirmation telephone call asking if you need any additional support with the process.
The next thing most people will receive is the ESA50 questionnaire, unless a decision to award you ESA is made just using the information already held about you.
Based on the information in the ESA50 questionnaire and any supporting evidence, plus on some occasions further evidence obtained from your GP or other health professional, either an award will be made or you will be asked to attend a medical.
New claims for ESA
New claims for ESA can be made by calling the job-centre plus on 0800 023 3419 (NI 0800 085 6318, textphone 0800 328 3419) and request an ESA 1 claim-form.
Processing your claim on the phone
Under no circumstances should individuals provide personal or financial details to the staff of Job Centre Plus or the DWP over the phone, either for new claims or transfer from IB.
You must refuse politely to provide information over the phone (having MS, you can say, probably with some truth, that your cognitive abilities have been markedly reduced by MS and you find it impossible to provide accurate information over the phone). You should, instead, request a paper copy of Form ESA 1. The Job Centre Plus staff may suggest that you can complete the Form ESA 1 online. Again you should, politely but firmly, refuse to adopt this option. It is your right to have a copy of Form ESA 1 in a paper format
Contributory or Income related ESA?
Contributory or Income-Related ESA?
There are two categories for ESA:
1. The Income-related
2. The Contribution-based
Contribution based ESA is based on paying sufficient National Insurance contributions. If you do not qualify for contribution based ESA you may be eligible for income-related ESA which is means tested and compares your needs with your resources (such as income and savings) and pays the difference. Note: Members should note that although savings and most other income do not affect the level of the Contributory ESA award, occupational or personal pensions can, and almost certainly will, affect the size of the award. The position of those members who receive a War Pension and DLA is not completely clear with respect to ESA at the moment.
How will I be assessed for ESA?
The work capability assessment (WCA) for ESA is similar to the personal capability assessment (PCA) for incapacity benefit. Most people must complete a questionnaire and attend a medical. A small number of people will be awarded ESA without having to attend a medical, especially those who are likely to be placed in the support group.
One of the main differences between an ESA assessment and an IB one is that for ESA you are being assessed not just to decide if you are capable of work but also to decide whether you are likely to be capable of work in the future.
If you are judged to be likely to be capable of work in the future you will be placed in the work-related activity group (WRAG). If it is decided that there is no reasonable prospect of you being fit for work now or in the future, you will be placed in the support group (ideally you need to be placed in the support group).
Depending on the responses that you provide on the ESA 1 (new claimants only) and providing your GP provides a ‘fit note’ (i.e. stating that you cannot work due to some level of disability, you will be put into the 13 week assessment phase and ESA will start to being paid at a lower level called the ’basic allowance’. In some circumstances the information you provide on the ESA 1 might allow a decision to be made straightaway but this will be the exception rather than the rule and most claimants will have to fill in the ESA 50 and many will also be sent for an examination.
The WCA is split into two parts:
1. The Limited Capability for Work Assessment which forms part of the ESA50 questionnaire
2. The Limited Capability for Work related Activity Assessment which may take place at the medical although some people can pass this second test by getting the highest score in certain activities in the first test.
Which Group will I be placed in?
Work Related Activity Group (WRAG)
To be put into the WRAG you have to score a total of 15 points in the first test, these points can be added together from your scores from each activity in both the physical and mental parts of the test. If you pass this first test but fail the second this is the group you will be placed in.
To get into the support group you must pass both tests. You do this by showing that one of a number of descriptors in the second test apply to you, there is no scoring involved though scoring the maximum of 15 points in some of the activities in the first test means you will automatically pass the second test and be placed in the Support Group.
What happens if I am put into the work related activity group?
The people who pass the first test but fail the second test go into the WRAG. This group includes the vast majority of successful ESA claimants, around 90%. Work-related activity group members get paid a basic allowance, plus a work-related activity component. If you get into this group, in return for your additional component, you are required to take part in certain work-related activities. If you fail to do so your additional component is reduced by 50% for four weeks and then taken away altogether. You can only get it back by taking part in the required activities.
Although you cannot be forced to take a job, private sector companies may to try to apply pressure on you to take a job if you have to take part in the work programme. Claimants transferred from IB to ESA are worth more money than anyone else if they take on a full-time job and stay in it for two years – up to £14,000. So you may receive a lot of attention from your work programme provider.
What happens if I am placed in the support group?
If you are placed in the support group you will be paid the basic allowance of ESA plus a support component. If you are eligible for income-related ESA and you are in the support group you will also automatically get an extra payment called an enhanced disability premium.
Members of the support group don’t have to work or undertake any work-related activities or attend work-focused interviews because it is considered that they have the most serious health conditions or disabilities.
How long will I get ESA for?
If you are in the work-related activity group and eligible for income-based ESA you will continue to be eligible for ESA for as long as you continue to pass your regular WCAs. However, if you receive contributory ESA things are very different. From April 2012, the DWP intends to only allow people to claim for a year. They also intend to backdate this provision, so that if you have already been receiving contributory ESA for a year by April 2012, your entitlement may end immediately.
This all seems very complicated – how should I proceed?
Although we believe these tests are going to be tough and it is not going to be easy to get into the Support Group, particularly for those with relapsing and remitting MS, all is not lost and with a bit of effort and guidance we can provide you with some expertly written, easy to follow guides to tell you how to make the best possible case for ESA.
Please contact the Support Team Manager who will arrange to forward the appropriate guides to you by e-mail (preferably) or post.