ESA

ESA is a complicated, the claim form is long, complex and often confusing.

Here is an overview of the benefit and we can provide a detailed guide to all claimants on request, to enable you to handle the claim yourself. Our Benefits Volunteers can give lots of good information to help and/or signpost you to someone for assistance with your claim.

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

Claimants should avoid giving 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 might want to refuse politely saying that your MS means you find it difficult to provide accurate information over the phone. 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 which you may choose to do if this suits you but it is your right to have a copy of Form ESA 1 in a paper format if you prefer it this way.

Types of ESA

The 2 types of ESA are:

  • contribution-based ESA (known as ‘new style’ ESA if you’re entitled to claim Universal Credit) – usually you get this if you’ve paid enough National Insurance contributions (National Insurance credits can count for part of this, if you get them)
  • income-related ESA – usually you get this on its own or on top of contribution-based ESA, if you’re on a low income

Contribution-based ESA

Contribution-based ESA lasts one year if you’re in the work-related activity group. You may be able to re-apply at least 12 weeks after your contribution-based ESA ends. You may qualify again depending on:

  • National Insurance contributions you paid in the last 2 full tax years before the tax year you’re claiming in
  • whether your health deteriorates and you’re placed in the support group

There’s no time limit on how long you can claim contribution-based ESA if you’re in the support group.

‘New style’ ESA

You can apply for ‘new style’ ESA if you’re entitled to apply for Universal Credit. You’re entitled if you’re either:

  • a single person anywhere in England, Wales and Scotland
  • a couple or family living in a Universal Credit area

New style ESA works in the same way as contribution-based ESA. Your partner’s income and savings won’t affect how much new style ESA you’re paid.

You can get new style ESA on its own or at the same time as Universal Credit.

If you get both at the same time your new style ESA payment will be deducted from your Universal Credit payment – you aren’t guaranteed to get any extra money.

You may qualify for income-related ESA if you no longer qualify for contribution-based ESA.

How much you get depends on your circumstances. There’s no time limit on income-related ESA.

You can’t get income-related ESA and Universal Credit at the same time.

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).

Assessment Phase

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 Assessment

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.

Support Group

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?

Contribution-based ESA lasts one year if you’re in the work-related activity group. You may be able to re-apply at least 12 weeks after your contribution-based ESA ends. You may qualify again depending on:

  • National Insurance contributions you paid in the last 2 full tax years before the tax year you’re claiming in
  • whether your health deteriorates and you’re placed in the support group

There’s no time limit on how long you can claim contribution-based ESA if you’re in the support group

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.