What is ESA?

ESA is Employment & Support Allowance. It was introduced in 2008 as a replacement for:

• Incapacity Benefit
• Invalidity and Sickness Benefit
• Income Support claimed on grounds of sickness

It has been rolled out slowly, gradually reassessing those who have been claiming those benefits name above. If you are claiming one of those, you will be reassessed at some point, so it would be wise to be prepared.

Employment & Support Allowance is intended for people who are unable to work due to sickness or ill health. There are different types of ESA. It can be quite daunting trying to understand which to apply for.

 

ESA - Contributions Based

• In order to claim Contributions Based ESA you need to have had an employer pay your National Insurance (Class 1 contributions) for the whole of the previous year. 
• If you were in full time employment before becoming ill, this is the type of ESA you should apply for.
• If you are in the WRAG (Work Related Activity Group - see below), on Contributions Based ESA, you will only receive it for a year. You can then apply for Income Related ESA (see below).
• If you are in the Support Group (see below), on Contributions Based ESA, you are not time limited to the year.

ESA - Income Related

• Income Related ESA is means tested. If you haven't been employed (do not have Class 1 contributions) this is the one you need to apply for.
• The means testing takes into account your income, your savings, and any income and savings of a partner if you live with one.
• It does not take into account your out goings.
• Income Related ESA is not limited to a year.

 

WRAG (Work Related Activity Group)

There are a lot of misunderstandings over what the Work Related Activity Group is.

• The Work Related Activity Group is for those who are expected to be able to return to work within a given time period.
• If you are placed in the WRAG you will be expected to seek and partake in 'activity' that progresses your situation to being able to work again in the future.
• This activity may be voluntary work, but it may also be attending therapy or specialist appointments - it depends upon how open and understanding the Job Centre Plus employee you work with, is.
• It is imperative that the 'activity' you undertake does not cause your health to decline. You can use letters from your GP to guide them in how much they push you.
• One of the useful bits of being in the WRAG is that having regular appointments with a DWP employee means there is a regular record if your health is declining.

It is NOT:

• A group. You do not sit in a circle with other people as if you were in group therapy.
• The Work Program.
• Forced unpaid labour.

The Support Group

The Support Group is for people considered too ill to be likely to return to work in the near future.

Rates

The rates paid to those on ESA have changed since it was introduced, but I believe they have been frozen for the next few years.

• £56.80pw is the introductory rate for under 25s.
• £71.70pw is the introductory rate for over 25s.
• £100.15 is the rate for the WRAG.
• £106.50 is the rate for the Support Group.

Officially the introductory rate is only for 13 weeks. In reality the assessment process often takes a lot longer. When you are eventually placed in WRAG or the Support Group you should get payment at the appropriate rate, back-dated to the 13th week.

If you do not have appropriate National Insurance Contributions, and your household income is too high to place you on Income Related ESA, you will receive no payments - £0.00pw - but they will still pay your National Insurance Credits. (Credits and Contributions are not the same thing).

 

The Process Outlined

If you are employed, and become severely ill:

• you can self certify yourself as ill for one week.
• a doctor can then sign you off work for as long as they consider you need to be off work.
• you send the the sick note (called a 'fit note' since 2010) you are given by the doctor to the DWP in order to receive Statutory Sick Pay from the government. (Statutory Sick Pay is £86.70).
• you can claim Statutory Sick Pay for 28 weeks 
• the DWP may ask you to complete the ESA1 when you send in your first sick note. You don't have to (until 28 weeks); basic rate ESA is less than Statutory Sick Pay.

You do not have to leave work because of sickness. Some employers will create an agreement with you whereby your position is held open for you should you be able to return to work in the future. You will no longer receive payment from your work place, but will receive ESA payments from the government, whilst still holding a contract with your work place. You are in a more secure position if you can make this arrangement with your employment, than if you resign.

If you have been severely ill for a few years, but haven't claimed ESA yet:

• you can also submit sick notes from your GP to the DWP for 28 weeks, as described above,
• or you can telephone the DWP and fill in an ESA1 form over the phone.

Once you have completed the ESA1:

• You will be sent the ESA50 form to complete.
• When you receive the ESA50 you will be given a three or four week time limit in which it must be returned. It is advisable to be prepared for this form before you receive it, and have evidence lined up to send with it.
• Once your form and evidence has been returned, it will be briefly assessed as to whether you require a Work Capability Assessment (the WCA - otherwise known as "the medical").
• Most people are invited to the WCA, but some are placed either in the WRAG or the Support Group on the strength of their form and evidence.
• If you are invited to the WCA and do not attend, your application for ESA will be declined.
• In the WCA you will be assessed by a doctor, a physiotherapist or a nurse. They will make a recommendation as to what they believe the decision on your case should be.
• A Decision Maker will then look at your form, the evidence you submitted with it, and the data collected in your WCA, and make a decision over which group you should be placed in, if you should receive ESA at all.
• You will receive a document from them informing you of the decision. You should then start to receive the higher rate of pay, and any back pay that has accumulated.
• If you disagree with the decision you can either request a Reconsideration or go straight to Appeal.
• If you request a reconsideration another Decision Maker will look at all your evidence again.You can write to them explaining why you disagree with the decision, but you do not have to.
• If you ask to go to Appeal, another Decision Maker will look at your case (Reconsideration) anyway.
• If the decision is not over turned at this point, you will eventually go before a tribunal panel to plead your case.

ESA - Descriptors

When you apply for Employment & Support Allowance your application is scored using 'descriptors'. The table below shows you these descriptors. You can work out how much you would score yourself using the table. The DWP are very harsh with their scoring though.

How it works:
For an example I will use walking. The first activity in the table below is called 'mobilising', that means walking. The form you filled in evaluates how far and how well you can walk. Using what you have written on the form (and what your supporting evidence says) the Decision Maker will assess whether you fall into 1a, 1b, 1c, 1d, or 1e. So, if for example, you cannot walk at all, you would fall in to 1a. You then use the column marked 'Points' to work out how many points you score for that descriptor. 1a scores 15 points.

You need to score 15 points in total, across the whole form, in order to receive ESA.

If you do not score 15 points you may receive ESA using certain regulations. This will be covered in another post.

You may be placed directly in the Support Group if you score 15 points under one descriptor; it depends which descriptor though. The Support Group also has a separate list of descriptors.

	SCHEDULE 2	Regulation 15(2) and (3)
	Assessment of Whether a Claimant has Limited Capability for Work
	PART 1
	Physical Disabilities
(1) Activity	(2) Descriptors	(3) Points
1. Mobilising unaided by another person with or without a walking stick, manual wheelchair or other aid if such aid is normally or could reasonably be worn or used.	1(a) Cannot, unaided by another person, either: (i) mobilise more than 50 metres on level ground without stopping in order to avoid significant discomfort or exhaustion; or (ii) repeatedly mobilise 50 metres within a reasonable timescale because of significant discomfort or exhaustion.	15
	(b) Cannot, unaided by another person, mount or descend two steps even with the support of a handrail.	9
	(c) Cannot, unaided by another person, either: (i) mobilise more than 100 metres on level ground without stopping in order to avoid significant discomfort or exhaustion; or (ii) repeatedly mobilise 100 metres within a reasonable timescale because of significant discomfort or exhaustion.	9
	(d) Cannot, unaided by another person, either: (i) mobilise more than 200 metres on level ground without stopping in order to avoid significant discomfort or exhaustion; or (ii) repeatedly mobilise 200 metres within a reasonable timescale because of significant discomfort or exhaustion.	6
	(e) None of the above applies.	0
2. Standing and sitting.	2(a) Cannot move between one seated position and another seated position which are located next to one another without receiving physical assistance from another person.	15
	(b) Cannot, for the majority of the time, remain at a work station: (i) standing unassisted by another person (even if free to move around); (ii) sitting (even in an adjustable chair); or (iii) a combination of paragraphs (i) and (ii), for more than 30 minutes, before needing to move away in order to avoid significant discomfort or exhaustion.	9
	(c) Cannot, for the majority of the time, remain at a work station: (i) standing unassisted by another person (even if free to move around); (ii) sitting (even in an adjustable chair); or (iii) a combination of paragraphs (i) and (ii), for more than an hour before needing to move away in order to avoid significant discomfort or exhaustion.	6
	(d) None of the above applies.	0
3. Reaching.	3(a) Cannot raise either arm as if to put something in the top pocket of a coat or jacket.	15
	(b) Cannot raise either arm to top of head as if to put on a hat.	9
	(c) Cannot raise either arm above head height as if to reach for something.	6
	(d) None of the above applies.	0
		0
4. Picking up and moving or transferring by the use of the upper body and arms.	4(a) Cannot pick up and move a 0.5 litre carton full of liquid.	15
	(b) Cannot pick up and move a one litre carton full of liquid.	9
	(c) Cannot transfer a light but bulky object such as an empty cardboard box.	6
	(d) None of the above applies.	0
5. Manual dexterity.	5(a) Cannot press a button (such as a telephone keypad) with either hand or cannot turn the pages of a book with either hand.	15
	(b) Cannot pick up a £1 coin or equivalent with either hand.	15
	(c) Cannot use a pen or pencil to make a meaningful mark with either hand.	9
	(d) Cannot single-handedly use a suitable keyboard or mouse.	9
	(e) None of the above applies.	0
6. Making self understood through speaking, writing, typing, or other means which are normally or could reasonably be used, unaided by another person.	6(a) Cannot convey a simple message, such as the presence of a hazard.	15
	(b) Has significant difficulty conveying a simple message to strangers.	15
	(c) Has some difficulty conveying a simple message to strangers.	6
	(d) None of the above applies.	0
7. Understanding communication by: (i) verbal means (such as hearing or lip reading) alone; (ii) non-verbal means (such as reading 16 point print or Braille) alone; or (iii) a combination of sub-paragraphs (i) and (ii), using any aid that is normally or could reasonably be used, unaided by another person.	7(a) Cannot understand a simple message, such as the location of a fire escape, due to sensory impairment.	15
	(b) Has significant difficulty understanding a simple message from a stranger due to sensory impairment.	15
	(c) Has some difficulty understanding a simple message from a stranger due to sensory impairment.	6
	(d) None of the above applies.	0
8. Navigation and maintaining safety using a guide dog or other aid if either or both are normally used or could reasonably be used.	8(a) Unable to navigate around familiar surroundings, without being accompanied by another person, due to sensory impairment.	15
	(b) Cannot safely complete a potentially hazardous task such as crossing the road, without being accompanied by another person, due to sensory impairment.	15
	(c) Unable to navigate around unfamiliar surroundings, without being accompanied by another person, due to sensory impairment.	9
	(d) None of the above applies.	0
9. Absence or loss of control whilst conscious leading to extensive evacuation of the bowel and/or bladder, other than enuresis (bed-wetting), despite the wearing or use of any aids or adaptations which are normally or could reasonably be worn or used.	9(a) At least once a month experiences: (i) loss of control leading to extensive evacuation of the bowel and/or voiding of the bladder; or (ii) substantial leakage of the contents of a collecting device, sufficient to require cleaning and a change in clothing.	15
	(b) The majority of the time is at risk of loss of control leading to extensive evacuation of the bowel and/or voiding of the bladder, sufficient to require cleaning and a change in clothing, if not able to reach a toilet quickly.	6
	(c) Neither of the above applies.	0
10. Consciousness during waking moments.	10(a) At least once a week, has an involuntary episode of lost or altered consciousness resulting in significantly disrupted awareness or concentration.	15
	(b) At least once a month, has an involuntary episode of lost or altered consciousness resulting in significantly disrupted awareness or concentration.	6
	(c) Neither of the above applies.	0
	PART 2
	Mental, cognitive and intellectual function assessment
(1) Activity	(2) Descriptors	(3) Points
11. Learning tasks.	11(a) Cannot learn how to complete a simple task, such as setting an alarm clock.	15
	(b) Cannot learn anything beyond a simple task, such as setting an alarm clock.	9
	(c) Cannot learn anything beyond a moderately complex task, such as the steps involved in operating a washing machine to clean clothes.	6
	(d) None of the above applies.	0
12. Awareness of everyday hazards (such as boiling water or sharp objects).	12(a) Reduced awareness of everyday hazards leads to a significant risk of: (i) injury to self or others; or (ii) damage to property or possessions, such that the claimant requires supervision for the majority of the time to maintain safety.	15
	(b) Reduced awareness of everyday hazards leads to a significant risk of: (i) injury to self or others; or (ii) damage to property or possessions, such that the claimant frequently requires supervision to maintain safety.	9
	(c) Reduced awareness of everyday hazards leads to a significant risk of: (i) injury to self or others; or (ii) damage to property or possessions, such that the claimant occasionally requires supervision to maintain safety.	6
	(d) None of the above applies.	0
13. Initiating and completing personal action (which means planning, organisation, problem solving, prioritising or switching tasks).	13(a) Cannot, due to impaired mental function, reliably initiate or complete at least two sequential personal actions.	15
	(b) Cannot, due to impaired mental function, reliably initiate or complete at least two sequential personal actions for the majority of the time.	9
	(c) Frequently cannot, due to impaired mental function, reliably initiate or complete at least two sequential personal actions.	6
	(d) None of the above applies.	0
14. Coping with change.	14(a) Cannot cope with any change to the extent that day to day life cannot be managed.	15
	(b) Cannot cope with minor planned change (such as a pre-arranged change to the routine time scheduled for a lunch break), to the extent that, overall, day to day life is made significantly more difficult.	9
	(c) Cannot cope with minor unplanned change (such as the timing of an appointment on the day it is due to occur), to the extent that, overall, day to day life is made significantly more difficult.	6
	(d) None of the above applies.	0
15. Getting about.	15(a) Cannot get to any place outside the claimant’s home with which the claimant is familiar.	15
	(b) Is unable to get to a specified place with which the claimant is familiar, without being accompanied by another person.	9
	(c) Is unable to get to a specified place with which the claimant is unfamiliar without being accompanied by another person.	6
	(d) None of the above applies.	0
16. Coping with social engagement due to cognitive impairment or mental disorder.	16(a) Engagement in social contact is always precluded due to difficulty relating to others or significant distress experienced by the claimant.	15
	(b) Engagement in social contact with someone unfamiliar to the claimant is always precluded due to difficulty relating to others or significant distress experienced by the claimant.	9
	(c) Engagement in social contact with someone unfamiliar to the claimant is not possible for the majority of the time due to difficulty relating to others or significant distress experienced by the claimant.	6
	(d) None of the above applies.	0
17. Appropriateness of behaviour with other people, due to cognitive impairment or mental disorder.	17(a) Has, on a daily basis, uncontrollable episodes of aggressive or disinhibited behaviour that would be unreasonable in any workplace.	15
	(b) Frequently has uncontrollable episodes of aggressive or disinhibited behaviour that would be unreasonable in any workplace.	15
	(c) Occasionally has uncontrollable episodes of aggressive or disinhibited behaviour that would be unreasonable in any workplace.	9
	(d) None of the above applies.	0

Special Circumstances

There are certain circumstances whereby you may be able to bypass the normal system. 

You may be treated as exempt from having the medical (the limited capability for work assessment) if:

• you have a terminal illness, and you are expected to pass away within six months.
• you are receiving chemotherapy or radiotherapy for cancer.
• in the next six months you are likely to receive chemotherapy or radiotherapy for cancer.
• you are recovering from chemotherapy or radiotherapy for cancer.

If you fail the medical you may still get ESA if:

• you have a life threatening disease, and have medical evidence that it cannot be controlled.
• there is a risk to you if you were found fit for work.
• there is a risk to anyone else if you were found fit for work.

You may be placed in the Support Group (not have to do work related activity) without meeting the Support Group Descriptors, if:

• you have a terminal illness.
• you are receiving chemotherapy or radiotherapy for cancer.
• in the next six months you are likely to receive chemotherapy or radiotherapy for cancer.
• you are recovering from chemotherapy or radiotherapy for cancer.
• you are pregnant, and work related activity would harm your health or the health of the child you are carrying.
• there is a risk to your health if you are put in the Work Related Activity Group.
• there is a risk to the health of anyone else if you are put in the Work Related Activity Group.

All of the above require medical evidence. As such, if any of the above apply to you, and you do not already have medical evidence that spells it out fairly clearly it is advisable to get a doctor's letter that does. It is essential that doctor's phrase letters carefully so that they are not inadvertently used against their patients. There is a template letter on Black Triangle that you can ask your doctor to use. (It will be placed on this blog soon too). It is advisable when requesting a letter based on the above to give your doctor the legislation upon which it is based. You will find it here.

If the DWP is already aware of these circumstances applying to you, you may not be asked to fill in the application form for ESA (the ESA50). One way in which they might already know this information, is if you've supplied sick notes (now called fit notes) from your GP which contain the appropriate information. 

If you do fall into one of the categories above and wish to apply for ESA, but do not know whether they have that information, telephone them and ask. The person you speak to may do a short application questionnaire on the phone with you (it's called the ESA1). Tell them that Special Circumstances apply to you. If they do not currently have evidence of this they may then write to your GP requesting a letter to confirm it. 

If the person you speak to does not do the questionnaire with you, but confirms that they do not have the evidence that Special Circumstances apply to you, take the legislation and template letter to your doctor, and write a letter yourself telling the DWP that you wish to apply for ESA, but believe you are exempt from the ESA50 and / or the work related activity assessment (the medical). They may still send you the ESA50, but the chances are largely reduced.

Regulations 29 & 35

Regulations 29 and 35 are otherwise known as 'special circumstances'. The legislation below is explained in this post.

Regulation 29

Entitles you to be placed in the WRAG because work carries a substantial risk (of being made more ill) to you or another person.

Exceptional circumstances

29.

(1) A claimant who does not have limited capability for work as determined in accordance with the limited capability for work assessment is to be treated as having limited capability for work if paragraph (2) applies to the claimant.

(2) Subject to paragraph (3), This paragraph applies if—

(a) the claimant is suffering from a life threatening disease in relation to which—
(i)
there is medical evidence that the disease is uncontrollable, or uncontrolled, by a recognised therapeutic procedure; and
(ii)
in the case of a disease that is uncontrolled, there is a reasonable cause for it not to be controlled by a recognised therapeutic procedure; or

(b) the claimant suffers from some specific disease or bodily or mental disablement and, by reasons of such disease or disablement, there would be a substantial risk to the mental or physical health of any person if the claimant were found not to have limited capability for work

(3) Paragraph (2)(b) does not apply where the risk could be reduced by a significant amount by—

(a) reasonable adjustments being made in the claimant’s workplace; or

(b) the claimant taking medication to manage the claimant’s condition where such medication has been prescribed for the claimant by a registered medical practitioner treating the claimant.

Regulation 35

Entitles you to be placed in the Support Group because work-related activity (ie what you have to do if you are in the WRAG) carries a substantial risk (of being made more ill) to you or another person. Certain claimants to be treated as having limited capability for work-related activity

35.

(1) A claimant is to be treated as having limited capability for work-related activity if—

(a) the claimant is terminally ill;

(b) the claimant is-
(i) receiving treatment for cancer by way of chemotherapy or radiotherapy;
(ii) likely to receive such treatment within six months after the date of the determination of capability for work-related activity; or
(iii) recovering from such treatment, and the Secretary of State is satisfied that the claimant should be treated as having limited capability for work-related activity; or

(c)
in the case of a woman, she is pregnant and there is a serious risk of damage to her health or to the health of her unborn child if she does not refrain from work-related activity.

(2) A claimant who does not have limited capability for work-related activity as determined in accordance with regulation 34(1) is to be treated as having limited capability for work-related activity if—

(a) the claimant suffers from some specific disease or bodily or mental disablement; and

(b) by reasons of such disease or disablement, there would be a substantial risk to the mental or physical health of any person if the claimant were found not to have limited capability for work-related activity.