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 Employment and Support Allowance:

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PostSubject: Employment and Support Allowance:    Thu Nov 15, 2012 11:23 pm

Employment and Support Allowance:
Outcomes of Work Capability
Assessments, Great Britain – new claims


The GOV.UK website provides a complete explanation of eligibility at the following links:

https://www.gov.uk/employment-support-allowance#overview

https://www.gov.uk/employment-support-allowance/eligibility

3.1.1. Claimant conditions

Employment and Support Allowance can be awarded on the basis of low income or National

Insurance (NI) contributions:

Income-related Employment and Support Allowance (ESA-IR) – in this instance a claimant may

be entitled to claim the benefit (regardless of how much they have paid by way of NI

contributions), if they satisfy the conditions relating to financial position. This means they must

have savings of less than £16,000, and if they have a partner or civil partner, this person must

work for less than 24 hours per week on average; and

Contributory Employment and Support Allowance (ESA-C) – in this case a claimant may be

entitled to claim contributory Employment and Support Allowance if they have paid enough NI

contributions. From May 2012, the Welfare Reform Act 2012, will time limit ESA-C to 12 months

for those in the Work Related Activity Group; however those exhausting ESA-C may still be

eligible for ESA-IR if they meet the conditions.

Note that those entitled to ESA-C in the Support Group and ESA-IR: Work Related Activity Group and

Support Group claimants are not subject to this time limit

3.2. Benefit structure

Time on Employment and Support Allowance is divided into two phases by the process of assessing

work capability.

17 3.2.1. Assessment phase (this lasts 13 weeks)

When a claimant first applies for the benefit, they are put into the assessment phase. During this

time, they are assessed through the Work Capability Assessment process. Individual claimants do

not have to engage in work-related activity. They receive benefit paid at the assessment phase rate

(equivalent to JSA personal allowances).

While in the assessment phase, the claimant has to provide up-to-date medical certification of their

disability or illness, and is assessed against the criteria set out in legislation. Most of them are sent a

limited capability for work questionnaire (also known as the ESA50) and following completion are

invited to a face to face assessment carried out by a trained healthcare professional (HCP) working

for Atos Healthcare. However, depending on the severity of an individual’s condition some claimant

journeys will differ; for example those who are terminally ill or otherwise have sufficient medical

evidence are fast-tracked into the Support Group on the basis of paper evidence rather than having

an assessment.

Information gathered through the questionnaire and the face to face assessment, together with any

other evidence provided by the claimant, is used by the DWP’s decision maker to determine their

eligibility for Employment and Support Allowance main phase.

3.2.2. Main phase (outcomes of the Work Capability Assessment process)

After the face to face assessment, a claimant can have three possible outcomes:

Individuals can be found fit for work –

in this case their claim closes and the claimant can move to JSA or it remains open pending

recourse against the decision, via reconsideration from DWP or appeal to HMCTS. If redress

is sought, the pre-assessment rates remain until closure;

Individuals can be found to have limited capability for work –

in this instance they are allowed the benefit and placed in the Work Related Activity Group.

Those in this group are not expected to work, but are provided with help and support to

prepare for work where possible. They receive a higher rate of payment than those on JSA;

and

Individuals can be found to have limited capability for work and in addition, limited capability for

work related activity –

in this situation they are allowed the benefit and placed in the Support Group. Those in this

group have the most severe functional impairments, and so are provided with unconditional

support and receive a higher premium than those in the Work Related Activity Group.

3.2.3. Repeat assessments

All claimants in the Work Related Activity Group and Support Group are given a prognosis of when

they may be fit for work. Individuals are then reassessed through repeat assessments after the initial

or last prognosis period expires.

The interval between assessments is usually but not always a standard length of time such as 3, 6,

12, 18 or 24 months based on the claimant’s health. This is to ensure that they are still eligible to

Employment and Support Allowance and are allocated to the correct group. Repeat assessments

include around 0.1% of those who originally migrated from Incapacity Benefit.

3.4. Assignment information

3.4.1. Reason for group placement

The tables below detail some of the reasons for placement into the Work Related Activity Group or

Support Group. The reasons offered below are merely inferences based on the claimant’s medical

condition and their assessment decision. This is because Employment and Support Allowance

entitlement and allocation is not based on the condition of the claimant but instead is based on the

effect that this has on their ability to work. For example an individual will not qualify simply because

they have arthritis, but could qualify if their condition means they have severe difficulty holding a pen.

3.4.2. Reasons for assignment to the Work Related Activity Group

Figure L: Reason for placement in the Work Related Activity Group

Reason Explanation 15 points or more

This is where claimants score 15 points or more against the functional descriptors laid down in

legislation. This award is based on the following functional impairment descriptors:

Physical functions

Lower limb – inability to mobilise, stand, sit;

Upper Limb – inability to reach, pick up and/or lack of other manual dexterity;

Sensory – inability to make self understood, understand communication or navigate safely

Continence – limitation of control over the bladder and bowel;

Consciousness – involuntary loss of consciousness;

Mental, cognitive and intellectual functions

Understanding and focus – this relates to inability to learn tasks, to be aware of hazards, inability to

initiate and complete tasks;

Adapting to change – this is to do with inability to cope with changes to routine, to get about; and

Social Interaction – this relates to inability to deal with other people.

Note that scoring 15 points or more is the most prevalent reason for being in the WRAG.

Medical reasons

This combines claimants with non-functional descriptors or those treated as limited capability to

work at assessment. This award can be based on the following non-functional impairments:

suffering from a life-threatening disease – this is where there is medical evidence that the disease

is uncontrollable or uncontrolled by a recognised therapeutic procedure, and 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; and suffering from some specific disease or bodily or mental disablement – this is whereby reasons

of such disease or disablement, there would be a substantial risk to the mental or physical health of

any person if they were found not to have limited capability for work.

It can also be based on the following limited capability to work:

undergoing regular treatment – this means receiving regular weekly treatment, such as by way of

20 haemodialysis for chronic renal failure, treatment by way of plasmapheresis or by way of radiotherapy,

or by way of total parenteral nutrition for gross impairment of enteric function;

undergoing medical or other treatment as an in-patient to a hospital or similar institution;

recovering from treatment as an in-patient to a hospital or similar institution;

undergoing pregnancy and in receipt of Maternity Allowance with an ESA top-up;

during a period of confinement for pregnancy; and pregnant where there is a risk of harm to the mother and/or child.

Clerical assessment

This is where the Atos Healthcare recommendations are recorded clerically. In such cases,

WRAG assignment is determined from the DWP decision maker information only, and so no

more detail about the nature of the health situation is recorded on the database.

At reconsideration

There are some cases because they come after DWP reconsiderations that are recorded

clerically. Once again in such cases, WRAG assignment is determined from the DWP decision

maker information only, and so no more detail about the nature of the health situation is

recorded on the database.

Here the Atos Healthcare recommendations may differ from the DWP decision, or else

recommendation might have changed but the revision is not on the system.

After appeal This is where a small number of cases because they come after appeals to HMCTS in favour of

the claimant are recorded clerically. Once more in such cases, WRAG assignment is

determined from the DWP decision maker information only, and so no more detail about the

nature of the health situation is recorded on the database.

Here the Atos Healthcare recommendations may differ from the DWP decision (after appeal

process). Note that claimants initially found FFW in the process of appealing remain in this

category for the purpose of statistical outputs until their cases are heard.

The GOV.UK website provides a broad explanation at the following link, including a document

explaining the functional impairments in further detail:

https://www.gov.uk/employment-support-allowance/overview

http://www.direct.gov.uk/prod_…..177366.pdf

3.4.3. Reasons for assignment to the Support Group Reason for placement in the Support Group

Reason Explanation

Chemotherapy This is where claimants are receiving certain types of chemotherapy, which qualifies them for

the SG. This award is based on the following limited capability to work at assessment:

receiving treatment by way of intravenous, intraperitoneal or intrathecal chemotherapy or is

likely to receive such treatment within the next 6 months; or

recovering from intravenous, intraperitoneal or intrathecal chemotherapy treatment.

Physical or Mental Health Risk

This is where regulations allow that in ‘exceptional circumstances’ claimants be put into the

(WRAG or) SG, if there would be serious risk to the mental or physical health of any person

were they found FFW (and they do not meet the usual criteria for WRAG or SG).

Pregnancy Risk This is where pregnant claimants are put in the SG, if there is a serious risk to her own health

or that of the unborn child were they found FFW.

Severe disability

This is where claimants meet the functional criteria for the SG, covering physical and mental

capacity

Terminally ill This is where claimants are diagnosed as terminally ill with a prognosis of 6 months or less.

Note that the department does not always capture the reason for placement in the Support Group (as with the Work Related Activity Group). This is often due to assessments recorded clerically where the reason is not stated, such as where assignment follows an appeal or reconsideration.

21 The legislation, specifically Part 6, gives more detail on allocation at the following link:

http://www.legislation.gov.uk/…..view=plain

3.8. Benefit rates

Employment and Support Allowance is paid at different rates depending on claimant’s situation and

stage in claim process:

3.8.1. Assessment Phase

The assessment phase rate, or basic rate, is normally paid for the first 13 weeks of the claim while a

decision is made on the claimant’s limited capability for work through the Work Capability Assessment

process. The assessment phase rates are aligned to those for JSA.

Additional premiums may be paid as part of income-related Employment and Support Allowance to

provide support for specific needs for example as a result of disability, age or caring responsibilities.

3.8.2. Main Phase

The main phase starts from week 14 of the claim for individuals who are assessed as having limited

capability for work. In the main phase claimants receive an additional Work Related Activity

component or Support component on top of the basic rate.

In addition to the premiums payable during the assessment phase, anyone receiving income-related

Employment and Support Allowance in the Support Group will automatically receive the Enhanced

Disability Premium, if they have not previously qualified for it.

23 The GOV.UK website provides the latest full information on rates at the following link:

https://www.gov.uk/employment-support-allowance/what-youll-get
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