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Employment and Support Allowance
A W4MP guide for MPs' Staff dealing with casework involving ESA

Added: 3 December 2009

Index

  1. Qualification

  2. Backdating and advance claims

  3. Linking

  4. Types of ESA

  5. Phases of ESA

  6. Premiums

  7. Work Capability Assessment

  8. Problems with Medical Certificates

  9. Permitted Work

  10. Work Focussed Interviews (WFI)

  11. Appeals and Reconsiderations

  12. Conclusion


Employment and Support Allowance (ESA) was introduced in October 2008 as a hybrid benefit intended to replace Incapacity Benefit (IB) and part of Income Support (IS) for new customers and eventually for existing customers.  It is processed by Benefit Delivery Centres (BDC), part of the JobCentrePlus Agency. 

1.  Qualification

 To be entitled to ESA, a customer needs to satisfy all the following basic conditions. Applicants must:

  • have a limited capability for work;

  • not be in work (they can be employed but not able to work);

  • be aged 16 or over;

  • be under pensionable age;

  • satisfy residence rules;

  • not be entitled to Income Support (IS), Jobseekers Allowance (JSA) or Statutory Sick Pay (SSP);

2.  Backdating and advance claims

ESA claims can be backdated for up to 3 months at the discretion of the Decision Maker.

If a customer is receiving Statutory Sick Pay (SSP) and will still be sick at the end of the SSP an ESA claim can be made in advance before the end of the SSP.

3.  Linking

If a customer comes off benefits, but then becomes ill again within twelve weeks of the previous claim, they may be able to get ESA as before, but they must obtain a sick note from the first day of their illness, otherwise they may lose money.

ESA claims can link with previous ESA claims or claims to other benefits. ESA does not link to Incapacity Benefit (IB).

If an ESA claim is received that links to a previous IB claim the new claim will also be for IB. Likewise if a claim to IB is received that does not link to a previous IB claim the new claim will have to be for ESA. Linking to a previous claim allows customers to return to their previous benefit rate.

IB claims link if the new claim is within eight weeks of a previous claim.

In addition a 104 week linking period can apply – see below for conditions.

ESA claims normally have a three day waiting period when no benefit is paid, but claims linking to some benefits will be paid from day one. ESA claims link if a new claim is within twelve weeks of a previous claim or within 104 weeks if the following conditions are satisfied:

  • a customer moved into work or training within one month of the benefit ending;

  • was not disqualified through failing a PCA/ WCA;

  • was not disqualified through not attending a medical;

  • was not disqualified through failing to return the form IB/ESA 50;

  • have previously had one or more Period of Limited Capability for Work (PLCW) of more than 13 weeks.

Benefits ESA links with are as follows:

  • Income Support (IS);

  • A previous Employment and Support Allowance (ESA) claim;

  • Pension Credit (PC);

  • Jobseeker’s Allowance (JSA);

  • Carer’s Allowance (CA);

  • Statutory Sick Pay (SSP);

  • Maternity Allowance (MA);

4.  Types of ESA

There are two types of ESA:

  1. Contribution based ESA (CB) is dependent on having the required National Insurance credits and a minimum income for the qualifying two years. The length of ESA (CB) is not limited and continues until the end of the claim. Some pension income may be taken into account, but other income will not.

  2. Income related ESA (IR) is means tested and allows access to other help such as Housing Benefit, free prescriptions etc. Any household income, or capital, will be taken into account so an ESA (IR) claim requires more information than ESA (CB). This information includes household income, capital, details of other household members and housing costs.  Customers claiming ESA (IR) can claim for a partner.

Customers can claim both types of ESA and will automatically be allocated the more suitable or a combination of the two.  If the amount of ESA (CB) is equal to or exceeds ESA (IR) the customer will receive ESA (CB). If the amount of ESA (IR) would exceed ESA (CB) the customer receives a mixture and is counted as receiving ESA (IR). If a customer claims both and is entitled to ESA (CB) and does not give enough information to assess an ESA (IR) claim ESA (CB) will be awarded.

5.  Phases of ESA

There are two phases of ESA:

  1. The initial phase is the first thirteen weeks of the claim and benefit will equate to basic Jobseekers Allowance (JSA).

  2. The main phase is paid normally from the start of the fourteenth week of the claim but only if the customer has passed the medical process Work Capability Assessment (WCA). If the WCA is passed after the start of the fourteenth week payment of the main phase will be backdated. Those customers accepted as being terminally ill are put in the main phase from the first day of the claim.

6.  Premiums

Premiums are paid only to customers entitled to Income Related ESA. The regulations are complicated but this is a breakdown:

  • Currently Pensioner Premium is paid where the customer is 60 or over (but not their own pensionable age). This will change to match the new retirement ages for women from 2010."  It is reduced or replaced by the main phase component.

  • Enhanced Disability Premium is paid when a customer is under 60 and receives either DLA care component higher rate or is in the Support Group.

  • Severe Disability Premium is paid in some cases where DLA care component is in payment at middle or higher rate, but other conditions apply. It can be paid in addition to Pensioner Premium or Enhanced Disability Premium.

7.  Work Capability Assessment (WCA)

Almost all ESA customers will have to go through the WCA and Work Focussed Health Related Assessment (WFHRA). This process is handled by an outside contractor (currently Atos Origin) and normally both assessments will be covered by the one medical. The process normally consists of completing a form ESA50 and attending a medical. Failure to comply with any part of the process can lead to disallowance. The process should be started at the latest by one month after the beginning of the claim.

Exceptions

There are a few customers who may be exempt from taking part in the WCA process. These customers include customers who are:

  • terminally ill;

  • receiving regular treatment such as weekly haemodialysis or  intravenous, intraperitoneal or intrathecal chemotherapy treatment;

  • recovering from intravenous, intraperitoneal or intrathecal chemotherapy treatment;

  • in a period of confinement for pregnancy;

  • recovering from treatment as an in-patient;

Results of WCA and WFHRA

If a customer is assessed as having fifteen points or more by an Atos medical professional they have passed the WCA. The customer will be placed in the Work Related Activity Group (WRAG) or Support Group. They will receive an additional component the amount depending on which group they are placed in. After passing a medical, customers are no longer required to send in medical certificates.

Customers placed in the WRAG will have to continue attending the Jobcentre for WFI. At present (2009) customers in the WRAG receive £25.50 extra a week.

Those in the Support Group can request to continue with the WFI process if they wish. At present (2009) they receive £30.85 extra per week, but if on ESA (IR) and placed in the support group they will also receive Enhanced Disability Premium if not already in payment.

The WFHRA report is forwarded to the customer’s Jobcentre who conduct the Work Focussed Interviews (WFI).

A customer who is assessed at fewer than fifteen points can appeal.

8.  Problems with Medical Certificates

A high percentage of MP enquiries received by BDCs have related to medical certificates due to the way the ESA system handles payments if a medical certificate ends before a customer’s payday.  The guidance has now been changed to allow ESA processors to add up to ten days to a medical certificate to match with a customer’s pay day. This should ease this problem as long as local offices keep up to date with the guidance.

9.  Permitted Work

To enable them to ease back into work ESA customers can be allowed to do “Permitted Work”. This is a Benefit Delivery Expert decision and requires permission although that permission can be backdated. There are three types of permitted work:

  1. Permitted Work higher limit – A customer can receive weekly payment up to a (current) limit of £92 while working less than 16 hours a week. This is for a maximum of 52 weeks.

  2. Supported permitted work – This is restricted to certain categories of customers who would normally only to expect to work with support. Earnings are restricted to a maximum of £92 per week and supervision must be provided within the workplace.  It can continue after a year.

  3. Permitted Work lower limit – the current maximum earnings are £20 per week, but there is no limit on hours or length of employment.

10. Work Focus Interviews (WFI)

The purpose of ESA is to “encourage” customers back to work, if possible, and therefore the majority of customers will be required to take part in Work Focussed Interviews (WFI). This consists of attending an interview at a Jobcentre to discuss preparation for returning to work. Failure to attend a WFI will result in a sanction being applied to the customer’s benefit once they are placed in the main phase. This sanction will not be imposed or will be lifted once the customer attends the WFI.

11. Appeals and Reconsiderations

Customers can appeal or ask for a reconsideration of any ESA decision.  Reconsiderations are done at a customer’s local office and are usually fairly quick (within a week under normal circumstances).

Appeals are heard by an independent tribunal and usually takes months to process. When a customer appeals, reconsideration will automatically be done in the local office, before the appeal is processed. Customer’s appealing most decisions, such as WCA, will continue to be paid at the base rate until the appeal is heard.

However customer’s appealing disallowance for failing to attend a medical will not be paid during the appeal and would normally be expected to claim JSA. Customers can also be disallowed for failing to return the questionnaire ESA50 within a six week period, but once the form is received these disallowances will normally be reviewed within the local office.

Customers can appeal against any other decision made on their case, but the most common appeals are to do with the WCA process.               

At any time before the tribunal meets the customer can withdrawn an appeal. If the customer fails to provide information requested by the tribunal the appeal will be struck out, but might be re-opened if the information is received within a month.

12. Conclusion

ESA is an incapacity based benefit which is expected to replace Incapacity Benefit and the incapacity related part of Income Support for all customers.  It works on the principle of encouraging customers back into work instead of claiming benefit long term.  It is one of the most complex benefits so this can only be a brief overview. Please contact any Benefit Delivery Centre for further information.

SW December 2009

 

 


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