Employment and Support Allowance (ESA)

Employment and Support Allowance is the benefit to claim if you are working age, and your ability to work is restricted by your health or disabilities.

If you are having trouble with any part of the claiming process, or you have been refused, you are not alone! Please get in contact with us.

Do not give up once you have been refused – read our advice document by clicking on the link below.  Alternatively, you can read it in full below.

ESA help 14.01.16

 

Been Refused ESA? Take Action Now

This leaflet is designed to offer help if you or someone you know has been refused Employment and Support Allowance.  This is the main benefit that is supposed to provide you with an income if you have health problems which limit your ability to work.

There is another benefit called Personal Independence Payments (previously Disability Living Allowance) which is claimed if you have personal care or mobility needs, but this leaflet does not discuss this benefit.

The main thing is to not back down. You may receive a negative decision and get told you must claim Jobseekers Allowance, but this is not always the case!  Contact us, we want to hear from you.

 

Terminology:

ESA – Employment and Support Allowance

WCA – Work Capability Assessment – this is the legal test which decides if you are entitled to ESA.  It is not actually a face to face assessment, but really is a decision made by DWP, based on your ESA50 form and the medical evidence they get about you from Maximus.

WRAG – Work Related Activity Group, or the ‘lower’ of the two groups in ESA.  It has a stupid name, because you are put in this group if you have ‘limited capability for work related activity’ – i.e. if you are unable to work.  You do not have to jobseek in this group, but you do have to ‘participate in work-focused interviews’ and you can be sanctioned if you do not.

Support Group – this is the ‘higher’ of the two groups in ESA.  You are put in this group if you have ‘limited capability for work’.  You do not have to ‘participate in work-focused interviews’ in this group, and you are entitled to additional premiums on your benefit when you are in this group, so it is often a lot more money.

 

“I want to claim ESA”

You normally claim ESA by phoning 0800 055 6688 (Monday to Friday from 8.00am to 6.00pm).

After that, you are sent a large form to complete called an ESA50.

You then may be sent to a face to face assessment.  Before 2015, these were conducted in Leeds by a private company called ATOS at Lawnswood Medical Centre, but they are now often conducted by Maximus at Quarry House.  This is because of the public pressure that was put on ATOS because of the dreadful quality of their assessments at that time, which lead them to withdraw from the contract.  If you have had an assessment with Maximus, we want to hear from you!

After that, you receive a decision.

Get help from friends, family, or us, if you have any queries with the process.

 

Tips for your face to face assessment:

  • Always attend it, but if you can’t attend, phone DWP as soon as possible and explain why you can’t attend. Do not back down.  Look to complain if you do not appear to be getting an outcome – workers at DWP can make a home visit if you are unfit to travel.
  • You have the right to ask in advance to have the examination audio recorded and they have to comply with your request “wherever possible”.
  • You are free to bring a friend or helper with you to the assessment, and this is always
  • You might have complaints over the arrangement of the assessment, or of the behaviour of staff, or of the quality of their report about you. If so, put a complaint in writing.  The complaints address for Maximus is: Ash House, The Broyle, Ringmer, East Sussex, BN8 5NN.  You can also email customer-relations@chdauk.co.uk.  If your complaint concerns the behaviour of an assessor, you can also escalate these complaints to the General Medical Council and their number is 0161 923 6602.

 

Tips for filling in your ESA50:

In order to get ESA, the DWP must be persuaded that you either:

  • Meet 15 points under a set of legal descriptors (discussed below), or
  • You score one of the ‘support group’ descriptors, or
  • Your health means there would be a substantial risk to any person’s physical or mental health if you do not receive a positive decision

It’s therefore a good idea to look up what these descriptors are.

  • Try to think which actual descriptors you meet, and target your answers in your ESA50 towards these ones. For example, you may have physical health problems and realise you have to show you can’t walk more than 100 metres without stopping, in which case you should make sure you give facts about why this is true in your case.
  • Don’t forget the ‘substantial risk’ rule. If you used to work, but have had suicidal periods or attempts, try to comment on these in the final box on the form.
  • Try to give clear examples of what you haven’t been able to do, or how you’ve had to adapt because of your health problems. For example if you needed to use a temporary wheelchair at an airport or large shop, write about this.  If you missed a close relative’s birthday because you couldn’t leave the house because of anxiety, write about this.
  • Avoid phrases like ‘on a good day’ or ‘sometimes I am able to…’. This may be true and you may want to give a balanced picture, but it may give justification for DWP not to award you the benefit.
  • Do not be scared about being accused of fraud. A very small proportion of ESA claimants are ever accused of fraud (less than 1%) and this normally comes after a period of claiming, not during the claim process itself.  If you have health problems, you are not a fraud.

 

“I have received my decision and it’s wrong!”

You get a decision by post.  Either you are in the highest group (the Support Group), or you are in the lower group (the Work-Related Activity Group), or they have decided you are not entitled.

If you think the decision is wrong, don’t back down!  You have a right of appeal, so you should appeal.

You first step is writing a letter to them.  You have one month to post this letter, normally called a Mandatory Reconsideration of the decision.  This is to try and get DWP to change their minds.

You don’t need to put further medical evidence with your letter, so don’t delay sending off the letter if you are waiting for medical evidence – you can send it to them later.

 

The letter should look like this:

[Your Name]

[DWP address – you should send it to the address on your decision letter. It is normally: Post Handling Site B, WolverhamptonWV99 1PB]

[Your address]

[Your National Insurance Number]

 

Mandatory Reconsideration request (ESA decision [date of decision letter])

I am writing to request mandatory reconsideration of your recent decision not to award me ESA / putting me in the WRA Group.  I think the decision is wrong.

I don’t think you understand how my health limits my ability to work. [You could leave it at that, or you could try and say where they have gone wrong, add other facts, include medical evidence, include a letter from someone who knows you, or anything else you think might help – remember, try to look at the descriptors first].

Please look at my decision in the next 14 days.

Yours faithfully

 

[Your name]

 

 

What happens next?

DWP should then phone you.

If they don’t change their minds after your letter, don’t back down!  You have a right to appeal to a tribunal next, and if you do this, your ESA will also be put back into payment.

You appeal on a form called an SSCS1 – you can get these off the internet, or a Jobcentre, or a Citizens Advice Bureau or other advice agency.

Again, you don’t need to include further evidence in an SSCS1, but if you have any, do include it.

It asks you if you “want to attend a hearing of my appeal” – tick YES to this – you are much more likely to win.

 

Benefits after you get a negative decision

If you get turned down for ESA, your payments will unfortunately stop.  Once you have sent off a mandatory reconsideration letter, got a reply, and then sent off your SSCS1 form, your ESA payments should start again.  However, in between this period (normally 3-6 weeks) you will be without money.  You therefore have to, for this short period, claim Jobseekers Allowance.

Claiming Jobseekers Allowance isn’t admitting you are fit for work.

You can normally only claim Jobseekers Allowance over the internet at www.gov.uk

You can try to phone to make a claim (Freephone 0800 055 6688, Monday to Friday from 8.00am to 6.00pm) but you may find that they tell you to use the internet of friends or family, local free internet services, or claiming online at your local Jobcentre.

During this time, you may get a letter that your Housing Benefit is being suspended.  Don’t worry.  DWP tell Leeds City Council that your ESA award has stopped, but as soon as you tell the council that it is because of your appeal, and once your benefit payments have started again, they should pay you the full housing benefit again for the whole period.

 

Where should I get medical evidence?

You could try your GP.  You may find however that your GP won’t write medical letters without charging you – normally anywhere between £25 and £200.  You won’t know unless you ask.

Often, specialists such as a mental health nurse, psychiatrist, physiotherapist, or even a social worker or other worker, may write you a letter for free.  You may no longer be with them, but if you saw them in the last 6 months it’s well worth asking them.

Also, letters from people who know you personally might help.  For example if you are on good terms with your local shop owner, and they see how you walk, even a short letter from them can be good evidence.

 

“I’ve got a tribunal hearing!”

If you have a tribunal hearing, this is a good thing.  They are independent from the DWP and this is your final chance to overturn the decision.

You will get at least 14 days notice of the hearing.  You do not need to dress up smart – even though it’s a kind of court, it’s supposed to be informal.

You might have an impression of what a court is like, but it is probably very different to what a benefits tribunal is actually like.  They normally take place in small rooms with a desk in.  There is no jury or raised benches.  You are not there to be punished – they just want to find out from you whether the decision is wrong or not.  Probably nobody from DWP will be there.

You will not have to stand up and speak – you will only have to answer questions that the panel (two people, normally called a judge and a doctor) ask you, so don’t prepare anything to say. If you don’t understand a question, ask them to repeat it or put it another way. If you still don’t understand, tell them that.  If they get something wrong, tell them.

You can bring anyone with you into the hearing.  They probably won’t be allowed to speak, but they can be supportive.

We wary that you may be observed from the moment you arrive, and you will probably be asked how you got to the tribunal.  If you have anxiety, don’t travel alone to the tribunal – get a friend to help, or failing that, a taxi.

You normally get the tribunal decision on the day, or it is posted to you.

 

Further help:

Leeds City Council’s Welfare Rights Unit are a large provider of free benefits advice.  They may be able to assist you to make appeals and write submissions to a tribunal.

Tel: 0113 376 0452 (you will have to leave a message with your details)

Email: welfare.rights@leeds.gov.uk

Address: St George’s Centre, St Georges Rd, Leeds LS10 4UZ

 

Leeds Citizens Advice Bureau

Tel 0113 223 4400 (Mon-Fri 9am – 5pm)

Open at 31 New York Street, LS2 7DT from 9am weekdays

 

Age UK (if you are over 50)

0800 169 29 39 (8.00am – 7.00pm)

 

Scope/Dial (if you have a disability)

0808 800 33 33 (weekdays 9am to 5pm)

 

Archway (if you are aged 16 – 25)

0113 383 3900, 95 Roundhay Road, Leeds LS8 5AQ

The Resource Centre is open and staffed for drop-in every Monday and Thursday, from 10am – 6pm, every Tuesday from 10am – 8pm and every Friday from 10am – 5pm.

 

Macmillan (anyone affected by cancer and who pays Leeds Council Tax)

0808 808 00 00 (Freephone Monday to Friday, 9am-8pm)

 

ASHA (South Asian ethnicity)

0113 270 4600

 

Disabled Students helpline (if you are a disabled student)

0800 328 5050

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