Employment and Support Allowance

Transcription

1 Employment and Support Allowance ESA - How to claim factsheet This factsheet is about employment and support allowance (ESA). It explains the different types of ESA and tells you how to claim. It also explains the various stages of the ESA assessment process and gives information about attending your medical assessment. If you need advice on completing your medical questionnaire (form ESA50) please ask for our factsheet called Guide to completing form ESA50. What is employment and support allowance? Employment and support allowance (ESA) is a benefit paid to those who are unable to work because of ill health or disability. From October 2008 ESA replaced new claims for incapacity benefit (IB), severe disablement allowance (SDA) and income support (IS) paid on the grounds of incapacity. The Jobcentre Plus (JC+) is in the process of reassessing existing claimants of these benefits to check whether they are entitled to ESA. Our ESA factsheets are also useful if you are an existing IB/IS/SDA claimant who is being reassessed for the new benefit (ESA) as they provide advice on filling in your medical questionnaire form (ESA50) and attending your medical. Am I entitled to ESA? You must be aged 16 or over and under pension age to claim ESA. There are two types of ESA - contribution based ESA and income related ESA. You could get either type of ESA, or both, depending on your circumstances. Contribution based ESA - ESA(C) Contribution based ESA is paid on the basis of the national insurance contributions you have paid (or been credited with if you have been on certain benefits) in specific tax years prior to your claim. ESA(C) is not means tested so is payable regardless of the amount of your or your households income or savings. If you have an occupational pension that pays more than 85 a week then your ESA(C) payment is reduced by half of the amount over this limit. The one year time limit In April 2012 the rules changed so that ESA(C) is now time limited to 52 weeks unless you are placed in the support group, in which case it is paid indefinitely as long as you continue to meet the entitlement conditions for it (see below to find out about the support group). When your ESA(C) ends after a year, you should check whether you are entitled to income related ESA (see below). You may be entitled to national insurance credits but will still have to meet eligibility criteria Income related ESA - ESA(IR) If you do not satisfy the national insurance conditions to get contribution based ESA, or your contribution based ESA has ended after the 1 year time limit, you may qualify for income related ESA. ESA (IR) is means tested so qualifying depends on how much savings and income you have. If you have a partner whose earnings are over

2 the allowed limits/threshold, you may not qualify. Depending on your circumstances you could get ESA(IR) to top up ESA(C), for example, if you are severely disabled or a carer or have mortgage costs. What about young people who have not worked/paid contributions? ESA in youth (ESA(Y)) has been abolished for new claims from 30 April Prior to this, those under 20 (25 in certain circumstances) could get ESA(C) without having to satisfy the contribution conditions. For those currently receiving ESA(Y), their ESA will be time limited to a year unless they are in the support group, though they may be entitled to ESA(IR) depending on their circumstances. What if I am employed? If you are off sick from work and your employer is paying you statutory sick pay (SSP) you cannot claim ESA just yet. SSP is usually paid for the first 28 weeks of sickness absence. You may be entitled to a top up of income support whilst you receive SSP. If you are still unable to work after this then you can claim ESA, even if your employer continues to pay you contractual sick pay. ESA - the claim process How do I claim ESA? Call the Job Centre Plus claim line on If you have difficulty using the phone then you can ask for a paper form to be sent to you instead or it is possible for someone to make the phone call on your behalf. There is a text phone service for those with a speech or hearing impairment on You can also download a claim form: Job Centre Plus call operator will take information from you and complete your claim over the phone. It is helpful to have as much information to hand as possible, for example; your national insurance number, bank account details, doctors name, address and phone number and details of your income, savings and mortgage. What happens after I claim? Job Centre Plus (JC+) will send you a copy of your claim form. You need to check it carefully. If any information is wrong or missing you need to amend it and return it to Job Centre Plus along with any documents they ask you for. You also need to send in a medical certificate (fit note) from your doctor. Your claim will then be assessed. The assessment period The first 13 weeks of your claim is called the assessment phase. During this period ESA is paid at a basic rate while the JC+ assesses your capability for work. You will undergo a work capability assessment (WCA). This test looks at your physical and mental health issues and assesses whether you have limited capability for work. You will be sent a questionnaire (ESA50) and most people will be asked to attend a face to face assessment carried out by a healthcare professional. To qualify for ESA you must satisfy the test or be exempt from the test.

3 Who is exempt from the test? You are exempt from the test if you are: terminally ill having/recovering from/likely to start chemotherapy within 6 months pregnant or have recently given birth, entitled to maternity allowance (MA) & are within the MA payment period pregnant or have recently given birth, but are not entitled to MA or statutory maternity pay from six weeks before the due date to two weeks after the birth pregnant and there is a serious risk to you or the unborn child if you do not refrain from work excluded from work due to an infectious disease. a hospital in patient (includes residential drug or alcohol rehabilitation programmes) or recovering from such in-patient treatment a student in full time education who is eligible for income related ESA because you receive DLA or PIP (must not be under 20 in full time nonadvanced education/training) someone who has problems conveying food or drink to the mouth someone who has problems chewing or swallowing food or drink receiving or recovering from one of the following treatments; haemodialysis for chronic renal failure, plasmapheresis, radiotherapy or total parenteral nutrition Exceptional circumstances If you do not score enough points under the WCA you may be treated as having limited capability for work. If you can prove that 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. This is called Regulation 29. The ESA50 questionnaire Around 4 weeks after making your claim you will be sent a medical questionnaire (form ESA50). This form is important as your answers help the JC+ assess how your health condition affects your ability to work. You must return the form by the date given in the letter sent with the form. The JC+ will consider the information in your ESA50 questionnaire plus any supporting evidence you send them when deciding whether you need to 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 (see below). Filling in the ESA50 questionnaire To be found to have limited capability for work you must score at least 15 points from any combination of descriptors in the questionnaire. There is a series of tick box questions about how your physical and/or mental health condition affects your ability to carry out certain activities or functions. Each activity or function has a points value (0, 6, 9 or 15 points), A diagnosis of a particular condition does not mean that you will automatically pass the test.

4 Do not simply tick the boxes indicating you have difficulty with a specific activity. You need to use the space provided to give details about your problems and how doing certain tasks affects you. Take your time filling in the form, include as much detail as possible and give examples. It is helpful to send in letters or reports which may support your claim, these could be from your doctor, counsellor or support worker for example If you need help filling in the form, ask for our ESA50 factsheet which gives more detailed advice on completing the ESA50 questionnaire. What if I fail to return form ESA50 or return it late? It is very important to send back your completed ESA50 form within the deadline. If you are having problems filling in the form, there is a delay getting the help you need or you have other good reasons your form is late, it is advisable to contact ESA to let them know - they may be willing to extend your deadline in some circumstances. Remember - if you fail to return your form or it is late, you will be treated as being capable of work and your benefit will stop unless you can show good cause for not returning the questionnaire on time. Attending the medical assessment Most people will be asked to attend a medical. You may not be called for a medical if you have a very severe disability and there is enough information to show that you should be in the support group (see below). From March 2015 MAXIMUS will carry out medical assessments on behalf of the JC+, having taken over from ATOS. MAXIMUS provides the JC+ with independent advice that helps the JC+ decision maker decide on your entitlement to benefit. The medical assessment is carried out by a qualified health care professional (HCP) who will have a copy of your ESA50 and any other information you sent. Failure to attend the medical assessment without good cause will mean you will be found capable of work and your benefit will stop. The HCP carrying out your medical assessment will come to the waiting room and call your name once they are ready to see you. On the way to the examination room they will have the opportunity to observe you rising from your chair, walking to the examination room and taking your seat there. They will also observe your ability to sit during the examination. It can be helpful to take someone with you to your medical to help you remember and to help you explain things, especially if you are anxious or have difficulties communicating. If it is not possible to take someone, it s a good idea to write down things you want to say beforehand to help you remember. You will be asked questions about your typical day. Try to give full answers, for example, if you are asked what time you get up in the morning, tell them what time but also explain about any difficulty such as pain, fatigue or lack of

5 motivation. If you are asked whether you dressed yourself that morning, give information about how long it took you and what you had difficulty doing. Remember to explain how your condition fluctuates and to explain whether doing an activity on one day affects you the day after. You may also be asked what would help you get back to work. It is worth thinking about this beforehand and asking for things that would be beneficial to you. It might include things like counselling, voluntary work, help with transport, special equipment. If you would like to do some training but have difficulty dealing with large groups of people, say so. You can ask for your medical to be recorded & request a copy on CD free of charge. You need to request this in advance and doing so may delay your medical. After the assessment phase the decision If you pass the work capability assessment (WCA) you move into main phase ESA You will receive an additional amount of ESA. The amount depends on whether you are placed in the work related activity group or the support group. If you qualify for income related ESA you may also get extra money if you are in the support group, are severely disabled, a carer or have mortgage costs. What is the support group? If you are placed in the support group you have been assessed as having limited capability for work related activity. This means that you do not have to undertake work related activities, though you can if you wish to. You will now get an additional payment (a support component) on top of your basic rate of ESA. The support component is paid at a higher rate than the work related activity component Remember, being in the support group means that if you qualify for ESA(C) then it is not time limited to one year (as it is for those placed in the work related activity group). Being in the support group will also exempt you from the benefit cap. You will still be subject to work capability assessments (WCAs) so you will receive ESA50 questionnaires and may be asked to attend medicals.the frequency of these assessments will depend on your particular circumstances. You will have repeat WCAs to make sure that you are still in the correct group and that you receive the support you need to return to work if your health improves. What is the work related activity group? Most ESA claimants are placed in the work related activity group. You will be expected to take part in work related activity with a view to moving into work at some point in the future.

6 You have to attend work focused interviews to discuss and prepare for an eventual return to work. You will get an additional payment (a work-related activity component) on top of the basic rate of ESA. You can appeal if you disagree with the decision not to place you in the support group. Ask for our factsheet ESA How to appeal for more information about this. What are work-focused interviews? At your first work focused interview you will draw up an action plan for work-related activity. Your plan can include anything that might help you to get to a position where you are more likely to be able to work for example; training, IT skills, voluntary work. There will be a further five work focused interviews at approximately monthly intervals. These will monitor your progress, identify potential job opportunities and help with things like job interviews. If you don t attend a work-focused interview, your ESA may be reduced unless the JC+ accept you had good cause for not attending. What if I fail my assessment and am found fit for work? If you disagree with the decision you can appeal against the decision. Please ask for a copy of our other factsheet ESA How to appeal. Otherwise you will need to claim Jobseekers Allowance (JSA) Produced by the Welfare Rights and Money Advice Service, Bristol City Council. If you would like this information in a different format; for example Braille, audiotape, large print or computer disk, or if you need information in a community language, please contact us at: FREEPOST RTKJ-SGBZ-ULSH Welfare Rights and Money Advice Service (100TS), Bristol City Council, PO Box 3176, BRISTOL, BS3 9FS. Telephone: Fax: Minicom: welfarerights@bristol.gov.uk