Time limit for ESA (contribution based) payments:

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1 1 Time limit for ESA (contribution based) payments: If you are receiving Employment and Support Allowance based on your National Insurance Contributions, and not because of low income (Income Based ESA), you may have been contacted by Jobcentre Plus recently to tell you that payment of your benefit will soon stop (you will continue to get National Insurance Credits while you are accepted as having limited capability for work). This is because, as part of the government s Welfare Reform Act, a new law was passed limiting the time you can receive this benefit to one year. It came into force from April 30th 2012, so if at this date you had already received ESA (contribution-based) for a year or more, your benefit stopped from this date. For people changing over from Incapacity Benefit or Severe Disablement Allowance (SDA) to Employment and Support Allowance, the date their benefit stops will be one year from the date they changed over. If the time-limit applies to you, but your household income and savings are low enough, then you may still be able to claim ESA on the basis of low income. Jobcentre Plus will send you a claim form for this if you request one or you can download a form from their website: If you have a partner who is working full-time, or you have other income, then you may not be entitled to income-based ESA but it is always worth checking if you are eligible.

2 2 The one year time limit only applies if you were placed in the Work- Related Activity Group (WRAG) of claimants when your fitness for work was last assessed. Most claimants are placed in this group. There is another group called the Support Group which is for people who, because of the level of their disability, are not expected to take part in return to work interviews and other activities aimed at getting ready for work. The one-year time limit does not apply to claimants who are in the Support Group their benefit can continue as long as they remain in that group. A list of Support Group descriptors (physical, mental and other activities) is on pages 3 6 of this guide. There is also a number of exceptional circumstances that mean a claimant can automatically be treated as having a limited capability for work. These are listed on page 7. Requests to go into the Support Group: If you have been placed in the WRAG, and feel that you should be in the Support Group, then you can dispute this decision. Please see our separate guide on how to dispute a decision that you are in the WRAG. If your request is more than one month after the date of the last decision on your claim, please contact us for advice on what to do in your particular circumstances. If you have missed a time limit for a mandatory reconsideration or an appeal the rules can be quite complex. Reassessments when your health has got worse: If your health has deteriorated since you were last assessed, for instance if you have a new medical condition or the existing condition has got worse and you think you should be in the Support Group, then you can send evidence of this to Jobcentre Plus and they should reassess you. Your existing claim could be reviewed or you might be asked to make a new claim and to have another Work Capability Assessment medical.

3 3 This gives you another opportunity to be placed in the Support Group and if you are still placed in the WRAG you have one month to request a mandatory reconsideration of that decision. If this is unsuccessful you can then appeal against that decision. Reassessments, reconsiderations and appeals could also result in you being found fit for work which means that your benefit would stop if this happened. Again, you would have the right to dispute this decision. New Claims: It may be possible to requalify for a further 365 days of contribution based ESA after a gap of more than 12 weeks if you meet the National Insurance contribution conditions without using the same two tax years of your previous claim. You may want to ask for advice about this because it can get quite complicated. Limited capability for work-related activity assessment: If one or more of the descriptors applies to you, you can be assessed as having a limited capability for work-related activity and you will be placed in the Support Group. The assessment takes into account your abilities when using any aid or appliance that you would normally wear or use, for example glasses, walking stick, artificial limps (prosthesis) and so on. 1. Mobilising unaided by another person with or without a walking stick, manual wheelchair or other aid if such aid can reasonably be used Cannot either: A. Mobilise more than 50 metres on level ground without stopping in order to avoid significant discomfort or exhaustion; or B. Repeatedly mobilise 50 metres within a reasonable timescale because of significant discomfort or exhaustion.

4 4 2. Transferring from one seated position to another Cannot move between one seated position and another seated position located next to one another without receiving physical assistance from another person. 3. Reaching Cannot raise either arm as if to put something in the top pocket of a coat or jacket. 4. Picking up and moving or transferring by the use of the upper body and arms (excluding standing, sitting, bending or kneeling etc.) Cannot pick up and move a 0.5 litre carton full of liquid. 5. Manual dexterity Cannot either: A. Press a button, such as a telephone keypad; or B. Turn the pages of a book with either hand. 6. Making self understood through speaking, writing, typing, or other means normally used Cannot convey a simple message, such as the presence of a hazard. 7. Understanding communication by hearing, lip reading, reading 16 point print or using any aid if reasonably used Cannot understand simple message due to sensory impairment, such as the location of a fire escape. 8. Absence or loss of control over extensive evacuation of the bowel and/or voiding of the bladder, other than enuresis (bed wetting), despite the presence of any aids or adaptations normally used At least once a week experiences

5 5 A. Loss of control leading to extensive evacuation of the bowel and/or voiding of the bladder; or B. Substantial leakage of the contents of a collecting device, sufficient to require the individual to clean themselves and change clothing. 9. Learning tasks Cannot learn how to complete a simple task, such as setting an alarm clock, due to cognitive impairment or mental disorder. 10. Awareness of hazard Reduced awareness of everyday hazards, due to cognitive impairment or mental disorder, leads to significant risk of: A. Injury to self or others; or B. Damage to property or possessions such that they require supervision for the majority of the time to maintain safety. 11. Initiating and completing personal action (which means planning, organisation, problem solving, prioritising or switching tasks) Cannot due to impaired mental function, reliably initiate or complete at least 2 sequential personal actions. 12. Coping with change Cannot cope with any change, due to cognitive impairment or mental disorder, to the extent that day to day life cannot be managed. 13. Coping with social engagement, due to cognitive impairment or mental disorder Engagement in social contact is always precluded due to difficulty relating to others or significant distress experienced by the individual.

6 6 14. Appropriateness of behaviour with other people, due to cognitive impairment or mental disorder Has, on a daily basis, uncontrollable episodes of aggressive or disinhibited behaviour that would be unreasonable in any workplace. 15. Conveying food or drink to the mouth A. Cannot convey food or drink to the claimant s own mouth without receiving physical assistance from someone else; B. Cannot convey food or drink to the claimant s own mouth without repeatedly stopping, experiencing breathlessness or severe discomfort; C. Cannot convey food or drink to the claimant s own mouth without receiving regular prompting given by someone else in the claimant s physical presence; or D. Owing to a severe disorder of mood or behaviour, fails to convey food or drink to the claimants own mouth without receiving: i. physical assistance from someone else; or ii. regular prompting given by someone else in the claimant s presence. 16. Chewing or swallowing food or drink A. Cannot chew or swallow food or drink; B. Cannot chew or swallow food or drink without repeatedly stopping, experiencing breathlessness or severe discomfort; C. Cannot chew or swallow food or drink without repeatedly receiving regular prompting given by someone else in the claimant s presence; or D. Owing to a severe disorder of mood or behaviour, fails to: i. chew or swallow food or drink; or

7 7 ii. chew or swallow food or drink without regular prompting given by someone else in the claimant s presence. (ESA Regs, Sch 3) Exceptional circumstances: You can be automatically treated as having a limited capability for work-related activity if you: have a terminal illness and are not expected to live longer than 6 months are receiving treatment (or are likely to receive it within 6 months) by way of intravenous, intraperitoneal or intrathecal chemotherapy or you are recovering from this treatment are pregnant and there would be a serious risk to the health of you or your baby if you did not refrain from work-related activity have a specific physical or mental health condition and as a result of this there would be a substantial risk to the physical or mental health of you or someone else if you were found not to have a limited capability for work-related activity (ESA REGs, reg 35). (C) DIAL (LEEDS) September 2014