Understanding Employment and Support Allowance (ESA) and The Work Capability Assessment: assessing your ability to work.

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1 shinecharity.org.uk 42 Park Road Peterborough PE1 2UQ Understanding Employment and Support Allowance (ESA) and The Work Capability Assessment: assessing your ability to work. What is Employment Support Allowance? Employment Support Allowance (ESA) is the benefit that has replaced incapacity benefit in the Government s welfare reforms. Why am I being assessed? You have made a first application for Employment & Support Allowance (ESA) or You are receiving ESA and it is due for renewal or You have been receiving Incapacity Benefit, Severe Disablement Allowance or disability-related Income Support and are being assessed to see if you can move onto Employment and Support Allowance How does the assessment work? If this is your first application, you will have made a first enquiry by phone. You will then be sent a questionnaire to complete. This will form part of the assessment for the benefit. If you have been receiving Incapacity Benefit or Severe Disablement Allowance you are being assessed as these benefits are being replaced by Employment and Support Allowance. You will have been sent a questionnaire to complete. 1

2 Get help from Shine or an advice agency like Citizens Advice with filling in the form at the very beginning. Before completing the form, make a list of any difficulties your hydrocephalus, spina bifida or any other condition cause you. You may find it helpful to talk to someone close like a family member about these or for them to be with you when you complete the form. For example: Physical difficulties can include: Need for wheelchair or ramped access Need for help with carrying or reaching items Problems with your bowel or bladder Coping with or avoiding pressure sores Fatigue Needing time off for treatment or appointments Problems with communication Problems with picking things up Problems with moving around Problems with co-ordination Problems with sitting and standing Difficulties that may be linked to hydrocephalus can include: Poor concentration Poor short term memory Problems with multi-tasking doing several things at the same time Difficulty finding your way around Working under stress Any problems with reading or number work Any problems with vision or perception (how you see things) Any problems with getting on with other people Any other difficulties with learning Severe learning disability Lack of awareness of danger Aggressive behaviour ATOS employ Mental Health and Cognitive Champions to advise the assessors. If you think your hydrocephalus affects your ability to work, you can request that a Mental Health and Cognitive Champion is available to advise your assessor. This is not guaranteed but it is worth asking. This 2

3 must be arranged in advance. You can request this on the form they send you where they ask about your access or other requirements. What happens after I have completed and sent in the form? Jobcentre Plus or Social Security (in Northern Ireland) may make a decision on your claim on the form alone but this is unusual. They may ask for medical evidence from a professional known to you They may ask you to go for an assessment interview or for a medical examination to decide whether you are fit to work and, if not, whether you might be capable of work at some time. The assessment interviews are carried out by health professionals, not necessarily doctors, who are employed by a private company called ATOS. Some people may have a physical examination carried out by a doctor. What do I do if I am called for an assessment? 1. Make sure you keep the appointment. Otherwise you will be assumed to be fit to work and may lose out on money. 2. If you have hydrocephalus, you can ask for a Mental Health and Cognitive Champion to advise your assessor. Please note: This cannot be requested on the day of the assessment. You must arrange this well in advance so phone ATOS as soon as you get your letter from them. 3. Check out where the assessment will take place Is it accessible to you? If not, ask for an alternative venue. Do you need transport? Will you need someone with you to cope with doors / ramps? A few people can have assessments at home, if their physical or mental health prevents them from attending an assessment centre. To ask for this: If you can, put your request in writing and send it by recorded delivery or with proof of postage. 3

4 If not, call the ATOS Contact Centre on to arrange a home assessment. ATOS will ask you to provide information from your treating medical professional to explain why you are unable to travel to an assessment centre. Your GP may charge you for this letter. 4. Arrange for someone to accompany you to the assessment. If possible, arrange for someone to be with you during the assessment. This could be a family member, a friend or any other advocate. You have the right to ask for the interview to be recorded though the DWP has very few recording machines available and waiting for one could delay the assessment and also delay you receiving your full benefit. This must be requested 3 weeks before the appointment or immediately on receipt of the assessment date. 5. Get professional evidence to support your claim This is not always easy as many GPs and hospital consultants do not want to provide letters or reports or may charge you for them. They may, anyway, not know much about how your condition affects you every day. Also many people with spina bifida or hydrocephalus are not in touch with other professionals. But if you do know someone who will help, ask them to write a letter of support for your claim. If they think you will have difficulties working, ask them to be specific about what these are likely to be. The Work Capability Assessment (WCA) itself. The Work Capability Assessment has two parts: Part 1 - The Limited Capablity for Work Assessment Part 2 - The Limited Capability for Work-Related Activity Assessment 4

5 So what s the difference? The Limited Capability for Work Assessment (part 1) is to decide whether you are entitled to ESA at all. To be found unfit to work you need to get 15 points on this test which looks at physical activities (moving, standing, sitting etc.) and also mental functioning (ability to learn, communicate, complete tasks, behave appropriately etc.) and gives a score for each one. If you do not get 15 points, you will be found fit for work. In this case you should take welfare rights advice about whether you are eligible for Jobseekers Allowance (JSA) which will require you to be more active in looking for work or for income support. If you get 15 points or more, the assessor will use a further test to decide whether you are likely to be able to do some work at some point in the future. This is called: The Limited Capability for Work-Related Activity Assessment (part 2) uses the same sort of system as above to will decide whether you are put in one of two groups: Group 1 - The Work-Related Activity group In this group you would have to do some tasks such as attending workfocussed interviews to continue getting ESA. If you have been getting Contributory Incapacity Benefit already and are put in this category, your award will be time-limited and you may lose it at some point. Group 2 - The Support Group In this group, you do not have to take part in any activities linked to getting work and you are paid a little more than if you are in the Work-Related Activity group. You do not have to attend an actual group. 5

6 If you have been getting Contributory Incapacity Benefit already, you will be able to keep your new ESA award. How am I assessed? From the beginning of the interview the assessor will be looking at you: how you look and behave, how you get up and sit down, move a wheelchair, communicate He or she will also ask you questions and use the answers you give to put into a computer programme which will work out how many points you have. They may ask you questions about your usual day such as: When do you get up? Can you wash and dress yourself? Can you make yourself a meal? (This is a main meal for one person using fresh ingredients. You must make it clear if your condition results in you living on convenience foods / microwave meals). Do you go out? How did you get to the interview? Do you watch television and which programmes?.and so on If you have problems that will affect your ability to work, you must explain them clearly. Maybe you can give examples from any work or work experience that you have done in the past. You could make some notes beforehand and take them along with you If you are feeling stressed you may find it hard to answer some of the questions in full so do try to have someone with you who knows you well and who can fill in any gaps. 6

7 What happens next? The health professional who has assessed you sends a report of the assessment to Jobcentre Plus or Social Security (in Northern Ireland) who decide whether you can get ESA and whether you should be put in the Work-Related Activity group or the Support Group. If you are unhappy with the decision you can appeal against it. Or you can see if you can claim Jobseekers Allowance (JSA) or Income Support. What do I do if I disagree with the decision? Can I appeal? You can appeal You must do this within one calendar month from the date on the decision notice unless there are very serious reasons stopping you. Get advice about appealing from Shine or an agency such as Citizens Advice. Get as much written evidence as you can in support of your appeal. Go to the appeal hearing: this increases your chances of success. The appeal will concentrate on your condition at the time of the decision so make sure that your evidence is about this and not about any changes since that time. What happens if I do not win my appeal? Take advice from Citizens Advice about whether you can make any further appeal and whether you may be entitled to Jobseekers Allowance. Where can I go for more detailed information about ESA and the assessment process? 7

8 Online Help: For general information on Employment & Support Allowance (ESA) AndOtherSupport/Illorinjured/DG_ Moving from Incapacity Benefit to Employment and Support Allowance For information on the Work Capability Assessment AndOtherSupport/Illorinjured/DG_ Citizens Advice Guide on benefits for people who are sick or disabled. disabled_people_and_carers_ew/benefits_for_people_who_are_sick_ or_disabled.htm Try a free online self-assessment test for ESA /start-the-esa-test General information about benefit changes 8 For individual help: Shine s First Point of Contact: Citizens Advice Bureau England: Citizens Advice Bureau Wales: Citizens Advice Bureau Northern Ireland:

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