Last Updated: September 2016
If you are sick or disabled and unable to work, you may be entitled to claim ESA.
ESA can provide financial help and it may also provide personalised assistance, so that you can work if you’re able to.
You can apply for ESA if you’re employed, self-employed or unemployed.
You might be transferred to ESA if you’ve been claiming other benefits like Income Support or Incapacity Benefit. Or you may need to apply because you are no longer or not entitled to Statutory Sick Pay (SSP).
There are two types of ESA:
- Contributory ESA – linked to your National Insurance contributions
- Income-related ESA – means-tested and taking into account your other income and savings.
Normally, when you first apply, you’ll get the assessment rate for 13 weeks. The assessment rate is:
- up to £57.90 a week if you’re aged under 25
- up to £73.10 a week if you’re aged 25 or over
When you apply for ESA you will have a Work Capability Assessment (WCA) It has two parts; the first part is the ‘limited capability for work assessment’ to find out if you can remain on ESA and the second part is the ‘limited capability for work-related activity assessment’ which decides which of the two groups you will be put in.
Disability Rights UK offer a factsheet about the Work Capability Assessment.
If you’re entitled to ESA following the WCA you will be placed in one of the following groups:
- Work Related Activity Group (WRAG) – where you’ll have regular interviews with an adviser, to help support you back to work. This pays up to £102.15 a week
- Support Group – where you don’t have interviews. This pays up to £109.30 a week. If you are placed in the Support group and on income-related ESA, you’re also entitled to the enhanced disability premium at £15.75 a week.
You may also qualify for the severe disability premium at £61.85 per week.
For further advice about this benefit and help in applying:
- Government website on ESA
- Citizens Advice – Help filling in your ESA50 form
- Disability Rights UK – ESA resources page
- ESA Guide from turn2us website
- Advice on preparing for an ESA Assessment from the seAp charity
If your claim for ESA has not been successful or you have been placed in the WRAG and you think that you should be in the Support group, then you may wish to get the decision looked at again. You need to ask the DWP for a Mandatory Reconsideration: you must do this before appealing. You have a calendar month from the date of your decision letter to ask for the Mandatory Reconsideration. Around a third of decisions are reversed when they are looked at again, so it is important you do this if you are unhappy about your outcome.
Using the information used to make their decision, you can request these at the same time as asking for an appeal or reconsideration, you will need to look at all the descriptors to ensure that you meet the 15 point threshold, that one of the Support Group descriptors applies or that the Exceptional Circumstance rule applies and this will then form the basis for your appeal.
The reports that you may wish to request to support your case for appeal are:
- ESA85 medical report form: this is the form that will have been completed by the Atos assessor if you had a face to face assessment.
- ESA85A form: this is completed by an Atos assessor if you did not have a medical
- ESA113 form: this may have been sent to your GP or consultant but it is quite likely that this will not have been sent out.
If you have not kept a copy of your ESA50 form (ie. the questionnaire you used to apply for ESA) you can ask for a copy of this at the same time as you ask for a reconsideration or appeal.
A new ‘decision maker’ at the DWP will look at your claim again to see if the original decision was correct. They will not have seen your claim before, so they may call you to discuss the decision and why you disagree. At this point, you should be able to explain why and give them more information about your condition or provide evidence. You can ask for them to call you at time when they can talk to you and your carer together, if you don’t feel able to do this alone, but this could delay your decision.
If you have more evidence they will tell you where you should send it and will give you 1 month to do so. They should agree not make a decision until they have seen the new evidence.
If they don’t get the evidence in 1 month, they will make a decision based on the information they already have. The DWP do not have to make their decision in a certain time, it can take up to few weeks to few months for them to get back to you.
If you do not receive an acknowledgement within 14 days, phone and make sure that your appeal has been received.
If the DWP changes their decision, it is backdated to the date of the original decision. If the DWP doesn?t change their decision, you can Appeal to an independent tribunal.
During this time, if you have no income you should be able to apply for Jobseekers Allowance Job Seekers Allowance (JSA). Jobcentre Plus offices are meant to have been issued with guidance about “flexible conditionality” for people who have failed the Work Capability assessment for ESA and have asked for a mandatory reconsideration. This means that people can be treated more flexibly than a usual jobseeker if they have to claim JSA whilst waiting for a decision to be made. In some areas of the country, you may need to apply for Universal Credits.
Where to go for more help and challenging ESA decisions: