What is ESA?

Taken from NRAS magazine, Winter 2010

Employment and Support Allowance (ESA) was introduced in October 2008 for new claimants and replaced 2 benefits - Incapacity Benefit and Income Support (because of a disability). ESA is intended to provide help for people who find it harder to get a job because:

• they have a disability
• they have a problem with their health and will have this problem for a long time or the rest of their life

ESA aims to offer you personalised support and financial help, so that you can do appropriate work, if you are able to. It also gives you access to a specially trained personal adviser and a wide range of further services including employment, training and condition management support, to help you manage and cope with your illness or disability at work.

ESA consists of two phases:

• the assessment phase rate is paid for the first 13 weeks of your claim while a decision is made on your capability for work through the Work Capability Assessment . Between week 9 and 13 of this phase, you will attend a work-focused interview with a Jobcentre Plus adviser
• the main phase starts from week 14 of your claim, if the Work Capability Assessment shows that your illness or disability does limit your ability to work

There are two groups within the main phase:

Work Related Activity Group

If you are placed in the Work Related Activity Group, you will be expected to take part in work focused interviews with your personal adviser. You will get support to help you prepare for suitable work. In return, you will receive a work related activity component in addition to your basic rate.

Support Group

If you are placed in the Support Group because your illness or disability has a severe effect on your ability to work, you will not be expected to take part in any work. You can do so on a voluntary basis if you want to. You will receive a support component in addition to your basic rate.

What should I expect from the Work Capability Assessment?

When you make a claim for ESA, you will usually have a Work Capability Assessment. You may also be asked to take part in a medical assessment if more information is needed about your illness or disability before a decision can be made on your capability for work.

As part of your initial claim you will be asked to complete a questionnaire about how your illness or disability affects your ability to complete everyday tasks and your GP asked to provide a medical report.  The questionnaire and medical reports will be assessed by an approved healthcare professional, who has been trained in handling ESA claims and they will provide advice to the Department for Work and Pensions (DWP), which is responsible for administering benefit claims.

The approved healthcare professional may recommend that you attend a medical assessment if they feel they need more information about your condition. Most people are asked to attend one. It doesn't mean the information you've provided on your claim form is being treated as suspicious or that your claim will be turned down. Your benefit claim will not be turned down without you either having a medical assessment or being offered one.

The medical assessment will usually take place at a medical centre near to home or in certain circumstances ie you are unfit to travel, the approved healthcare professional may visit you at home. It is very important to attend and fully participate in your medical assessment as your benefit may be affected if you don't.

At the assessment you have the right to:

• have a friend, relative or support worker with you
• ask for an interpreter if you cannot speak in English (Welsh interpreters may be available in Wales) 
• ask to be assessed by an approved healthcare professional of the same gender as yourself

What happens next?

The report of your medical assessment will be sent to a decision maker at the DWP who will decide whether you are entitled to ESA. If you are entitled, they will also decide whether you should be placed in the Work Related Activity Group or the Support Group. You will receive a letter stating their decision.

What can I do if I am not happy about the medical assessment?

If you are not happy, you can complain to Medical Services or to the approved healthcare professional at the time of the assessment. If they cannot resolve the problem, they will give you a brochure explaining the formal complaints procedure.

What can I do if I am not happy about the benefits decision?

If you think the decision about your benefit claim is wrong, or you do not understand it, you can:

• ask the office who made the decision to explain it
• ask to have the decision reconsidered by another decision maker 
• appeal against the decision to an independent tribunal

What help will be offered me if I am in the Work Related Activity group?

If you are in the Work Related Activity Group, you will regularly see your personal adviser to discuss your work prospects. They will give you help and advice with:

• your job goals
• your skills, strengths and abilities 
• steps you can take to help find suitable work 
• your ideas, problems and any other work related issues you want to talk about.

If you refuse to go to the work focused interviews, or to take part fully in the work focused interviews, it may affect your entitlement to ESA.

If you are in the Support Group you do not have to go to interviews, but you can ask to talk to a personal adviser if you want to.

If my claim is successful what am I entitled to?

There are two types of Employment and Support Allowance contribution-based and income-related.

• You may be entitled to claim contribution-based ESA if you have paid enough National Insurance contributions.
• You may be entitled to claim income-based ESA if you do not have enough money coming in, or you have not paid enough National Insurance contributions, and you satisfy the entitlement conditions. This means that you have savings of less than £16,000 and, if you have a partner or civil partner, they work for less than 24 hours a week on average.

How much might I receive?

The amount you get paid depends on your circumstances. There are several things that will be taken into consideration. It also depends on what effect your disability has on your ability to do any work. The following will give some idea of the rates which may be paid during each phase.

Weekly rate during the assessment phase (as at Oct 2010)

A single person under 25 could receive up to £51.85
A single person over 25 could receive up to £65.45

Weekly rate during the main phase

A single person in the Work Related Activity group could receive up to £91.40
A single person in the Support group could receive up to £96.85

NB In most cases you will not get any money for the first three days of your claim. These are called 'waiting days'. Depending on your circumstances you may be able to get more money if you get income-related ESA. You can only get extra money for your husband, wife or civil partner if you get income-related Employment and Support Allowance.

During the last few months we have been contacted by our Members who have been experiencing difficulties in claiming ESA.  We would love to hear from anyone who has been through the claim process, good or bad experiences, as we feel, as do other charities working with people who have long term conditions or disabilities that more understanding of the specific diseases and conditions is needed on the behalf of the decision makers to enable them to make better and fairer decisions.  Please send your experiences to enquiries@nras.org.uk they will help us get a better picture of what is happening and help us to determine what campaigning is needed to highlight these issues.

Sources and further reading

Direct Gov website
Disability Alliance
NRAS – Benefits and RA booklet