Employment and Support Allowance:
Outcomes of Work Capability
Assessments, Great Britain – new claimsThe GOV.UK website provides a complete explanation of eligibility at the following links:
https://www.gov.uk/employment-support-allowance#overviewhttps://www.gov.uk/employment-support-allowance/eligibility3.1.1. Claimant conditions
Employment and Support Allowance can be awarded on the basis of low income or National
Insurance (NI) contributions:
Income-related Employment and Support Allowance (ESA-IR) – in this instance a claimant may
be entitled to claim the benefit (regardless of how much they have paid by way of NI
contributions), if they satisfy the conditions relating to financial position. This means they must
have savings of less than £16,000, and if they have a partner or civil partner, this person must
work for less than 24 hours per week on average; and
Contributory Employment and Support Allowance (ESA-C) – in this case a claimant may be
entitled to claim contributory Employment and Support Allowance if they have paid enough NI
contributions. From May 2012, the Welfare Reform Act 2012, will time limit ESA-C to 12 months
for those in the Work Related Activity Group; however those exhausting ESA-C may still be
eligible for ESA-IR if they meet the conditions.
Note that those entitled to ESA-C in the Support Group and ESA-IR: Work Related Activity Group and
Support Group claimants are not subject to this time limit
3.2. Benefit structure
Time on Employment and Support Allowance is divided into two phases by the process of assessing
work capability.
17 3.2.1. Assessment phase (this lasts 13 weeks)
When a claimant first applies for the benefit, they are put into the assessment phase. During this
time, they are assessed through the Work Capability Assessment process. Individual claimants do
not have to engage in work-related activity. They receive benefit paid at the assessment phase rate
(equivalent to JSA personal allowances).
While in the assessment phase, the claimant has to provide up-to-date medical certification of their
disability or illness, and is assessed against the criteria set out in legislation. Most of them are sent a
limited capability for work questionnaire (also known as the ESA50) and following completion are
invited to a face to face assessment carried out by a trained healthcare professional (HCP) working
for Atos Healthcare. However, depending on the severity of an individual’s condition some claimant
journeys will differ; for example those who are terminally ill or otherwise have sufficient medical
evidence are fast-tracked into the Support Group on the basis of paper evidence rather than having
an assessment.
Information gathered through the questionnaire and the face to face assessment, together with any
other evidence provided by the claimant, is used by the DWP’s decision maker to determine their
eligibility for Employment and Support Allowance main phase.
3.2.2. Main phase (outcomes of the Work Capability Assessment process)
After the face to face assessment, a claimant can have three possible outcomes:
Individuals can be found fit for work –
in this case their claim closes and the claimant can move to JSA or it remains open pending
recourse against the decision, via reconsideration from DWP or appeal to HMCTS. If redress
is sought, the pre-assessment rates remain until closure;
Individuals can be found to have limited capability for work –
in this instance they are allowed the benefit and placed in the Work Related Activity Group.
Those in this group are not expected to work, but are provided with help and support to
prepare for work where possible. They receive a higher rate of payment than those on JSA;
and
Individuals can be found to have limited capability for work and in addition, limited capability for
work related activity –
in this situation they are allowed the benefit and placed in the Support Group. Those in this
group have the most severe functional impairments, and so are provided with unconditional
support and receive a higher premium than those in the Work Related Activity Group.
3.2.3. Repeat assessments
All claimants in the Work Related Activity Group and Support Group are given a prognosis of when
they may be fit for work. Individuals are then reassessed through repeat assessments after the initial
or last prognosis period expires.
The interval between assessments is usually but not always a standard length of time such as 3, 6,
12, 18 or 24 months based on the claimant’s health. This is to ensure that they are still eligible to
Employment and Support Allowance and are allocated to the correct group. Repeat assessments
include around 0.1% of those who originally migrated from Incapacity Benefit.
3.4. Assignment information
3.4.1. Reason for group placement
The tables below detail some of the reasons for placement into the Work Related Activity Group or
Support Group. The reasons offered below are merely inferences based on the claimant’s medical
condition and their assessment decision. This is because Employment and Support Allowance
entitlement and allocation is not based on the condition of the claimant but instead is based on the
effect that this has on their ability to work. For example an individual will not qualify simply because
they have arthritis, but could qualify if their condition means they have severe difficulty holding a pen.
3.4.2. Reasons for assignment to the Work Related Activity Group
Figure L: Reason for placement in the Work Related Activity Group
Reason Explanation 15 points or more
This is where claimants score 15 points or more against the functional descriptors laid down in
legislation. This award is based on the following functional impairment descriptors:
Physical functions
Lower limb – inability to mobilise, stand, sit;
Upper Limb – inability to reach, pick up and/or lack of other manual dexterity;
Sensory – inability to make self understood, understand communication or navigate safely
Continence – limitation of control over the bladder and bowel;
Consciousness – involuntary loss of consciousness;
Mental, cognitive and intellectual functions
Understanding and focus – this relates to inability to learn tasks, to be aware of hazards, inability to
initiate and complete tasks;
Adapting to change – this is to do with inability to cope with changes to routine, to get about; and
Social Interaction – this relates to inability to deal with other people.
Note that scoring 15 points or more is the most prevalent reason for being in the WRAG.
Medical reasons
This combines claimants with non-functional descriptors or those treated as limited capability to
work at assessment. This award can be based on the following non-functional impairments:
suffering from a life-threatening disease – this is where there is medical evidence that the disease
is uncontrollable or uncontrolled by a recognised therapeutic procedure, and in the case of a disease
that is uncontrolled there is a reasonable cause for it not to be controlled by a recognised therapeutic procedure; and suffering from some specific disease or bodily or mental disablement – this is whereby reasons
of such disease or disablement, there would be a substantial risk to the mental or physical health of
any person if they were found not to have limited capability for work.
It can also be based on the following limited capability to work:
undergoing regular treatment – this means receiving regular weekly treatment, such as by way of
20 haemodialysis for chronic renal failure, treatment by way of plasmapheresis or by way of radiotherapy,
or by way of total parenteral nutrition for gross impairment of enteric function;
undergoing medical or other treatment as an in-patient to a hospital or similar institution;
recovering from treatment as an in-patient to a hospital or similar institution;
undergoing pregnancy and in receipt of Maternity Allowance with an ESA top-up;
during a period of confinement for pregnancy; and pregnant where there is a risk of harm to the mother and/or child.
Clerical assessment
This is where the Atos Healthcare recommendations are recorded clerically. In such cases,
WRAG assignment is determined from the DWP decision maker information only, and so no
more detail about the nature of the health situation is recorded on the database.
At reconsideration
There are some cases because they come after DWP reconsiderations that are recorded
clerically. Once again in such cases, WRAG assignment is determined from the DWP decision
maker information only, and so no more detail about the nature of the health situation is
recorded on the database.
Here the Atos Healthcare recommendations may differ from the DWP decision, or else
recommendation might have changed but the revision is not on the system.
After appeal This is where a small number of cases because they come after appeals to HMCTS in favour of
the claimant are recorded clerically. Once more in such cases, WRAG assignment is
determined from the DWP decision maker information only, and so no more detail about the
nature of the health situation is recorded on the database.
Here the Atos Healthcare recommendations may differ from the DWP decision (after appeal
process). Note that claimants initially found FFW in the process of appealing remain in this
category for the purpose of statistical outputs until their cases are heard.
The GOV.UK website provides a broad explanation at the following link, including a document
explaining the functional impairments in further detail:
https://www.gov.uk/employment-support-allowance/overviewhttp://www.direct.gov.uk/prod_…..177366.pdf3.4.3. Reasons for assignment to the Support Group Reason for placement in the Support Group
Reason Explanation
Chemotherapy This is where claimants are receiving certain types of chemotherapy, which qualifies them for
the SG. This award is based on the following limited capability to work at assessment:
receiving treatment by way of intravenous, intraperitoneal or intrathecal chemotherapy or is
likely to receive such treatment within the next 6 months; or
recovering from intravenous, intraperitoneal or intrathecal chemotherapy treatment.
Physical or Mental Health Risk
This is where regulations allow that in ‘exceptional circumstances’ claimants be put into the
(WRAG or) SG, if there would be serious risk to the mental or physical health of any person
were they found FFW (and they do not meet the usual criteria for WRAG or SG).
Pregnancy Risk This is where pregnant claimants are put in the SG, if there is a serious risk to her own health
or that of the unborn child were they found FFW.
Severe disability
This is where claimants meet the functional criteria for the SG, covering physical and mental
capacity
Terminally ill This is where claimants are diagnosed as terminally ill with a prognosis of 6 months or less.
Note that the department does not always capture the reason for placement in the Support Group (as with the Work Related Activity Group). This is often due to assessments recorded clerically where the reason is not stated, such as where assignment follows an appeal or reconsideration.
21 The legislation, specifically Part 6, gives more detail on allocation at the following link:
http://www.legislation.gov.uk/…..view=plain3.8. Benefit rates
Employment and Support Allowance is paid at different rates depending on claimant’s situation and
stage in claim process:
3.8.1. Assessment Phase
The assessment phase rate, or basic rate, is normally paid for the first 13 weeks of the claim while a
decision is made on the claimant’s limited capability for work through the Work Capability Assessment
process. The assessment phase rates are aligned to those for JSA.
Additional premiums may be paid as part of income-related Employment and Support Allowance to
provide support for specific needs for example as a result of disability, age or caring responsibilities.
3.8.2. Main Phase
The main phase starts from week 14 of the claim for individuals who are assessed as having limited
capability for work. In the main phase claimants receive an additional Work Related Activity
component or Support component on top of the basic rate.
In addition to the premiums payable during the assessment phase, anyone receiving income-related
Employment and Support Allowance in the Support Group will automatically receive the Enhanced
Disability Premium, if they have not previously qualified for it.
23 The GOV.UK website provides the latest full information on rates at the following link:
https://www.gov.uk/employment-support-allowance/what-youll-get