ESA is a continuing benefit for people aged between 16 and state pension age, who have a health condition or impairment that makes it difficult or impossible for them to work. Income-related ESA,
is for disabled or ill people who have a low income and low savings; contribution-based ESA is for people who have paid enough National Insurance in the past whatever their income.
The distinction is important, as there are different rules for people on contribution-based ESA who have been placed in certain groups – see below.
New (often called “fresh”) claims for help with living costs for people for whom work is difficult or impossible because of a health condition or impairment are included within Universal Credit, and paid to people as a special additional element to their Universal Credit payment.
Contribution based ESA (known as “new style” ESA) continues in parallel to Universal Credit.
Whether you are eligible or not for the UC Element or “new style” ESA is decided by a Work Capability Assessment. This looks at how your health condition or disability affects your ability to carry out a range of everyday activities.
It has two parts. The purpose of the first part is to determine “Are you fit for work”. This is not an assessment of whether or not you can do any particular real job and it ignores the availability of work, its accessibility as well as your own experience or expertise.
This assessment is carried out using information you provided on the ESA50 form and, in most cases, a face-to-face assessment by a ‘healthcare professional’ working for a private company called Maximus, contracted to DWP.
The Assessment looks at ten physical activities:
• standing and sitting
• picking up and moving things
• manual dexterity
• making yourself understood
• understanding communication
• navigating and maintaining safety
• bowel or bladder control
and seven mental, cognitive and intellectual activities:
• learning tasks
• awareness of everyday hazards
• initiating and completing personal action
• coping with change
• getting about
• coping with social engagement
• appropriateness of behaviour with other people.
Within each of these 17 areas, there are “descriptors” of physical or mental tasks worth differing amounts of points (6, 9,or 15).
As an example, the different descriptors on the “Reaching” Activity are as follows:-
Cannot raise either arm as if to put something in top pocket of a coat or jacket 15 pts
Cannot raise either arm to top of head as if to put on a hat 9 pts
Cannot raise either arm above head height as if to reach for something 6 pts
None of the above apply 0 pts
In general, the less you are able to do, the more points you earn.
The highest points scored under each activity heading, are then added together.
If you score fewer than 15 points added up in this way, you are regarded as “fit for work” – i.e. not eligible for ESA, and you may apply for Job Seekers Allowance (JSA).
If you score 15 or more points added up in this way, then you are assessed in the second part of the WCA test which asks – “Are you capable of Work Related Activity?” An almost identical list of 16 Activities from the first part of the test, as well as eating and drinking, is considered. In general, the descriptors used for this part of the test are those which were worth 15 points in the first part.
If you meet one or more of these descriptors you will be placed in what is called the Support Group. This means you will get a continuing award (subject to periodic review) of ESA at a higher rate regardless of whether you are claiming income-related or contributory ESA.
If you do not meet any of the descriptors in the second part of the test, you will be placed in the Work Related Activity Group (WRAG). This means you will get the standard rate of benefit for job seekers, and you must undertake work-focused interviews and other “work-related activity” required by the Job Centre.
It is important to undertake whatever is required, because if you do not, you are likely to be “sanctioned” which means your benefit may be reduced or stopped for a period.
ESA is a complicated benefit and the information above is only intended to provide an easy-to-follow guide. You are strongly advised to consult a competent benefit adviser before taking any decisions.