Unfit for work - Employment and Support Allowance and Universal Credit
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Unfit for work – Employment and Support Allowance and Universal Credit This factsheet was produced in July 2020. See website for latest version.
This factsheet tells you about the main benefits you may be able to claim if you are
unfit for work. These are employment and support allowance (ESA) and/or
universal credit (UC), which has replaced the majority of means-tested benefits and
tax credits paid to people of working age.
What is contributory employment and support allowance?
If you have limited capability for work due to illness or disability and have paid
enough national insurance contributions, you may be able to claim contributory
employment and support allowance (ESA), now called New Style ESA (NESA). You
must be aged 16 or over and under state pension age. You must also have paid
certain national insurance contributions in specific tax years. The contribution rules
are relaxed for certain carers, disabled workers, and previous ESA claimants.
If you are employed and off sick from work you may get statutory sick pay (SSP)
from your employer for up to28 weeks of illness. You cannot get NESA during this
time but if you are still unable to work after 28 weeks, you can then claim NESA,
even if your employer continues to pay contractual sick pay. If you do not qualify for
SSP or if your employer stops paying SSP during the first 28 weeks of your illness,
for example, because your contract of employment ends, you should claim NESA
straight away.
Contributory employment ESA - ‘new style’ or ‘old-style’?
If you claimed contributory ESA before your area came under the universal credit
system the benefit you are receiving is ‘old style’ ESA. If your income is low enough
you may still be able to claim income-related ESA to top this up.
Most new claimants will have to claim ‘new style’ contributory ESA. If you need a top
up to your benefit, this will be from universal credit.
You cannot get ‘new style’ ESA if you:
get, or are entitled to, the severe disability premium,
got, or were entitled to, the severe disability premium in the last month, and
you’re still eligible for it (until 27 January 2021)
You should claim ‘old style’ contributory ESA instead.
How much is contributory ESA?
For the first 13 weeks you will receive the basic weekly allowance:
single person aged under 25 £58.90
single person aged 25 or over £74.35
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www.hertfordshire.gov.ukAfter 13 weeks, everyone is paid the basic weekly rate for a person aged 25 or over,
plus an additional component of £ 39.20 if you are placed in the support group
following a work capability assessment (see page 11).
If you were in the assessment period before 3 April 2017 and placed in the ‘work
related activity group’ you may get an extra £29.55. This component is not payable
for new claims from that time although certain exceptions apply – see appendix 3.
Contributory ESA is only paid for one year if you are in the assessment or ‘work-
related activity’ group. If you are getting the assessment rate, your ESA will be
stopped until you assessed. The ESA will be reinstated along with the additional
component if you are placed in the support group. The time limit does not apply to
those in the support group. See appendix 2 for the criteria for being placed in the
support group. If you think you satisfy any of these you can ask to be reassessed.
If you receive a private or occupational pension, your contributory ESA is reduced by
half the pension payments above £85 a week.
How do I claim ESA?
During the Covid-19 outbreak you can claim ESA online at
www.gov.uk/guidance/new-style-employment-and-support-allowance#how-to-claim-
new-style-esa or ring the universal credit helpline on 0800 328 5644 - choose option
2, then option 6 (NB- you do not need to claim universal credit as well)
You will need to submit a fit note (medical certificate) from your doctor and must
continue to provide them until you are assessed for limited capability for work. The
need to provide the medical certificate was temporarily deferred until 9 July 2020.
From 20 July 2020 all new claimantsof NESA are required to provide the fit note.
From 13 March 2020 until 12 November 2020, claimants ‘affected by COVID-19’ do
not have to serve 7 waiting days before they can be paid ESA and they do not have
to provide fit notes or isolation notes to be treated as having limited capability for
work. The regulations state that a person is affected by coronavirus disease (COVID-
19) if they are:
infected or contaminated with coronavirus disease or
in isolation (because they have been advised to isolate by NHS 111 Online) or
caring for a child or qualifying young person who is a member of the person’s
household and who is in isolation or infected with coronavirus disease
If you have Covid-19 or are advised to stay at home, you can get an ‘isolation note’
by visiting NHS111 online, rather than visiting a doctor. For Covid-19 cases this
replaces the usual need to provide a ‘fit note’ after 7 days of sickness absence.
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www.hertfordshire.gov.ukYou should try to have the following information when you make your claim: national
insurance number, medical certificate or ‘isolation note’ for Covid-19 cases, GP’s
address and phone number, home and mobile telephone numbers, employer’s
address and telephone number, dates of employment or last day worked, bank
account details.
You usually need to attend a new claim appointment at your local jobcentre. During
the Covid-19 outbreak, you will not need to attend an appointment in person; instead
everything will be done on the phone. If you have downloaded and completed the
form, book the appointment straight away by calling 0800 328 5644 (option 2 then
option 6). If you telephoned the helpline and they sent a form to you the DWP should
contact you with your appointment details. If you have collected the application form
from the jobcentre you should be advised of your appointment when you collect the
form. You need to take your completed form, proof of ID and your fit note to the
appointment.
To apply for ‘old style’ contribution-based ESA, you can either:
download and print the ESA1 form and send or take it to your local Jobcentre
Plus or
call Jobcentre Plus to apply by phone on 0800 169 0310
Payment
ESA is not payable until seven days after you have made the claim. However, the 7
waiting days for ESA will not apply to you, if you are suffering coronavirus or are
required to stay at home – so it will be payable from day one. ESA can be backdated
for up to three months prior to the date of the claim if you satisfied the conditions.
You do not need special reasons but will need to provide a backdated fit note from
your GP.
Who can get income-related ESA?
If you are in receipt of old style ESA you can still make a new claim for income-
related ESA to top up your old style contributory ESA (for example, if you have a
partner or are severely disabled).
You can also claim income-related ESA if you are entitled to the severe disability
premium in your legacy benefits or were entitled to it in the last month, and you’re
still eligible for it.
How much is income-related ESA?
If you are claiming income-related ESA you will be subject to a means test which
looks at your income and your savings. Your income is then topped up to a basic
level of benefit.
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www.hertfordshire.gov.ukIf you have savings of more than £16,000, you cannot get income-related ESA. If
you have between £6,000 and £16,000 in savings, the amount of income-related
ESA you get will be reduced by £1 a week for every £250 (or part of £250) you have
over £6,000.
If you are part of a couple (including same sex couples) your partner’s savings and
income are also taken into account. If your partner works 24 hours or more, you
cannot claim income-related ESA.
The maximum amount of income-related ESA is paid at different rates depending
upon your personal circumstances, and is made up of different components:
A basic allowance - paid for the first 13 weeks:
single person aged under 25 £58.90
single person aged 25 or over £74.35
couple where both are 18 or over £116.80
After 13 weeks you will receive an additional component of £39.20 if you are
placed in the support group following a work capability assessment.
Premiums
If you are claiming income-related ESA you may also qualify for additional weekly
money:
carer premium - paid if you are a carer who receives, or has an underlying
entitlement to, carer’s allowance - £37.50
enhanced disability premium - paid if you or your partner receive the highest
rate of the care component of disability living allowance (DLA), the enhanced
rate of the daily living component of the personal independence payment
(PIP) or the higher rate of attendance allowance (AA). You will also get the
enhanced disability premium if you have been placed in the support group -
£17.10 for a single claimant, £24.50 for a couple
severe disability premium (SDP)- paid if you get DLA care component at the
middle or highest rate, or the daily living component of PIP, or attendance
allowance, and no one gets carer’s allowance for looking after you, and you
are treated as living alone. The SDP is £66.95 per week for a single claimant
or £133.90 for a couple where both members of the couple meet the
qualifying conditions or one is getting a qualifying benefit and the other is
registered blind.
Owner occupiers
You may be able to get a loan to help towards your mortgage interest payments up
to £200,000 of your loan. There is a qualifying period of 39 weeks for most new
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www.hertfordshire.gov.ukclaimants and the loan is repayable with interest on the sale of the property or when the ownership is transferred. How do I claim income-related ESA? Phone the DWP on 0800 169 0310. Make sure you tell them that you are on old style ESA. Alternatively you can download an ESA3 form www.gov.uk/guidance/new-style-employment-and-support-allowance Make sure you have details of any savings or other money you (and your partner) have coming in, for example, benefits or sick pay. Universal Credit There is no income-related version of ‘new style’ ESA. You will need to claim universal credit if you have not paid enough national insurance contributions for ‘new style’ ESA or if you need to top up your ESA, for example, if you have children, housing costs etc. NESA counts as unearned income for universal credit, reducing your monthly payment by the exact amount of your ESA. There are no disability premiums in universal credit. How much universal credit will I get? While you are going through the work capability assessment you will be paid the standard monthly allowance: Single claimant under 25 £242.72 Single claimant 25 or over £409.89 Joint claimants both under 25 £488.59 Joint claimants one 25 or over £594.04 Plus any other elements you are entitled to: children, rental costs, caring or child-care costs. If you are found to have limited capability for work-related activity, £341.92 will be added to your award in the monthly assessment period that starts 3 months after the date you provided a fit note. If you have previously claimed ESA and already been assessed as having the support component in that benefit, the limited capability for work-related activity element should be included in your universal credit straight away, providing there was no gap between your ESA ending and your UC claim starting. Money Advice Unit 6 Issue 3 0300 123 4040 www.hertfordshire.gov.uk
If you are in the ESA assessment period at the time of claiming universal credit any time spent onESA will count towards the assessment period in universal credit. Run-on of legacy benefits introduced for new Universal Credit claimants From 22 July 2020, the DWP introduced a run-on of legacy benefits for those moving to UC, to provide them with extra support. This means if someone’s existing claim of income-based jobseeker’s allowance (JSA), income-related employment and support allowance (ESA) or income support ends due to them applying for UC they will now receive a new, additional payment, worth up to two weeks of their legacy award. The one-time run-on payment does not need to be paid back, and will be paid automatically to eligible claimants when they claim UC for the first time. It will not affect the amount of UC they receive. Run-on payments will also be made for other premiums claimants have been receiving prior to moving over to UC including enhanced disability premium, carer premium or ESA work-related activity component. How do I claim universal credit? Universal credit is administered by the Department for Work and Pensions. It is an online system and claims should be made via www.gov.uk/apply-universal-credit If you cannot claim online you should be able to get help over the phone or in your local jobcentre - phone the universal credit helpline on 0800 328 5644 Your local Citzens Advice can also help with the early stages of a universal credit claim. Their support is available online www.citizensadvice.org.uk/helptoclaim or over the phone 0800 144 8 444.. When you make a claim for universal credit as unfit for work you will need to tick the box ‘I have a fit note’ on the online form. After submitting a claim the DWP will contact you to tell you the date of your personalised work search interview and what evidence you need to bring. A text message should confirm the details. You will also be asked to confirm your identity (if you have not verified your ID online) and bring in any other requested documents, including your ‘fit note’. You are then taken through your claim details and must sign a form to confirm that you accept/understand the elements that make up your universal credit payment. Your ‘claimant commitment’ will be discussed and you must sign this in order for the claim to proceed. During the Covid-19 outbreak period, Money Advice Unit 7 Issue 3 0300 123 4040 www.hertfordshire.gov.uk
all these will be done on the phone. After you submit a claim online, you will receive
a phone call from the UC section to book a telephone appointment.
Backdating of UC is limited to a maximum of one month but only for specific
circumstances which include grounds of disability, illness, and official online
application system failure.
For more information about universal credit– see appendix 4.
What is the assessment phase?
Once you claim ESA and/or universal credit as unfit for work, you will usually enter a
13-week assessment phase and receive ESA or universal credit at the basic rate
unless you are terminally ill.
Normally you must attend any appointments you are given at the jobcentre, for
example, for a compulsory ‘health to work conversation’ and you can be sanctioned
if you don’t turn up without good reason.
Since 30 March 2020, UC claimants did not have any work search requirements
placed upon them and were not required to be able and willing to immediately take
up paid work. However, since 1 July the DWP have reintroduced the requirement for
claimants of universal credit to accept a claimant commitment as part of any new
claim. For existing claimants, DWP will review and update their claimant commitment
as capacity allows, to “provide tailored support to help them find work or increase
hours.” Claimant commitments must be reasonable for the ‘new normal’,
acknowledging the reality of a person’s local jobs market and personal
circumstances to prepare them for getting back into work.
From July claimants will be able to make an appointment to see their work coach if
they can’t get the help they want online or over the phone.
If you are claiming ESA you are treated as having limited capability for work during
the assessment phase. However this is not the case for universal credit. You will
continue to be paid any other applicable elements such as the standard allowance,
housing costs and any child elements. However, during this time you will still be
subject to work–related requirements although you can ask for your claimant
commitment to be modified due to your health condition. You can also have two, 2-
week periods of sickness in a 12 month period in which any work-related
requirements are suspended. After that any further suspension/modification is at the
discretion of your work coach.
During the assessment phase you will also undergo a work capability assessment
(WCA) which tests you in the following areas:
an assessment of limited capability for work (LCW) – this looks at the
extent of your overall physical and/or mental disabilities
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www.hertfordshire.gov.uk an assessment of limited capability for work-related activity (LCWRA) –
this looks at your ability to do some form of work-related activity. If you are
considered to have limited capability for work-related activity you will be
placed in the support group (for ESA) or the limited capability for work-related
activity group (for UC). You will get extra benefit and won’t have to engage in
any work preparation. If, however, the decision maker considers you have
some capacity for work you will be placed into the work-related activity group.
What does the limited capability for work test
involve?
Around a month after you first claim you are sent a self-assessment questionnaire to
complete. This is called an ESA50 (for ESA) and a UC50 (for universal credit). It is a
test of your ability to perform certain activities and points are awarded based on your
ability to carry them out. You normally have four weeks to return the form. If it is not
returned by this deadline you will be treated as not having limited capability for work
unless you can show that you have good cause for not returning the questionnaire.
If you are getting ESA, this will stop. If you are getting UC, this will continue but you
will fall into another claimant category, for example, jobseeker.
Most claimants are also required to attend a medical assessment.
The form consists of a series of tick boxes about how any physical or mental
conditions affect your ability to carry out various specific everyday activities.
For each activity, there are a series of statements called ‘descriptors’ describing the
difficulties that you may have in that activity – see appendix 1. You score points for
each descriptor that applies to you and points scored in each activity are added
together. If you get 15 points or more you are considered to have limited capability
for work and have passed the assessment. You can combine points from the
physical and mental descriptors.
If you do not get 15 points you are considered not to have limited capability for work
and do not qualify for ESA. If you are claiming UC this means you can continue to
get universal credit but your work-related requirements will change.
In both benefits, even if you don’t get the 15 points, you can still be treated as having
limited capability for work if you are suffering from:
an uncontrolled or uncontrollable life threatening disease or
some physical or mental disease or disablement which would be a substantial
risk to you or anyone else if you were found not to have limited capability for
work; however you must also be able to show that this risk could not be
significantly reduced by reasonable adjustments being made to the workplace
or by taking prescribed medication
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www.hertfordshire.gov.ukIf you fail the work capability assessment you can challenge the decision - see page 16. For further information see the guide to completing an ESA50/UC50 on www.hertfordshire.gov.uk/benefits What happens at the medical assessment? After the relevant form has been received by the assessment providers (currently the Centre for Health and Disability Assessments) most claimants are invited to a local assessment centre for a medical examination. These are usually held in Luton or Hatfield for Hertfordshire residents. During the Covid-19 period you will not be asked to attend a face to face assessment, instead you will be contacted by phone and/or the professional involved with your health condition will be contacted for further information. You can reclaim your travel expenses and those of a companion, if you need one. If you can‘t travel by public transport, you can claim for taxi fares with prior approval. You will need a doctor’s letter confirming you are unable to use public transport. If you are not able to travel at all, you can ask for the assessment to be carried out in your home but, again, you will need a doctor’s letter. You are normally given seven days’ notice of the date of the medical. If you are unable to go, you should inform the office that arranged the medical straight away. If you fail to attend, any ESA will be stopped unless you can show you have a good reason for not attending. If you are getting UC, this will continue but you will fall into another claimant category, for example, jobseeker. The assessment is carried out using a computer-based questionnaire. You are likely to be asked questions about how you travelled to the assessment centre and how you intend to travel back. It is important to explain any difficulties you had with the journey. It is also important to tell the healthcare professional about your abilities to perform certain functions and the difficulties you have. If your condition or ability varies from day to day – remember to say so. If you can only perform an activity with pain or it causes tiredness, either that day or in the following days, remember to mention this. It is the effect of your condition over time, not just on the day of your assessment that should be taken into account. You can ask for the medical assessment to be audio recorded. However, a request will only be considered if it is made in advance and this can cause delays. Who is treated as having limited capability for work? Money Advice Unit 10 Issue 3 0300 123 4040 www.hertfordshire.gov.uk
You are treated as having limited capability for work for both ESA and universal
credit purposes if you are:
terminally ill *
undergoing, or recovering from, any form of chemotherapy or radiotherapy, or
are likely to receive chemotherapy within 6 months and the decision maker is
satisfied that the cancer treatment has work-limiting side effects and these are
likely to limit all forms of work
excluded from work due to a notifiable disease
are pregnant and there is a serious risk to your health or your baby’s health if you
do not refrain from work
in hospital (including residential drug or alcohol rehabilitation programmes) or
recovering from treatment as an inpatient – you are treated as an inpatient where
a health professional has advised a stay of 24 hours or more
receiving one of the following treatments or recovering from such treatments and
the DWP is satisfied you should be treated as having limited capability for work:
haemodialysis for chronic renal failure
plasmapheresis
total parenteral nutrition for gross impairment of enteric function
* If you are terminally ill you will move into the support group or LCWRA group
straight away without having to undergo the 13 week/3 month assessment period.
You will need to ask your health care professional for a DS1500 certificate. Your
health care professional will be able to send the certificate to the DWP directly.
For ESA only, you are:
entitled to the support component because you are someone who meets the
eating and drinking descriptors in the limited capability for work related activities
assessment (see appendix 2)
pregnant and entitled to maternity allowance or you are in the period between 6
weeks before the baby is due up to 2 weeks after the actual birth, and you are not
entitled to maternity allowance or statutory maternity pay for that period
(for income-related ESA only) a student in full time education who is eligible for
income-related ESA because you receive DLA or PIP (this does not apply to
those who would otherwise attract child benefit)
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www.hertfordshire.gov.uk (for contributory ESA only) in the universal credit system and have already been
assessed as having limited capability for work for UC
waiting for a work capability assessment and have provided a current medical
certificate; this does not apply if you are reclaiming ESA after having failed the
WCA, unless your condition has significantly worsened* or you have a new health
condition; however, if you are reclaiming ESA after being treated as failing the
WCA because you failed to return the ESA50 or to attend the medical, you may
be able to get ESA while awaiting your assessment if you satisfy certain
conditions – see page 17.
In some circumstances if you are appealing an ESA decision that you failed the work
capability assessment, you may also be treated as having limited capability for work
and continue to get ESA at a basic rate of £74.35 per week pending the appeal –
see page17.
(*Your condition has significantly worsened if it is considered that you would now be
likely to pass the WCA.)
For UC only, you:
have already been assessed as having limited capability for work for new style
ESA under the UC system
are transferring to UC from ESA and you were assessed as having it for ESA
are at least state pension age and get disability living allowance or personal
independence payment
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www.hertfordshire.gov.ukWhat is the limited capability for work-related
activity assessment?
This assessment also looks at whether or not you have limited capability for work-
related activity. It determines whether you are placed in the support group for ESA or
found to have LCWRA for universal credit and, as a consequence, get extra benefit
and not be required to undertake any work-related activity.
Support group/limited capability for work-related activity
You will be put in the support group (for ESA) /found to have LCWRA (for UC) after
the assessment period if you are considered to have limited capability to do work-
related activities because one of the descriptors in appendix 2 applies to you.
Some people are treated as though they have passed this test. You are
automatically placed in the support/LCWRA group if you:
are terminally ill (you also do not need to go through the assessment period
but will need to ask your health care professional for a DS1500 certificate) or
are receiving any form of chemotherapy or radiotherapy, or are recovering
from that treatment, or are likely to receive chemotherapy or radiotherapy in
the next 6 months; the decision maker must be satisfied that the cancer
treatment has work limiting side effects and those are likely to limit your ability
to carry out work-related activity or
are pregnant and there is a serious risk to your health or your unborn child’s
health if you don’t refrain from work-related activity and, for UC only, from
work or
have some physical or mental disease or disablement which would be a
substantial risk to you or anyone else if you were found not to have a limited
capability for work-related activity or
(for universal credit only) have reached state pension age and you are entitled
to attendance allowance, the highest rate care component of disability living
allowance or the enhanced rate of the daily living component of personal
independence payment or
(for universal credit only) are transferring to UC from ESA and you had, or
were treated as having, limited capability for work-related activity for ESA
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www.hertfordshire.gov.ukHow is the decision made?
Once enough information has been collected, this will be passed on to a DWP
decision maker who will decide whether you qualify for ESA or the relevant element
in universal credit. You will be sent a decision letter or receive notification on your
online account for universal credit. If awarded, you will enter the ‘main phase’ of
benefit and your payments will increase if you are placed in the support group/found
to have LCWRA.
What about people with severe conditions?
Once the first work capability assessment has taken place you will normally need to
attend further WCAs at intervals in the future. The healthcare professional who
assesses you will advise on when you should next be re-assessed.
However, if you are in the ESA support group or the limited capability for work-
related activity group of universal credit you may be told that you no longer need to
be reassessed if you:
have a severe, lifelong disability, illness or health condition and
are unlikely to ever be able to work again.
In addition, a recognised diagnosis must have been made. The condition must be
lifelong and there should be no realistic prospect of recovery or your level of function
improving.
No medical condition will automatically qualify someone for exemption from routine
reassessment. Every case should be looked at individually.
The DWP have said that the following conditions are accepted as examples of life
long conditions, but even people with these conditions will still have to meet the
above criteria: Motor Neurone Disease (MND); severe and progressive forms of
Multiple Sclerosis; Parkinson’s Disease; dementia; chromosomal conditions such as
Downs Syndrome; Huntingdon’s; severe irreversible cardiorespiratory (heart and
lung) failure or severe acquired brain injury.
You cannot appeal against a decision not to judge you as having a severe condition.
This is because this is a discretionary, non-legal, scheme without any set appeals
process.
What happens if I am placed in the work-related
activity group?
If you are found not to have a limited capability for work-related activity you will be
placed in the work-related activity group and have to comply with work-related
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www.hertfordshire.gov.ukconditions. You will have to attend regular work-focused interviews with a work coach and may have to engage in some work-preparation activity. If you fail to comply with the work-related requirements your benefit can be reduced through sanctions. When can benefit sanctions be applied to my benefit? Sanctions can apply, and your ESA/UC reduced, if you have been placed in the work-related activity group and you fail, without good reason, to attend a work- focused interview, or meet requirements relating to work preparation. A good reason for not attending a work-focused interview can include things like being too ill to attend, problems with literacy, language or transport, or any other good cause. If the work coach does not accept your reasons you have the right to ask for a mandatory reconsideration within a month of their decision followed by an appeal to an independent tribunal if you are still not satisfied (see page 16). ESA is reduced by £74.35 a week (although you will always be left with 10p) and universal credit by the single standard allowance. The reduction will apply until the requirement has been met followed by a fixed period sanction of one week for the first failure, two for the second failure or four weeks for a subsequent failure in a year. DWP internal guidance advises that their staff will try to visit you before applying a sanction if you have a mental health condition, learning disability or condition affecting communication or cognition. This should be to ensure that you understood what you needed to do and to find out whether you had good cause for your failure to meet the condition. If you are sanctioned you can apply for a hardship payment if you have no other means of financial support. Hardship payments – ESA If you do not come under the universal credit system and are entitled to income- related ESA, you may be able to get a hardship payment. You can get 60% of the ESA personal allowance or 80% if you are not getting the work-related activity component and you or any member of your family is pregnant or seriously ill. It is not automatic; you must be able to show that you and your family will suffer a hardship unless a hardship payment is made. Hardship payments are paid in addition to any premiums or housing costs.Hardship payments of ESA are not recoverable. Money Advice Unit 15 Issue 3 0300 123 4040 www.hertfordshire.gov.uk
You must complete an application for hardship payment. Ring Jobcentre Plus
on08001690310 for further information. Unless you (or your partner) fall into a
particular vulnerable group, you will not get paid a hardship payment for the first two
weeks of your claim.
Hardship Payments - UC
If you are in receipt of universal credit or new style ESA under the UC system you
can apply for a hardship payment of UC which is paid at 60% of your standard
allowance by contacting your local jobcentre or phoning the universal credit helpline:
Telephone: 0800 328 5644
The universal credit hardship payment is recovered at a maximum of 40% of your
standard allowance once your sanctioned is lifted. If you work over your earnings
threshold repayments will be suspended. If you continue to work to at least this level
any remaining debt will be written off once you have been working for 26 weeks.
Can I work and claim ESA?
The general rule is that you cannot work and get ESA at the same time. However,
the law allows you to claim ESA and do some types of ‘exempt work’ such as:
being a councillor
doing domestic tasks in your home
caring for a close relative
volunteering
for contributory ESA only, any work you do in a week in which you are treated
as having limited capability for work because you are having certain types of
regular treatment (e.g. haemodialysis for chronic renal failure) or are
recovering from that treatment (seek advice first if you are in this situation).
However your earnings may affect or stop the amount of ESA you get.
Permitted work
You can also take up certain ‘permitted work’ or supported permitted work’ and still
get full ESA housing and council tax benefit.
It’s permitted work if both of the following apply:
you earn up to £140.00 a week after tax
you work less than 16 hours a week
You can do supported permitted work and earn up to £140.00 a week if it is:
part of a treatment programme or
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www.hertfordshire.gov.uk supervised by someone from a local council or voluntary organisation whose
job it is to arrange work for disabled people
There is no limit on how many weeks your ‘permitted’ or ‘supported permitted’ work
can last for.
You don’t need a letter or any agreement from your doctor but should tell the office
that deals with your benefit claim. Fill in the form available on
www.gov.uk/government/publications/employment-and-support-allowance-permitted-
work-form
Can I work and claim universal credit if I have limited
capability for work?
There is no ‘permitted work’ rule in universal credit.
There is no time limit to how many hours or weeks you can work. Instead, if you
work, you are automatically treated as not having limited capability for work if your
monthly earnings are at least the level of earnings you would receive for 16 hours a
week paid at the national living wage for people aged 25 and over – currently
£604.58 a month.
However, you can work and earn above amount without automatically being
treated as not having limited capability for work if you:
are entitled to attendance allowance, DLA or PIP, or
have already been assessed as having limited capability for work (although
the DWP may still reassess you) or
are automatically treated as having limited capability for work because of a
specific circumstance (e.g. you are terminally ill - see page 10), or you are
treated as having limited capability for work-related activity (see page 12).
What can I do if I am unhappy with a decision?
If you are unhappy with any decision about ESA or universal credit, for example, if
you have failed the limited capability for work assessment, you have failed to attend
a medical, or if you believe you should have been found to have LCWRA (support
group), you can challenge the decision.
Challenging ESA decisions
You must ask the DWP for a mandatory reconsideration first. You can phone, fill in
a CRMR1 form from gov.uk or put the request in a letter with your name, date of birth
national insurance number and the decision you are challenging. You must usually
Money Advice Unit 17 Issue 3
0300 123 4040
www.hertfordshire.gov.ukdo this within one month from the date of the decision but it may be possible to ask for a late reconsideration (within 13 months) in special circumstances. ESA will not be reinstated during this stage but you can continue to get other benefits like housing benefit, PIP etc. If you need money to live on while waiting for the mandatory reconsideration, you will be asked to claim universal credit unless you have a severe disability premium in your award in which case you may be able to claim income support or income-based JSA instead. If you are on ‘old-style’ ESA you should seek advice before claiming universal credit to see if this is the best course of action in your particular circumstances. Once a claim for UC is made, any housing benefit or tax credits will stop and you will have to wait at least five weeks for your first payment. You will not be able to go back on income-related ESA or other legacy benefits again, even if you win your challenge. If you decide to try to manage without claiming universal credit, you could ask the DWP to make the ESA decision as soon as possible. As long as you haven’t claimed UC, ‘old-style’ ESA can be reinstated if your mandatory reconsideration is successful or you can get assessment rate ESA pending appeal if you decide to challenge the decision further. If you are unhappy with the new decision, you can then appeal to an independent tribunal. You should complete form SSCS1 and send it direct to HM Courts and Tribunals Service. You must also enclose a copy of the mandatory reconsideration notice. If you have not claimed UC, you are entitled to receive ESA at the assessment rate until while the appeal is pending unless you were treated as not having limited capability for work because you did not return the questionnaire or attend the medical. You will need to submit medical certificates during this period and ask for the ESA to be reinstated. For failure to return the questionnaire or attend the medical cases please refer to page 18. However, you cannot get ‘ESA pending appeal’ if the decision that you do not have limited capability for work is the second or subsequent such decision in a row, unless the decision is about a claim made before 30 March 2015. If you have been getting universal credit, you will remain on this until the appeal is decided but will not be able to return to income-related ESA. Challenging a work capability assessment decision in UC If you are challenging a work capability assessment decision while claiming universal credit you should ask for a mandatory reconsideration via your online journal. If you are unhappy with the decision you can then appeal the decision by completing a SSCS1 (see above). Money Advice Unit 18 Issue 3 0300 123 4040 www.hertfordshire.gov.uk
You will continue to be paid at the assessment rate. However, if the decision is
overturned and you are assessed as having LCWRA this will be backdated to the
date you were found fit for work.
What happens if I make another claim for ESA?
If you make a repeat claim for ESA after being found not to have limited capability for
work you will usually not be awarded ESA pending a fresh work capability
assessment unless you can demonstrate that there has been a significant worsening
in your health condition or that a new health condition has developed.
However, if you make a repeat claim after a previous decision that you were treated
as having limited capability for work because you failed to return the ESA50 or
attend the medical examination, you can get ESA at the assessment rate while you
are waiting for a new assessment if one of the following applies:
you have now returned the questionnaire or
it is more than six months since the decision treating you as not having limited
capability for work or
your condition has significantly worsened or
you have a new health condition
For universal credit the DWP will not reassess you after failing the work capability
assessment unless there has been a relevant change in your condition or the
decision was based on ignorance of, or a mistake about, a relevant fact.
What if I am still getting incapacity benefit, severe
disablement allowance or income support on the
basis of incapacity?
If you are still getting any of the above benefits you could be reassessed for
employment and support allowance. You will be assessed for ‘new style’ ESA and/or
universal credit. This is known as the conversion process and you will be subject to
the work capability assessment (see page 8). Since 2011 some people were
underpaid on transfer over to ESA and will receive a backdated payment of income-
related ESA. This should happen automatically.
Are ESA and universal credit affected by the benefit
cap?
There is a limit on the total amount of certain benefits working age people can claim.
This is called the benefit cap.
Money Advice Unit 19 Issue 3
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www.hertfordshire.gov.ukOutside of London your benefits are limited to £20,000 per year for couples or
families and £13,400 if you are a single person without children.
However, certain people are exempt from the benefit cap, including those who are:
in the ESA support group or
have limited capability for work-related activity for universal credit or
receive disability living allowance, personal independence payment,
attendance allowance, carers allowance (including underlying entitlement in
legacy benefits or the carer element in UC) or guardian’s allowance.
We hope you have found this factsheet, useful. If you have any comments to make
about content – things you would like to see or other changes you think we should
make, please let us know on moneyadvice.unit@hertfordshire.gov.uk
Unfortunately, we can’t assist with individual benefit queries – please see list of
advice agencies below.
Further help and advice
DWP
Universal credit helpline 0800 328 5644
Online information: www.gov.uk/universal-credit
Toolkit: www.gov.uk/universal-credit-toolkit-for-partner-organisations
Citizens Advice Help to Claim
(UC only) 0800 144 8 444
Online information: www.citizensadvice.org.uk/helptoclaim
Citizens Advice (CA) 0344 4111 444
Online information www.adviceguide.org.uk
Information about local CA: www.hcas.org.uk/
and opening times
How you can contact Hertfordshire County Council.
Our website
Information about adult social care – find out about care services, day centres and
apply online for meals on wheels or a Blue Badge. You can also comment,
compliment and complain.
www.hertfordshire.gov.uk/adults
Money Advice Unit 20 Issue 3
0300 123 4040
www.hertfordshire.gov.ukHertfordshire Directory
Find national and local community groups, charities, services and activities
www.hertfordshire.gov.uk/directory
HertsHelp
Independent information and advice on local community services and care funding
Telephone: 0300 123 4044
Minicom: 0300 456 2364
Email: info@hertshelp.net
Contact us
For information on how to get care and support
Email: contact@hertfordshire.gov.uk
Telephone: 0300 123 4042
Textphone: 0300 123 4041
British Sign Language (BSL) video interpreting service available
Monday to Friday 8am-6pm.
Drop in
To your local library – see www.hertfordshire.gov.uk/libraries
If you are worried that you or someone you know is at risk of abuse or neglect
Call us on 0300 123 4042 (24 hours a day)
If you need help to understand
Call 0300 123 4042 if you would like help to understand this information or need it in a
different format. You can also ask to speak to someone in your own language.
Calls to 0300 cost no more than a national rate call to a 01 or 02 number
Money Advice Unit 21 Issue 3
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www.hertfordshire.gov.ukAppendix 1
ASSESSMENT OF WHETHER A CLAIMANT HAS LIMITED CAPABILITY FOR WORK
Part 1 Physical disabilities
Activity Descriptors Pts
1. Mobilising unaided by (a) Cannot either: 15
another person with or (i) mobilise more than 50 metres on
without a walking stick, level ground without stopping in
order to avoid significant discomfort
manual wheelchair or or exhaustion;
other aid if such aid is or
(ii) repeatedly mobilise 50 metres
normally, or could within a reasonable timescale
reasonably be, worn or because of significant discomfort or
exhaustion.
used.
(b) Cannot 9
mount or descend two steps
unaided by another person even
with the support of a handrail.
(c) Cannot either: 9
(i) mobilise more than 100 metres on
level ground without stopping in
order to avoid significant discomfort
or exhaustion;
or
(ii) repeatedly mobilise 100 metres
within a reasonable timescale
because of significant discomfort or
exhaustion.
(d) Cannot either: 6
(i) mobilise more than 200 metres on
level ground without stopping in
order to avoid significant discomfort
or exhaustion;
or
(ii) repeatedly mobilise 200 metres
within a reasonable timescale
because of significant discomfort or
exhaustion.
(e) None of the above apply. 0
Money Advice Unit 22 Issue 3
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www.hertfordshire.gov.ukActivity Descriptors Pts
2. Standing and sitting. (a) 15
Cannot move between one seated
position and another seated position
located next to one another without
receiving physical assistance from
another person.
(b) 9
Cannot, for the majority of the time,
remain at a work station, either:
(i) standing unassisted by another
person (even if free to move
around); or
(ii) sitting (even in an adjustable
chair); or
(iii) a combination of (i) and (ii)
for more than 30 minutes, before
needing to move away in order to
avoid significant discomfort or
exhaustion.
(c) Cannot, for the majority of the time, 6
remain at a work station, either:
(i) standing unassisted by another
person (even if free to move
around); or
(ii) sitting (even in an adjustable
chair) or
(iii) a combination of (i) and (ii)
for more than an hour before
needing to
move away in order to avoid
significant
discomfort or exhaustion.
(d) None of the above apply 0
3. Reaching. (a) Cannot raise either arm as if to put 15
something in the top pocket of a coat
or jacket.
(b) Cannot raise either arm to top of 9
head as if to put on a hat.
(c) Cannot raise either arm above head 6
height as if to reach for something.
(d) None of the above apply. 0
Money Advice Unit 23 Issue 3
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www.hertfordshire.gov.ukActivity Descriptors Pts
4. Picking up and moving or (a) Cannot pick up and move a 0.5 litre
carton full of liquid.
transferring by the use of the 15
upper body and arms.
(b) Cannot pick up and move a one litre 9
carton full of liquid.
(c) Cannot transfer a light but bulky object 6
such as an empty cardboard box.
(d) None of the above apply. 0
5. Manual dexterity. (a) Cannot either: 15
(i) press a button, such as a telephone
keypad; or
(ii) turn the pages of a book with either
hand.
(b) Cannot pick up a £1 coin or equivalent 15
with either hand.
(c) Cannot use a pen or pencil to make a 9
meaningful mark.
(d) Cannot single–handedly use a suitable 9
keyboard or mouse.
(e) None of the above apply. 0
6. Making self understood (a)
Cannot convey a simple message,
through speaking, writing, such as the presence of a hazard. 15
typing, or other means which are
normally, or could reasonably (b)
Has significant difficulty conveying a
be, used, unaided by another simple message to strangers 15
person. Has some difficulty conveying a simple
(c)
message to strangers.
6
(d) None of the above apply. 0
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www.hertfordshire.gov.ukActivity Descriptors Pts
7. Understanding communication Cannot understand a simple message
due to sensory impairment, such as the
by (i)verbal means (such as (a) location of a fire escape. 15
hearing or lip reading) alone,
(ii) non-verbal means (such as
reading 16 point print or Braille)
(b) Has significant difficulty understanding 15
alone, or
a simple message from a stranger due
(iii) a combination of (i) and (ii), to sensory impairment.
using any aid that is normally, or
(c) Has some difficulty understanding a 6
could reasonably be, used simple message from a stranger due to
unaided by another person. sensory impairment.
(d) None of the above apply. 0
8. Navigation and maintaining (a) Unable to navigate around familiar 15
surroundings, without being
safety, using a guide dog or accompanied by another person, due
other aid if either or both are to sensory impairment.
normally, or could reasonably Cannot safely complete a potentially
(b) 15
be, used. hazardous task such as crossing the
road, without being accompanied by
another person, due to sensory
impairment.
(c) Unable to navigate around unfamiliar
surroundings, without being
accompanied by another person, due
to sensory impairment. 9
(d) None of the above apply. 0
Money Advice Unit 25 Issue 3
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www.hertfordshire.gov.ukActivity Descriptors Pts
9. Absence or loss of control (a) At least once a month experiences: 15
whilst conscious leading to (i) loss of control leading to extensive
extensive evacuation of the evacuation of the bowel and/or voiding
of the bladder; or
bowel and/or bladder, other than
(ii) substantial leakage of the contents
enuresis (bed-wetting), despite of a collecting device sufficient to
the wearing or use of any aids or require cleaning and a change in
clothing.
adaptations which are normally,
or could reasonably be, worn or
used.
(b) The majority of the time is at risk of 6
loss
of control leading to extensive
evacuation of the bowel and/or voiding
of the bladder, sufficient to require
cleaning and a change in clothing, if
not able to reach a toilet quickly.
(c) None of the above apply. 0
10. Consciousness during (a) At least once a week, has an 15
involuntary episode of lost or altered
waking moments. consciousness resulting in significantly
disrupted awareness or concentration.
(b) At least once a month, has an 6
involuntary episode of lost or altered
consciousness resulting in significantly
disrupted awareness or concentration.
(c) None of the above apply. 0.
Money Advice Unit 26 Issue 3
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www.hertfordshire.gov.ukPART 2 Mental, cognitive and intellectual function assessment
11. Learning tasks. (a) Cannot learn how to complete a simple task, 15
such as setting an alarm clock.
(b) Cannot learn anything beyond a simple task, 9
such as setting an alarm clock.
(c) Cannot learn anything beyond a moderately 6
complex task, such as the steps involved in
operating a washing machine to clean
clothes.
(d) None of the above apply. 0
12. Awareness of everyday (a) Reduced awareness of everyday hazards 15
leads to a significant risk of:
hazards (such as boiling
(i) injury to self or others; or
water or sharp objects).
(ii) damage to property or possessions
such that they require supervision for the
majority of the time to maintain safety.
(b) Reduced awareness of everyday hazards 9
leads to a significant risk of
(i) injury to self or others; or
(ii) damage to property or possessions
such that they frequently require supervision
to maintain safety.
(c) Reduced awareness of everyday hazards 6
leads to a significant risk of:
(i) injury to self or others; or
(ii) damage to property or possessions
such that they occasionally require
supervision to maintain safety.
(d) 0
None of the above apply.
Money Advice Unit 27 Issue 3
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www.hertfordshire.gov.uk13. Initiating and completing
Cannot, due to impaired mental function,
personal action (which means (a) reliably initiate or complete at least 2 15
planning, organisation, problem sequential personal actions.
solving, prioritising or switching Cannot, due to impaired mental function,
(b) 9
tasks). reliably initiate or complete at least 2
personal actions for the majority of the
time.
(c) Frequently cannot, due to impaired 6
mental function, reliably initiate or
complete at least 2 personal actions.
(d) None of the above apply. 0
14. Coping with change. (a) Cannot cope with any change to the 15
extent that day to day life cannot be
managed.
(b) Cannot cope with minor planned change 9
(such as a pre-arranged change to the
routine time scheduled for a lunch
break), to the extent that overall day to
day life is made significantly more
difficult.
(c) Cannot cope with minor unplanned 6
change (such as the timing of an
appointment on the day it is due to
occur), to the extent that overall, day to
day life is made significantly more
difficult.
(d) None of the above apply. 0
15. Getting about. (a) 15
Cannot get to any place outside the
claimant’s home with which the claimant
is familiar.
(b) Is unable to get to a specified place with 9
which the claimant is familiar, without
being accompanied by another person.
(c) Is unable to get to a specified place with 6
which the claimant is unfamiliar without
being accompanied by another person.
(d) None of the above apply. 0
Money Advice Unit 28 Issue 3
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www.hertfordshire.gov.uk16. Coping with social (a) Engagement in social contact is always 15
precluded due to difficulty relating to
engagement due to cognitive others or significant distress experienced
impairment or mental disorder. by the individual.
(b) Engagement in social contact with 9
someone unfamiliar to the claimant is
always precluded due to difficulty
relating to others or significant distress
experienced by the individual.
(c) Engagement in social contact with 6
someone unfamiliar to the claimant is not
possible for the majority of the time due
to difficulty relating to others or
significant distress experienced by the
individual.
(d) None of the above apply. 0
17. Appropriateness of behaviour (a) Has, on a daily basis, uncontrollable
episodes of aggressive or disinhibited
with other people, due to behaviour that would be unreasonable in
cognitive impairment or mental any workplace. 15
disorder.
(b) Frequently has uncontrollable episodes 15
of aggressive or disinhibited behaviour
that would be unreasonable in any
workplace.
(c) Occasionally has uncontrollable 9
episodes of aggressive or disinhibited
behaviour that would be unreasonable in
any workplace.
(d) None of the above apply. 0.”
Money Advice Unit 29 Issue 3
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www.hertfordshire.gov.ukAppendix 2
ASSESSMENT OF WHETHER A CLAIMANT HAS LIMITED CAPABILITY FOR
WORK RELATED ACTIVITY
Activity Descriptors
1. Mobilising unaided by another person with or
Cannot either:
without a walking stick, manual wheelchair or
other aid if such aid is normally, or could (a) mobilise more than 50 metres on level ground
reasonably, be worn or used without stopping in order to avoid significant
discomfort or exhaustion; or
(b) repeatedly mobilise 50 metres within a reasonable
timescale because of significant discomfort or
exhaustion.
2. Transferring from one seated position to Cannot move between one seated position and
another. another seated position located next to one another
without receiving physical assistance from another
person.
3. Reaching. Cannot raise either arm as if to put something in the
top pocket of a coat or jacket.
4. Picking up and moving or transferring by the Cannot pick up and move a 0.5 litre carton full of
use of the upper body and arms (excluding liquid.
standing, sitting, bending or kneeling and all other
activities specified in this Schedule).
5. Manual dexterity.
Cannot either:
(a) press a button, such as a telephone keypad; or
(b) turn the pages of a book with either hand.
6. Making self understood through speaking, Cannot convey a simple message, such as the
writing, typing, or other means which are normally, presence of a hazard.
or could reasonably be, used, unaided by another
person.
7. Understanding communication by Cannot understand a simple message due to sensory
impairment, such as the location of a fire escape.
(i) verbal means (such as hearing and lip reading),
alone, or
(ii) non-verbal means (such as reading 16 point
print or Braille) alone, or
(iii) a combination of (i) and (ii) using any aid that
Money Advice Unit 30 Issue 3
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www.hertfordshire.gov.ukActivity Descriptors
is normally, or could reasonably be, used,
unaided by another person
At least once a week experiences:
8. Absence or loss of control whilst conscious
(a) loss of control leading to extensive evacuation of
leading to extensive evacuation of the bowel
the bowel and/or voiding of the bladder; or
and/or voiding of the bladder, other than enuresis
(bed-wetting), despite the wearing or use of any
aids or adaptations which are normally, or could (b) substantial leakage of the contents of a collecting
reasonably be, worn or used. device sufficient to require the individual to clean
themselves and change clothing.
9. Learning tasks. Cannot learn how to complete a simple task, such as
setting an alarm clock, due to cognitive impairment or
mental disorder.
10. Awareness of hazard.
Reduced awareness of everyday hazards, due to
cognitive impairment or mental disorder, leads to a
significant risk of:
(a) injury to self or others; or
(b) damage to property or possessions
such that they require supervision for the majority of
the time to maintain safety.
11. Initiating and completing personal action Cannot, due to impaired mental function, reliably
(which means planning, organisation, problem initiate or complete at least 2 sequential personal
solving, prioritising or switching tasks). actions.
12. Coping with change. Cannot cope with any change, due to cognitive
impairment or mental disorder, to the extent that day
to day life cannot be managed.
13. Coping with social engagement, due to Engagement in social contact is always precluded due
cognitive impairment or mental disorder. to difficulty relating to others or significant distress
experienced by the individual.
14. Appropriateness of behaviour with other Has, on a daily basis, uncontrollable episodes of
people, due to cognitive impairment or mental aggressive or disinhibited behaviour that would be
disorder. unreasonable in any workplace.
Money Advice Unit 31 Issue 3
0300 123 4040
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