ESA Repeat Claims
High Level Overview for External Partners
Version v1.0 March 2015
Purpose and background of this presentation
• This presentation specifically provides information about one of the ESA
Reform measures; ESA Repeat Claims
• In November 2014, the Government response to the Work and Pensions
Select Committee report on ESA and the WCA announced a package of
measures to increase health and employment support for claimants with a
disability or health condition
• The measures outlined included this change to ESA repeat claims
Department for Work & Pensions
2
The package of support
The package of measures will be introduced in Spring 2015 and are made
up as follows:
• Two national measures:
• JSA extended periods of sickness – from 30 March
• Restricting Repeat ESA Claims – from 30 March
• Plus additional pilots in several Jobcentre Plus districts:
• ESA Claimant Commitment Trial – from 23 March
• More intensive support for ESA claimants pilot – from 23 March
• ESA Voluntary Early Intervention pilot – from 23 March
• Personalisation Pathfinders – from 1 April
Department for Work & Pensions
3
Aims of the ESA Reforms
The aims of the ESA reforms are to:
• Gain robust evidence about what types of support will help this
group of claimants into employment
• Minimise the movement of claimants between Jobseeker’s
Allowance (JSA) and ESA and the associated disruption to benefit
payments, and
• Increase the health and employment support for claimants with a
health condition or disability
Department for Work & Pensions
4
Restricting ESA Repeat Claims
• From 30th March 2015, claimants who are found not to have limited
capability for work (LCW), following a Work Capability Assessment
(WCA) will not be paid the ESA assessment rate for a repeat claim;
unless they have developed a new condition or an existing condition
has significantly worsened
• Currently, claimants can make another claim for ESA after six months
and potentially be paid ESA, even if there is no change in their health
condition
• To prevent this happening ESA regulations are being amended to
remove:
 the reference to ‘six months’ and
 entitlement to payment pending appeal for claimants who have
had two consecutive decisions that they do not have limited
capability for work.
Department for Work & Pensions
5
Restricting ESA Repeat Claims (continued)
• Where someone makes a repeat claim for ESA and there is no
change in their health condition, DWP Decision Makers will be able to
consider evidence from their previous WCA, when considering
whether to disallow the repeat claim immediately, or refer for a further
WCA, without paying the ESA assessment phase rate
• This change does not prevent someone from making another claim to
ESA
• It also does not prevent someone whose condition has significantly
worsened or who has developed a new condition from being entitled
to ESA during the assessment phase
Department for Work & Pensions
6
Restricting ESA Repeat Claims (continued)
• The changes will not affect new claims where the claimant previously
Failed to Attend their WCA or Failed to Return their ESA50
questionnaire; the six month rule will still apply to these claimants
• Claimants affected by this change who are found not to have limited
capability for work, should claim Jobseeker’s Allowance or Universal
Credit as appropriate
• This is to ensure that claimants receive the right advice and support
from a Jobcentre Plus Adviser or Work Coach
Department for Work & Pensions
7
Restricting ESA Repeat Claims – Examples
Example 1
•
•
•
•
ESA disallowed as following WCA, decision made no LCW
Repeat claim made and claimant disallowed based on previous WCA or repeat claim
made and no decision until WCA,
After WCA, decision made no LCW
Appeal received by HMCTS, following mandatory reconsideration, ESA cannot be paid
whilst the appeal is on-going as there have been two consecutive no LCW decisions.
Example 2
•
•
•
ESA disallowed as following WCA, decision made no LCW
Repeat claim, DM accepts new or significantly worsened condition; claimant is treated as
having LCW and is paid ESA and referred for WCA at the relevant time
After the WCA, the DM decides no LCW and ESA ends. If after a mandatory
reconsideration the claimant appeals, the claimant cannot be paid ESA whilst the appeal
is on-going as there has been two consecutive no LCW decisions.
Example 3
•
•
•
ESA disallowed as following WCA, decision made no LCW
Repeat claim made and following WCA, claimant has LCW and is placed in WRAG for
one year. One year later, repeat WCA, decision made no LCW
Appeal received by HMTCS following a mandatory reconsideration, ESA can be paid
whilst the appeal is on-going as there has not been two consecutive no LCW decisions.
Department for Work & Pensions
8
What does this mean for Customer Representative
Groups?
• Your role
 Groups may be asked to support claimants due to the changes so will
need to understand the new measures and the evidence required to
support repeat claims
 Staff will continue to follow current Departmental guidance for
vulnerable claimants who may require additional support
 www.gov.uk has more information regarding eligibility criteria for each
benefit
• Insert any local material as appropriate
Department for Work & Pensions
9