In this blog post, we talk about the ESA reassessment process, what is the timeline for a Work Capability Assessment and whether the benefits payments will be affected by the 2020 Coronavirus pandemic.
What is an ESA reassessment process?
An ESA reassessment process is another Work Capability Assessment. You already know that WCA is the process used in claims for Universal Credit (UC) and Employment and Support Allowance (ESA) to determine whether or not DWP accept that the disabled person is incapable of work and also to award them points to place them in the appropriate category if they are incapable of work.
Work Capability assessments are rearranged at regular intervals and are known as ESA reassessments. The intervals for the reassessment periods are determined by advice given by the Healthcare Professional at the previous assessment. The periods recommended can be 3,6,12,18,24 months or “in the longer term”.
To avoid a reassessment, claimants will have to satisfy, all four of the following:
- the level of function will always meet limited capability for work-related activity (LCWRA) criteria;
- the condition will always be present (some lifelong conditions are present from birth, but others will develop or be acquired later in life);
- no realistic prospect of recovery of function (with advice on this being based on currently available treatment and not on the prospect of scientists discovering a cure in the future);
- unambiguous condition (following all relevant clinical investigations a recognised medical diagnosis has been made).
Since 29 September, these criteria have been considered as part of Work Capability Assessments. You will be told if you meet the above criteria following the work capability decision by a DWP decision-maker.
If you disagree with the decision, you can ask the DWP to look at it again, but there is no right to the formal mandatory reconsideration and appeals process after this.
There is still uncertainty as to whether or not M.E. will fall under the above criteria, and the DWP has decided against releasing specific illnesses to allow the criteria to be flexible.
This enables individual healthcare professionals who are conducting Work Capability Assessments to use a considerable amount of discretion as to whether someone should be excluded from future assessments. It may be the case that if those living from M.E. are able to be considered under the above criteria, it will probably only be a very small minority such as those who are most severely affected.
You can read more about this criteria on the Disability Rights UK website.
Read more about the Work Capability Assessment in our blog post, here.
How often are ESA reassessments?
Where an ESA or Universal Credit claimant has been assessed as having or treated as having a limited capability for work (LCW) or limited capability for work-related activity (LCWRA), social security law provides that the DWP may require them to undergo a further Work Capability Assessment (WCA) to determine whether:
- There has been a relevant change of circumstances in the claimant’s physical or mental condition; or
- The previous determination was made in ignorance of or based on a mistake as to, some material fact.
ESA claimants may also be reassessed if it is at least three months since the previous determination of LCW/LCWRA.
There are no rules on how often reassessments take place, but the DWP normally follows the recommendation of the Maximus assessor (Healthcare Professional or “HCP”) on when it might be appropriate for the individual to be reassessed.
The Work Capability Assessment will continue to be applied at regular intervals during the life of an award to ensure the conditions for entitlement are maintained. The timing of further assessments is determined by the Jobcentre Plus decision-maker.
To assist the decision-maker, the approved healthcare professional includes advice on the assessment report about when it is likely the claimant will be able to return to work. However, the assessment can be applied sooner if the decision-maker considers there has been a significant change in the claimant’s health condition or disability.
The categories of prognosis that an assessor can advise are:
- three months
- six months
- 12 months
- 18 months
- Within two years
- In the longer-term
On 29 September 2017, the DWP announced that ESA claimants in the Support Group and Universal Credit claimants with limited capability for work and work-related activity (LCWRA) will no longer need to be reassessed if they:
- have a severe, lifelong disability, illness or health condition; and
- are unlikely to ever be able to move into work
Claimants will be told if they will not be reassessed following their WCA.
This means that if a person has not undergone an assessment since September 2017, they will have to be reassessed for it to be determined whether they meet the “severe conditions” criteria for switching off future reassessments.
What is the ESA reassessment timescale?
From March 2011 the Department for Work and Pensions (DWP) began reassessing people on incapacity benefits (for example, Incapacity Benefit and Severe Disablement Allowance) for eligibility for ESA.
More than 2 million claimants were receiving incapacity benefits before reassessment began and we have now reassessed around 1.5 million people, nearly all of those who required a reassessment.
The department is correcting some past underpayments of ESA, which arose while reassessing incapacity benefit claims.
According to the latest National Statistics on the outcomes of completed Employment and Support Allowance (ESA) Work Capability Assessments (WCA), of 4.6 million ESA WCAs started between October 2013 and June 2019:
- 65% had a completed assessment; WCAs for the remaining claims are either still in progress or were closed by the claimant
- 400,000 MRs have been registered in relation to the 3,000,000 completed WCAs
- 99.7% of these MRs have been completed, with the original decision revised 16% of the time
- 25% of assessments with a completed MR also went on to complete an appeal; of these 100,000 appeals, 34% of DWP decisions were upheld
More on ESA reassessment delays and processing data
For the initial WCA completed in September 2019 the median end-to-end clearance time decreased by five weeks to stand at 14 weeks.
The median time from the WCA Referral to Assessment Provider (AP) recommendation was 9 weeks in September 2019.
This stage will usually involve a WCA assessment and includes the waiting time for the customer to complete and return the questionnaire. Multiple referrals are sometimes required before an assessment is completed and a recommendation received, as customers may not attend appointments or return questionnaires.
In September 2019, the average time between referral to the AP and their recommendation was 9 weeks.
The majority (87%) of ESA WCA assessments in the latest quarter (data published in March 2020) were repeat assessments.
At the end of 2013, repeat ESA WCA assessment volumes dropped substantially as the focus moved to clear new claims. During this period, claimants could still request a repeat assessment due to a change of circumstances, such as the development of a new condition or deterioration of the existing one.
After almost 2 years, processing was re-introduced for repeat assessments in December 2015. The numbers of repeat assessments have risen substantially from 35,000 in the quarter to December 2015 to 190,000 in the quarter to March 2019. Since then, numbers have fallen to stand at 140,000 in the latest quarter to September 2019.
ESA reassessment delays 2018 versus 2020
When speaking about the ESA reassessment delays 2018 versus 2020, we have to speak about the current situation that is stressing most of us in 2020.
We are all aware of how disruptive the Coronavirus pandemic is. Recently, on 18 March 2020, Charities told MPs on Wednesday that individuals claiming sickness and disability benefits could be left out of pocket as the Department for Work and Pensions (DWP) diverts resources to tackling the outbreak., according to Independent UK.
Tens of thousands of unwell people could be left for “months on end” not receiving the benefits to which they are entitled due to delays in the system caused by coronavirus.
The DWP announced that face-to-face assessments for disability benefit claimants would be put on hold as a precautionary measure against unnecessary exposure to infection from coronavirus.
But charities told MPs this did not go far enough and called on the government to temporarily suspend all disability benefit reassessments of people already in receipt of support.
A DWP spokesperson said: “The government is committed to strengthening our welfare safety net at this unprecedented time. Our first priority is to ensure that the most vulnerable in our society are kept safe and lives are not put at risk. Our dedicated staff will continue to provide the best possible service.”
Coronavirus and claiming benefits
If you’re in work and not claiming benefits
If you cannot work due to coronavirus and are eligible for Statutory Sick Pay you will get it from day one, rather than from the fourth day of your illness. DWP intends to legislate so this measure applies retrospectively from 13 March 2020.
Statutory Sick Pay will be payable if you have coronavirus or are self-isolating on government advice.
If you’re already claiming benefits
People receiving benefits do not have to attend jobcentre appointments for three months, starting from Thursday 19 March 2020.
People will continue to receive their benefits as normal, but all requirements to attend the jobcentre in person are suspended.
In light of the current coronavirus outbreak, the Department for Work and Pensions has taken the precautionary decision to temporarily suspend all face-to-face assessments for health and disability-related benefits. This is aimed at reducing the risk of exposure to coronavirus and safeguarding the health of individuals claiming health and disability benefits, many of whom are likely to be at greater risk due to their pre-existing health conditions.
Changes to how much you’ll get:
From 6 April the government is increasing the standard allowance in Universal Credit and the basic element in Working Tax Credit for one year. Both will increase by £20 per week on top of planned annual uprating. This will apply to all new and existing Universal Credit claimants and to existing Working Tax Credit claimants.
Read more about your benefits payment during the Coronavirus here.
ESA reassessments are rearranged at regular intervals. The intervals for the reassessment periods are determined by advice given by the Healthcare Professional at the previous assessment. The periods recommended can be 3,6,12,18,24 months or more.
According to the latest government statistics, the average time between referral to the Assessment Provider and their recommendation was 9 weeks.
The difference between ESA reassessment delays in 2018 and in 2020 is the Coronavirus pandemic that is through will slow things down.
However, The DWP recommends to not delay making a benefit claim, even if you think you may be affected by the coronavirus. They also stated that all benefits will be paid in time.
If you are concerned about your benefits payments we recommend to contact the Citizens Advice Bureau for advice.
Please feel free to leave any comments or questions you may have, in the comments section below.
FAQ about ESA reassessment delays
How often is ESA reassessed?
Usually, ESA is reassessed every 1, 2 or 3 years. The goal is to make sure you are still not fit for work. However, if you’re in the support group or getting income-related ESA, your claim will be ongoing.
How long does ESA decision take 2019?
In 2019, ESA decisions took 2-4 weeks after the face to face assessment, if one was required.
How long does income-related ESA last for?
Income-related ESA last for a year, if you’ve been placed in the work-related group. At this point, you can reapply for either when 12 weeks have passed since you received your last payment.
What is the highest rate of ESA?
The highest rate of ESA is usually £73.10 a week if you’re aged 25 or over. If you are aged under 25, you’ll normally get the assessment rate for the first 13 weeks up to £57.90 a week.
How do I contact ESA by email?
The email address where you can contact the Department for Work & Pensions which ESA falls under is [email protected] Response times for a reply to this email address can be over 7 working days.
- Government’s response to the Independent Review of the Work Capability Assessment
- An independent review of the Work Capability Assessment
- Project Management Capability Assessment
- This Book Will Change Your Mind About Mental Health: A journey into the heartland of psychiatry
- Understanding Mental Illness 6th edition: Mental Health Awareness For Self Teaching
- Understanding Mental Disorders: Your Guide to DSM-5
- ESA and PIP reassessments – BRIEFING PAPER Number 07820, By Steven Kennedy
- Guidance on Work Capability Assessment reassessment published- disabilityrightsuk.org
- Work Capability Reassessments – benefitsaware.centralenglandlc.org.uk