Employment and Support Allowance (ESA) is a benefit that is paid to people who have a limited ability to work because of illness or disability.

ESA was introduced in 2008 and replaced Incapacity Benefit (including Incapacity Benefit in Youth) and Income Support paid on the basis of incapacity. People who currently receive these old benefits will be reassessed and moved off those benefits between October 2010 and March 2014. Please see our information The reassessment of incapacity benefits for more information about this.

ESA has both an 'income-related' strand and a 'contributory' strand. Anyone who has paid enough National Insurance contributions through work can claim ESA through the contributory strand, but those who haven't paid enough can still claim ESA through the income-related strand. However, the income-related strand of ESA is means-tested, so your income and savings will be looked at before you can qualify for it.

ESA can be claimed from age 16 up to state pension age. People aged under 20 (and in some cases 25) can qualify for the contributory-based ESA without having paid National Insurance contributions, in a similar way to Incapacity Benefit in Youth.

The assessment for ESA is called the 'work capability assessment'. It is a points-based assessment that looks at your ability to carry out various activities. If you score 15 or more points you are said to have a 'limited capacity for work'.

How does ESA work?

All claims to ESA go through an initial 'assessment phase' of 13 weeks, before entering the 'main phase' of the benefit. The amount of money paid is less in the first 13 weeks and increases in the main phase. The only exception to this is for people who are terminally ill, whose claims will be fast-tracked.
 
The first stage of the assessment phase is completing and returning a claim form. The claim form is normally completed over the telephone and a statement is then sent out in the post for you to sign and return.

Then, evidence to support your claim is required. You will need to obtain a medical certificate from a GP, and often you will be asked to provide other evidence such as bank statements.

After submitting your claim form and the evidence requested you will be in the assessment phase of the benefit. You will be paid ESA at a basic rate while your capability for work is assessed.

The work capability assessment

You will be assessed using the 'work capability assessment'. This determines whether you have 'limited capability for work' or 'limited capability for work-related activity'. A single assessment process is used to decide if either of these apply to you.

First, you will be sent a questionnaire (ESA50) about your health. This is followed, in most cases, by a face-to-face assessment by a Department for Works and Pensions-approved health care professional. A company called ATOS is currently paid to do these assessments.

Information about you is collected using the ESA50 form that you complete (including any evidence that you send with this such as letters or reports) and the report written by the ATOS assessor who carries out your face-to-face assessment. This information is sent to a decision-maker at the Department for Work and Pensions (DWP).

The DWP then carries out a test called the limited capability for work test. This test uses a point-scoring system based on assessment of a variety of physical and mental health functions (referred to as 'descriptors'). These descriptors include physical tasks, such as reaching or mobilising, and mental health functions, such as learning tasks, awareness of hazards and coping with social engagement. There are 17 descriptors in all.

See Employment and Support Allowance and the Work Capability Assessment for a full list of descriptors. 

For each descriptor, points are awarded according to the level of difficulty you experience completing them. For example, one of the descriptors in the mental, cognitive and intellectual function assessment is called 'Coping with change'. If it is considered that you experience the following difficulties you would score six points:

Cannot cope with minor unplanned 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.

However, if the decision-maker thinks that you experience a higher degree of difficulty, as described below, you would score 15 points:

Cannot cope with any change to the extent that day-to-day life cannot be managed.

To qualify as having 'limited capability for work' you need to score 15 points in total. As you can see from the example above, it is actually possible to pass the test based on just one descriptor. However, the higher scores in each descriptor relate to people who experience the most severe physical and mental health difficulties. In many cases, if you pass the test you'd do so based on a combination of descriptors.

If you score less than 15 points then you are not found to have 'limited capability for work' and will not be entitled to continue to receive ESA, though you have the right to appeal against this decision. You may also be able to claim Jobseeker's Allowance instead.

If you pass the limited capability for work test, the decision-maker will decide whether you should be placed in the 'support' group or the 'work-related activity' group. Their decision will be based upon an assessment of a number of physical and mental health tasks. You only need to satisfy one of the descriptors in this second test to pass it.

The descriptors in this test relate only to people who experience the most severe forms of physical or mental health problem. If one or more of the descriptors is met, they will be placed in the support group. If none of the descriptors are met they will be placed in the work-related activity group. 

The support group

If you are placed in the support group you are not required to take part in work-related activity (though you can choose to do so if you like). You will also receive a higher amount of ESA. However, the criteria for entering the support group is very restrictive - only approximately 5% of ESA claimants are placed in the support group.

The work-related activity group

The majority of ESA claimants are placed in the work-related activity group.

The amount of benefit is lower for the work-related activity group than for the support group and you will attend 'work-focused interviews'. Failure to take part in these interviews can result in your benefit being 'sanctioned'. This means that the benefit is reduced for a period of time.

Your work-focused interview will take place with a personal adviser who will try to help you into work by drawing up an action plan.
The Government plans to require people to undertake other types of work-related activity, too. This is likely to be organised though the Work Programme, which helps people with disabilities get into employment: activities may include training or support to prepare for work. Claimants cannot be forced to apply for a job or to undergo any medical treatment. 

Is anyone exempt from the ESA medical assessment?

There are fewer exemptions from medical assessment for Employment and Support Allowance than there were with Incapacity Benefit. Usually, the only groups of people who are automatically treated as having limited capability for work are the terminally ill, people receiving chemotherapy and pregnant women who are due to give birth shortly.

It is possible for the Department for Work and Pensions to carry out the assessment without you having to go to the face-to-face assessment with ATOS. If it would be unreasonable or inappropriate for you to be required to attend the face-to-face assessment, you should explain why when you return the ESA50 form. It helps to give as much information as possible at this stage so that the Department for Work and Pensions has enough information to make the decision without a report from ATOS. 

What if I already receive Incapacity Benefit?

From October 2010 people who currently receive Incapacity Benefit and Income Support will be reassessed and, if they meet the criteria, will be moved onto ESA. Claimants who do not meet the ESA criteria will have their benefit stopped. They will have the option of claiming Jobseeker's Allowance.

The reassessment process should be completed by March 2014. Two million people will have their benefits reassessed, and the Government predicts that 23% of them will have their benefit stopped.

Please see The reassessment of incapacity benefits for more information.

Working and claiming ESA

Although ESA is paid to people who have limited capability for work, it is possible to receive the benefit and still work. This is known as 'permitted work'. There are complex rules about what counts as permitted work, so get advice about this and check carefully with the office that pays your benefit before starting any work. 

Claiming ESA under the age of 25

If you are under the age of 20 you can claim contributory-based ESA without having paid National Insurance contributions through work. In certain cases, this can be extended to the age of 25 if you have been in education or training.

How much is ESA?

The calculation of ESA is complex. The basic rate for both contributory and income-based ESA is £67.50 per week (£53.45 for those under 25), and this will be paid during the 13-week assessment phase of the benefit. This figure can be reduced in income-related ESA if, for example, the claimant has other income and savings.

However, the basic rate of ESA can also be increased by 'premiums'. These are extra amounts paid to people in certain situations, for example carers can receive the carers' premium, and the severely disabled can receive the severe disability premium. So, a person aged over 25 who is entitled to the severe disability premium would get a basic rate of £122.80 per week.

At the end of the assessment phase, and assuming the limited capability for work test has been passed, more money is added to the basic rate and any premium you qualify for. The amount varies: if you are in the work-related activity group you will get an extra £26.75 per week if you are in the work-related activity group and if you are in the support group you will get an extra £32.35 per week. After the assessment phase those under 25 no longer get a reduced rate, they get the full £67.50 basic rate, plus any applicable premiums and additional money. 

Further reading

Read more information about the limited capability for work section of ESA here .

Easy read: download Your guide to Employment and Support Allowance

Greaves, I. (2007). Disability Rights Handbook 32nd edition April 2007 April 2008. London: Disability Alliance.

If you have any queries about Employment and Support Allowance, email our Welfare Rights Service: welfarerights@nas.org.uk

Quick link to this page: www.autism.org.uk/23627