Universal credit, ESA, sickness and disability

If you have a health condition or disability you may already be claiming Universal Credit or Employment and Support Allowance (ESA).

New claims for income related ESA are no longer possible so if you are making a new claim with a health condition or disability it will be for Universal Credit and/or ‘New Style’ contributory ESA.

When you claim benefit with a health condition or disablity, the assessment process for Universal Credit and ESA is known as the Work Capability Assessment.

We'll guide you through that process in this section. It is mostly the same process for both benefits.

You may be able to claim Personal Independence Payment  (PIP) in addition to Universal Credit or ESA. We have a different guide about Personal Independence Payment. 

Universal Credit is the new benefit for people of working age. 

It replaces all the main means tested benefits including income related ESA and housing benefit. 

You usually claim Universal Credit online.

If you need to make a new claim for benefit to help with your living costs or your rent or mortgage, it may be a claim for Universal Credit. 

During the online claim process, you will be asked if you have a health condition or disability that affects your ability to work. 

It is possible to make a phone claim for Universal Credit if you are vulnerable and find it difficult to use the internet. Phone 0800 328 5644.

ESA can be paid as a contributory or income related benefit. 

It is no longer possible to make a new claim for income related ESA because it has been replaced by Universal Credit.

You can still claim contributory ESA, known as ‘new style’ ESA if you have paid sufficient National Insurance contributions. If you are paid contributory ESA, your partner’s earnings and any savings you or your partner have do not affect your claim.

Contributory ESA can be paid along with Universal Credit which tops up your income if you have a partner or children or rent to pay and also adds amounts if there are carers or disabled children in your household.

You may be getting income related ESA already because you claimed before it was replaced with Universal Credit.  

On income-related ESA or Universal Credit your household income, including any earnings from your partner, is taken into account.

Savings are ignored up to £6,000. If you (and your partner) have more than £16,000 in savings, you can’t receive income-related ESA or Universal Credit.

You can claim ‘new style’ contributory ESA by:

• completing the form ESA1
• phoning the Universal Credit helpline on 0800 328 5644

You will need to have proof of identity and your medical certificate from your GP verified by the local jobcentre before your benefit can be paid.  You can send a medical certificate or fit note to the ESA team at the jobcentre.

If you want to claim benefit for your partner, children or to help with rent you will also need to make a claim for Universal Credit. ESA can be backdated for up to 3 months.

A few weeks after your new claim for either contributory ESA or Universal Credit, you will be sent a form or questionnaire. 

You might become unwell or disabled while you are already receiving Universal Credit, in which case you will be sent the questionnaire when you notify Universal Credit staff and submit your medical certificate as evidence.

The questionnaire is UC50 if you have claimed Universal Credit and ESA50 for ESA. 

You may also receive further questionnaires if you have been receiving benefit for a while. This is so you can be reassessed to check whether your health condition or disability has changed. 

The questionnaire asks about your illness or disability. You will have a time limit within which to return it. If it is late without ‘good reason’ your claim could be stopped.

It is a very good idea to include any medical evidence you may have, such as letters from doctors, when you return the questionnaire.

Keep a copy of everything you send.

Once you have completed and returned the questionnaire you will usually be asked to attend a medical assessment with a health professional. This could be a doctor, but it might be a physiotherapist or nurse. If you don’t attend, your claim could be stopped unless you can show you had ‘good reason’ for missing the appointment.

It is a good idea to take a friend or relative with you to the appointment and to take copies of your completed questionnaire and any medical evidence.

The test is called the work capability assessment. Your answers on the questionnaire are considered alongside what you say and do at the appointment. You are only entitled to benefit if you can show that you have ‘limited capability for work’. You are scored against a list of descriptors. To qualify you need to score 15 points.

As part of the assessment the decision maker also decides whether you should be in the support group, known as Limited Capability for Work Related Activity (LCWRA), under Universal Credit or the work related activity group known as Limited Capability for Work (LCW), under Universal Credit. See our Work-related activity/LCW or support group/LWCRA section.

At the start of your claim you are paid at basic rates during the assessment phase. These rates are lower if you are under 25. These rates continue for everyone for the first 13 weeks or 3 months of claim during which time you should be assessed. You need to continue submitting medical certificates from your GP until the assessment process is complete.

In practice it may take longer than 3 months for you to be assessed. If you are found to be entitled and placed in the support group, your benefit should increase and if necessary, be backdated to the 13th week or start of the fourth month of your claim.

On ESA, so long as you submit medical certificates from your GP, you can be treated as having limited capability for work. This means you do not have to be available for and actively seeking work while you are in the assessment phase.

On Universal Credit there is no automatic rule allowing you to be treated as having limited capability for work even though you are submitting medical certificates. Instead, you need to negotiate your claimant commitment (the steps you need to take each week to stay on Universal Credit) with your work coach and ask them to take your health condition or disability in to account.

As part of the assessment the decision maker also decides whether you should be in the support group/LCWRA or the work-related activity group/LCW. The support group/LCWRA is for people who are considered to have greater difficulties because of their health condition or disability.

In the work-related activity group/LCW you are expected to:

• attend work focused interviews
• draw up an action plan
• participate in agreed activities on your claimant commitment.

You may lose benefit if you miss interviews or don’t participate in activities.

People who had already claimed before 3 April 2017 receive an extra £30.60 per week in ESA , £132.89 per month in Universal Credit on top of the basic rate. If your claim started after 3 April 2017 you stay on basic rates with no extra component. 

If you are placed in the support group/LCWRA you get an extra £40.60 per week/£354.28 per month on top of the basic rate. You are not required to attend work focused interviews or activities.

For you to qualify for the support group/LCWRA you need to be able to answer ‘yes’ to at least one of a second list of descriptors. You can also qualify for the support group/LCWRA in ‘exceptional circumstances’ 

A small number of people will be exempt from assessment.

You should automatically qualify without attending an assessment if you are:

• terminally ill - meaning you are expected to die within the next 6 months
• receiving or recovering from chemotherapy or radiotherapy for cancer or due to start such treatment within 6 months
• excluded from work because you’ve been in contact with an infectious disease
• a hospital in-patient for 24 hours or more
• attending a residential programme of rehabilitation for the treatment of drug or alcohol addiction for 24 hours or more
• the qualifying age for state pension credit and also entitled to disability living allowance or personal independence payment
• pregnant and there is a serious risk to you or your unborn child if you don’t stop work months; or
• receiving or recovering from:
  • regular weekly haemodialysis for chronic renal failure
  • Plasmapheresis or radiotherapy
  • regular weekly treatment for total parenteral nutrition for gross impairment of enteric function

For ESA only, you are also exempt if you are entitled to the support group component on the basis that you meet one of the support group descriptors.

Even if you do not score 15 points, you can still be treated as having passed the test in the following exceptional circumstances:

• you have an uncontrolled or uncontrollable life-threatening disease, and there is medical evidence to show this. There must be reasonable cause for the disease not to be controllable by a recognised therapeutic procedure
• you suffer from some specific disease or disability which means there would be a substantial risk to the mental or physical health of anyone (including you) if you didn’t pass the test. This doesn’t apply if the risk could be significantly reduced by reasonable adjustments in the workplace or by taking prescribed medication. 

Your highest scores for each descriptor are added together. Scores for mental and physical health descriptors are added together. A score of 15 points means you qualify. It is a very good idea to send medical evidence in with your questionnaire. 

1. You can’t either:

• mobilise more than 50 metres on level ground without stopping in order to avoid significant discomfort or exhaustion
• repeatedly mobilise 50 metres within a reasonable timescale because of significant discomfort or exhaustion

2. You can’t move between one seated position and another seated position located next to one another without receiving physical assistance from another person.

3. You can’t raise either arm as if to put something in the top pocket of a coat or jacket.

4. You can’t pick and move a 0.5 litre carton full of liquid

5. You can’t either:

• press a button, such as a telephone keypad
• turn the pages of a book

6. You can’t convey a simple message, such as the presence of a hazard.

7. You can’t understand a simple message due to sensory impairment, such as the location of a fire escape.

8. You have an incident at least once a week bad enough for you to need to clean yourself and change your clothes where you:

• lose control leading to extensive evacuation of your bowel and/or emptying of your bladder
• have substantial leakage of the contents of a collecting device.

9. Due to cognitive impairment or mental disorder, you can’t learn how to complete a simple task, such as setting an alarm clock.

10.  Your reduced awareness of everyday hazards, due to cognitive impairment or mental disorder leads  

 to a significant risk of:

• injury to yourself or others
• damage to property or possessions

So that you need to be supervised for the majority of the time.

11. Due to impaired mental function, you can’t reliably initiate or complete at least two sequential personal actions, i.e. one after the other.

12.  Due to cognitive impairment or mental disorder, you can’t cope with any change to the extent that you can’t manage day to day life.

13.  You can’t ever engage in social contact because you have difficulty relating to others or you experience significant distress.

14.  You have uncontrollable episodes of aggressive or disinhibited behaviour on a daily basis that would be unreasonable in any workplace.

16. You can’t chew or swallow food or drink.

You:

• can’t chew or swallow food or drink without repeatedly stopping, experiencing breathlessness or severe discomfort
• can’t chew or swallow food or drink without repeatedly receiving regular prompting by someone who is with you
• don’t chew or swallow drink because of a severe disorder of mood or behaviour

You don’t chew or swallow food or drink because of a severe disorder of mood or behaviour, without regular prompting from someone else who is with you.

If you don’t score 15 points in the assessment, the process will be different depending on whether you are on ESA or Universal Credit.

Universal Credit

On Universal Credit if you score less than 15 points your benefit will not stop. Universal Credit will continue in payment, but you may need to agree and sign a new claimant commitment containing different work-related activities for you to undertake each week. 

If you pass the assessment you don’t need to be available for or actively seeking work.

If you fail the assessment your work coach can require you to look for work. 

It is very important to give them sufficient information about your health condition and to challenge the assessment decision if you feel it is wrong. If you don’t meet the requirements of your claimant commitment you can be sanctioned and lose benefit.

If you feel the decision is wrong, you need to request a mandatory reconsideration of the decision. You can do this by putting your request on your online journal. If you can provide more medical evidence, then you should give this to your work coach. You have a month to request the mandatory reconsideration, but late requests can still be accepted.

Your mandatory reconsideration decision will be posted on the online journal. If it does not change the decision and you still disagree then you can appeal.

ESA and payment of the appeal rate

If you were on ESA when you failed the assessment, your benefit will stop. If you disagree with the decision you can lodge an appeal to challenge it. When your appeal is lodged you can be paid benefit at the basic appeal rate until your appeal is heard and/or decided. You will need to continue to submit medical certificates from your GP until you get a decision on your appeal. You have a month to lodge an appeal but late requests can still be accepted.

You may still wish to request a mandatory reconsideration or review of the decision at the same time as appealing, this means that the department who decided to stop your benefit will look at their decision again to see if they can change it. It is important to remember that just asking for a mandatory reconsideration does not get your ESA back in to payment, you need to appeal to get paid again.

Payment of the appeal rate of ESA is only possible if you are appealing a decision that you failed the assessment because you didn’t score enough points. 

If your ESA stopped because you failed to return the questionnaire or to attend the assessment, then your benefit will not be paid while you appeal the decision. 

The best course of action is to request a mandatory reconsideration and try and show that you had good reason for the failure with evidence. If this takes a long time or you are turned down and have to appeal, you may want to consider claiming Universal Credit while you wait. You cannot go back on to ESA once you have claimed Universal Credit but if you get the ESA decision changed, your Universal Credit may increase.

You appeal directly to the Tribunals Service on form SSCS1 from GOV.UK. It may take several months to get a hearing date. Your case will be heard by an independent tribunal looking at all the evidence and anything new that you submit.

It is a good idea to have a representative at a tribunal. You might be able to get help from the Welfare Rights Team or one of the other organisations listed in this guide.

Get more advice on How to win a Work Capability Assessment appeal.

On Universal Credit you can work even if you have scored 15 points in the assessment. 

You usually need to earn less than 16 hours at the minimum wage (£658.67 per month for people aged 23+).  You need to be able to show that you still score 15 points even though you are working.  If you receive PIP or DLA you can earn more than this but you can still be referred for a new assessment if it looks like your health condition or disability has improved because of the work you are able to do.

If you are on ESA, there are special rules allowing you to do more work and have some earnings disregarded. This is called ‘permitted work’. 

You or your partner can earn up to £20 per week without your ESA being affected. This is called the ‘lower earnings limit’.

Supported permitted work

You can also do work:

• carried out as part of your treatment programme under medical supervision while you are an inpatient or a regular outpatient of a hospital or similar institution
• under the supervision of a person employed by a public or local authority or voluntary or community-interest organisation that provides or arranges work opportunities for disabled people

If your work is supported employment, there is not a limit on the number of hours of supported work you can do or on how long you can do the work for providing your earnings are no higher than £152.00 per week.

Permitted work higher limit

If your work does not come under the definition of supported work above, you can still try out work and keep your ESA and other benefits providing you:

• work for less than 16 hours per week
• and earn under £152.00 per week

You must advise DWP that you are working and they will ask you to fill in a form, you still need to ensure you are clear about why you still qualify as sick or disabled under the usual ESA rules but you can manage this work. For example, the work might be flexible so you can take time off if you are unwell. There is no limit on this type of work.

You can:

• send an email to welfarerights@ brighton-hove.gov.uk 
• write to Revenues and Benefits, Brighton & Hove City Council, 1st Floor Bartholomew House, Bartholomew, Square, Brighton, BN1 1JE
• phone the advice Line: 01273 291 116 - open Monday, Tuesday, Wednesday, 10am to 1pm

Citizens Advice Bureau - Brighton & Hove

You can:

• go to the Citizens Advice Bureau website
• visit the office at Hove Town Hall, Tisbury Road Offices, Hove Town Hall, Tisbury Road, Hove, BN3 3BQ
• phone 0808 278 8715

Possability People (Brighton & Hove)

You can:

• send an email to hello@possabilitypeople.org.uk
• go to the Possability People website
• visit the office at Disability Advice Centre, Montague House, Montague Place, Brighton, BN2 1JE
• phone 01273 894 040

Brighton Unemployed Centre Families Project

You can:

• send an email to welfarerights@bucfp.org
• go to the Brighton Unemployment Families Centre Project website
• visit the office at 6 Tilbury Place, Brighton, BN2 0GY
• phone the confidential Advice Line: 01273 676 171

CASE Central

You can:

• send an email to case_enquiries@yahoo.co.uk
• go to the CASE Central website
• visit the office at 4 Crestway Parade, The Crestway, Brighton, BN1 7BL
• phone 01273 540717

Money Works

You can:

• send an email to info@moneyadviceplus.org
• go to the Money Advice website
• phone the Moneyworks Advice Line: 0800 988 7037

For Occupational Therapy, contact the council’s Access Point on 01273 295 555