EMployment & support Allowance; Medical Tests

There are big changes afoot regarding disability benefits, especially incapacity benefit, which will soon cease to exist.
It is to be replaced with Employment & Support Allowance (ESA).

The fact sheet below, Reproduced here by kind permission of D.I.A.L.< gives info about how the assessments for this benefit will be carried out and what may happen to you depending on the outcome of the assessment.
The fact sheet is very long, so a lot of reading!
How you will be assessed is based on a points system and to qualify for ESA you must reach 15 points.
If you are totally blind or have a very severe sight loss then you will get 15 points regardless of how you score on the other categories.

Employment and support allowance - the medical tests - Disability Alliance Factsheet F32

Disability Alliance Factsheet

Employment and support allowance - the medical tests

This factsheet explains the basic rules for the medical tests for employment and support allowance. If, after reading it, you want to find out more or need help with making a claim see the "Where can I get more help or information?" section below.

1. Introduction

The work capability assessment (WCA) is a key part of employment support allowance (ESA).
The assessment will be carried out by a health care professional working on behalf of the Department for Work and Pensions, known as an approved disability analyst.

An approved disability analyst may be a doctor, nurse, occupational therapist or physiotherapist.

The WCA test is intended to:
. find out whether you have a 'limited capability for work' and stay on ESA.
. find out whether you have a 'limited capability for work-related activity and need to be placed in the support group.
. carry out a 'work-focused health-related assessment' if you are placed in the work-related activity group.

This factsheet is a brief overview of the ESA medical tests. for a more detailed description see either our "Disability Rights Handbook" or "employment and support allowance guide."

2. Limited capability for work

The limited capability for work test decides whether or not you remain on ESA. If you do not pass the test, because you are not considered to have a limited capability for work, you would need to consider appealing this decision or claiming jobseeker's allowance instead.

For this test you are assessed on your ability to carry out a number of physical and mental health activities and points are awarded on the basis of your limitations with respect to each activity.
These points are totalled up and if the total reaches the threshold of 15, you are deemed to have limited capability for work and thus stay on ESA.

The physical functions

The physical functions in the limited capability for work test are grouped into 11 different types of activity.
These are:
1. Walking.
2. Standing and sitting.
3. Bending or kneeling.
4. Reaching.
5. Picking up and moving things.
6. Manual dexterity.
7. Speech.
8. Hearing.
9. Vision.
10. Continence.
11. Remaining conscious.

For a full list of activities, descriptors and points see our Factsheet F33 available at www.disabilityalliance.org/f33.htm.
For more detailed guidance see our link to the Medical Services Training and Development ESA Handbook below.

Within each type of activity there is a list of descriptors with associated scores ranging from 0 to 15.
These descriptors describe related tasks of varying degrees of difficulty.
You score when you are not able to perform the activity described. Though more than one descriptor may apply to you, you can only pick up one score from each type of activity; in each case whichever scores the highest.

If you score 15 in any one activity, you automatically pass the test.
If your score is less than 15, it can be added to the scores you pick up from any of the other types of activity (in both the physical and the mental parts of the test).
If your total score reaches 15, you pass the test.

The mental,cognitive and intellectual functions

These functions in the limited capability for work test are grouped into sets of activities under the following 10 headings:

1. Learning or comprehension in the completion of tasks.
2. Awareness of hazard.
3. Memory and concentration.
4. Execution of tasks.
5. Initiating and sustaining personal action.
6. Coping with change.
7. Getting about.
8. Coping with social situations.
9. Propriety of behaviour with other people.
10. Dealing with other people.

For a full list of activities, descriptors and points see our Factsheet F33 available at www.disabilityalliance.org/f33.htm.
For more detailed guidance see our link to the Medical Services Training and Development ESA Handbook below.

As with the physical descriptors, there is a list of descriptors under each activity heading. The scoring follows a similar pattern. You score points because you cannot perform the activity described; the highest points you score under each heading are totalled up and the target is again 15. As mentioned above, the points you gain under the mental activities headings can be added to those under the physical activities, to reach the magic 15.

3. Treated as having limited capability for work

You will be automatically treated as having a limited capability for work in the following circumstances:

. you are a hospital inpatient
. receiving treatment or recovering from treatment by way of haemodialysis, plasmapharesis, radiotherapy or total parenteral nutrition. (You will only be treated as having limited capability for work from the first week that you have 2 days of treatment or 2 days of recovery or 1 day of treatment and one day of recovery (these days do not have to be consecutive).)
. you are suffering from a progressive disease and consequently your death can reasonably be expected within 6 months
. you are receiving treatment by way of intravenous, intraperitoneal or intrathecal chemotherapy
. you have been requested or given notice, under specific legislation, to refrain from work because you are a carrier of , or have been in contact with, an infectious disease
. you are pregnant and there would be a serious risk to the health of you or your child if you did not refrain from work
. you are pregnant or have recently given birth and are entitled to maternity allowance and are within the maternity allowance payment period
. you are pregnant or have recently given birth but are not entitled to maternity allowance or statutory maternity pay, from 6 weeks before the baby is due to 2 weeks after the birth

4. Limited capability for work-related activity

The second test within the WCA considers whether you have a 'limited capability for work-related activity'.
Though the wording may seem similar to that of the first test, the second test has a very different function.
It is used to determine whether you are placed in the support group of claimants or the work-related activity group.

Which group you are placed in will determine both the level of ESA that you will receive and the responsibilities you will need to meet in order to retain the benefit.
The test has a list of 46 descriptors, relating to both physical and mental functions. If at least one of them fits, you will be placed in the support group of claimants.
The descriptors are grouped together under the following 11 activity headings:

1. Walking.
2. Rising from sitting.
3. Picking up and moving things.
4. Reaching.
5. Manual dexterity.
6. Continence.
7. Maintaining personal hygiene.
8. Eating and drinking.
9. Learning or comprehension in the completion of tasks.
10. Personal action.
11. Communication.

For a full list of activities, descriptors and points see our Factsheet F33 available at www.disabilityalliance.org/f33.htm.
For more detailed guidance see our link to the Medical Services Training and Development ESA Handbook below.

5. How the tests are applied

In order to apply the tests for limited capability for work and limited capability for work-related activity a decision maker will first look at the information that you have provided in your initial claim for ESA to see if you pass these tests without the need for further enquiries.

If the decision maker considers that there is not enough information to make a decision you will normally be sent an ESA50 (available at www.disabilityalliance.org/esa50.pdf) questionnaire to complete.
This form has a number of questions about both physical and mental activities. Each activity has a section with tick-boxes and space to provide more detailed information about each activity.

Once the decision maker has received your completed ESA50 they may decide that there is clear evidence that you have limited capability for work (and possibly work-related activity).
If not, you will be sent an appointment to attend a medical carried out by an approved disability analyst.

The disability analyst will have read a copy of the ESA50 form that you have completed and at the medical they will be trying to identify whether or not your account in that form of your functional limitations corresponds with their findings.

They will ask you a series of questions, relating to both your physical and mental capabilities, guided by what you have put down on the ESA50.
Once they have finished this, they will then give you a physical examination.

The decisions on whether or not you have limited capability for work and limited capability for work-related activity will not, however, be taken by the disability analyst.
He or she will complete an ESA85 medical report form which will be sent to a decision maker, who will make these two decisions.

The report form also has recommendations as to when you should be retested for limited capability for work and limited capability for work-related activity.

6. Exceptional circumstances

Even if the decision maker decides that you do not pass the limited capability for work test they can still treat you as having passed it if the health care professional has obtained evidence that one of the following exceptional circumstances apply:

1. You are suffering from a severe life threatening disease in relation to which there is medical evidence that the disease is uncontrollable, or uncontrolled, by a recognised therapeutic procedure; and in the case of a disease that is uncontrolled, there is a reasonable cause for it not to be controlled by a recognised therapeutic procedure.
2. you suffer from some specific disease or bodily or mental disablement and consequently there would be a substantial risk to the mental or physical health of any person if you were found not to have limited capability for work.

7. Work-focused health-related assessment

The third test within the WCA is the 'work-focused health-related assessment' (WFHRA).
This is usually carried out after the limited capability for work and limited capability for work-related activity tests have been assessed.
This is because those who fail these tests will be moved on to jobseeker's allowance and so less people will be required to have a work-focused health-related assessment. Also if you are placed in the support group you will not have a WFHRA.

The work-focused health-related assessment collects additional information about the things that you can do - your 'functional capacity' - despite your condition. In this respect, it is coming from the opposite direction to the first two tests, which focus on the things you can't do. The WFHRA also collects information about any health interventions that could improve your functional capacity and thus support a move back into work. This could include the use of appropriate aids and adaptations.

You will be asked to complete a WFHRA form (available at www.disabilityalliance.org/wfhra.pdf), and invited to attend a medical assessment centre interview conducted by the health care professional. This interview can be done in your own home if attending a centre would cause you undue inconvenience. From 28 June 2010 it may be possible to have this interview done by phone.

The information obtained from the form and the interview will be put into a 'capability report' which will be made available to both you and your personal adviser each time you are required to attend follow-up work-focused interviews.

For more detailed guidance see our link to the Medical Services Work Focused Health Related Assessment (WFHRA) Handbook below.

Note: DWP has announced that, as part of the new Government's welfare plans, the Work Focused Health Related Assessment (WFHRA) is to be cancelled from July 2010.

8. If you are on incapacity benefit

For the moment, if you are claiming incapacity benefit (IB) or income support (IS) on grounds of disability, you still have to satisfy the old personal capability assessment test rather than the new ESA test.
For information on this see our Factsheet F25 - incapacity benefit - the personal capability assessment test available at www.disabilityalliance.org/f25.htm.

However at some point between October 2010 and March 2014 you will be reassessed under the new Work Capability Assessment instead. If you are found to have a limited capability for work in this assessment, you will be moved onto ESA.

9. If you are a student

If you are a full time student claiming contributory ESA you will have to satisfy the limited capability for work test. If you are claiming income-related ESA you will be treated as having limited capability for work if you are getting disability living allowance (DLA).

Whether or not you automatically satisfy the limited capability for work test you will still be assessed under the limited capability for work-related activity test, which decides whether you are in the support group or the work-related activity group.

If you are in the work-related activity group you will also have to attend a work-focused health-related assessment.

If you are a part-time student you will have to satisfy the limited capability for work test and be assessed under the limited capability for work-related activity test. You may also have to attend a work-focused health-related assessment if you are placed in the work related activity group.

10. Where can I get more help or information?

You can get information about employment and support allowance at your local advice centre, such as a citizen's advice bureau. You can get more information about this from our Factsheet F15 - Finding a local advice centre, available at www.disabilityalliance.org/f15.htm

For basic information on ESA see Factsheet F31 - employment and support allowance overview, available at www.disabilityalliance.org/f31.htm

For more detailed information on ESA see the following:

. Disability Rights Handbook - www.disabilityalliance.org/drh35.htm
. Employment and support allowance guide - www.disabilityalliance.org/esaguide.htm.
. Factsheet F33 - employment and support allowance activities,descriptors and points - www.disabilityalliance.org/f33.htm
. Employment and support allowance resource page, available at www.disabilityalliance.org/esa.htm
. Medical Services Training and Development ESA Handbook, which is the official guidance for approved disability analysts carrying out medical assessments - www.disabilityalliance.org/esahandbook.pdf. (This handbook also includes a sample ESA85.)
. Medical Services Work Focused Health Related Assessment (WFHRA) Handbook, which is the official guidance for approved disability analysts carrying out these assessments - www.disabilityalliance.org/esawfhra.pdf.

You can also obtain copies of our factsheets and publications by contacting Disability Alliance on 020 7247 8776 (this is not an advice line) or by fax on 020 7247 8765. All factsheets are available at www.disabilityalliance.org/fact.htm.
All publications are available at www.disabilityalliance.org/shop.htm

www.disabilityalliance.org - 18 August 2010