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Employment and Support Allowance (ESA)

This guide for RCN members outlines who is eligible for Employment and Support Allowance (ESA) payments, how to apply and how it is paid.




What is Employment and Support Allowance (ESA)?

You may be entitled to ESA if you are unable to work because of sickness or disability and you are not receiving Statutory Sick Pay (SSP). It is paid by the Department of Work and Pensions (DWP) or the Social Security Agency in Northern Ireland.

There are two types and depending upon your circumstances you may be eligible for both:

  •  Contributory ESA, which you can claim if you have paid enough National Insurance contributions
  • Income-related ESA, which is paid if your income and capital are low enough.

To claim ESA you will be expected to undertake a number of tests to confirm that you have limited capability for work.

If successful, the amount you will receive will depend on whether you are entitled to contributory ESA, income-related ESA or both. It also depends on whether or not you are in the first 13 weeks of your claim as an additional component may be payable after 13 weeks. For further information see the ‘limited capability for work-related activity assessment’ section below.

You cannot normally get ESA for the first 3 days of your claim, known as waiting days. You can continue to receive ESA if you go into hospital.

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Eligibility

To get ESA you must:

  • be over 16 and under you own state pension age (please see the state pension age calculator at Gov.uk
  • be unable to work because of sickness or disability and not entitled to SSP
  • not be in receipt of (or have a partner who is in receipt of) Income Support, income based Job Seeker’s Allowance or Pension credit
  • be ordinarily resident in the UK
  • for income-related ESA, you must not have any immigration controls on your stay here that would stop you getting the benefit
  • if requested, undertake a medical examination to confirm your limited capacity for work.

If you are already getting ESA and move from Great Britain to Northern Ireland, you will need to make a new claim. Depending upon your circumstances the amount of ESA you receive may change. If you lose money we recommend that you consult an experienced adviser, for example at your nearest CAB.

Depending upon your circumstances you may be entitled to contributory ESA, Income-related ESA or both.

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Contributory ESA

To qualify for contributory ESA, you must have paid enough National Insurance contributions. This does not apply if the DWP converts you Incapacity Benefit or Severe Disablement Allowance into contributory ESA (please see the relevant section below).

If you are only entitled to contributory ESA, you will get a basic allowance in the first 13 weeks. This amount is less if you are under 25. After 13 weeks, you will also get a support component or work related activity component and if you are under 25 your basic allowance will rise in line with everyone else. Your contributory ESA may be reduced if you are receiving an occupational or personal pension.

In some circumstances you can only get contributory ESA for up to 365 days. Once it ends, depending on your circumstances, you may be able to get:

  • Income-related ESA
  • other means tested benefit e.g. housing benefit or council tax benefit (you may also be entitled to an increase in any means tested benefit you are already receiving)
  • National Insurance credits if you continue to have limited capability for work. It is important to carry on getting National Insurance credits if possible because they may help you:
    • qualify for other benefits e.g. state pension
    • get an increase in benefits e.g. housing benefit.
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To get income-related ESA, your income will be compared to the amount that the Government thinks is enough for you to live on. If your income is less that this amount then you will receive a basic allowance to make up the difference. This amount will be less if you are under 25. If your income is equal to, or greater than this amount, you will not be able to claim income-related ESA.

On top of the basic allowance, you may qualify for some premiums, for example if you are severely disabled or if you are a carer. If you have a mortgage and qualify for income-related ESA, you may get help for some of your housing costs, e.g. the interest on your mortgage loan. If you pay rent, you should check whether you can claim Housing Benefit. Please see our Housing benefit advice for more information.

After the first 13 weeks you will be entitled to a support component or work-related activity component and if you are under 25, your basic allowance will be increased.

Calculating your entitlement to income-related ESA can be complicated, certain rules are applied and some income is not counted when working out your total income. If you think you are not getting the right amount, please call us for further support.

Income-related ESA is not time-limited; you can continue to receive it as long as you remain eligible.

You cannot claim income-related ESA if you:

  • have savings of more than £16,000
  • are a member of a couple and your partner works for 24 hours or more per week.
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Making your application

You can make your initial claim for ESA through Job Centre Plus. Full contact details are available at Gov.uk/employment-support-allowance. Please see the section on how to claim.

If you want to apply in writing you can download a claim form at Gov.uk or www.nidirect.gov.uk.

When making a claim you must provide proof of your National Insurance number. If you do not have a National Insurance number, you should be given one when making your claim. If you are making a claim for income-related ESA, you must also provide your partners National Insurance number if they are living with you.

When making your claim, you can request reasonable adjustments to ensure that your claim is not affected by your illness or disability. These might include asking for large print documents, provision of a BSL interpreter or ensuring that your assessment is held at an easily accessible venue. If you ask for a reasonable adjustment which is not provided, this may be discrimination and you may wish to complain. Please see our discrimination advice for more information.

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The ESA50 medical questionnaire

You will usually be asked to complete this within 13 weeks of making your claim. A copy of the questionnaire is available at Gov.uk and it must be returned to the DWP. If you need assistance completing the form please contact us. You can also get information, including a sample copy of the form, from the National Association of Welfare Rights Advisers (NAWRA website at www.nawra.org.uk).

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Demonstrating limited capability for work - medical assessments

To get ESA, you will usually have to prove that you cannot work by sending in medical certificates to the DWP.

During the first 13 weeks of your claim you will also usually take two tests which make up the ‘work capability assessment’. They are:

  • the limited capability for work assessment
  • the limited capability for work-related activity assessment.

If you do not attend you may not be entitled to ESA. Further information is available at Gov.uk and www.nidrect.gov.uk.

At the assessments you will be given points for meeting various conditions called descriptors. If you score 15 points or more in each assessment, you will be considered to have limited capability for work related activity and you will be put in the support group of claimants.

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The limited capability for work assessment

Most people will have a face-to-face medical assessment to decide if they satisfy the limited capability for work assessment. Your ability to perform a range of particular activities will be assessed along with any physical and mental health problems which may make you unfit for work.

If you have certain conditions, receive certain treatments or have a severe disability, you will automatically be considered to have limited capability for work and will not need a face-to-face medical assessment. This would apply to you if, for example, you have a terminal illness or if you are pregnant and there is a serious risk of harm to you or your child if you do work.

If, following the assessment, you do not qualify for ESA you may wish to consider applying for Job Seeker’s Allowance. You may also wish to appeal the decision.

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The purpose of this test, which is usually carried out at the same time as the limited capability for work assessment, is to decide how much money you will get and any further steps which can be taken to help you return to work.

Following the test, if you have a severe disability, you may be put into a group known as the ‘support group’. After the first 13 weeks of your claim, you will receive an extra amount in your ESA known as the ‘support component’. If you are placed in this group you will not have to have a work-focused interview or undertake work-focused activity but can if you wish.

If you are not placed in the ‘support group’ you will be put in the ‘work-related activity group’. After the first 13 weeks of your claim, you will receive an extra amount in your ESA known as the ‘work-related activity component’. In this group, you must meet a number of conditions to continue to receive the full rate of ESA. Failure to meet these conditions may result in you being sanctioned which means that you may lose some of the ESA.

If you are put in the ‘work-related activity group’, you can only get contributory ESA for up to 365 days. If you are put in the ‘support group’, your contributory ESA is not time limited. Income-related ESA is not time limited for either group.

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Converting existing benefits to ESA

If you are currently getting Incapacity Benefit, Severe Disablement Allowance (SDA) or Income Support paid on disability grounds, you will have a work capability assessment before a decision is made to convert your current benefit into ESA.

If your benefit is converted, you will not have another work capability assessment during the first 13 weeks of your claim.

If the DWP converts your benefit into ESA:

  • You will get a basic allowance. If you are under 25, the amount will be paid at the higher rate.
  • You will also get the support component or a work-related activity component from the beginning of your claim, rather than after 13 weeks.
  • You may also be entitled to an amount known as a transitional addition. This is paid so you won't get less money than you were getting before but will be reduced over time and will eventually end.

If your benefit is converted into contributory ESA and you are placed in the work-related activity group, your 365 days of possible entitlement will start on the first day for which you get ESA.

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Work focused interviews

After your work capability assessment, you will usually be expected to take part in an initial work-focused interview. This does not apply if:

  • you’re put in the support group following the limited capability for work-related activity assessment, or
  • you are a woman who has reached state pension age, or
  • you are a man who has reached the state pension age of a woman with the same date of birth as you, or
  • you are a single parent and you are responsible for a child under one who lives with you.

While receiving ESA in the work-related activity group, you may be required to have further work-focused interviews where a personal adviser will discuss your work prospects, the steps you can take to obtain work and the support available.

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If you are in the work-related activity group, as well as work-focused interviews, you may have to undertake work-related activity. This does not apply if you are:

  • a lone parent with a child under 3 (lone parents with children under 13 only have to undertake work-related activity during normal school hours)
  • a carer receiving Carer’s Allowance or a carer premium as part of your ESA claim

Work-related activity can include things like voluntary work, work trails or a training programme.

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Appeals

If you do not agree with a decision about your capability for work then you have the right to appeal. Before submitting a formal appeal you will need to follow a process called ‘mandatory reconsideration’.

If you need help with your appeal, you can get advice from an experienced adviser, for example, at your nearest CAB.

If you are waiting for an appeal to be heard, you can either claim Job Seeker’s Allowance (JSA) or continue to get the basic rate of ESA, depending on your circumstances. You may need to obtain advice about the best option for you during this time.

You can only receive ESA if you are appealing a decision, not if you have asked for a decision to be reviewed or while your decision is going through mandatory reconsideration. You must continue to provide medical certificates and inform the DWP that you wish to continue receiving ESA.

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Sanctions

A sanction means that Job Centre Plus reduces your ESA. You can only be sanctioned if you are placed in the work-related activity group and you are required to attend work-focused interviews or undertake work-related activity.

You may be sanctioned if you do not participate in work-focused interview or work-related activity without a good reason. You should not be sanctioned if you do have a good reason for missing these for example, if you were sick. If you are unable to attend, please let Job Centre Plus know immediately. This is known as showing you had good cause.

Any sanction will continue until you have completed the work-focused interview or work-related activity you were asked to do. It will also be extended by one, two or four weeks depending upon whether this is the first, second or third time you have failed to comply with Job Centre Plus requirements.

If you do not agree with the sanction, you can appeal.

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Working while receiving ESA

Although ESA is usually paid if you are too ill or disabled to work, you may still be able to get it if you are doing certain types of work e.g. working as a councillor, being a carer or doing ‘permitted work’ (work which can be done without affecting your ESA). The rules around permitted work can be complicated but it is usually work of less than 16 hours per week where you do not earn over a specified amount.

More information is available at Gov.uk.

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Backdating ESA

ESA can be backdated for up to 3 months prior to your claim. You do not have to give a reason for your late claim, but when making your application you should explain that you would like your benefited back dated to the date you became entitled to ESA.

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Call the RCN on: 03457726100