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ESA - Understanding the decision
- longcovidjourney
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3 years 1 month ago #266840 by longcovidjourney
ESA - Understanding the decision was created by longcovidjourney
I have received my ESA decision letter today and am looking for some support to make sense of it please.
For context I returned the forms in August 2021 and had assessment last Monday. I was off sick from March 2020 and dismissed in November 2021. I had been receiving standard rate all through the assessment period.
My letter states there will be no change to my benefit and the reason for decision is ‘ to work out how much you get we have used information given to hmrc by you, your employer or pension provider and checked against what you have told us before about your income’
I was under the impression that ESA was not income related. Is this not correct?
I received a call yesterday from DWP asking me about a payment I received from my ex employer in November. It was my final salary/dismissal payment. When I questioned her if it would make a difference to my claim she said no. She asked if I was no longer working and when I last worked.
I am bed bound with severe limited functioning. At my assessment the assessor explained that due to the report she had from my gp there would be fewer questions. She explained at the end that they were more focused on my mobility and not emotional capability. I did explain that cognitive function was also a large issue but she said it wasn’t a focus here. She also asked me off record if I had applied for pip as I would definitely be entitled to that (awaiting outcome of assessment).
What has the payment I received from my employer got to do with the benefit award? I thought the benefit was assessed on your capability to work. If I am receiving £74 per week does that mean I am in the wrag and will need to attend interview etc and/or submit fit notes?
Before I appeal I would like to understand more about the decision as it doesn’t seem to be related to my health.
Many thanks
Vicky
For context I returned the forms in August 2021 and had assessment last Monday. I was off sick from March 2020 and dismissed in November 2021. I had been receiving standard rate all through the assessment period.
My letter states there will be no change to my benefit and the reason for decision is ‘ to work out how much you get we have used information given to hmrc by you, your employer or pension provider and checked against what you have told us before about your income’
I was under the impression that ESA was not income related. Is this not correct?
I received a call yesterday from DWP asking me about a payment I received from my ex employer in November. It was my final salary/dismissal payment. When I questioned her if it would make a difference to my claim she said no. She asked if I was no longer working and when I last worked.
I am bed bound with severe limited functioning. At my assessment the assessor explained that due to the report she had from my gp there would be fewer questions. She explained at the end that they were more focused on my mobility and not emotional capability. I did explain that cognitive function was also a large issue but she said it wasn’t a focus here. She also asked me off record if I had applied for pip as I would definitely be entitled to that (awaiting outcome of assessment).
What has the payment I received from my employer got to do with the benefit award? I thought the benefit was assessed on your capability to work. If I am receiving £74 per week does that mean I am in the wrag and will need to attend interview etc and/or submit fit notes?
Before I appeal I would like to understand more about the decision as it doesn’t seem to be related to my health.
Many thanks
Vicky
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- Gary
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3 years 1 month ago #266849 by Gary
Nothing on this board constitutes legal advice - always consult a professional about specific problems
Replied by Gary on topic ESA - Understanding the decision
Hi longcovidjourney
Welcome to the forum, you might want to have a look at the following FAQ which explains where everything is
Welcome to Benefits and Work
I would advise you to seek help from a Welfare Rights Organisation who can take all your circumstances into consideration. You can find your local Welfare Rights Organisation to help you with advice by clicking on the link below and putting in your post code, it will then come up with a MAP with a list of agencies. advicelocal.uk
By the sound of your post you had a 'good customer service adviser'. The reason for the phone call was to find out when you started employment and when you finished. You must be over 16 and under state pension age, you also must not be entitled to Statutory Sick Pay. You also need to have paid enough National Insurance contributions to qualify (class 1 or class 2 credits). They will look at certain Tax years and Benefit year.
I have assumed from your post that you are talking about claiming New Style ESA which is contribution based. Under the legacy system there was Income related ESA and Contribution based ESA. NS ESA comes under the new system along with UC, UC is income related.
In answer to your questions:
If the money you received from your employer was in regard to your ill health (SSP) then you will not be entitled to claim NS ESA. NS ESA is paid once SSP finishes. (SSP lasts for up to 28 weeksin any period of sickness lasting 4 days or more).
If you are receiving £74.70 you will not be in the WRAG group as WRAG no longer exists for new claimants, you will be placed in the LCW group (Limited Capability for Work).
Yes you do need to keep supplying 'Fit Notes' unless you are told by DWP that 'Fit Notes' are no longer required.
Gary
Welcome to the forum, you might want to have a look at the following FAQ which explains where everything is
Welcome to Benefits and Work
I would advise you to seek help from a Welfare Rights Organisation who can take all your circumstances into consideration. You can find your local Welfare Rights Organisation to help you with advice by clicking on the link below and putting in your post code, it will then come up with a MAP with a list of agencies. advicelocal.uk
By the sound of your post you had a 'good customer service adviser'. The reason for the phone call was to find out when you started employment and when you finished. You must be over 16 and under state pension age, you also must not be entitled to Statutory Sick Pay. You also need to have paid enough National Insurance contributions to qualify (class 1 or class 2 credits). They will look at certain Tax years and Benefit year.
I have assumed from your post that you are talking about claiming New Style ESA which is contribution based. Under the legacy system there was Income related ESA and Contribution based ESA. NS ESA comes under the new system along with UC, UC is income related.
In answer to your questions:
If the money you received from your employer was in regard to your ill health (SSP) then you will not be entitled to claim NS ESA. NS ESA is paid once SSP finishes. (SSP lasts for up to 28 weeksin any period of sickness lasting 4 days or more).
If you are receiving £74.70 you will not be in the WRAG group as WRAG no longer exists for new claimants, you will be placed in the LCW group (Limited Capability for Work).
Yes you do need to keep supplying 'Fit Notes' unless you are told by DWP that 'Fit Notes' are no longer required.
Gary
Nothing on this board constitutes legal advice - always consult a professional about specific problems
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- longcovidjourney
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3 years 1 month ago #266853 by longcovidjourney
Replied by longcovidjourney on topic ESA - Understanding the decision
Thank you so much Gary for the information. I will contact an agency on Monday. In the meantime please can I ask a few questions for clarification? I have read your guides etc now and prior to submitting my application however I am now questioning my interpretation of them.
I assumed I was applying for new style esa also.
I have worked without a break for 27 years. Started sick pay In april 2020 and ssp ran out in sept 2020. I was receiving a small amount of contractual sick pay after this..
As I said I have been receiving £74.70/week and the letter states there will be no change to my benefit. Am I to assume from this that I have been placed in the LCW group? Does this mean that it will stop after 12 months?
What I am struggling to understand is what the payment from my employer has to do with it? NS ESA is not means tested , is this correct? And the fact that they have awarded some benefit ie. £74/ week surely indicates that I am entitled to the benefit SO what does the payment have to do with the decision? Am I making sense? The income is only relevant to whether I get the benefit or not and I have been awarded the benefit. I am aware that this is positive in some sense as i could have been awarded nothing but would it not been more likely that the stated reason for being awarded would be related to how many points and why not support group? (Sorry I am very new to this and have no idea what could be given in the decision section)
I strongly believe that I should be in the support group. I am a little confused how I appeal this now. I was expecting if I wasn’t awarded the support group then I would have a decision I could respond to or contest.
I would be very grateful for your suggestions as to how to take this forward? What information should I be asking from DWP?
Many thanks in advance
Vicky
I assumed I was applying for new style esa also.
I have worked without a break for 27 years. Started sick pay In april 2020 and ssp ran out in sept 2020. I was receiving a small amount of contractual sick pay after this..
As I said I have been receiving £74.70/week and the letter states there will be no change to my benefit. Am I to assume from this that I have been placed in the LCW group? Does this mean that it will stop after 12 months?
What I am struggling to understand is what the payment from my employer has to do with it? NS ESA is not means tested , is this correct? And the fact that they have awarded some benefit ie. £74/ week surely indicates that I am entitled to the benefit SO what does the payment have to do with the decision? Am I making sense? The income is only relevant to whether I get the benefit or not and I have been awarded the benefit. I am aware that this is positive in some sense as i could have been awarded nothing but would it not been more likely that the stated reason for being awarded would be related to how many points and why not support group? (Sorry I am very new to this and have no idea what could be given in the decision section)
I strongly believe that I should be in the support group. I am a little confused how I appeal this now. I was expecting if I wasn’t awarded the support group then I would have a decision I could respond to or contest.
I would be very grateful for your suggestions as to how to take this forward? What information should I be asking from DWP?
Many thanks in advance
Vicky
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- Gary
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3 years 1 month ago #266866 by Gary
Nothing on this board constitutes legal advice - always consult a professional about specific problems
Replied by Gary on topic ESA - Understanding the decision
Hi longcovidjourney
I cannot tell you exactly what is what as I do not have all your information, but I will try and answer your questions from a general perspective.
1) Any contractual sick pay paid by your employer will not affect your entitlement to 'new style' ESA or CB ESA. ESA Regs, reg95(2)(b); ESA Regs 2013, reg 80(2)(b)
2) No you cannot assume that you have been placed in the LCW group as you have not yet had an assessment. At present you are in the Assessment phase, this lasts for 13 weeks but usually longer, what this means is that if it takes 26 weeks before you have an assessment and you get a decision to place you in the support group then the support premium will be backdated to the end of the 13th week Assessment week.
3) There are two parts to the work capability assessment :-
The first part looks at whether you have 'limited capability for work' (LCW) (15 points)
The second part looks at whether you have a 'limited capability for work related activity' (LCWRA)
In order to qualify for the Support Group(LCWRA) you need to;
* meet one or more of the relevant descriptors, or
* meet one of the associated Exceptional Circumstances rules.
The Support Group descriptors and the Exceptional Circumstances are listed in the Claiming ESA guides in the members area, page 14 onwards.
At this moment in time you cannot appeal as no decision has been made. We are hearing from the forum that it can take ages to get an assessment, even after an assessment it can take many weeks before a decision is made, again time varies across different regions.
Gary
I cannot tell you exactly what is what as I do not have all your information, but I will try and answer your questions from a general perspective.
1) Any contractual sick pay paid by your employer will not affect your entitlement to 'new style' ESA or CB ESA. ESA Regs, reg95(2)(b); ESA Regs 2013, reg 80(2)(b)
2) No you cannot assume that you have been placed in the LCW group as you have not yet had an assessment. At present you are in the Assessment phase, this lasts for 13 weeks but usually longer, what this means is that if it takes 26 weeks before you have an assessment and you get a decision to place you in the support group then the support premium will be backdated to the end of the 13th week Assessment week.
3) There are two parts to the work capability assessment :-
The first part looks at whether you have 'limited capability for work' (LCW) (15 points)
The second part looks at whether you have a 'limited capability for work related activity' (LCWRA)
In order to qualify for the Support Group(LCWRA) you need to;
* meet one or more of the relevant descriptors, or
* meet one of the associated Exceptional Circumstances rules.
The Support Group descriptors and the Exceptional Circumstances are listed in the Claiming ESA guides in the members area, page 14 onwards.
At this moment in time you cannot appeal as no decision has been made. We are hearing from the forum that it can take ages to get an assessment, even after an assessment it can take many weeks before a decision is made, again time varies across different regions.
Gary
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- longcovidjourney
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3 years 1 month ago #266881 by longcovidjourney
Replied by longcovidjourney on topic ESA - Understanding the decision
Thank you Gary.
Apologies I don’t think I mentioned I have had my assessment (last Monday) and received the decision letter on Friday hence my assumption about the group.
The letter does not state which group, only that there will be no change to my benefit so this is why I have assumed to be in lcw group as remaining on £74.70’per week.
I meet the support group descriptor for mobility, I am bed bound, and as such wish to appeal the decision. Please can you advise what I should be requesting from DWP at this stage? What am I entitled to access to as part of the decision process? Can I ask DWP to explain the reason for decision and what the hmrc payments have to do with the outcome?
Many thanks
Apologies I don’t think I mentioned I have had my assessment (last Monday) and received the decision letter on Friday hence my assumption about the group.
The letter does not state which group, only that there will be no change to my benefit so this is why I have assumed to be in lcw group as remaining on £74.70’per week.
I meet the support group descriptor for mobility, I am bed bound, and as such wish to appeal the decision. Please can you advise what I should be requesting from DWP at this stage? What am I entitled to access to as part of the decision process? Can I ask DWP to explain the reason for decision and what the hmrc payments have to do with the outcome?
Many thanks
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- Gary
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3 years 1 month ago #266935 by Gary
Nothing on this board constitutes legal advice - always consult a professional about specific problems
Replied by Gary on topic ESA - Understanding the decision
Hi longcovidjourney
There is nothing you can do at present until you receive the decision, once you receive the decision then you can contact UC via your journal and request a copy of the assessors report, once you have a copy of the report go through it with a highlighter then apply for a MR highlighting all the inaccuracies. Don't forget to use our guides to help you with the MR.
Gary
There is nothing you can do at present until you receive the decision, once you receive the decision then you can contact UC via your journal and request a copy of the assessors report, once you have a copy of the report go through it with a highlighter then apply for a MR highlighting all the inaccuracies. Don't forget to use our guides to help you with the MR.
Gary
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