Employment & Support Allowance (ESA)

The Employment and Support Allowance (ESA) is the primary benefit for those whom are unable to work due to a long term illness or disability. ESA can be awarded if a person is able to obtain enough points from the ESA eligibility tests. Currently, you can apply for ESA if you are: 

  • Employed, self-employed or unemployed. ​
  • You meet the descriptor tests that are detailed in the eligibility section
  • You have enough national insurance contributions to receive Contribution Based ESA, or you have such a low income that you are eligible for ‘Income Related ESA’.

If you meet all the necessary requirements and are awarded ESA, then you will receive one of the two types of ESA (please click on the eligibility section above for more details on each of them): the ESA (Work-Related Activity Group) and the ESA (Support Group).

Firstly, if you pass the first assessment (for the Work-Related Activity Group) then you are eligible for ESA, but paid at the lower rate and you may be asked to attend interviews or undertake activities. Secondly, if you pass the second assessment (for the Support Group) then you are paid at a higher rate and you do not have to attend interviews or activities.

The legal framework

The rules for ESA are now set within the Employment and Support Allowance Regulations 2008 (as amended). ESA is run by the Department of Work and Pensions (DWP) which is a government run department. In making its decision, the DWP must comply with the regulations, but in the process of making the decision, they generally consult the ‘decision makers’ guidance’ documents which is there to help them to make decisions that are accurate and consistent. You can find these documents on the internet and there is a link to them on our “more information” page.

If you are not happy with a decision made by the DWP in relation to your ESA then, depending upon the circumstances, you can appeal the decision to the First Tier Tribunal once you have gone through ‘Mandatory Reconsideration’ (which entails asking the DWP to look at your decision again). If this is not an option, then you can appeal via the complaints route which is also detailed in our appeals section.

 

For more information, please click on the tabs on the menu at the top of the page or consult our factsheets.

To see how much you may be paid if you are eligible for ESA click here.

Employment and Support Allowance Regulations 2013

Eligibility for ESA is determined according to five conditions:

  • Your Age and Status.
  • Residency.
  • The outcome of your Work Capability Assessments.
  • Income/Capital.
  • Your National Insurance contributions.

 

  1. Age and Status

​​The first thing to be aware of is that you must be aged 16 years old or over and under the state retirement age. The current state retirement age for men is 65 (which will rise to 66 by 2020). For women, it is about 63.5 depending on your date of birth (which will also gradually rise to 66 by 2018).

Status entails that you are not entitled to the following:

  • Statutory Sick Pay.
  • Statutory Maternity Pay.
  • Income Support.
  • ​Jobseekers Allowance (either alone or as part of a joint claim couple).

 

  1. Residency
  • You must have lived in the UK for at least 26 weeks out of the last 52 weeks
  • You currently live in the UK.
  • You are not subject to immigration control.

 

  1. The Work Capability Assessments

To be eligible for the ESA, you must undertake the Work Capability Assessment (WCA). The WCA takes place during a 13-week period and determines the following:

  1. ​​Whether or not you would be entitled to keep receiving ESA after the end of the 13-week period, and,
  2. Whether you will be placed in the ‘work-related activity group’ or the ‘support group’.

This is effectively two tests: the first being the ‘limited capability for work assessment’, and the second being the ‘limited capability for work related activity assessment’.  Both of the tests are simply a set of questions which are referred to as ‘descriptors’ and relates to your physical and mental capabilities.

Limited Capability for Work Group (limited capability for work test). (Lower amount ESA) –

You need to carefully read through the descriptors and identify enough of them to qualify for 15 points. Some of them are worth 15 points alone, so you may only need one to pass this test. The descriptors are split into physical impairments and mental/cognitive impairments. You can add physical scores and mental/cognitive scores to reach the score of at least 15. (Click here to view the ‘Limited Capability for Work descriptors’.)

Support Group (limited capability for a work related activity test). (higher amount ESA) –

If one or more of the support group descriptors apply to you, you will be assessed as having limited capability for work and will be placed in the ‘Support Group’ of claimants.

We advise that you view the test beforehand by clicking here to view the ‘Support Group descriptors’.

Exceptional circumstances route –

There is an exceptional circumstances route that you may be able to use so that you can qualify for either of the ESA Groups in the event that you do not qualify using the normal descriptor route. You can be automatically treated as having limited capability for work, without having to score 15 points, in the following circumstances:

  • You have a specific disease or bodily or mental disablement which would put any person at risk if you were not found to have limited capability for work.
  • You are terminally ill.
  • You are receiving chemotherapy or radiotherapy treatment for cancer.
  • You are pregnant and there would be a serious risk to the health of you or your child if you were to work.

 

  1. Financial Eligibility – income/capital or NI contributions

The main sections of ESA can be paid on the basis of you having had enough national insurance contributions in the last two years. The premiums for ESA are only available if your income is low enough.

You can also qualify for the main sections of ESA by having a low income. As stated above, if your income is low enough you may also qualify for the premiums. (To find out if you may pass the financial eligibility tests for ESA, please click the link).

Below are links to the forms for the ESA. These links go directly to the DWP website, however, we cannot guarantee that they are the up-to-date forms. It is your responsibility to contact the DWP to verify their validity before you use them.

ESA1 Form – This is the form to apply for ESA. It also contains the details that will allow for your contributions to national insurance to be considered.

ESA50 Form – This is the Work Capability Assessment form. This is the opportunity for you to state the details of your disability.  

Before using the above form please read through the descriptors on the eligibility page so that you are aware of what the DWP is testing you for. In addition, please make sure that you supply any necessary evidence with your application form. Please never assume that the DWP will find the evidence for you (generally they will not) as it is your responsibility!

Medical Assessment GP’s Guidance – This guidance is intended for healthcare professionals who undertake the WCA on behalf of the DWP. However, it can give you additional insight into to the tests for ESA. It is important to remember that you are likely to be asked to attend a medical or assessment as part of your application (or review) for your benefit.

Important reminder – Please make sure to check that these are the current versions of the forms before using them for an application for ESA otherwise your application will not be accepted!

The application 

This is the point where you, a claimant, submits the ESA50 claim form (and any available supporting medical evidence). The date of your claim is calculated to be either the date of your telephone call or the date that the DWP receives your claim form.

The assessment phase (13 weeks)

After your claim form has been submitted, barring any errors, you should move into the assessment phase. This normally lasts 13 weeks.

During the 13 weeks, the DWP will organise a medical known as the Work Capability Assessment to help decide what activities you can complete and what group you should be in. You can find out more about this by clicking here.

The DWP notifies you of a decision

If you are found to be eligible for ESA, you will be placed in either the Support Group or the Limited Work Activity Group:

    1. ​Main Phase: Support Group – If you are found to have limited capability for work related activity you will be put into the Support Group. This means you are entitled to receive £109.65 a week.  It should be noted that your entitlement could be topped up with premiums.
    2. Main Phase: Limited Work Activity Group – If you are placed in the Work Related Activity Group, your ESA will be payable for a maximum of 12 months based on your national insurance contributions. During this time, you will receive:
      1. £102.15 per week if your claim was made before the 3rd of April 2017; or,
      2. £73.10 per week if your claim was started on or after the 3rd of April 2017.

 

It should be noted that your entitlement could also be topped up with premiums.

Receiving a decision

If you are unhappy with the DWP’s decision and believe it is incorrect, you should apply for a mandatory reconsideration. Be aware that you normally only have 30 days from the date stated on the decision letter to request a mandatory reconsideration.

Mandatory reconsideration

Note: You only have one month from the date of the decision to request a reconsideration.

You can ask for a reconsideration over the phone, but you should confirm your request in writing. When you ask for the decision to be reconsidered, you should explain why you think the decision is wrong. If you can, get as much evidence as you can to back up your argument! This may have been the reason your application was rejected in the first instance.  

​Reconsideration generally takes 2-6 weeks. Unfortunately, if you were assessed as not being eligible for ESA, you will not receive ESA during this period. However, it is possible to claim for Jobseeker’s Allowance (JSA).

Mandatory reconsideration notice

Once a decision has been reconsidered, the decision maker will send you two copies of a ‘mandatory reconsideration notice’ letting you know of the outcome of the reconsideration. Remember to safe-keep the extra copy of the notice should you wish to appeal the new decision!

You will have 30 days from the date you receive the mandatory reconsideration notice to make the further appeal.

Appealing a decision

If you are unhappy with the result of the mandatory reconsideration, you can also make an appeal to the HM Courts & Tribunals Service (HMCTS). Your appeal must normally reach the HMCTS within one calendar month of the date the mandatory reconsideration notice was sent to you. Appeals are made on the SSC1 form.

​The HMCTS will send you a copy of your appeal to the DWP and ask them to provide a ‘response’. The response requires the DWP to explain how they came to their decision – and they must do this within 28 days.

Note: During the appeal you will be entitled to receive ESA at the assessment rate.

The Tribunal hearing

You must be given 14 days’ notice of the time and place of the appeal hearing.

The appeal tribunal will be made up of a judge, a doctor and a disability expert. The judge will ask you questions about the issues related to your appeal. You should be given the opportunity to explain your case.

To find out how long it will take for you to attend a tribunal hearing after you have lodged your appeal, please call the ‘First-tier Tribunal (Social Security and Child Support)’, on 0300 123 1142 (England and Wales) and tell them which tribunal Centre you will be attending.

Collecting Evidence for a Tribunal Hearing

It is up to you to bring forward evidence that supports your claim! It is important to remember that you are not being asked about your condition as it currently is, but your condition as it was when you made your claim. This means you should be prepared to talk about how your health was at that time. 

Some of the written evidence which the Tribunal will consider in the hearing include:

  • Your original ESA questionnaire form (ESA50 Form).
  • The medical assessment report completed by the doctor or Health Care professional as part of the Work Capability Assessment.
  • Reports requested by the DWP from any other medical source (a G.P, Consultant or Specialist that you may have seen recently).

It is vital that you familiarise yourself with these documents before your tribunal hearing so you can answer any questions the Tribunal Members may have about them. Remember, that you want to present your case in the most accurate and coherent way that you can.

Oral Evidence

The oral evidence that you will give in the tribunal is very important. Before the tribunal, you should identify which activities (descriptors) apply to you (please see page 8 of our ESA Factsheet for a full list of the descriptors, by clicking here).   

Identify the level of difficulties you have with these activities. Think about whether you can perform the tasks reliably, safely, repeatedly and at reasonable speed, and, if when carrying out these activities, whether you experience pain, tiredness, stiffness, breathlessness, dizziness, nausea and balance problems. 

Make a note of the activities (descriptors) that you feel you satisfy and why. You can send this to the Tribunal Service before you attend the tribunal.  Keep a copy of this for yourself so that you can refer to it during the tribunal hearing.

If possible, review the answers you made in your ESA 50 form. Try to make sure there aren’t any inconsistencies with your oral evidence, or be prepared to tell the tribunal why what you wrote in the ESA 50 form might not have properly represented your situation. 

Medical Evidence

You should back up your oral evidence with medical evidence.

Ask your doctor, consultant, physiotherapist or other health care professional who knows about your condition to write you a supporting letter.  However, please be aware this may not always be done for free.

It is important that your evidence does not just state what condition you have and the treatment you receive. It needs to adequately deal/make clear how your condition affects your ability to carry out your day-to-day activities. 

Make a note of all the medication that you were taking at the time of your claim.

Appealing a Tribunal decision

You will get a decision notice on the day of the hearing or soon after. If the appeal is unsuccessful, you can ask for a ‘statement of reasons’ which will explain the Tribunal’s decision. You have one month from the date of the decision in which to do this.

If you disagree with the decision, you may be able to further appeal to an ‘Upper Tribunal’. However, you can only do this if the tribunal has made a legal error.

Please see the Appeals Factsheet for more information.