High Level Overview for External Partners ESA Repeat Claims High Level Overview for External Partners Version v1.0 March 2015

Purpose and background of this presentation This presentation specifically provides information about one of the ESA Reform measures; ESA Repeat Claims In November 2014, the Government response to the Work and Pensions Select Committee report on ESA and the WCA announced a package of measures to increase health and employment support for claimants with a disability or health condition The measures outlined included this change to ESA repeat claims

The package of support The package of measures will be introduced in Spring 2015 and are made up as follows: Two national measures: JSA extended periods of sickness – from 30 March Restricting Repeat ESA Claims – from 30 March Plus additional pilots in several Jobcentre Plus districts: ESA Claimant Commitment Trial – from 23 March More intensive support for ESA claimants pilot – from 23 March ESA Voluntary Early Intervention pilot – from 23 March Personalisation Pathfinders – from 1 April Further details of the ESA Reforms to be introduced by the Labour Marker Programme can be found on the Labour Market Programme DWP intranet site

Aims of the ESA Reforms The aims of the ESA reforms are to: Gain robust evidence about what types of support will help this group of claimants into employment Minimise the movement of claimants between Jobseeker’s Allowance (JSA) and ESA and the associated disruption to benefit payments, and Increase the health and employment support for claimants with a health condition or disability

Restricting ESA Repeat Claims From 30th March 2015, claimants who are found not to have limited capability for work (LCW), following a Work Capability Assessment (WCA) will not be paid the ESA assessment rate for a repeat claim; unless they have developed a new condition or an existing condition has significantly worsened Currently, claimants can make another claim for ESA after six months and potentially be paid ESA, even if there is no change in their health condition To prevent this happening ESA regulations are being amended to remove: the reference to ‘six months’ and entitlement to payment pending appeal for claimants who have had two consecutive decisions that they do not have limited capability for work. Specific information about the ESA Repeat Claims measure is available on the Benefit Delivery Programme DWP intranet site.

Restricting ESA Repeat Claims (continued) Where someone makes a repeat claim for ESA and there is no change in their health condition, DWP Decision Makers will be able to consider evidence from their previous WCA, when considering whether to disallow the repeat claim immediately, or refer for a further WCA, without paying the ESA assessment phase rate This change does not prevent someone from making another claim to ESA It also does not prevent someone whose condition has significantly worsened or who has developed a new condition from being entitled to ESA during the assessment phase Specific information about the ESA Repeat Claims measure is available on the Benefit Delivery Programme DWP intranet site.

Restricting ESA Repeat Claims (continued) The changes will not affect new claims where the claimant previously Failed to Attend their WCA or Failed to Return their ESA50 questionnaire; the six month rule will still apply to these claimants Claimants affected by this change who are found not to have limited capability for work, should claim Jobseeker’s Allowance or Universal Credit as appropriate This is to ensure that claimants receive the right advice and support from a Jobcentre Plus Adviser or Work Coach Specific information about the ESA Repeat Claims measure is available on the Benefit Delivery Programme DWP intranet site.

Restricting ESA Repeat Claims – Examples ESA disallowed as following WCA, decision made no LCW Repeat claim made and claimant disallowed based on previous WCA or repeat claim made and no decision until WCA, After WCA, decision made no LCW Appeal received by HMCTS, following mandatory reconsideration, ESA cannot be paid whilst the appeal is on-going as there have been two consecutive no LCW decisions. Example 2 Repeat claim, DM accepts new or significantly worsened condition; claimant is treated as having LCW and is paid ESA and referred for WCA at the relevant time After the WCA, the DM decides no LCW and ESA ends. If after a mandatory reconsideration the claimant appeals, the claimant cannot be paid ESA whilst the appeal is on-going as there has been two consecutive no LCW decisions. Example 3 Repeat claim made and following WCA, claimant has LCW and is placed in WRAG for one year. One year later, repeat WCA, decision made no LCW Appeal received by HMTCS following a mandatory reconsideration, ESA can be paid whilst the appeal is on-going as there has not been two consecutive no LCW decisions. Specific information about the ESA Repeat Claims measure is available on the Benefit Delivery Programme DWP intranet site.

What does this mean for Customer Representative Groups? Your role Groups may be asked to support claimants due to the changes so will need to understand the new measures and the evidence required to support repeat claims Staff will continue to follow current Departmental guidance for vulnerable claimants who may require additional support www.gov.uk has more information regarding eligibility criteria for each benefit Insert any local material as appropriate