ESA decision letter (Template)

In this blog post, we talk about what is an ESA decision letter and what is a Decision Maker’s role.

We also mention what are the ESA descriptors and what does it take to make an ESA decision. 

What is an ESA decision letter?

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An ESA decision letter should contain a summary of the Health Care Professional’s report, and a summary of the points you scored at your ESA medical assessment.

If you disagree with the DM’s decision, you can request a reconsideration of the decision. 

To better understand how a decision is made and what an ESA decision letter’s purpose is, we have to talk about what a Decision Maker needs in order to make a decision. 

Role of the Decision Maker in the decision making process

The role of the DM in a claim for ESA is to gather and review a claimant’s evidence in support of their claim for ESA and make an informed and, importantly, justifiable decision on whether or not that claimant is eligible to receive ESA, and, if so, which of the two groups (Support or Work Related Activity Group (WRAG)) the claimant should be placed in. 

Typically, the evidence includes the claimant’s ESA50 in which they describe how their condition affects their ability to execute daily tasks, an Atos medical report compiled by the Healthcare Professional (HCP) who conducted the WCA to gauge an individual’s capability for work, alongside any other additional evidence submitted by the claimant’s General Practitioner (GP), advocate or other support worker. 

The evidence is scrutinised by the DM and descriptors or points awarded to the claimant based on the perceived severity of the condition or disability.

What is a Work capability assessment? 

The Work Capability Assessment (WCA)  is the test used by the British Government’s Department for Work and Pensions (DWP) to distinguish if an individual is eligible for Employment and Support Allowance (ESA). 

A work capability assessment allows the Department for Work and Pensions to look at how mental conditions affect an employee’s ability to work. 

Work Capability Assessment was made to focus on a person’s capability to work rather than their inability to work and it’s a first positive step towards finding or getting a job for most people. 

When is the Work Capability Assessment used?

If someone wants to qualify for Employment and Support Allowance (ESA), they first have to get the approval of the Department of Work and Pensions (DWP) so DWP can decide if someone has limited capability to work.

The assessment process starts 13 weeks after the initial declaration when a healthcare professional approved by the Department for Work and Pensions (DWP) thoroughly examines the claim form and decides whether to seek further evidence from the claimant’s GP or another appropriate source.

The assessors who are healthcare professionals rely on their knowledge gathered from working in a clinical environment so they can:

  • Answer factual questions that have a bearing on eligibility, such as: “Is the claimant receiving intravenous therapy?”
  • Explore the medical history
  • Deliver clinical judgments, such as on whether the claimant is at substantial risk or terminally ill?
  • Estimate the date of any future recovery?

WCA limited capability for work assessment descriptors

To be assessed as having a limited capability for work, you need to score 15 points or more.

The assessment takes into account your abilities when using any aid or appliance you would normally or could reasonably be expected to use.

Part 1: Physical functions

Activity 1. Mobilising unaided by another person with or without a walking stick, manual wheelchair or other aid if such aid is normally or could reasonably be worn or used. 

Activity 2. Standing and sitting.

Activity 3. Reaching.

Activity 4. Picking up and moving or transferring by the use of the upper body and arms. 

Activity 5. Manual dexterity.

Activity 6. Making self understood through speaking, writing, typing, or other means which are normally or could reasonably be used, unaided by another person.

Activity 7. Understanding communication by: (i) verbal means (such as hearing or lip reading) alone; (ii)  non-verbal means (such as reading 16-point print or Braille) alone; or (iii) a combination of (i) and (ii), using any aid that is normally or could reasonably be used, unaided  by another person.

Activity 8. Navigation and maintaining safety using a guide dog or other aid if either or both are normally or could reasonably be used.

Activity 9. Absence or loss of control whilst conscious leading to extensive evacuation of the bowel and/or bladder, other than enuresis (bed-wetting), despite the wearing or use of any aids or adaptations which are normally or could reasonably be worn or used.

Activity 10. Consciousness during waking moments.

Part 2: Mental, cognitive and intellectual functions

Activity 11. Learning tasks.

Activity 12. Awareness of everyday hazards (such as boiling water or sharp objects).

Activity 13. Initiating and completing personal action (which means planning, organisation, problem solving, prioritising or switching tasks).

Activity 14. Coping with change.

Activity 15. Getting about.

Activity 16. Coping with social engagement due to cognitive impairment or mental disorder.

Activity 17. Appropriateness of behaviour with other people, due to cognitive impairment or mental disorder.

The Decision Maker’s perspective on taking an ESA decision

There were wide ranging views among DMs on how they characterised their contribution towards the decision-making process, according to a research report

Some DMs felt that they were at the heart of the decision making process, with the ability to use their experience and judgement to weigh up the evidence available to them. 

Some felt that their role was in effect just to ‘rubber stamp’ the outcome advised by Atos in the WCA report. 

Others felt that their role lay somewhere between these two extremes. 

Generally, it was felt that pressure to reduce the volume of ESA decisions that were appealed underpinned the guidance to involve Atos in any cases where the DM was minded to disagree with the HCP advice. 

The feeling was that the instructions that they had received were designed to ensure a clearer audit trail in the event of an appeal. 

Others felt that the guidance stemmed from concern over a drop of the volume of cases processed since DMs were first instructed to take a more central role in the decision-making process. 

In either case, DMs felt that management teams with responsibility for different areas of the business were pulling in opposing directions, leading to them receiving conflicting guidance on their role. 

The Atos perspective on DMs taking an ESA decision

In the same research report, Atos HCPs were also asked to give their views on the role of the DM in the decision making process. 

The majority of HCPs viewed the DMs to be independent assessors of the claimant’s evidence and that, ultimately, any ESA decision should be made by a DM. 

Atos HCPs tended to regard themselves as advisors to DMs, and on hand to offer further medical knowledge or clarification if a DM was unsure about a condition. 

Overall, HCPs felt that DMs should evaluate all evidence presented to them and draw a conclusion looking at everything in combination (the ESA50, the medical report and any other correspondence received in relation to the claimant’s condition). 

They, generally, saw value in this overall assessment being conducted by an individual outside of the medical profession who could review all evidence objectively. 

A minority of HCPs felt that DMs assigned too much importance to the ESA50 and this was thought to be problematic, particularly in cases where claimants exaggerated the severity of their illness.

 They were also concerned that DMs took additional evidence supplied at face value and did not always consider the provenance of this additional information. 

HCPs viewed themselves as medical experts and ‘disability analysts’ and therefore felt that if the report had been compiled correctly then it should be taken to be an accurate measure by which to gauge an individual’s capability for work.

Similarly, if conducted correctly, HCPs felt the WCA report should cover information the claimant had given in their ESA50, therefore giving a more comprehensive document on which the DMs should base their decision. 

A small number of HCPs, who believed that DMs did not possess the necessary medical knowledge, felt that DMs should always consult an HCP if they wanted to go against Atos advice. 

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Conclusions

In this blog post, we talked about what is an ESA decision letter and what is a Decision Maker’s role.

We also mentioned what are the ESA descriptors and what does it take to make an ESA decision. 

The most important thing to remember is that an ESA decision letter should contain a summary of the Health Care Professional’s report, and a summary of the points you scored at your ESA medical assessment.

This letter is very important and it’s a starting point if you want to challenge the DM’s decision.

Please feel free to leave any comments on the content or questions in the comments section below. 

FAQ about ESA decision letter

How long does a decision take for ESA?

To receive a decision from your ESA claim it can take several weeks or months.

If it’s been more than two months and you haven’t heard anything, you could contact the DWP to ask why you haven’t had a decision letter yet.

How long does it take for the ESA Decision 2019?

In 2019, on average, ESA decisions took 2-4 weeks after the face to face assessment, if one is required.

How do I get a copy of my ESA award letter?

If you need a copy of your ESA  award letter, you can request a copy by calling Social Security at 800-772-1213 or visiting your local office.

How long do DWP decision makers take?

On average, DWP decision makers take 12 weeks from the date you started your claim to make a decision. Some claims take less time, some take more.

How many points do you need to be in the support group for ESA?

To be in the support group you have to score 15 points or more.

If you score 15 points you’re thought to have limited capability for work and are entitled to ESA.

Does ESA get backdated after assessment?

ESA will be backdated once you’re assessed. Any extra money you get should be backdated to the 14th week of your claim.

If you were getting a premium during the assessment phase as a carer or someone with a severe disability, this will continue. If you get contribution-based ESA, it’ll last for only 1 year.

Recommendations

  1. Government’s response to the Independent Review of the Work Capability Assessment
  2. An independent review of the Work Capability Assessment
  3. Project Management Capability Assessment
  4. Positive Behavior Supports for Adults with Disabilities in Employment, Community, and Residential Settings
  5. Investigation into errors in Employment and Support Allowance
  6. Guide to Government Benefits: Social Security, Medicare, Medicaid, Unemployment Insurance, Disability

References

Research report Decision making on Employment and Support Allowance claims

Durham.gov.uk

disabilityrightsuk.org

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