ESA decision phone call. What to expect?

In today’s article, we are talking about the ESA decision phone call.

What’s the purpose of the call and what are the Decision Makers looking for?

ESA decision phone call – The Decision Maker’s perspective

An ESA decision phone call is an additional step that has been built into the decision-making process that requires DMs to attempt to speak to claimants on the phone to advise them of the likely outcome for their claim for ESA before the final decision is made. 

If the claimant is likely to be found disallowed, DMs ask at this point if they have any additional evidence that might further support their claim. 

The phone call had only been introduced in some of the Benefit Centres visited. 

However, those working in Benefit Centres that were not yet making these calls were aware that they would soon be asked to do so.

DMs had mixed views on the value of these phone calls. 

Overall, the call was felt to be helpful in generating additional evidence only in a small minority of cases.

‘Every now and again you do pick up some new information and you’re very grateful you didn’t disallow them in the first place and then get the information after.’

(ESA DM) DMs felt that because the call reached claimants ‘out of the blue’ they were often too shocked to respond to the request for additional information.

They felt claimants tended to be unable to respond at all or were simply preoccupied by concerns over when their payments would stop.

Some felt that the call was a waste of resources and could not see any positive value in contacting claimants in this way.

Others felt that it had the potential to provide better customer service but felt that the call would have more value after claimants had had time to consider whether they had any additional evidence to provide.

Their suggestion was that claimants should receive some sort of written summary of the evidence considered and likely outcome prior to receiving the call.

DMs generally felt frustrated that they were expected to attempt to call all claimants and that they were not able to exercise any discretion over which claimants to call. 

This lack of discretion appeared to DMs to be at odds with an intention to give them greater empowerment in handling cases. 

‘When we make these phone calls there is there is no evidence, you know before you phone that you are not going to get anything different because of the nature of their incapacity, and the claimants are saying “Send me a GL24 form” which is the appeal form…so that phone call isn’t achieving anything, it is taking up our time because you know you are not going to get them to claim JSA and why should they, because it is the same rate of benefit as it is on the appeal rate.’

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 workers. 

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

Recent changes in Decision Makers’ working practices

Aside from the direction about the overall role of the DM in processing ESA claims, there have been three specific changes to DM working procedures since the implementation of the first Harrington Review.

 All of these were introduced in an effort to simultaneously empower DMs and manage and support the claimant throughout the process.

These changes were the introduction of a: 

• ESA decision phone call made by the DM to the claimant to explain their decision on whether or not the claimant has been found eligible for ESA; 
• More detailed written justification by the DM to explain the reason(s) for allowing or disallowing a claimant ESA;
•  Personalized summary statement written by the Atos HCP in their WCA report to justify their choice of descriptor(s). 

These changes had some bearing on the evidence available to DMs in processing ESA cases.

Claimant calls from Decision Makers 

Not all Benefit Centres had introduced the calls to claimants to inform them of the likely outcome of their claim and to give them the opportunity to provide additional evidence at the time of the research, but those not making the calls knew that they would need to in the near future. 

DMs felt that it would be more in keeping with a move to empower DMs if they had some discretion over which claimants they made calls to.

This would enable them to focus their efforts on borderline cases where they felt there was potential for their decision to be influenced by the call. 

While this focuses on the aim of the call to obtain any previously undisclosed evidence, rather than its aim to provide good customer service, DMs often doubted that the call actually met the latter aim because claimants were frequently too shocked to react rationally to the information provided (although some felt that if the call followed written communication then it could have a value from a customer service perspective). 

ESA decision phone call – What’s the purpose?

The purpose of the ESA decision phone call is to notify the claimant that they are likely to be found disallowed for ESA and check whether or not the claimant has any additional evidence they would like to submit that would further support their claim. 

This sometimes generated verbal evidence that DMs found difficult to take into account when making their decision.

DMs mentioned experiences of claimants giving further information that they were too embarrassed to disclose to the Atos HCP at the WCA.

In instances where claimants were able to provide further information over the phone, some DMs felt that they did not possess sufficient medical knowledge to be able to understand the importance or relevance of the information in how an individual’s day-to-day capabilities were affected.

Some DMs felt unsure of how much weight they could or should give to information given verbally. 

Useful to know: If you disagree with the DWP’s decision

It can take several weeks or months for the DWP to make a decision.

You’ll get all the necessary information when the DWP writes to you with the result of your claim.

This is called a decision letter.

If you disagree with the decision in your letter, you can ask for it to be looked at again. This is called a ‘mandatory reconsideration’.

You need to ask for this within a month of getting your decision letter.

If you miss the deadline, you can make a late request, but you have to show that you had a good reason for being late.

You can challenge most decisions made by DWP about your ESA including:

• not getting ESA
• being put in the work-related activity group and not the support group
• getting a sanction

There are 2 steps to challenging a decision.

1. You must ask DWP to look at the decision again. This is called ‘mandatory reconsideration’.

2. If you still disagree after the mandatory reconsideration, you can appeal to an independent tribunal. You can’t appeal to a tribunal until you have the result of a mandatory reconsideration in writing from the DWP.

If you don’t want to challenge the decision, it’s worth checking if you could get other benefits.

Conclusions

In this article, we talked about what’s the purpose of the ESA decision phone call, what is the role of a Decision-Maker from the DWP and what should one expect when receiving an ESA decision phone call. 

In summary, the purpose of the ESA decision phone call is to notify the claimant that they are likely to be found disallowed for ESA and check whether or not the claimant has any additional evidence they would like to submit that would further support their claim. 

Please feel free to leave any comments and questions you may have, in the comments section below.

FAQ about ESA decision phone call

Recommendations

1. Employment and Support Allowance: A Guide to ESA for People with a Disability or Long Term Health Condition, Their Families, Carers and Advisors 
2. Investigation into errors in Employment and Support Allowance
3. Providing Employment Support for People With Long-Term Mental Illness: Choices, Resources, and Practical Strategies
4. How to Win an Argument: An Ancient Guide to the Art of Persuasion
5. How To Be Right: … in a world gone wrong
6. Plead Your Case

References

Decision making on Employment and Support Allowance claims (Adams, 2012) 

Gov.uk

Citizensadvice.org.uk