In this blog post, we talk about what happens if ESA is stopped after medical assessment. We discuss what your options are and what the next step should be.
When ESA is stopped after medical assessment
Central to ESA is the medical assessment that examines what claimants can do, rather than what they can’t.
If you have failed your ESA medical and have not scored enough points to be placed in either the work-related activity group or the support group there are steps you can take.
Your payment of ESA will stop until the decision is changed.
Employment and Support Allowance and Work Capability Assessments
If you are claiming Employment and Support Allowance (ESA), you are required by the Department for Work and Pensions (DWP) to have a Work Capability Assessment that focuses on how your illness or condition affects you on a day-to-day basis.
The Work Capability Assessment is one part of the process used by DWP to assess your entitlement to ESA.
You will be sent a questionnaire that you need to complete and return to the Health Assessment Advisory Service.
After you return the questionnaire, a fully trained Healthcare Professional carries out an initial paper-based assessment.
During this early check, the Healthcare Professional will look for information to decide whether or not you will need to have a face-to-face assessment and advise DWP accordingly.
The DWP may have enough information to make an immediate decision on your entitlement to benefits.
If DWP does not have enough information to make an immediate decision, you are required by DWP to have a face-to-face assessment.
The majority of assessments are carried out in an Assessment Centre.
A home visit can be arranged when there is medical evidence confirming you cannot leave your home to attend an Assessment Centre.
During a claim period, it is normal for you to be asked to attend a Work Capability Assessment more than once and each time you will be sent a new questionnaire to ensure you have the opportunity to provide the latest information on how your condition currently affects you.
What to Expect from a Medical Assessment for ESA
The assessment will look at the effects of any health condition or disability on your ability to carry out a range of everyday activities.
It will be carried out by a Healthcare Professional.
The Healthcare Professional will discuss your medical history and activities you undertake in a typical day.
This information will be recorded but will not be a word-for-word record.
You can bring extra information or medical information with you to assist the Healthcare Professional with their report.
You can bring a companion for help and support who can also supply information.
Where appropriate, you may have a physical examination that is designed to assess your function and is not the same as an examination in a diagnostic or treatment setting with a GP or Consultant.
Your verbal consent will be obtained for any physical examination to proceed, should it be necessary.
You are encouraged to do as much of the examination as you feel comfortable with.
You will not need to remove items of intimate clothing. A physical examination is not always required.
Once the Healthcare Professional has all the necessary information, your face-to-face interview ends.
The Healthcare Professional will then evaluate the information, suggesting the most appropriate descriptors (phrases defined by DWP), and writing a justification of their choices, to complete the Assessment Report for DWP.
The Assessment Report is known as an ESA85 and will be sent electronically to DWP immediately after completion.
ESA stopped after medical assessment. What can I do?
The first stage to challenging a Decision is for you to request a Mandatory Reconsideration, this needs to be done in writing to the DWP, within one month of the Decision, to the office that dealt with your claim, have a look at our ESA MR & Appeal guide for details of the process, the ESA area also has template letters that you can use to make the request with.
You should contact the DWP for a copy of the assessment report (ESA85), if you have not already done so, phone them but again follow up on the request in writing.
Once you have the assessment report you will have a better understanding of how the DWP Decision Maker has come to their conclusions and will then be able to argue against them.
Your primary task is to show that you meet the criteria, there are many reasons you may have failed, you need to address each of these but don’t get bogged down in criticizing the assessment report unless you can clearly show that it is incorrect, it is a lot easier to argue the facts of the situation;
“The assessor recorded that I walked 50m, I did but they have failed to document that I had to stop every 10m for a rest due to breathlessness“
“Based on my observations of the claimant walking I believe that they can reliably walk more than 200m.
If you are confident of these scores the next stage is to reconsider any reasons that have been given in the DWP decision letter and write a Mandatory Reconsideration letter giving the reasons you disagree with the decision focussing on the points you feel you should have been awarded and the reasons why giving examples of problems you have had.
You should consider whether there is any other medical evidence you could send in to support your Mandatory Reconsideration.
The letter should be sent to the address at the top of the decision letter and should be sent within 1 month of the date of the decision.
A late mandatory reconsideration can be done up to 13 months after the date of the decision but you should give reasons for lateness.
If you aren’t confident about how to do this you should seek advice.
If the Mandatory Reconsideration is refused or if you are awarded work-related activity group and you feel you should be placed in the support group you will need to appeal.
It is best to seek advice at this stage. You can contact an advice agency, who will help you to lodge your appeal.
If you live in Coventry you will be referred through to the Law Centre for representation at the hearing.
Will I be paid ESA during Mandatory Reconsideration?
While you are going through the Mandatory Reconsideration stage you are not paid Employment and Support Allowance.
If you are not in a Universal Credit full-service area, you will need to claim Job Seeker’s Allowance (JSA) if you are on a low income until the Mandatory Reconsideration is completed.
To claim Job Seeker’s Allowance you should ring 0800 055 6688 or you can claim on-line here Job Seekers Allowance claim If you claim on-line you will get a call or text inviting you to a meeting at the Job Centre.
You will have to state you are actively seeking work while you dispute the decision but can place restrictions on what actions you will take or work you are looking for because of your health problems.
You should ask for the claim to be backdated to the date your ESA was last paid.
If there is a delay in paying, you can ask for a short term advance. More information about this is available here: Short Term Advance.
If you are in a Universal Credit full-service area then you need to be aware that you cannot make a new claim for JSA and will need instead to claim Universal Credit(UC).
You can either opt to do this or you can opt to delay a transfer to UC by getting your ESA reinstated once the case progresses to the appeal stage see below.
You may want to discuss these options with an advisor.
Once the ESA appeal has been lodged you can be paid ESA, unless you have had a previous refusal of a claim dated after 30th March 2015 in which case you should refer to the article about repeat ESA claims for more advice.
You will need to obtain a new fit note from your GP to cover the period since your ESA was last paid and an ongoing period.
If you were not paid JSA during the Mandatory Reconsideration your benefit should restart and be backdated to the date of the last payment of ESA.
If you were paid JSA then you will be transferred over from JSA to ESA and if there have been any gaps or shortfall in the amount you should be paid the balance as ESA.
If you were paid UC you will remain on UC.
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In this blog post, we talked about what happens if ESA is stopped after medical assessment.
You should know that you have the right to appeal the DWP’s decision if you disagree with the Decision Maker.
Search for and read more about ESA mandatory reconsideration and ESA appeals throughout our blog posts.
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FAQ on ESA stopped after medical
What happens when my ESA stops?
When you ESA stops the DWP will usually tell the council and the council may stop your Housing Benefit or Council Tax Reduction.
This is because they might think you’ve got other income now, for example, that you might have started a job.
How long does it take to get ESA decision after medical?
To get an ESA decision after medical assessment it can take several weeks or months.
If you haven’t heard anything after 8 weeks, you could contact them to ask why you haven’t had a decision letter yet.
Can your Esa be stopped without notice?
Sometimes yes, your ESA can be stopped without notice.
This may happen if the DWP needs further evidence regarding your case.
You shall be informed of what is the reason for stopping your payments.
What benefit can I claim after ESA?
After ESA you can claim the Council Tax Reduction benefit, as well as:
Personal Independence Payment, Support for Mortgage Interest (if you’re entitled to income-related ESA).
What happens when ESA stops after a year?
After one year, Contribution-based ESA stops.
After that, you will be reassessed by the DWP in order to establish if your claim can be renewed or not.
- Employment and Support Allowance: A Guide to ESA for People with a Disability or Long Term Health Condition, Their Families, Carers and Advisors
- Providing Employment Support for People With Long-Term Mental Illness: Choices, Resources, and Practical Strategies
- Positive Behavior Supports for Adults with Disabilities in Employment, Community, and Residential Settings
- Investigation into errors in Employment and Support Allowance
- Guide to Government Benefits: Social Security, Medicare, Medicaid, Unemployment Insurance, Disability