PIP and ESA Assessment processes (Guide)

In this post, we talk about the similarities and differences between PIP and ESA assessment processes, and what are some challenges that claimants have to face when applying for either benefit. 

PIP and ESA Assessment processesAlthough PIP and ESA have very similar assessment processes, their purposes are different.

Personal Independence Payment (PIP) is a benefit paid to people aged between 16 and 64, that live with a long-term disability or a long-term condition that impacts their day-to-day life.

Employment and Support Allowance (ESA) is a benefit for people who can’t work because of a disability (long or short-term).

The assessment timelineBoth PIP and ESA claimants begin by filling in application forms detailing their conditions and their effect on their daily activities.

The forms are submitted, alongside any supporting evidence to the Department for Work and Pensions.

All of the evidence and the documentents belonging to a claimant are then analyzed by one of the DWP’s assessment providers. 

The healthcare professionals (HP) assess the claimant’s capability based on a series of descriptors provided by the DWP.

The HP is not the one who makes the final decision, but a decision-maker has this responsibility.

The HP’s goal is to present an accurate assessment about the claimant’s mental and physical condition. 

Most claimants have to attend a face-to-face medical assessment with the HP.

This assessment is extremely important, as it has great weight in the final decision.

Read more about the medical assessment for PIP or ESA in our other blogs. 

After a decision is made, if the claimant disagrees and thinks the DWP made a mistake,  he/she has a right to ask for a revision of that decision.

This is an internal review called a Mandatory Reconsideration.

The next step in challenging the DWP’s decision after MR would be appealing to a Tribunal. 


What should you do before the assessment?

If the medical assessment with the Healthcare Professional worries you, you should know you are not alone.

Some people are concerned whether they would be eligible for the benefit, whether the application would be difficult to complete, and worry about disclosing sensitive details of their illness.

For both PIP and ESA, claimants have to fill out a form and send it to the DWP along with other information about their health-related issues.

The PIP form has 15 questions and it’s based on how the condition affects the claimant.

It’s not based on a particular illness or disability, or a medication. The ESA form, known as the NSESAF1 form, has to be delivered at one’s closest Jobcentre.

The form has 12 parts and asks about the claimant’s work history, pensions, and various questions about the illness, disability, injury or health condition that affects him or her. What should you know about the PIP and ESA assessments
The main goal of the PIP and ESA assessment is to understand how the claimant’s disability or illness impacts his or her day-to-day life.

PIP and ESA are based on a medical diagnosis, rather on the impact of your diagnosis and how you are managing the illness. 

This being said, the Healthcare Professionals are trained to accurately assess claimants with a high range of conditions.

The HP’s medical background and knowledge should be as expansive as possible. 

In carrying out assessments, HCPs should draw on insights from a range of different sources:information shared by the claimant in the face-to-face assessment; the outcomes of any examinations conducted, and observations of claimants during the assessment; information shared by companions or advocates that claimants bring to assessments; additional evidence submitted by claimants, including reports from medical professionals, carers, support workers or family members.


PIP and ESA assessment processes are believed to be the most stressful part in claiming a benefits award,  for all of the claimants. 

Many claimants worry that the HP is not fully trained to understand their illness and how it affects them.

Some feel they cannot trust the HP in recording accurately what they are expressing. Therefore, this could bias their claim. 

When receiving the medical assessment report, along with the DWP’s decision letter, many claimants declared that what was written there was news to them.

The report did not picture by far the struggles they are going through daily, or even was describing another claimant’s issue. 

Receiving the DWP’s decision

Along with the decision letter, the claimant will also receive a summary on how the decision was made.

The medical assessment report will only be sent to the claimant if they decide to appeal the DWP’s decision. 

Many claimants complain that they don’t really understand how a decision is made, what are the eligibility criteria and the descriptors they should meet.

This is an issue that could be easily fixed if the claimants would be able to see what is written about them at the medical assessment.

This would allow them to rectify any perceived errors. 

What are the Disability Premiums and are you eligible for them?

The Disability premiums are extra amounts of money that a claimant can receive.

The claimant has to satisfy certain criteria for this, however.

Among them, the claimant should already be claiming a benefits award such as:

  •  Income Support
  • income-based Jobseeker’s Allowance (JSA)
  • income-related Employment and Support Allowance (ESA)
  • housing benefit

A clarification: If the claimant is already getting the PIP award they can also qualify for the Disability premium.

If the claimant gets income-related Employment and Support Allowance (ESA) they can only get the severe or enhanced premium. 

Below you will find the correspondent rates:

For the Disability premium you’ll get:

  • £34.35 a week for a single person
  • £48.95 a week for a couple

Severe disability premium you’ll get:

  • £65.85 a week for a single person
  • £131.70 a week for a couple if you’re both eligible

You do not have to claim disability premiums.

If you’re eligible, it’s automatically added to your:

  • Income Support
  • Jobseeker’s Allowance (JSA)
  • Employment and Support Allowance (ESA)
  • Housing benefit.

PIP and ESA statistics

PIP was introduced in England, Scotland, and Wales in 2013, replacing Disability Living Allowance (DLA).

ESA was introduced in 2008, replacing Incapacity Benefit

According to the most recent DWP statistics, since 2013 there were a little over 3.2 million total PIP and ESA applications; 3.0 million PIP assessments, 1.7 million ESA assessments; 1.6 million PIP awards and 1.0 million ESA awards

According to an official report of the Parliament of the UK: 

“The PIP and ESA assessments work well for the majority of claimants, only a minority of PIP and ESA claimants choose to challenge the initial decision made on their claim. Claimants of both benefits who want to challenge the Department’s decision are required to request a Mandatory Reconsideration (MR). MR was introduced in 2013, in an effort to reduce the number of disability and incapacity benefit cases going to appeal.

Taking MRs and Appeals for both benefits together, the figures show that there are at least 290,000 claimants of PIP and ESA for whom the correct decision on entitlement was not made at the earliest possible point in the process. Many more will have disagreed with their initial or MR decision but felt unable to face challenging it further.

Since letting the PIP and ESA contracts, the Government has spent hundreds of millions of pounds—in addition to the money paid to contractors for carrying out assessments—checking and defending DWP decision-making.”

Conclusions

In this post we showed you some important figures regarding the PIP and ESA assessments.

We also talked about the similarities and differences between PIP and ESA awards, and what are some challenges that claimants have to face when applying for either. 

Don’t hesitate to let us know what your experience with PIP and ESA is.

And if you have any questions for us, leave them in the comments section below. 

FAQ about PIP and ESA 

Can you get PIP and ESA at the same time?

You can claim PIP and ESA at the same time. They are two separate benefits.

What else can you claim if you get PIP?

If you claim PIP, you are also allowed to claim Jobseeker’s Allowance, Income Support, Working Tax Credit. You can also claim Pension Credit, but only if you get the PIP daily living component.

What is enhanced disability premium ESA?

Enhanced disability premium ESA is an extra amount of £16.80 a week that you get if you’re entitled to income-related ESA.

Does Universal Credit replace PIP and ESA?

Universal Credit does not replace PIP and ESA.

All three benefits can be claimed and paid along. 

How long is PIP awarded for?

Usually PIP is awarded for a fixed amount of time. It could be one, two or three years.

This will be specified in your decision letter.

How long can you go abroad PIP?

You can continue to claim PIP if you’re going abroad for up to 13 weeks.

This is extended to 26 weeks if it’s for medical treatment.

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. Personal Independence Payment: What You Need to Know
  4. Nolo’s Guide to Social Security Disability: Getting & Keeping Your Benefits
  5. Guide to Government Benefits: Social Security, Medicare, Medicaid, Unemployment Insurance, Disability

References

  1. Help for People Claiming ESA or PIP
  2. PIP and ESA assessments – Work and Pensions Committee
  3. Disability premiums: Eligibility – GOV.UK

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