Sickness, carers, UC and New-style ESA

A look at some of the specific Universal Credit (UC) issues for people affected by cancer. How does UC dealing with asessing whether you have limited capability for work and with whether someone counts as a carer? How does the closely related - but entirely separate New-style Employment and Support Allowance work or do things a little differntly?

Welcome to Part 4 of this mini-series of benefit blogs on Universal Credit (UC):

Part 1 looks at What is Universal Credit?
Part 2 looks at issues around it's gradual introduction and particularly for people switching over to UC from the "legacy benefits" that UC eventually replaces
Part 3 looks at how you claim Universal Credit (UC) and what happens next

Here in Part 4, we look at some of the specific issues for claims from people affected by cancer: those who are too unwell to work, are carers, experience extra costs or who are returning to work with ongoing health and disability issues. UC's approach is often different from that of the legacy benefits that UC is due to replace.

This means that if you have had any previous experience of benefits claims in the past - or are getting help and support from others who have - UC may not behave as you (or they) might expect . Even if you are coming to Universal Credit (UC) completely fresh to claiming benefits, it can be useful to know about how UC is meant to work in these areas and so avoid some of the pitfalls when it doesn't quite do so.

Assessments for "sickness" from work under UC

Unwell when you start your UC claim:

I'll start by looking at the process of how UC deals with new claims from people who are off sick or too unwell to work much or at all. In the jargon, it is about the process for accepting that you have "limited capability" whether for work or even just doing some "work related activity". The issues about "limited" rather than no capability: you are allowed to do some work - as and when you feel up to it - while claiming UC on the grounds of being off sick i.e. having "limited capability".

The actual assessment of your "limited capability" is the same no matter which benefit relating to sickness you claim. It's the same Work Capability Assessment (WCA) whether you are claiming under the new system of New-style Employment and Support Allowance and/or Universal credit or the "old system" made up of two kinds of ESA. So that means you don't need to go through the WCA twice if you are applying for both of the new benefits; nor that you need to be re-assessed if you switch from the old system to the new.

So how does the WCA work? The full process - through which many people with a cancer diagnosis can take a short cut - works as follows under UC:

you indicate when you make your UC claim that you are unwell and answer questions about your health situation
you send in a "Fitness for Work" certificate signed by your GP. If you are claiming under the special rules, you may also be asked for a DS1500 certificate. UC will say that you don't need to send in further sick notes but there is a good reason to still do so, at least until your WCA status is confirmed
if you are covered by a DS1500 this should be actioned quickly and you should be "treated as" passing the WCA without further ado.
if you are "awaiting, receiving or recovering" from cancer treatments, you will also be treated as passing the test. However, you should still be sent the UC50 self-assessment questionnaire, but straightaway rather than after a usual wait of 29 days. You will, though, only need to fill in a few pages of that form
If neither of these - or any other "treated as" scenario - applies, then you will have to go through the full WCA. For people with cancer, that might apply if you are unwell, but on a "watch and wait" regime as far as treatment is concerned . Or you may be well through recovery from treatment and its side effects, but still unwell, perhaps due to late effects or other health issues.
If you do need to go through the full process that starts with the UC50 form. But this time it won't be sent out until day 29 of your sickness and you would need to complete the whole form, where you indicate the limitations you experiece across 17 different areas of physical and psychological activity. These difficulties score points and the points add up to make prizes - or rather whether or not you get extra amounts and allowances made for having "limited capability" . Do get advice to help you with that.
in most cases where you have to do the full process, the UC50 form is followed up by a "face to face" assessment with a Health Care Professional employed by a private assessment provider. After you session they complete a report based on their assessment of your limitations across the WCA activities. where a health professional completes a report.
their report goes to a DWP Decision Maker who should look at all the information to hand and decides what points to awards and whether or not you have "limited capability". If you do, then the WCA also decides into which of two limited capability groups you are placed in. In UC, these groups are named after the tests, so there is: a "limited capability for work" (LCW) group and a "limited capability for work related activity" (LCWRA) group. Under ESA, these have different names : the LCW group is known as the "Work Related Activity" group and the LCWRA group is called the "Support" group
the difference between the groups is in what extra elemnt (in UC) or component (under ESA) you will have added on to your benefit, and whether or not you have to participate in some work related activity as a condition of getting the benefit. For people with cancer who are treated as passing the WCA - under special rules or because of treatments - you will be placed in the LCWRA/Support group

What if I become unwell during a UC claim or move over from "legacy benefits"?

Becoming unwell while on UC

Its exactly the same processes - and cancer exemptions - involved as above. The only difference is that instead of your WCA being triggered by the information on your UC claim - the process is triggered by you getting in touch with your UC workcoach and providing a GP' Fitness for Work note

What if I move over to UC from legacy benefits?

The key question here is whether those legacy benefits include ESA in which case you already ghave a valid WCA. You may be switching over for reasons entirely unrelated to sickness eg, if you moved house and needed to claim for help with rent from a new council. Sometime UC can live in its own bubble and the default reaction might be to start up a new WCA on the spot. The transitional regulations very specifically state that you do not have to undergo a new WCA simply because you have moved over. Get advice if this seems to be happening to you.

There is though greater freedom to trigger fresh assessments of WCA under UC and some people have found that while their current WCA is respected UC wants to trigger a new one shortly after. This can't though just be done on a whim

More about the quick routes through the WCA for people with cancer:

Many people with a cancer diagnosis are treated as passing the WCA without needing to go through the full WCA process.

Special rules / DS1500

Some people receive a diagnosis of and advanced and potentially life-limiting cancer. You can find out more about this in a pair of blogs starting with Special Rules 1 The difference they make. If these rules apply, your consultant or GP will issue you with a DS1500 certificate. This speeds up the processes - and by-passes the assessments - for both benefits for sickness benefits (ESA and UC) and the extra benefits for disability costs - such as Personal Independence Payment (PIP). The effect within UC should be that you should be quickly "treated as" passing the WCA and are are allocated to the LCWRA group. You also have the extra LCWRA element added in to your UC sums straightaway, rather than the usual 3 months.

This has been the historic experience with ESA, but it seems UC's "one size doesn't quite fit all" approach is too often struggling to deliver the same level of care and rapid response . Problem areas include: sending you out the UC50 form when they should not, requiring their own DS1500 when they can go with the one already sent into PIP, forgetting that the LCWRA element is due in your first payment, and insisting on a new DS1500 every 6 months which is not necessary. The results can be hassle, time wasting and delays in your payment. UC needs to learn to ask a grown up in ESA and PIP to help them do rather better. If you do get any problems, do get advice.

"Awaiting, receiving or recovering" from cancer treatment

This can apply to a far wider group of people with a cancer diagnosis: it doesn't matter whether you cancer has been picked up early or late nor what the hopes of what treatments can achieve are. So this fast route can apply for an early cancer with godd hopes of cure or long term remission too. It is based on the common sense and experience that treatments may actually make you feel a lot worse before you feel the benefit. In the past this was limited to intrvenous and similar chemo or radiotherapy. However, increasingly chemo can be given via tablets/medication so the scope has been widened. It can also include ongoing treatments such as tamoxifen and herceptin. Under this provision:

you are also "treated a"s passing the WCA, placed in the LCWRA group and avoid most of the assessment.
the payment of the extra LCWRA element, however, won't start until the usual three assessment periods (after you claim UC or become unwell if already on UC).
unlike under the special rules you still need to complete an UC50, but only a few pages of it. You should be issued with this form straightaway rather than having to wait the usual 29 days and you only need fill in just a few pages relating to your cancer treatment
your WCA status should then be quickly confirmed, even if your payments don't change for a bit. This means that there is no longer any issue around doing any work related activity nor looking at work you might do. If you are at any point able to do some paid work, UC will also ignore some of your earnings by giving you a "work allowance".

You may need to remind UC to get that UC50 to you, and to process it quickly, as they may just put you into the normal slower process by mistake.

Differences within the ESA process

In general, it is the exact same WCA process - and exemptions - whether you claim under UC or ESA. There are though some differences:

the self assessment form is almost identical, but is called a UC50 under UC and an ESA50 under ESA
there can - too often - be marked differences in how confidently and efficiently the same WCA process is carried out under UC compared to under ESA. The reason may be that UC is newer to sickness claims and is managing this as a non-specialist benefit. ESA has built up experience over the years and their staff only deal with people claiming while unwell. ESA staff may be much more familiar and the benefit feel more as if they know what they are doing.
UC could then usefully learn from ESA and perhaps set up specialist teams dealing with the 36% of UC claimants who would have been claiming ESA previously. Or they could do what was done on the last occasion there were two distinct benefits. Back in the day, all matters to do with sickness criteria were dealt with by Incapacity Benefit (the equivalent to New-style ESA) while the former Income Support (equivalent to UC) focussed on financial assessments and doing the sums. In the meantime, if you are claiming both benefits you may want to get the WCA up and running under New-style ESA.
there is a marked difference in any "work conditionality" requirements while you await the outcome of your WCA to be confirmed.
the decision at the end of the WCA process means different things. For ESA, you need to pass - or be " treated as" passing - the WCA to remain on ESA. So, "failing" the test would mean your ESA claim stops, though it can return on a reduced basis, if you go on to appeal. UC, however, is not just for those who are unwell, so failing the WCA does not affect whether you can stay on UC. You would carry on , but would no longer have the advantages of an extra "limited capability" amount, limits on any work conditionality or a work allowance.

Work requirements while awaiting the outcome of your WCA

ESA is interested in exploring ways to help you move back to work, but sensibly not at the start of your claim. Experience showed that claimants were either only on ESA for a few weeks before going back to work or were at the start of a much longer journey. For the former, work options were irrelevant as they had a job to return to while the start of a long term illness may also be the wrong time.

Looking forward to work in recovery is important to ESA, but their experience was that this was best started after the WCA was completed, both for the customer being in a better place and for everyone to know if the person was required to do any work related activity or not. So with ESA, everyone is "treated as" having limited capability for work until the WCA decision, based on on their GP's "Fitness for work notes"

UC wants to leave that all to the discretion of UC work coaches. Essentially, it borrows the processes for dealing with temporrily unwell jobseekers from the old Jobseeker's Allowance. The result is a bit messy for the longer term unwell.

Technically for the first 2 weeks you are excused all work requirements, the next 2 weeks you could be required to do some work related activity and thereafter its the full on "all work" requirements of an active jobseeker. However, these requirements can be moderated according to health limitations (which many work coaches may be used to doing from experience working on JSA) or switched off altogether.

Unlike ESA, UC does not require you to keep on submitting GP's notes until your WCA has been determined. However, you will need to keep them going, if you need your UC work coach to switch off work requirements altogether,

in theory, dealing with the two exceptions quickly, means that many people never hit this period of potential "all work requirements". But delays in sorting these out means this can happens. If you get any issues around this - whether due to delays or because you do need to go through the full WCA process - do get advice.

How does UC deal with carers?

There is good and bad news in UC arrangements compared with the legacy benefits:

The good news is that an extra amount is now extended to carers who are working and earning too much to claim Carers Allowance. For the first time, thse working carers can now get an extra amount within UC - called the carers element - ,which was not available under legacy benefits.
The not so good news is for carers who are unwell themselves, - or who become so possibly linked to caring. Unlike under legacy benefits, UC does not allow a carer's element to be included in the sums for the same person as well as either an LCW or LCWRA element for sickness. It will be one or the other - UC will apply whichever is the highest. However, in a couple an unwell person might have a limited capability element and their partner have the carers element. Carers with health issues may also lose out because UC does not have any adult disanility elements.
Finally, if you are a carer for someone who is receiving a severe disability premium in their "legacy benefits" or a svere disability addition in Pension Credit , BEWARE . In the past it was only if you actually received Carers Allowance that their severe disability" amounts were lost. It was possible for some carers to have their Carers Allowance blocked off, but still qualify for the "carers premium" in their benefits. Howver under UC, just receiving the equivalent "carers element" will be enough to stop that important extra money. That may need reading a blog for carers to make more sense.

In theory then, the test for UC carer's element is not so different to the “carers premium” in legacy benefits , with exactly the same extra amount Hoever there are but some swings and roundabouts.

There can be some issues with understanding the connection between Carer's Allowance and carer's element. Staff on Income-related ESA will know that it is impossible for someone to have the income from Carer's Allowance deducted and not have a carer's premium added into the sums or that anyone who gets or applies for carers allowance meets the criteria for being counted as a carer.

However, sometimes this has been news to UC staff, who may not see the link or rfer the situation to a Decision Maker to make a separate decision as to whether you count as a carer or not . That should only be needed for the new category of working carer who will not have been through a Carer's Allowance process. The result can be a missing or delayed carer's element and in recognising that you have no work conditionality requirements when you are busy being a carer. If you get any problems, do get advice.

How do I just claim "New-style" ESA?

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What is New-style ESA?

Contributory Employment and Support Allowance (C-ESA) remain as a separate benefit outside of UC, even though it's means tested companion - Income-related ESA - is in the process of merging into UC. Contributory ESA is the non-means tested version of ESA that can be paid regardless of most other income, your partner's income or any savings. In the past:

some people only claimed Contributory ESA as a basic benefit to replace earnings when unwell. This might be because other income or savings were too high for any means tested benefits to apply.
others, on lower incomes, may have had their Contributory ESA topped up with Income-related ESA (as this had some extra amounts not included within Contributory ESA). And/or they might claim Housing Benefit (HB) to help with the rent.
some would not have the right National Insurance record for any Contributory ESA, so there claims would just be for Income-related ESA and HB

However most people will start claims under the new system. Here Contributory ESA has been unnofficialy renamed as "New- style ESA", and the means tested supprt - that previously came from Income-related ESA and/or HB - comes from Universal Credit (UC) instead. So, just as under the old system, some people will only be interested in "New-style" ESA, while others will claim this alongside UC or just claim UC.

What's different about "New Style" ESA?

New-style ESA is a DWP term for what is still officially Contributory ESA. The main differences for people claiming this under the new system ,are:

it is now a stand-alone benefit, with the link with Income-related ESA - as part of the same benefit - removed
there is a different route to claiming New-style ESA, as opposed to the small group who may still claim under the old ESA system
you do have to verify your ID and sign a "claimant commitment" for New-style ESA, but it is a very different from an UC one. That's because there is no work conditionality involved under ESA as you await your sickness status to be confirmed under the WCA, but under UC there may be.

Claiming New-style ESA

New style ESA remains a seperate benefit claimable in its own right, but the problem was that at first the DWP forgot that many people will only be interested in claiming New -style ESA, as their savings or a partners income might prevent any entitlement to UC. They only had a system in place to claim New-style ESA as part of a UC claim, even when you knew you were not going to get any UC. So you had to go through a pointless UC claim process and fill in a short supplementary ESA(UC) form.

After some pressure, DWP tried a couple of different ways of allowing people to claim New style ESA on its own, but these were a bit tricky. Some wily - and fed up - advisers took to just using the old ESA forms or sending the ESA(UC) with the necessary additional information to ESA direct. This has been stopped, but a new improved process put in place:

first check if you should be claiming New style ESA . Some can still make new claims under the old system
you can either ring up to ask for a form, dowload one online or pick one up from a local Jobcentre plus office. for more details click here
you also need to make an appointment for an interview to verify your ID / sign an ESA claimant commitment. If you phoned up for the form you can make that appointment in the same call.

Beware of old myths that may still be around amongst UC staff. Hopefully, under the new system your call gets through to someone trained up in New style ESA. Ignore any comments such “ESA has been abolished for new claims”, “you can’t claim it without claiming UC” or “you might as well claim UC instead and not bother with New Style ESA, as it only gets taken away from UC”.

That last one has a grain of truth - it will be taken off any UC. So, is there any point claiming New-style ESA if you are looking at UC as well. The reasons why the answer may still be "Yes", are:

being on New-style ESA gives you full Class 1 National Insurance credits that can count towards all future claims for contributory benefits. UC, uniquely, only offers Class 3 credits that count only count towards State Retirement Pension
your WCA could be administered by ESA, who may do so more effectively than UC. Their decision will have the same force on any UC claim
there will be two separate payments, even if the total is the same. With ESA paid fortnightly this may help in budgeting and separate payments may help if something odd happens to your UC claim.
some people - such as students with disabilities hit a strange catch 22 when claiming UC. Student restrictions mean they need to pass the WCA to be eligible for UC, but UC won't let them claim UC in order to go through that WCA, because they are not eligible to claim UC as they don't have a WCA.... The way through - is either a) to persuade UC to take the claim anyway but suspend payment until the WCA or b) to claim New style ESA even if you know you don't have the NI record to ever be paid . They will though get that WCA in place and you can then go back to UC and say "ha" , with every good case for backdating that UC claim.

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Further health related issues

There are some further issues for people who have limited capability for work that are really worth looking at:

How does UC recognise the difference between "sickness" (needing a basic income when you have limited capability to earn) and disability (helping with extra disability costs whether you are able to work or not)?
Does it offer any specific extra disability amounts to top up separate disability benefits (in the same way that "legacy benefits" and Pension Credit do?
How does UC differ in the support it offers for people easing back into work?

However, it makes more sense to look at that after we have looked - in Part Five - at how the sums work to determine how much Universal Credit you get.

So for now, please hold that thought and all will be revealed after we have looked at the sums

Next time: doing the sums.

Whether you are new to means tested benefits entirely - or whether you are moving over to UC - a key question is "How much will I get? . For those switching over to UC from a legacy benefit the added worry is "Will I be a winner or a loser under the UC sums?" . The only way to know the answer for sure is to try an online calculator or talk your situation through with a benefits adviser.

In Part 5 we will take a look at how the sums work in general: How do the the different elements of UC stack up to work out the Maximum UC that applies in your situation? How are any other income and savings assessed?

Essentially, it’s a simple matter of take one from t’other to give the amount of UC due in that monthly assessment period . The basic idea is the same as you may have come across under the old legacy benefits, but with some important differences in the elements that UC has on offer and in the way other income is assessed.

I will though try to avoid making this sound like double maths on a Tuesday afternoon and will use some examples and scenarios to try and make sense of it all