.Understanding Welfare Reform

Finding your way ………

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If you claim housing benefit to pay some or all of your rent, you may be affected by this change

If you have more bedrooms than the Government say you need you will lose part of your housing benefit. You are allowed one bedroom for:

Each adult couple Any other person aged over 16 Two children of the same sex under 16 Two children under 10 regardless of their sex Any other child A carer if you or your partner need overnight care

If you have a spare bedroom your housing benefit will be cut by 14%, if you have 2 or more spare bedrooms it will be cut by 25%

Bedroom Tax

From April 2013 the overall amount of benefits a person can receive has been capped. The Government will add up how much benefits you receive such as Housing Benefit, Job Seekers Allowance, Employment Support Allowance, Child Benefit and Tax credit and Carer’s allowance

The maximum amount you will be able to receive is £500 for families and £350 for a single person without children

This will not apply if:

You get pension credit or working tax credit A member of your household is claiming disability living allowance,

attendance allowance or the support element of employment support allowance

Council Tax benefit is being replaced by Council Tax Support. Each Local Council gets to decide how they are going to implement these changes

You are not affected by this if you are over working age

BenefitCap

Council Tax

Personal Independence Payments will replace Disability Living Allowance for disabled people aged 16-64 making new claims. This will then be rolled out to all people who claim DLA. You will be assessed against the new criteria to see if you are entitled to the Benefit

Employment and Support Allowance is a benefit paid to people whose ability to work is limited by either ill health or disability.

ESA has two elements – contributory ESA and Income related ESA, you can receive either of these elements of both together

ESA is included in benefits to which the benefits cap applies.

Contributory is linked to your national insurance record, income related is means tested.

Personal Independence

Payments

Employment and Support Allowance

Personal Independence Payment is a new benefit for anybody who needs help participating in daily life or find it difficult to get around.

PIP is tax free, it isn’t means tested, you don’t have to have paid National Insurance to get it and it isn’t affected by your earnings.

PIP has two components

Daily Living – for help participating in everyday life Mobility – for help getting around.

You can get one or both and each component is paid at different levels – standard rate or enhanced rate.

To qualify for PIP you must:

Make a claim for it Pass the PIP assessment Be within the age limit (between 16 and 64) Pass the residence and presence test

The PIP assessment tests your ability to participate in everyday life. It is a points related assessment of your physical and mental condition and cognitive function.

The assessment looks at lots of different activities and asks you to consider each in turn.

Understanding PIP

Definitions

Assistance – This means physical intervention by another person

Prompting – This is where somebody needs to remind you to do something – even if you only need prompting for part of an activity

Supervision – This means somebody needs to be continually with you to ensure your safety

Unaided – You can perform an activity without any help at all

Aids or Appliance – Any device that you use to help you complete activities – when you are being assessed, you will be assessed as though you are using the aid or appliance (this might be a walking stick, a prosthesis, glasses or a colostomy bag)

Variable and fluctuating conditions – If your condition changes, a descriptor will apply if it reflects your ability for the majority of days – this will be considered over a 12 month period, when you are assessed it is important that you reflect not just how you are feeling on that particular day but how your condition affects you at its worst.

If you cannot complete an activity safely, to an acceptable standard, repeatedly and in a reasonable time, you should be treated as unable to complete it.

How do you claim?

You can start claiming PIP by ringing 0800 917 2222. The lines are open 8am to 6pm Monday to Friday and are free on BT landlines and most mobiles. Someone else can make the call on your behalf but you do need to be with them when they do so.

During this call, which should last about 15 minutes, basic details will be taken from you including:

Your personal and contact details including your national insurance number

Information about your nationality and whether you have spent any time abroad in the last 3 years

Whether you are in hospital, a hospice or a care home or have been in the last 28 days

Which healthcare professional supporting you would be best to contact? It would be best if they are aware of your day to day problems.

Details of your bank or building society Questions related to the special rules around terminal illness Whether you find it difficult to return forms

If it is clear from the information you provide at this stage that your disability does not meet the requirements for PIP you will be sent a letter telling you this. If not you will be sent a form and will have 1 month to complete this.

When you have completed the form, take a copy and send it in the freepost envelope that should have been provided

Your claim will be allocated to a health care professional employed by the chosen provider (ATOS or Capita depending on where you live).

They will start by contacting the health care professional you have provided details for – this might be by phone or face to face or they may ask them to provide a report.

You will then be invited to a face to face consultation – usually at an assessment centre. If you cannot attend a centre it is important you tell the office arranging your consultation as soon as possible giving reasons why you can’t attend.

You should be given at least 7 days notice, if you cannot attend you should tell the office as soon as possible. If you do not attend you will be contacted to ask for reasons, which your case manager may not accept.

At the assessment the health care professional will ask you questions about your daily life, your home, your job, social and leisure activities etc.They will often ask you to describe a typical day in your life – when you are describing this think about your ‘worst day’ as this will be used as part of your assessment.

When answering explain your abilities as fully as you can – tell them about pain or tiredness you feel, or would feel, while carrying out tasks, not just on the day of the examination but at your worst point. Consider how you would feel if you had to do things repeatedly. Remember to tell them if you need reminding repeatedly or encouraging to do things.

Try not to over estimate your ability to do things, the assessor does not know you and will go on what you say. Think about good and bad days if your condition fluctuates. The decision should not be based on a snap shot of your condition on the day of the assessment

The assessor will observe your ability to stand, sit and move around. They may watch you getting on and off the examination couch, bending down to get your belongings, they may notice your ability to use technology or travel to the assessment centre independently.

They will ask you about aids and appliances you use and will test your ability to understand and express yourself and your levels of concentration, if that is applicable.

Once the assessor has completed their report, they will send it to a case manager who will decide whether or not to award you PIP and if it is awarded for how long and how much.

The decision

If your claim is disallowed or is reduced the DWP will write to tell you this. The letter should include the reasons for choosing the descriptors they think apply to you, but will not necessarily include scores.

If you are awarded PIP you will receive a notice telling you this and giving you details of how long for.

Appealing

If you are not happy with the decision you have one calendar month to ask for a reconsideration. You can appeal a decision to disallow PIP or the rate at which you are being paid.

You should get the chance to ask for a reconsideration when the DWP contacts you to talk through your decision, if you do not get this call you should call the number on your appeal letter.

In either case you should do the following:

Request a reconsideration of the decision. State your grounds simply for example ‘I believe that you have underestimated the degree of my disability and have therefore underestimated the extent of my mobility and/or the difficulties I have carrying out daily living activities’

Ask them to send you copies of all the evidence that was used in making the decision

Ask them not to take any further action until you have had to chance to respond to the evidence.

Put your request in writing too and keep a copy of the letter yourself, send the letter to the address on the decision letter.

Building your case

In some cases the only evidence used will be the information you provided on the form, in most cases however there will be a report by a health care professional.

Compare this report to your account on the form. Try to find where a difference of opinion occurs. For example you may have said that you cannot get out of bed unaided, the health care professional may have said you can. Try to get medical evidence to prove your account

If it’s going to take a while to get the evidence, let the appeal panel know as soon as possible so they don’t make a decision. Once you have the evidence send it to the address on the appeals letter.

A case manager will then review the evidence and decide to award you PIP or change the rate, or uphold the decision. If the decision is upheld you can then take your case to an independent tribunal

If the decision was notified more than a month ago you can only challenge the decision if:

Your condition has changed The case manager didn’t know some relevant facts

It is very important to lodge your appeal within the month time frame.

We have included more information on the specifics of the assessment in this pack

Employment and Support Allowance is a benefit paid to people whose ability to work is limited by either ill health or disability.

ESA has two elements – contributory ESA and Income related ESA, you can receive either of these elements of both together

ESA is included in benefits to which the benefits cap applies.

Contributory is linked to your national insurance record, income related is means tested.

Assessment Phase

An assessment phase of 13 weeks applies to all new applicants for ESA with a few exceptions. During this phase you are paid a basic allowance of ESA, if you are under 25 it is at the lower rate.

Work capability assessment

There are two parts to the work capability assessment:

Limited capability for work assessment: you are not entitled to ESA unless you have a limited capability for work.

Limited capability for work-related activity assessment: this assessment determines whether you should be placed in the work related activity group or the Support group.

Employment Support

Allowance

If you are found not to have a limited capability for work related activity you will be placed in the work-related activity group, in this group you must meet work related conditions like attending work focused interviews and possibly attending work-related activity. Failure to do this may mean your ESA is stopped.

You will receive a lower level of ESA than if you are in the support group, if you are entitled to contributory ESA this is limited to 12 months of payment – however you may be able to claim income related ESA instead.

If you are found to have limited capacity for work related activity, you will be placed in the support group. In this group you do not have to undertake work related activities although you can volunteer to do so. If you are placed in this group you will receive a higher rate of payment and your award will continue for as long as you meet the entitlement conditions.

Do you qualify?

The following rules apply to ESA – you must:

Have limited capability to work Be aged 16 or over Be under the state pension age Be in Great Britain Not be in work Not be entitled to income support Not be entitled to job seekers allowance Not be within a period where you are entitled to statutory sick pay

How to make a claim

You are normally expected to start your claim by ringing the JobCentre Plus claim line (0800 055 6688), you will be put through to your nearest job centre. The Jobcentre will confirm your identity and ask you if you want to claim under the special rules that apply to terminally ill people.

The Jobcentre will take details of your claim over the telephone. Once they have finished they will send you a ‘customer statement’ confirming your details so you can check they are correct.

You can ask for a paper claim form (ESA1) to make a written claim if you prefer.

For telephone claims your date of claim is the date you make the initial call to the claim line. For written claims it is the date you inform the jobcentre of your intent to claim – if you intend to claim in writing inform the jobcentre claim line straight away, you then have a month to complete and submit the written claim.

ESA is paid fortnightly, but if this causes you a problem you can speak to the Jobcentre Plus about a different arrangement.

Any two periods of incapability for work (days you have limited capability to work) that are separated by no more than 12 weeks are treated as a single period – this means if you need to reclaim within this time you won’t have to go through another waiting period

Work Focused Interviews

If you are placed in the work focus group you will be required to attend a work focused interview shortly after the work capability assessment. You will then be expected to take part on a series of 5 work focused interviews at monthly intervals. You will meet with a personal adviser who should help you explore the barriers to work

You are not required to take part in work focused interviews if:

You have been placed in the support group You have reached the age where you qualify for pension credit You are a lone parent responsible for a child under 1 You are only entitled to limited capability for work national insurance

credits

The requirement to take part can be waived altogether in limited circumstances or deferred at the discretion of the personal adviser

When you take part in the interviews you will be asked to answer questions on the following:

Your educational qualifications and vocational training Your work history Any paid or unpaid work you are doing Your aspirations for future work Your work related skills and abilities Any caring or childcare responsibilities you may have

If you do not take part in an interview and you do not have good cause your ESA amount may be reduced.

You may also be required to take part in work related activity, which is activity that makes it more likely you may get a job. You cannot be asked to apply for a job or undertake work or undergo medical treatment.

You will not be required to undertake work related activity if:

You are a lone parent with parental responsibility for a child under 5 You are entitled to carer’s allowance or a carer’s premium You are in the support group

If you are a lone parent with a child under 13 you would be required to take part in work related activity only during school hours.

If you are required to take part in work related activity you will be provided with an action plan which specifies which activity you are required to undertake.

Failure to take part in work related activity as set out in your action plan could result in a reduction of your ESA

You can appeal against the decision that you did not take part in activity or did not have just cause within one month of the decision, you can do this by completing a form GL24 which is available from the job centre

If your ESA is reduced you may be entitled to a hardship payment if you can prove that you or your family will suffer hardship unless a payment is made (and you are entitled to income related ESA)

Challenging a decision

You can appeal against decisions made during the work capability assessment. You can appeal against a decision:

Because you do not feel you have capability to work Because you do not feel you have a limited capability for work related

activity Because you feel you have good cause for failing to send back the

ESA50 questionnaire or attending a face to face assessment In exceptional circumstances

Challenging a decision is based on strict criteria, you can get advice on this from your local Citizens Advice Bureau or by contacting the advocacy service

You have one calendar month from the date the decision was sent to lodge your appeal, before a full appeal you must first ask for a reconsideration of the decision.

Your appeal will be heard by a First-tier tribunal, the members of which are independent of the DWP. You should do the following:

Get the ESA85 – attached to the decision will be a summary of the face to face assessment which will tell you the activities in which you it is felt you have some limitation and the points allocated. This won’t give you the information you need (particularly where there are disputes) so you should contact Job Centre Plus and ask for a copy of the DWP Health care professionals assessment report – the ESA85. This contains a statement that explains their recommendations on which activities apply to you and how they conflict with your statement. This will help you see where you need to challenge findings, it is also worth noting any inaccuracies

Opt for a hearing – your chances are much higher if you opt to attend an appeal hearing in person

Prepare your case – you can get support to prepare your case by contacting your local CAB or the advocacy service

Get medical or supportive evidence – ask your doctor or health care professional to comment on each factor you have highlighted as a dispute – be aware though doctors may wish to charge you for this.

Useful Contacts

Total Voice Lincolnshire Advocacy Service – 01522 706580

Citizens Advice Bureau – 08444 111 444

Upper Tribunal Administrative Appeal – Upper Tribunal (Administrative Appeals Chamber), 5th Floor Rolls Building, 7 Rolls Buildings, Fetter Lane, London EC4A 1NL – 020 70715662 Typetalk – 18001 0207071 5662

Benefit Enquiry Line (BEL) – 0800 882 200 Textphone – 0800 243 355 Mon-Fri 8am-6pm . Provides general advice on benefits for disabled people, their carers and representatives.

Community Legal Advice helpline – 0845 345 4345 Textphone – 0845 609 6677