Coming changes to ESA. (Government response to report on WCA)

rogerblack

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/380265/esa-and-wca-work-and-pensions-committee-response.pdf

In no particular order.

We intend to introduce a measure to prevent claimants being paid the ESA assessment rate where a claimant has been found fit for work, but makes a repeat claim for benefit and has not developed a new condition or had a significant worsening of their condition. We would still need to consider the repeat claim but while we are considering it, and pending any appeal against our refusal of that claim, no ESA would be paid although JSA could be claimed. This is due to be introduced next spring and should help ensure that claimants found fit for work claim JSA and remain closer to the labour market, rather than looping around the ESA system.

...
But this is already the law.
Unless they are proposing the hideous and ******* insane step of introducing legislation solely because they can't process appeals within 6 months.

Another proposal - which is positive - is extending the time you can be sick on JSA from 2 to 13 weeks a year.
And proposals to offer help before people get 'into the system'.

Little else seems likely to in practice actually improve outcomes, rather than simply a clumsy attempt at reducing costs.

TELLIT01

I don't undserstand this either, unless they mean that if somebody has been signed off by their GP as fit to work they can't claim with the same incapacity for another 6 months. As present it's only if somebody is deemed fit for work at a WCA that the 6 month rule applies.
Increasing the time that somebody can stay on JSA when sick seems sensible although 13 weeks does seem a lot. What happens after 13 weeks? Do they then move to ESA and have to serve another 13 weeks in the assessment phase?

epitome

Currently, someone who has been found to have No LCW, can make a new claim straight away and once it is disallowed can ask for a Man Recon, and after that, can go to appeal, and they WILL be paid on appeal.

The new measure appears to me to be saying that this person will NOT be paid on appeal.

Ordinarily, this person should Man Recon the original disallowance on the old claim and then appeal and be paid on appeal.... this process appears not to be changing.

So this new government measure appears to be being introduced to stop the following:
01/01/2014 Found to have No LCW
01/01/2014 Submits a Man Recon
17/01/2014 Man recon decision not changed
30/01/2014 An Appeal is received
07/02/2014 Claimant is paid arrears from 01/01/2014
07/03/2014 Claimant loses appeal and payments stop from 07/03/2014
07/03/2014 Claimant makes a new claim to ESA
10/03/2014 New claim is disallowed at the outset.
10/03/2014 Claimant requests Man Recon
24/03/2014 Man Recon is not changed
26/03/2014 Appeal is made
02/04/2014 Appeal is received at DWP
05/04/2014 Claimant is paid appeal arrears from 26/03/2014 and ongoing payments until appeal is heard.


So rather than this being an indication that appeals are taking too long, it is the exact opposite, it is because the appeal system is improving so much that a new claim is being made after appeal within the 6 months..

epitome

TELLIT01 wrote: »

Increasing the time that somebody can stay on JSA when sick seems sensible although 13 weeks does seem a lot. What happens after 13 weeks? Do they then move to ESA and have to serve another 13 weeks in the assessment phase?

That's a good point.

rogerblack

epitome wrote: »

07/03/2014 Claimant loses appeal and payments stop from 07/03/2014
07/03/2014 Claimant makes a new claim to ESA
10/03/2014 New claim is disallowed at the outset.
10/03/2014 Claimant requests Man Recon
24/03/2014 Man Recon is not changed
26/03/2014 Appeal is made
02/04/2014 Appeal is received at DWP
05/04/2014 Claimant is paid appeal arrears from 26/03/2014 and ongoing payments until appeal is heard.

I don't think this works.

The new claim would not be disallowed at outset.
The new claim would start - but with no payment due to the WCA failure within 6 months.
You cannot appeal the amount you are paid - only the reason for the decision on the amount.
Mandatory reconsideration does not apply to requests for reconsideration or appeals that are outside the decisions you can appeal against.

The correct response to such a request is not to issue a MR - as this is something that can't be appealed.

You can't appeal to be paid more or less money.
Unless you're claiming a new or changed condition, the amount you are due to be paid has been correctly assessed as zero, and if that's your only appeal ground, they can throw out the appeal as it has no chance of success.

There was a memo to DWP DMs back in 2012? about throwing out appeals with no prospect of success.
This hasn't changed AIUI.
If you are claiming for a new or worsened condition - then ...

I think the procedure in detail is for the DM to issue a refusal - which is not a MR - stating this decision can't be appealed.
The claimant would then need to appeal directly to the FtT that it's in jurisdiction - at which point it should bounce - if they are not alleging worsening or a new condition.

epitome

rogerblack wrote: »

The new claim would not be disallowed at outset.

But new claims (like these) ARE disallowed at the outset.

The new claim would start - but with no payment due to the WCA failure within 6 months.

This is rare, almost unheard of now.

You cannot appeal the amount you are paid - only the reason for the decision on the amount.

Yes, but, as I said, they ARE disallowed at the outset and that is an appealable LCW decision. and as such, is payable on appeal.

The DMG that is used to disallow at the outset is as follows:

Further claim after determination that claimant does not have LCW
42206 If the claimant cannot be treated as having LCW because DMG 42203 applies, and they do not have a new or worse health condition, their claim cannot be decided until the LCWA is carried out.

42207 The DM may already have sufficient information with which to carry out the LCWA. This could include the medical report from a previous HCP examination, medical evidence provided to support the new claim and any other evidence received by the DM which is relevant to the LCWA on the new claim.

Having said all this, I am looking at your original post again and this sentence is a bit ambiguous
"We would still need to consider the repeat claim but while we are considering it, and pending any appeal against our refusal of that claim, no ESA would be paid"

Do they mean...

• Pending the appeal outcome i.e. "whilst on appeal" which would be a new process.
• Pending the submission of an appeal i.e. "until an appeal is made" which is what happens now

rogerblack

epitome wrote: »

But new claims (like these) ARE disallowed at the outset.

This is rare, almost unheard of now.
Yes, but, as I said, they ARE disallowed at the outset and that is an appealable LCW decision. and as such, is payable on appeal.

Ah - right.
But that is a matter of DWP practice, which they could trivially change tomorrow with no legislation whatever.

TELLIT01

It might just be a very poorly worded press release, but there is no mention of appeal, mandatory recon etc. It refers to a new claim to benefit with no new or worsened condition. As has already been said, new claims with the same condition are already covered.

JaneDoeJohnDoe

rogerblack wrote: »

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/380265/esa-and-wca-work-and-pensions-committee-response.pdf

In no particular order.


...
But this is already the law.
Unless they are proposing the hideous and ******* insane step of introducing legislation solely because they can't process appeals within 6 months.

Another proposal - which is positive - is extending the time you can be sick on JSA from 2 to 13 weeks a year.
And proposals to offer help before people get 'into the system'.

Little else seems likely to in practice actually improve outcomes, rather than simply a clumsy attempt at reducing costs.

But is this a pilot or for all? It's not clear is it? Who decides on "worsening of condition"?

rogerblack

TELLIT01 wrote: »

It might just be a very poorly worded press release, but there is no mention of appeal, mandatory recon etc. It refers to a new claim to benefit with no new or worsened condition. As has already been said, new claims with the same condition are already covered.

On reflection - not if it's been over six months since the last decision of fitness.

They could be intending to extend that, or make it a blanket prohibition without time limit.

More worryingly - it may be to forbid claims in some manner for those who have recently been found fit - rather than to allow them to continue with no payment.

rogerblack

JaneDoeJohnDoe wrote: »

But is this a pilot or for all? It's not clear is it? Who decides on "worsening of condition"?

The DWP.
If your last claim was for depression - and you've been found fit, and then claim again for depression - it may be quite difficult to get them to accept the claim - even if your depression has gotten worse.
If you have a new condition agreed by your doctor - then it's less problematic.

It seems unlikely this would be piloted.
It's 'obviously right' and 'uncontraversial' - in their view.