Work Capability Assessment
If you're injured, or too ill to work properly, you can ask for financial support. This kind of financial support is called an Employment and Support Allowance – an ESA. However, since this money is intended for people with a genuine need, it's almost certain that you'll have to undergo a Work Capability Assessment – which may possibly include a medical assessment.
The Work Capability Assessment is the primary way in which ESA claims are assessed. The initial assessment happens at a Jobcentre Plus location, and will be carried out by an approved healthcare professional who's trained to handle ESA claims. Their job is to assess how much your condition affects your capability to work, and then advise the Department for Work and Pensions (DWP) – the department that administers benefit claims.
When you first make an ESA claim, you'll be asked to fill out a questionnaire. The answers to this questionnaire (an ESA50 form), along with any other information you may have offered, should provide a picture of how your illness or disability affects your ability to carry out everyday tasks. Then, if they still feel that the DWP might require more information, then they'll recommend that you attend a face-to-face medical assessment.
The ESA is a safety net for people unable to work actively. Naturally, it doesn't only apply to physical difficulties, but also to those have a mental health condition. This is viewed as any mental condition that can significantly affect your mood, your behaviour, your ability to cope with normal day-to-day activities, or the way in which you relate to the world around you. If you're making a claim on this basis, you'll probably be asked to fill out a questionnaire about your mental health, and may also be asked to see one of the Jobcentre's healthcare professionals about your condition.
About the medical assessment
Most people are asked to have a face-to-face medical assessment.
There are a number of reasons why it may happen – it certainly doesn't imply that any information you've provided is seen as suspicious, or suggest that that your claim may be unsuccessful. In fact, your claim won't be turned down unless you've been to a medical assessment, or at least been offered the opportunity to have one.
If you need to have a medical assessment, the process is designed to accommodate people with difficulties, so it'll usually happen at a medical centre close to where you live. If your nearest facility is more than a 90 minute journey away, or you're unfit to travel for any reason, a healthcare professional may then visit you at your home.
For appointments, there's a specific protocol that is followed. Designed to be as practical as realistically possible, the standard way of making these arrangements is for a Medical Services Provider to phone you between 8 am and 8 pm to tell you when your appointment is - it'll be for between 9 am and 5 pm, and you'll be given the option to change it if the time offered doesn't suit you.
Because your benefit will depend on the outcome of this, it's imperative that you attend - and participate fully. But, since this involves the state accessing your personal information in what is viewed by many as an invasive way, you do enjoy a range of rights. If you feel it will help you in the process, you can bring a relative, a friend, or a support worker to be with you at the medical assessment. If you struggle with English, you have the right to an interpreter; in Wales, there are Welsh speaking healthcare professionals available if you want your assessment conducted in Welsh. You may also insist that the healthcare professional is the same gender as you if this makes you more comfortable. The medical centre is obliged to accommodate you, if possible, provided that you let them know ahead of time so that they can make arrangements.
All the medical information that has been gathered to complete your assessment, including the report from the medical assessment is strictly confidential. The information will not be released to anyone outside of the DWP.
You can ask for a copy of your medical report any time, and it'll be posted to you. And, if the healthcare professional that you've seen feels that some of the information should be shared with your own doctor, the DWP's Medical Services – who are responsible for organising all medical assessments for the department - must make a written request to you for permission to do so. It's your choice to agree or not.
What happens next?
When your medical assessment is complete, the healthcare professional's report goes to someone at the DWP. This decision-maker is responsible for deciding the outcome of your claim.
They'll take the report and any other relevant information that you've provided into account, and decide whether you will receive an Employment and Support Allowance. They'll also decide whether you'll be part of their Work Related Activity Group, or placed in the Support Group. You will be sent a letter telling you what their decision is.
If you're unhappy with how the medical assessment was handled, you may complain to Medical Services. The correct procedure for doing this is included in the letter you'll have received about your medical assessment.
You can also raise any issue you have immediately with the healthcare professional while the assessment is under way. If they can't sort the problem out then and there, they're obligated to give you a brochure that will explain the correct procedure for making a formal complaint.
If you believe that the final decision on your benefit claim is the wrong one, or if you don't understand the decision or how it was reached, you have a few remedial options. You can ask the office that made the decision to explain it, or even ask for a different person (who is also a recognised decision-maker for the DWP) to review the material and reconsider the decision. Failing all of these options, you are entitled to appeal against the decision. There is an independent tribunal set up to hear these appeals.
