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Use of Employment and Support Allowance Information in Claims for Disability Living Allowance

Use of Employment and Support Allowance Information in Claims for Disability Living Allowance

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Published by Paul Smith
Use of Employment and Support Allowance Information in Claims for Disability Living Allowance
Use of Employment and Support Allowance Information in Claims for Disability Living Allowance

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Published by: Paul Smith on Aug 30, 2012
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10/12/2013

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USE OF EMPLOYMENT ANDSUPPORT ALLOWANCEINFORMATION IN CLAIMS FORDISABILITY LIVING ALLOWANCEA Handbook for Decision Makers
Forward
This handbook has been prepared by the Department’s Health, Work andWellbeing Directorate. It considers how Disability Living Allowance (DLA)Decision Makers (DMs) can use the information obtained in assessingEmployment and Support Allowance in determining DLA benefit entitlement.Employment and Support Allowance (ESA) has been introduced in October 2008, for new claimants, and will replace Incapacity Benefit and IncomeSupport paid on grounds of incapacity. Analysis has shown that a largepercentage of DLA claimants have a current or recent claim to incapacitybenefit. Valuable information relating to the customer’s medical condition andfunctional limitations will be available in the documentation used to evaluatethe ESA claim. Using this information may save the customer from having toundergo an examination in connection with their DLA claim, and reduce theneed to obtain further clinical information from the customer’s doctor or another health care professional (HCP).
Section 1 – Background
1
The Employment and Support Allowance has been designed to enablepeople to achieve their full potential through work and to help them to gainindependence from benefits. It will focus on what the person can do rather than what they cannot do. The overarching principle is that everyone shouldhave the opportunity to work, and that people with an illness or disabilityshould get the help and support needed for them to engage in appropriatework.
2
ESA requires all but those patients with the most severe illnesses or disabilities to engage in a programme of work focused interviews and developa work related action plan as a condition of receiving the allowance.
3
The assessment process for deciding entitlement to benefit and rate of benefit paid is the Work Capability Assessment (WCA). The Work Capability Assessment replaces the Personal Capability Assessment (PCA) used todetermine entitlement to Incapacity Benefit. Within the WCA, there are anumber of assessments:
 
 
Limited Capability for Work Related Activity (LCWRA) – Thisassessment aims to identify, through a series of descriptors, customerswith the most severe illnesses or disabilities. These customers willidentified as members of the Support Group of ESA and will not haveto engage in work - focused interviews as a condition of receivingbenefit.
 
Limited Capability for Work Assessment (LCW) - This aims to identifythose people who currently have a limited capability for work, but whowould benefit from assistance and support with work and health relatedactivity to maximise their full potential. This part resembles the PCA,but the descriptors have be reviewed and revised for both physical andmental functional capabilities. The report (ESA 85) generated from thispart of the assessment will available to the DLA Decision Maker.
 
Work Focused Health related Assessment (WFHRA) – This partcomprises an interview with a healthcare professional to explore thecustomer’s views about moving into work and any health relatedinterventions that would facilitate this.
Section 2 – The Work Capability Assessment
1
The Work Capability Assessment will be applied to all customers within thefirst thirteen weeks of claiming Employment and Support Allowance. It willassess, for the purposes of determining entitlement, whether a customer canbe considered to have limited capability for work. It will also help determinethe rate at which ESA is awarded from week fourteen.
2
The Work Capability Assessment looks at the effects of any illness or disability on the customer’s ability to carry out a range of everyday workrelated activities. The outcome of WCA determines if a person has limitedcapability for work. If a customer does not have limited capability for work theywill be provided with advice about registering for employment and claimingother benefits.
3
The following Activities are evaluated in the assessment:
Physical assessment
4
There are eleven Activities relevant to the physical assessment:
 
Walking with a walking stick or other aid if such aid is normally used;
 
Standing and sitting;
 
Bending or kneeling ;
 
Reaching;
 
Picking up and moving or transferring by the use of the upper body andarms;
 
Manual dexterity;
 
Speech;
 
Hearing with a hearing aid or other aid if normally worn;
 
 
Vision including visual activity and visual fields, in normal daylight or bright electric light, with glasses or other aid to vision if such aid isnormally worn;
 
Continence; and
 
Remaining conscious during waking moments.
Mental, cognitive and intellectual function assessment
5
There are ten Activities relevant to the mental, cognitive and intellectualfunction assessment:
 
Learning or comprehension in the completion of tasks;
 
 Awareness of hazards;
 
Memory and concentration;
 
Execution of tasks;
 
Initiating and sustaining personal action;
 
Coping with change;
 
Getting about;
 
Coping with social situations;
 
Propriety of behaviour with other people; and
 
Dealing with other people.
6
For each of the Physical and Mental Health Activities there is a set of statements ranked in order of functional restrictions known as the descriptors.They describe different levels of functional limitation.
7
Each descriptor that is relevant to a customer’s illness or disability has ascore.For example,
Walking
is defined as ‘Walking with a stick or other aid if suchaid is normally used’ and there are six descriptors:-
 
Cannot walk at all (score 15)
 
Cannot walk more than 50 metres on level ground without repeatedlystopping or severe discomfort (score 15)
 
Cannot walk up or down two steps even with the support of a handrail(score 15)
 
Cannot walk more than 100 metres on level ground without stopping or severe discomfort (score 9)
 
Cannot walk more than 200 metres on level ground without stopping or severe discomfort (score 5)
 
None of the above apply (score 0).
8
Getting about is an example of one of the Mental function Activities, andthere are five descriptors:-
 
Cannot get to any specified place with which the customer is, or 
 
would be, familiar (score 15)
 
Is unable to get to a specified place with which the customer is

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