Entitlement to the Mind Boggling World of ESA

Good evening everyone. I have today had a call from my PIP Case Manager who has been amazing. She told me my claim had been awarded for 4 years - Standard Daily Living and Enhanced Mobility which I was delighted to hear. She also gave me a huge surprise when she said arrears had been backdated and asked if I wanted lump sum or instalments; I chose the lump sum so I can pay off my current car loan. Even more surprised was I, when she said it was authorised and will be in my account in 3 to 5 working days. I dropped the phone at that point…😶

The lady asked about my employment status and having told her I have had to finish work due to the extreme pain levels I am living with, in this horrible cold, damp weather, she advised me to DWP landing page, as there may be other financial help I could get alongside PIP and mentioned ESA.

I had a look earlier and the guidance might as well having been written in Cantonese, as I wasn’t able to understand it. I came off DWP and found a disability benefits calculator, which seems to suggest I am missing out on a ESA Ltd capacity to work payment of £90 a week!

Does this sound about right? If so, my next question would be whether I would need a further MEDICAL ASSESSMENT re capacity to work (given mobility issues were awarded by PIP at the enhanced rate), or whether they’d use the PIP Health Assessor’s report, only completed 7 days ago.

All advice/signposting will be gratefully received. Thank you for reading xxx 🙏🏼

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Comments

JF7891

If you don't mind me asking, what diseases do you have to get PIP? I have been trying for decades to get it, I got over 12 hardcore diseases, I can barely function, and every time I get zero points. My citizen's advise advisor told me that some of her friends only have anxiety and depression and still got it…

It makes me so jealous, every time I see people getting all that support, where I am absolutely struggling to survive, I can't even afford a bus ticket, just on top got a tooth abscess, but can't afford to get to the hospital even, my boiler completely broke down too…

Kimi87

Link to find local advice agency who can advise you on the phone or in person :

https://advicelocal.uk/welfare-benefits

A step by step guide which is fairly simple:

https://www.gov.uk/how-to-claim-new-style-esa

For New Style ESA you would need to go through another medical assessment, called the Work Capability Assessment. You'd need Fit Notes from GP, to fill in a ESA50 form and go through an assessment, most have them via phone or in person.

Unfortunately PIP has no bearing on the ESA process, they are entirely separate benefits.

Ostia

If you don't know it, the best guide to claiming PIP or other benefits is on www.benefitsandwork.co.uk. It has good advice about how to present your case and answer the questions in the forms, with evidence. If you don't clearly explain how you meet certain criteria you won't be awarded the points to qualify. You can submit medical evidence and also your own evidence eg a week or two's journal of how you manage tasks, if you are in pain and so on.

Best wishes, A

Danlangridge88

Do you not automatically qualify for ESA if you get pip? I'm not sure as I got it (and LWCRA) before PIP but I'm sure someone i read if you get PIP first this is the case. I could be wrong though, can anyone clarify?

Kimi87

No PIP and ESA are separate benefits, different assessment criteria, and getting either one does not give automatic entitlement to the other.

PIP is designed to help with the additional costs of being disabled, ESA is an income replacement benefit for those who cannot or have limited capacity to work.

WhatThe

If you don't mind me asking, what diseases do you have to get PIP?

JF7891, if you don't mind me saying, personal questions like this should not be asked on this forum.

JF7891

https://forum.scope.org.uk/discussion/comment/953860#Comment_953860

I do mind.

poppy123456

@Dolly_Daydream333 to claim New style ESA you must have worked at some point in Tax years 2021/22 and 2022/23. You can check your NI contributions online. You will need class 1 or class 2 if you were self employed.

https://www.gov.uk/check-national-insurance-record

You can also use a benefits calculator to check entitlement to Universal Credit. It's a means tested benefit so if you live with a partner you'll need to claim as a couple. If you have capital of more than £16,000 you're excluded from claiming.

If you claim both of the above together the ESA will be deducted in full from any UC entitlement.

You will also need a fit note for both benefits.

Benefit calculator here.

https://www.entitledto.co.uk/benefits-calculator/

poppy123456

https://forum.scope.org.uk/discussion/comment/953836#Comment_953836

You can't really compare someone else to yourself because PIP isn't awarded based on any diagnosis. As we are all affected differently by these conditions it's impossible to compare. You can have 5 people in a room all with the same conditions. 2 may qualify for PIP but the other 3 may not.

Have you ever challenged the decision? If you constantly reapply using the same evidence you previously used a constant refusal may happen. The best way forward is to challenge it. Although having said that, some people have health conditions but don't qualify for PIP because if you don't meet the descriptors, you won't score the points needed for an award.

lees

Go to age concern or citz advice as they will do the forms for you, they really are a great help , i know a few who should of had it a long time ago but didnt know and they got it for them, good luck

MCMikey

https://forum.scope.org.uk/discussion/comment/953836#Comment_953836

It's not the diseases or conditions per se (although it's of course worth listing them), it is how they affect you, but in particular how they affect you doing certain tasks/everyday things according to the PIP criteria list (you can find out about these by doing a search on the internet). Keep this in mind at all times.

For example, if you have a physical disability, you may not be able to cook yourself a proper meal each day or maybe some days and not others, or get dressed without an aid or walk X metres. You may be able to do a task once or walk X metres once with some pain, but cannot repeat this, so this becomes a question of how reliably you can something and how often without it adversely affecting you. You may be a lot worse in the morning for X hours, but later in the day a bit better. With PIP, the mention of using an aid will usually gain points towards your final points score as this signifies to the assessor of your restriction.

Finally, if you are a very positive and proud person and like to put a positive spin on how you are, this will often be to your detriment in the eyes of your assessor, whether that be on the phone or via the forms.

Finally (again), you may need some help in how to fill in forms or what to say on the phone from welfare rights or similar to ensure you give an accurate picture of how you are and what you can do.

MCMikey

I went a bit off the main topic on PIP earlier. ESA limited capability for work is similar in some ways to the PIP assessment, but is more focused on how your condition affects your ability to do work as you might expect. So again it is not your conditions per se, it is what is stopping you getting a job even though you have a condition, albeit your work options maybe very reduced. So keep in mind why your condition(s) are preventing you from working, not so much the name of the condition. Just saying to an assessor for example, "I can't work because I've got osteoarthritis" doesn't really help your case. Better would be, I find it very difficult to work because my osteoarthritis / previous fractures in my back / knees or hips as I am waiting for an operation/ energy levels as my lungs are only working at 1/3 capacity...means that I find it difficult/painful doing xyz and explain why.

If you have enough NI contributions, you may get contribution based ESA, if not you may get income based ESA or possibly a blend of the two depending on your circumstances.

poppy123456

@MCMikey it’s no longer possible to start a new claim for Income Related ESA because Universal Credit has replaced it.

The only ESA possible to claim now is New style ESA, which is based on NI contributions in the previous 2 tax years as stated in my previous comment.

MCMikey

https://forum.scope.org.uk/discussion/comment/954188#Comment_954188

I stand corrected, thank you. Must have changed in the last 2 years, although my previous post on assessment for ESA and PIP are probably still valid, but do your own checks just in case.

Dolly_Daydream333

JF7891 - I sense your frustration at being denied PIP. I'm sorry you are struggling. I was told by a close friend who is also a benefits advisor - to read the info on the benefitsandwork website which is what I did.

I remember being bombarded with "most days" rather than "I cannot do" per se.

A lady called Charlie on YouTube has tonnes of articles on her website and video blogs and lots of useful information. Just search Charlie PIP Advisor on YouTube and you should find her channel.

The other people on here are so much more experienced and clued up than me - this is my first and only experience of claiming benefits from DWP

With regard to my conditions, I have formal diagnoses of the following -

Osteoarthritis in knee, spine and hip.

Degenerative disc disease in lower back.

Fibromyalgia Syndrome

Spinal Spondylosis/Spondylitis,

Chronic Pain

Chronic Fatigue/ME

I hope this adds some perspective for you.

What about evidence re your anxiety? GP letter? Medication regime? CBT/other talking therapy? How does your anxiety prevent you from leading a completely normal life?

The evidence I provided was plentiful. MRI scan results, evidence of treatments tried and tested - some not so as they didn't have improved mobility and pain management positivity. I applied for a Blue Badge in March and after being told I would hear something 8-12 weeks. I actually received an e-mail within 18 hours of applying, confirming my app was accepted and blue badge arrived 3 days later and is valid for 4 years now.

One letter from my GP (along with an MRI scan clearly defining my spinal issues which he wrote in support of a Blue Badge on one page, was all it took for the PIP to be awarded.

I hope this answers some of your queries and wish you well moving forward xxx

curiousspin

https://forum.scope.org.uk/discussion/comment/953836#Comment_953836

Only Anxiety and depression? I'll have you know mental health is just as debilitating. With 12 different diseases I'm sure you would be entitled.

flour

Hi @Dolly_Daydream333

I hope you can ignore the debate around health earlier up in the thread. But I've come on because I've noticed something you might do with knowing.

Just to make you aware there is a strict annual deadline for applying for New Style ESA. After this point your national insurance may become out of date depending on how much work you did in the last few tax years?

The annual deadline is the first Saturday in January. Which means really you'll need to apply today (especially if doing by phone as they are shut Saturday) but you don't need to have sorted out your fit note yet, you can send that on later. All you need to do is give them your name address etc… no complex health details are required.

Further, you can also ask to start the claim up to 3 months in the past without giving a reason. You can include this on the form if you claim online or tell them on the call if you claim by phone.

Details on how to apply are here

https://www.gov.uk/employment-support-allowance/how-to-claim?step-by-step-nav=a661e652-204c-4abf-a2ce-9f183aca85b9

Hope this helps and please come back on if you have any more questions. Equally if you've already claimed then well done! I hope they get in touch soon.

The information I've used for the post has been from this document

https://data.parliament.uk/DepositedPapers/Files/DEP2024-0673/119_New_Style_ESA_only_claims_V6.0.pdf

poppy123456

https://forum.scope.org.uk/discussion/comment/953865#Comment_953865

To add additional information to this now we are almost at the end of the benefit years I mentioned above. (Which were correct at the time my advice was given)

The benefit years change from Sunday 5th January 2025 to 2021/22 and 2022/23. Those are the years for NI contributions they look at when claiming New style ESA/JSA.

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