Field: ESA Group Allocation (and Reasons)
Description
ESA Group Allocation refers to the result of the WCA decision that been adjusted for appeal outcome. The outcome recorded is the final DWP Decision Maker's decision or appeal tribunal's decision or the recommendation made by the Healthcare Professional where the Decision Maker's decision is not yet available.
Work Related Activity Group – offers support in preparing for work where claimants are required to comply with conditionality. Claimants assigned to this group must attend regular interviews with an adviser who can help setting job goals and improving skills.
Support Group – for claimants unable to work or take part in work-related activity. These claimants usually have the most severe functional impairments, hence are provided with unconditional support.
Fit for Work – deemed able to work therefore not entitled to claim ESA.
Detailed breakdowns refer to the result of the WCA decision adjusted for completed appeal outcomes, specifying the reason why a claimant is assigned to that group (see Annex A and B).
Classification
Applicable to: all claimants.
Work Related Activity Group
Support Group
Total number of categories:
Quality Statement
DWP only receives WCA data for completed assessments. Therefore, cases classed as still in progress are not necessarily waiting for an assessment following referral to the healthcare provider but may include:
Annex A: Reason for placement in the Work Related Activity Group
| Reason | Explanation |
|---|---|
| 15 points or more | This is where claimants score 15 points or more against the functional descriptors laid down in legislation. This award is based on the following functional impairment descriptors: Physical functions Lower limb – inability to mobilise, stand, sit; Upper Limb – inability to reach, pick up and/or lack of other manual dexterity; Sensory – inability to make self understood, understand communication or navigate safely Continence – limitation of control over the bladder and bowel; Consciousness – involuntary loss of consciousness; Mental, cognitive and intellectual functions Understanding and focus – this relates to inability to learn tasks, to be aware of hazards, inability to initiate and complete tasks; Adapting to change – this is to do with inability to cope with changes to routine, to get about; and Social Interaction – this relates to inability to deal with other people. Note that scoring 15 points or more is the most prevalent reason for being in the WRAG. |
| Medical Reasons | This combines claimants with non-functional descriptors or those treated as limited capability to work at assessment. This award can be based on the following non-functional impairments: suffering from a life-threatening disease – this is where there is medical evidence that the disease is uncontrollable or uncontrolled by a recognised therapeutic procedure, and in the case of a disease that is uncontrolled there is a reasonable cause for it not to be controlled by a recognised therapeutic procedure; and suffering from some specific disease or bodily or mental disablement – this is whereby reasons of such disease or disablement, there would be a substantial risk to the mental or physical health of any person if they were found not to have limited capability for work. It can also be based on the following limited capability to work: undergoing regular treatment - this means receiving regular weekly treatment, such as by way of haemodialysis for chronic renal failure, treatment by way of plasmapheresis or by way of radiotherapy, or by way of total parenteral nutrition for gross impairment of enteric function; undergoing medical or other treatment as an in-patient to a hospital or similar institution; recovering from treatment as an in-patient to a hospital or similar institution; undergoing pregnancy and in receipt of Maternity Allowance with an ESA top-up; during a period of confinement for pregnancy; and pregnant where there is a risk of harm to the mother and/or child. |
| Clerical Assessment | This is where the Healthcare Provider recommendations are recorded clerically. In such cases, WRAG assignment is determined from the DWP decision maker information only, and so no more detail about the nature of the health situation is recorded on the database. |
| Physical or Mental Health Risk | The physical or mental health risk category is for claimants who do not have a functional impairment as determined by the WCA descriptors, but finding them fit for work would result in a substantial risk to the physical or mental health of themselves or others. |
| After Appeal | This is where a small number of cases because they come after appeals to HMCTS in favour of the claimant are recorded clerically. Once more in such cases, WRAG assignment is determined from the DWP decision maker information only, and so no more detail about the nature of the health situation is recorded on the database. Here the Healthcare recommendations may differ from the DWP decision (after appeal process). Note that claimants initially found FFW in the process of appealing remain in this category for the purpose of statistical outputs until their cases are heard. |
| At reconsideration | There are some cases, coming after DWP reconsiderations, that are recorded clerically. Once again in such cases, WRAG assignment is determined from the DWP decision maker information only, and so no more detail about the nature of the health situation is recorded on the database. Here the Healthcare recommendations may differ from the DWP decision, or else recommendation might have changed but the revision is not on the system. |
Annex B: Reason for placement in the Support Group
| Reason | Explanation |
|---|---|
| Chemotherapy/Radiotherapy |
The Chemotherapy breakdown has been replaced by Chemotherapy/Radiotherapy to reflect the change in legislation from January 2013 where people who are awaiting, receiving, or recovering from any form of chemotherapy or radiotherapy for cancer will be placed in the Support Group for ESA subject to a light touch evidence gathering process.
This award is based on the following limited capability to work at assessment:
The claimant is:
|
| Physical or Mental Health Risk | The physical or mental health risk category is for claimants who do not have a functional impairment as determined by the WCA descriptors, but finding them fit for work would result in a substantial risk to the physical or mental health of themselves or others. |
| Pregnancy Risk | This is where pregnant claimants are put in the SG, if there is a serious risk to her own health or that of the unborn child were they found FFW. |
| Severe Functional Disability | This is where claimants meet the functional criteria for the SG, covering physical and mental capacity. |
| Terminally Ill | This is where claimants are diagnosed as terminally ill with a prognosis of 6 months or less. |
Note that the department does not always capture the reason for placement in the Support Group (as with the Work Related Activity Group). This is often due to assessments recorded clerically where the reason is not stated, such as where assignment follows an appeal or reconsideration.
The legislation, specifically Part 6, gives more detail on allocation at the following link:
http://www.legislation.gov.uk/uksi/2008/794/contents/made?view=plain