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Exclusion from re-assessment: ESA criteria released

October 16, 2017

The Department for Work and Pensions (DWP) has released new criteria to be used when making decisions as to whether or not someone claiming Employment and Support Allowance (ESA) can be exempt from re-assessment.

The first condition for exemption is that you must be in either the ESA Support Group or the Universal Credit equivalent of this (the Limited Capability for Work-Related Activity group). This group must have been accessed via one of the Support Group descriptors. This means that if you have accessed the Support Group via Regulation 35(2)(b) only, you may not be exempt from re-assessments.

In addition to this, you must also meet the following four criteria:

  1. Your level of function must be consistent enough to always meet Low Capability for Work. This means you are unlikely to meet this criterion if you have periods of reasonable function.
  2. The condition must be lifelong once diagnosed.
  3. There must be no realistic prospect of future function.
  4. It is an unambiguous condition.

Since 29 September, these criteria have been considered as part of Work Capability Assessments. You will be told if you meet the above criteria following the work capability decision by a DWP decision-maker. If you disagree with the decision, you can ask the DWP to look at it again, but there is no right to the formal mandatory reconsideration and appeals process after this.

There is still uncertainty as to whether or not M.E. will fall under the above criteria, and the DWP has decided against releasing specific illnesses to allow the criteria to be flexible. This enables individual healthcare professionals who are conducting Work Capability Assessments to use a considerable amount of discretion as to whether someone should be excluded from future assessments. It may be the case that if those living from M.E. are able to be considered under the above criteria, it will probably only be a very small minority such as those who are most severely affected.

This criteria does not apply to Personal Independence Payment (PIP), but it is important to note that you can request an "on-going" award for PIP which lasts up to 10 years (subject to review only if the DWP deems it necessary). This has been granted to those whose M.E. is very severe and unlikely to change over the next 10 years.

You can read more about this criteria on the Disability Rights UK website

Share your experience of ESA and/or PIP

If you have M.E. and have applied for PIP, or Employment Support Allowance (ESA), you can share your experience by taking part in our short survey (open until 9am Monday 6 November). We will use this data to inform our submission to the Work and Pensions Committee’s latest inquiry into PIP and ESA.

The Committee is undertaking its this inquiry following concerns about the disparity between how claimants recalled the assessment process and the final report. Claimants who go on to appeal against their initial assessment decision are successful in 65% of cases.