Work Capability Assessment - What next?
What happens next?
The person who decides if you should get ESA is called the ‘decision maker’. They work for the DWP. Once you send back the health questionnaire and have been to the medical assessment, they will decide if you should get ESA. They will make one of the following decisions:
a) You don’t have limited capability for work
This means that the DWP have decided that you are able to work. This means that you need to claim Jobseeker’s Allowance (JSA) or Universal Credit (UC) and look for work. If you don’t think you are fit for work you can ask the decision maker to look at their decision again. This is called Mandatory Reconsideration. You have to do this within 1 month of getting their decision.
You can find more about 'Appealing benefit decisions' here.
b) You have limited capability for work
This means that the DWP have decided that you have ‘limited capability for work’. This means that you will get ESA or UC and not have to look for work. You may still have to do ‘work-related activity.’ ‘Work-related activity’ includes going to work focused interviews.
They then have to decide if you have ‘limited capability for work-related activity’.
If they decide you cannot do work-related activity they will put you in the ‘support group’. They make this decision based on the criteria that we have set out here in Table 2. If you meet one of the criteria then the DWP will put you in the support group.
Can I get ESA if I don’t have limited capability for work?
Sometimes the DWP can treat you as having limited capability even if you are fit for work. You will need to show that:
- you would be a risk to yourself or others if they decided you can work. This could include suicidal feelings, self-harm or violent behaviour, and
- the risk of hurting yourself or others will not go away if a future employer makes changes to help you, or you take proper medication.
The DWP calls these rules “Regulation 25” and “Regulation 31”. They may be known as “Regulation 29” and “Regulation 35” for older ESA claims.
For example, if you suffer depression you may apply for ESA. You might make it clear that not awarding ESA will make you feel worse. The DWP will then have to assess if you are a “substantial risk” or not. They will look at things such as:
- if you have current plans for suicide,
- if you self-harm,
- if you have been in hospital under the Mental Health Act in the last 12 months, or had a voluntary stay in a psychiatric unit in the last 6 months,
- if you have a current care plan from secondary mental health services, or
- if the DWP have assessed you as being vulnerable to relapse.
If they decide you are at “substantial risk”, then they may award you ESA even if they would normally think you can work. To prove this you will need a letter from your health care professional such as a doctor, Community Psychiatric Nurse (CPN) or social worker.
Need practical advice & info? We can help.
Contact our Advice team about mental health & related issues
0300 5000 927 Monday - Friday 9.30am - 4pm, not including bank holidays