Health And Universal Credit

Alex’s recent ordeal with Universal Credit (UC) and their reversal of their previous decision about his health and its impact on his ability to work motivated me to write a quick article about health and Universal Credit.

For those with health conditions, registering for Universal Credit can be an intimidating ordeal.

When it comes to those with health conditions, typically people only apply for Universal Credit (UC) if there is a new condition that has affected their ability to work, or because they have been told to apply for it. That is either due to a change in circumstances such as moving address or because they have been found fit for work by Employment Support Allowance (ESA).

Applying for Universal Credit with a health condition.

The application for Universal Credit asks about health conditions that affect your ability to work, and this begins to “Refer for Work Capability Assessment (WCA)” process on the agent side.

Once you have reported a condition and have provided fit notes, if you remain unable to work due to health issues then after 30 days the referral will start.

This process may start on day 1 of the claim if you declare that you are terminally ill, which is defined by the Department for Work and Pension (DWP) as reasonably expected to die within six months.

Migrating to Universal Credit (UC) from Employment Support Allowance (ESA)

If you have moved from ESA, and you still have an active work capability decision, the process is mostly the same, which is a problem.

If someone is on Employment Support Allowance (ESA), they are found to be unable to work, but they move address, then that person will be expected to claim Universal Credit if that is the active benefit in the area they move to.

Universal Credit does not automatically recognise the existing ESA decision, it must be manually applies. In theory what happens is this:

1. Once the application is submitted, Universal Credit (UC) submits “stop notices” to any other benefits that the claimant was in receipt of. These tell those benefits to stop paying the claimant.
2. The other benefits reply to the stop notice with a form called an MGP1. The MGP1 shows what benefit the person was receiving, when entitlement stopped, when the last payment was, and in the case of ESA it also shows whether the claimant was in the work-preparation group or the support group.
3. The case manager sees this, and then creates a to-do, “Refer to Decision Maker – Work Capability Decision.” He completes this form to request that the decision maker review the person’s Employment Support Allowance (ESA) claim, and apply the relevant capability decision to the claim.

Step 3 is where it often falls apart. Case managers regularly do not check the MGP1 or refer them to the decision makers. If this is not done manually, then it is not done at all, which means that the person will have to continue submitting fit notes and will also have to complete a new Work Capability Assessment.

All of this despite the fact that they have already been assessed as not fit for work.

MSRS (Health assessment data)

The referral for the Work Capability Assessment (WCA) is done on a system called MSRS. The claimant completes their Universal Credit (UC) application, and the case manager inputs the information on MSRS. Many agents, telephony agents and Work Coaches, do not have access to MSRS, meaning that they cannot advise the claimant of the progress of their referral.

This information is then sent to Maximus, the company that complete UC’s Work Capability Assessments. It is never made clear to agents how this process works from start to finish, meaning people are often sent back and forth between the telephony team, work coaches, case managers, and Maximus.

The “Relevant Period”

Once a claimant has applied for Universal Credit (UC), submitted fit notes all the way up to their assessment, completed the assessment itself, then a decision is made by a decision maker. They will look at the information provided (again, Alex has written an article about some of the less clear aspects of this process) and decide whether the person has “Limited Capability for Work,” or “Limited Capability for Work Related Activity.”

Limited Capability for Work (LCW) does not include an additional financial element of Universal Credit, meaning a claimant will not be paid more if they are found to have Limited Capability for Work. They will not be expected to apply for work for the time being, and certain other requirements may be relaxed, but their award will not increase.

Someone found to have Limited Capability for Work Related Activity (LCWRA) however will receive an additional element, however they will find that they are affected by something called the “Relevant Period.” This is a three month period, and as with all things on Universal Credit, it’s not an easy thing to describe simply.

The relevant period starts from the date that the Decision Maker says the claimant would be considered Limited Capability for Work Related Activity (LCWRA). If you were ill when you started your claim, this will typically be the start date of your claim. During the three months from that date, there is no award increase. The Limited Capability for Work Related Activity (LCWRA) element will not kick in until the AP following the third month of the relevant period.

This means that someone could finally be found to have Limited Capability for Work Related Activity (LCWRA), and for almost four months not receive any increase in their award.

Underpayments for those with Limited Capability for Work Related Activity (LCWRA)

So, let’s say someone is found to have Limited Capability for Work Related Activity, and because of the delay in their assessment, even with the relevant period they are entitled to a payment for the previous two months.

Rather than this simply being calculated and paid to the claimant, it will be referred to Debt Management. Debt Management will deduct any amounts based on debts that they can see on their system. For example, if you were overpaid a benefit six years ago, they will deduct all of it from the underpayment you would have received for your health condition.

“Just a day after telling me that they had overturned their original decision on my fitness to work and stating that I’m due back payment, the Department for Work and Pensions have now suddenly found debts to recover from it.” – DWP suddenly find debts to recover from Universal Credit back payment

This process of reviewing any debts and adjusting the underpayment based on these can delay the claimant receiving this money by six to eight weeks, which can be devastating when they have already been waiting months for their work capability decision.

As with everything else, this process was designed with agents in mind, with no regard for keeping claimants informed, protecting their welfare or supporting them through hardship. – Click to Tweet

It is another example of the DWP’s neglect for vulnerable claimants that after months of waiting for a decision about money specifically awarded to help those with significant health problems, the Department has no hesitation in withholding that payment or offsetting it against prior debts.

The fact that people are unnecessarily being dragged through the Work Capability Assessment (WCA) process because agents didn’t notice that they had already been assessed on Employment Support Allowance (ESA) is unforgivable, and the fact that it hasn’t been corrected this far into the UC roll-out is symbolic of the DWP’s attitude to claimants.

I’ve included an infographic below to try and summarise this process on Universal Credit (UC). Let me know if you find it helpful in any way or would like similar graphics about other UC processes.

As always, please note that this information was up-to-date at the point I left Universal Credit on 20 July 2018 and is based on the assumption that no major changes have taken place since then. I do my best to fact-check myself where possible, but with limited access to current DWP guidance this can be difficult.

Follow me on Twitter at @BayardTarpley for updates on future posts about Universal Credit or to let me know if there’s anything about Universal Credit that you would like me focus on in a future article from an agent’s point of view.

Thanks again for reading

Bayard Tarpley

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