1.3. Other background information

Reassessment

Both PIP and ESA were designed to include periodic reassessment of a claimant’s eligibility. Claimants will be asked to complete forms updating the DWP of any changes in their conditions, and will usually be asked to attend another medical assessment. Many of Z2K’s clients are appealing an ESA/PIP refusal following reassessment (or in the case of PIP following failed transfer from DLA to PIP).

ESA eligibility is usually reviewed within two years of the original decision, and PIP eligibility within either three or five years. The tribunal will normally recommend one of these common timeframes, but there is no legal weight to that recommendation, and the DWP have the right to reassess eligibility at any time. NB, given delays in appeals being listed before a tribunal, claimants are commonly reassessed for ESA around one year from the tribunal decision.

Interaction with other benefits/schemes

Both benefits, but especially PIP, are said to “passport” claimants to other benefits and schemes once awarded. The following information gives brief details on these schemes for your interest. If a client mentions one, or you think that one may be applicable to a client and they are not receiving it, please let Z2K know and we can follow-up.

Severe Disability Premium (SDP)

This is a weekly top-up to ESA, awarded if the claimant also receives PIP Daily Living component. Claimants must normally be single with no non-dependents living with them, and no one receiving carer’s allowance for them.

Carer’s Allowance and the Carer Element of Universal Credit

Carers are eligible to receive Carer’s Allowance providing that they care for someone for at least 35 hours a week, and that the person being cared for receives a qualifying benefit, which includes the Daily Living component of PIP. In Universal Credit areas, the Carer Element may be applied instead.

Housing Benefit (HB) and Non-Dependant Deductions

Income-based ESA can passport to Housing Benefit eligibility. Therefore, when claimants are reassessed and their ESA refused, they will no longer automatically be eligible for HB. However, claimants will usually still be eligible on the grounds of low-income. Their council should send them a form to fill in with details of their income, and process this to give no break in the HB. Unfortunately, this does not always happen, so please inform Z2K if any clients mention problems with their HB.

It is assumed, in HB calculations, that all adults (with some exceptions) living with a HB claimant should contribute towards the cost of the property’s rent, even if not contractually obliged, and money is deducted from the HB amount paid accordingly. If the HB claimant is in receipt of the PIP Daily Living component, no deductions are made.

Exemption from the Benefit Cap (BC)

The BC was introduced in order to limit the total amount that individuals could receive in benefits. Receipt of PIP, or being in the ESA Support Group, exempts individuals from the BC.

Exemption from the Bedroom Tax

The “spare room subsidy”, more commonly called the bedroom tax, is a reduction in HB applied to those working council or housing association tenants who exceed the number of bedrooms allowed by the rules. Local authorities may, at their discretion, exempt individuals in receipt of the Daily Living component of PIP.

Motability Scheme

Disabled people can exchange all or part of their mobility allowance in order to lease a vehicle such as a car (that may be adapted) or a powered wheelchair, if they are in receipt of the Enhanced Rate Mobility component of PIP or the Higher Rate Mobility component of DLA.

1.2. Stages of Claim before Appeal

2.1. ESA Regulations and Commentary