Limited capability for work
The limited capability for work test decides whether or not you remain on ESA. If you do not pass the test, because you are not considered to have a limited capability for work, you would need to consider appealing this decision or claiming jobseeker's allowance instead.
For this test you are assessed on your ability to carry out a number of physical and mental health activities and points are awarded on the basis of your limitations with respect to each activity. These points are totalled up and if the total reaches the threshold of 15, you are deemed to have limited capability for work and thus stay on ESA. Please see the assessment scoresheets to find out exactly what the Atos Healthcare alleged professional is marking you against.
As far as we aware they are paid per assessment and the healthcare professional a commission, all the information obtained is input into a computer software program, and believe it or not the answers are preset to save time, and the healthcare professional adjusts them where necessary. This should tell you all you need to know really. We have had many experiences where the healthcare professional has taken no notice what so ever of what has been said, or the blatantly obvious incapacitating injuries and failed the claimant. One can only assume the healthcare professional wasn't in the same room at the time of the medical.
The mental,cognitive and intellectual functions
These functions in the limited capability for work test are grouped into sets of activities under the following 10 headings:
Please see the Mental, cognitive and intellectual function scoresheet for a comprehensive list of what the Atos Healthcare alleged professional is marking you against.
- Learning or comprehension in the completion of tasks.
- Awareness of hazard.
- Memory and concentration.
- Execution of tasks.
- Initiating and sustaining personal action.
- Coping with change.
- Getting about.
- Coping with social situations.
- Propriety of behaviour with other people.
- Dealing with other people.
Treated as having limited capability for work
You will be automatically treated as having a limited capability for work in the following circumstances:
- You are a hospital inpatient
- You are suffering from a progressive disease and consequently your death can reasonably be expected within 6 months;
- You are receiving treatment by way of intravenous, intraperitoneal or intrathecal chemotherapy;
- You have been requested or given notice, under specific legislation, to refrain from work because you are a carrier of , or have been in contact with, an infectious disease;
- You are pregnant and there would be a serious risk to the health of you or your child if you did not refrain from work;
- You are pregnant or have recently given birth and are entitled to maternity allowance and are within the maternity allowance payment period.
- You are pregnant or have recently given birth but are not entitled to maternity allowance or statutory maternity pay, from 6 weeks before the baby is due to 2 weeks after the birth.
Limited capability for work-related activity
The second test within the work capability assessment considers whether you have a 'limited capability for work-related activity'. Though the wording may seem similar to that of the first test, the second test has a very different function. It is used to determine whether you are placed in the support group of claimants or the work-related activity group.
Which group you are placed in will determine both the level of ESA that you will receive and the responsibilities you will need to meet in order to retain the benefit. The test has a list of 46 descriptors, relating to both physical and mental functions.
If at least one of them fits, you will be placed in the support group of claimants. The descriptors are grouped together under the following 11 activity headings:
For a guide to find out exactly what the Atos Healthcare alleged professional is marking you against please see the actual scoresheet Limited Capability For Work-related Activity - Test.
- Rising from sitting.
- Picking up and moving things.
- Manual dexterity.
- Maintaining personal hygiene.
- Eating and drinking.
- Learning or comprehension in the completion of tasks.
- Personal action.
How the tests are applied
In order to apply the tests for limited capability for work and limited capability for work-related activity a decision maker will first look at the information that you have provided in your initial claim for ESA to see if you pass these tests without the need for further enquiries. Basically if you have a pulse the general scenario is you will fail.
If the decision maker considers that there is not enough information to make a decision you will normally be sent an ESA50 questionnaire to complete, available to download here. This form has a number of questions about both physical and mental activities. Each activity has a section with tick-boxes and space to provide more detailed information about each activity.
Once the decision maker has received your completed ESA50 they may decide that there is clear evidence that you have limited capability for work (and possibly work-related activity). If not, you will be sent an appointment to attend a medical carried out by an approved disability analyst, which as it stands is Atos Healthcare, but that may change, watch this space.
The disability analyst will have read a copy of the ESA50 form that you have completed and at the medical they will be trying to identify whether or not your account in that form of your functional limitations corresponds with their findings.
They will ask you a series of questions, relating to both your physical and mental capabilities, guided by what you have put down on the ESA50. Once they have finished this, they will then give you a physical examination.
The decisions on whether or not you have limited capability for work and limited capability for work-related activity will not, however, be taken by the disability analyst. He or she will complete an ESA85 medical report form which will be sent to a decision maker, who will make these two decisions.
The report form also has recommendations as to when you should be retested for limited capability for work and limited capability for work-related activity.
Even if the decision maker decides that you do not pass the limited capability for work test they can still treat you as having passed it if the health care professional has obtained evidence that one of the following exceptional circumstances apply:
- You are suffering from a severe life threatening disease in relation to which 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.
- You suffer from some specific disease or bodily or mental disablement and consequently there would be a substantial risk to the mental or physical health of any person if you were found not to have limited capability for work.
Work-focused health-related assessment
The third test within the WCA is the 'work-focused health-related assessment' (WFHRA). This is usually carried out after the limited capability for work and limited capability for work-related activity tests have been assessed. This is because those who fail these tests will be moved on to jobseeker's allowance and so fewer people will be required to have a work-focused health-related assessment. Also if you are placed in the support group you will not have a WFHRA.
The work-focused health-related assessment collects additional information about the things that you can do your 'functional capacity' despite your condition. In this respect, it is coming from the opposite direction to the first two tests, which focus on the things you can't do. The WFHRA also collects information about any health interventions that could improve your functional capacity and thus support a move back into work. This could include the use of appropriate aids and adaptations.
If you are a student
If you are a full time student claiming contributory ESA you will have to satisfy the limited capability for work test. If you are claiming income-related ESA you will be treated as having limited capability for work if you are getting disability living allowance (DLA).
Whether or not you automatically satisfy the limited capability for work test you will still be assessed under the limited capability for work-related activity test, which decides whether you are in the support group or the work-related activity group.
If you are in the work-related activity group you will also have to attend a work-focused health-related assessment.
If you are a part-time student you will have to satisfy the limited capability for work test and be assessed under the limited capability for work-related activity test. You may also have to attend a work-focused health-related assessment if you are placed in the work related activity group.