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ESA Contribution based

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9 years 4 months ago #126115 by philologus
Replied by philologus on topic ESA Contribution based
Thank you for the further information Gordon.

I rang the benefits helpline and asked why my daughter was not getting the extra £15.55 as she gets DLA highest rate for care.

I was told that when they transferred her from IB to ESA (2011) her ESA became contribution based. For them to award the premium she would have to be on ESA income based. In other words she does not qualify for the premium.

I was told that she would also not be eligible for free NHS treatment either as her ESA would need to be income based for this too. I was advised to use the HC1 claim form to try to get some help for the £319 demand for dental care she has just received.
How confusing can they make all this?

My own research tells me that you are right and that she does qualify for the disability premium, but I'm not sure how to go about challenging what I've just been told.
Regards,
George

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9 years 4 months ago #126119 by Gordon
Replied by Gordon on topic ESA Contribution based
A

I am afraid that you need to contact the DWP again and ask for the issue to be escalated, basically what you have been told is incorrect.

ESA is a single benefit with two sets of eligibility criteria, the DWP have clear guidance when transferring claimants from IB to ESA that in addition to calculating an ESA(CB) payment that they should also check whether they are eligible for an additional ESA(IR) payment, even if they were not entitled to Income Support with their IB.

I don't have the guidance to hand but I will try and find it when the forum is quieter or after we close and add it to the topic.

Gordon

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9 years 4 months ago #126120 by Gordon
Replied by Gordon on topic ESA Contribution based
A

This is the document that I was talking about.

www.rightsnet.org.uk/?ACT=39&fid=3&aid=8...5lcDDnohU&board_id=1

There is also an entry in the Decision Makers Guide with a worked example www.dwp.gov.uk/docs/dmgch45.pdf

45413 The claimant’s duty to disclose information relevant to their existing award of benefit is modified to enable the Secretary of State to require from the claimant information or evidence for the purposes of determining whether that award should be converted to ESA1.

45414 This enables the Secretary of State to establish whether a claimant whose existing award is IB or SDA, and who is not entitled to IS, might be entitled to ESA(IR) as well as ESA(Cont) on conversion.

Example
Carlton is entitled to IB of £91.40. During the conversion phase the Secretary of State establishes that he has no other income. Following application of the WCA, Carlton is placed in the support group. On conversion, Carlton is entitled to ESA of £110.50 made up of ESA(Cont) of £96.85 and ESA(IR) of £13.65 (EDP).


Gordon

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9 years 4 months ago #126129 by philologus
Replied by philologus on topic ESA Contribution based
Hello Gordon and thank you again for your help in this matter. I think I'm finally getting my head round some of the information now. Thank you for your patience with an old codger who's brain is not as sharp as it used to be.

Is the following correct?
When someone is moved from IB to ESA the DM must assess the person to see if they should be receiving any earnings related ESA along with their contribution based ESA. The fact that they get DLA at the highest rate has to be taken into account in this and should trigger a payment of EDP which would add an element of ESA (earnings related) to their existing ESA (contribution related).

So far so good, but what if the DM did this at the relevant time and decided that no ESA (I) was due - only ESA (C)? Could there be any reason that they could legitimately reach such a decision?

Was my daughter automatically entitled to EDP because she has been getting DLA with the higher rate for care since before the migration from IB to ESA took place?

The example given of "Carlton" mimics the situation with my daughter: She was on IB and was converted to ESA. She had no other income (other than DLA) and she went through the WCA and was placed in the support group.

Assuming that we are both right I now need to contact the DWP again and ask them to escalate my claim (to a higher DM?) Is it better to write to them/email them quoting the "Carlton" example etc. Or is it better to 'phone them again and see if I can convince them?
Thanks again.
Regards,
George.

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9 years 4 months ago #126131 by Gordon
Replied by Gordon on topic ESA Contribution based
A

Although it is down to a Decision maker to decide whether a claimant is entitled to a premium, this is matter of fact not of decision, in other words either a claimant is or is not eligible, if they meet the criteria as your daughter does then they should be found eligible.

Entitlement to payment, assuming her DLA HRC pre-dates her transfer to ESA, only kicked in when she was transferred as IB did not enable the payment of any premiums.

You can write to them in which case there should be no need to escalate the problem, or you can phone them and ask to speak to a supervisor, this will require a call back. I would start by just quoting the references to the documents I posted yesterday, I always think it is best for the DWP to discover then mistakes themselves rather than having them pointed out :)

Gordon

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9 years 4 months ago #126133 by philologus
Replied by philologus on topic ESA Contribution based
Good idea! I know that they are under-staffed and under-trained so pointing them in the right direction so that they can not only revise their thinking but learn from it too is a step in the right direction.
I will let you know what happens.
Thanks again.
George

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