What if you fail the assessment? Mandatory reconsiderations and appeals
If you don’t score 15 points in the assessment, the process will be different depending on whether you are on ESA or Universal Credit.
Universal Credit
On Universal Credit if you score less than 15 points your benefit will not stop. Universal Credit will continue in payment, but you may need to agree and sign a new claimant commitment containing different work-related activities for you to undertake each week.
If you pass the assessment you don’t need to be available for or actively seeking work.
If you fail the assessment your work coach can require you to look for work.
It is very important to give them sufficient information about your health condition and to challenge the assessment decision if you feel it is wrong. If you don’t meet the requirements of your claimant commitment you can be sanctioned and lose benefit.
If you feel the decision is wrong, you need to request a mandatory reconsideration of the decision. You can do this by putting your request on your online journal. If you can provide more medical evidence, then you should give this to your work coach. You have a month to request the mandatory reconsideration, but late requests can still be accepted.
Your mandatory reconsideration decision will be posted on the online journal. If it does not change the decision and you still disagree then you can appeal.
ESA and payment of the appeal rate
If you were on ESA when you failed the assessment, your benefit will stop. If you disagree with the decision you can lodge an appeal to challenge it. When your appeal is lodged you can be paid benefit at the basic appeal rate until your appeal is heard and/or decided. You will need to continue to submit medical certificates from your GP until you get a decision on your appeal. You have a month to lodge an appeal but late requests can still be accepted.
You may still wish to request a mandatory reconsideration or review of the decision at the same time as appealing, this means that the department who decided to stop your benefit will look at their decision again to see if they can change it. It is important to remember that just asking for a mandatory reconsideration does not get your ESA back in to payment, you need to appeal to get paid again.
Payment of the appeal rate of ESA is only possible if you are appealing a decision that you failed the assessment because you didn’t score enough points.
If your ESA stopped because you failed to return the questionnaire or to attend the assessment, then your benefit will not be paid while you appeal the decision.
The best course of action is to request a mandatory reconsideration and try and show that you had good reason for the failure with evidence. If this takes a long time or you are turned down and have to appeal, you may want to consider claiming Universal Credit while you wait. You cannot go back on to ESA once you have claimed Universal Credit but if you get the ESA decision changed, your Universal Credit may increase.