2. It is important that premiums are awarded or ended correctly and at the right time.

Transcription

1 Summary 1. Premiums are fixed rates of Employment and Support Allowance (ESA) paid in addition to the personal allowance to those who satisfy certain conditions. 2. It is important that premiums are awarded or ended correctly and at the right time. Note: Failure to award or end premiums may result in underpayment / overpayment of benefit to our most vulnerable claimants 3. There are four categories of premium: Severe Disability Premium (SDP) Enhanced Disability Premium (EDP) Carer Premium (CP) Pensioner Premium (PP) 4. These conditions may be satisfied by: the claimant the claimant s partner

2 Severe Disability Premium 5. A Severe Disability Premium (SDP) is an additional amount of benefit paid to some claimants as part of their ESA (IR) award. 6. SDP can be awarded in addition to other premiums. Eligibility 7. SDP must be considered in every case if the claimant o o o o is entitled to ESA (IR) and is living alone or treated as living alone and is receiving: Disability Living Allowance (DLA) care component at the middle or higher rate or Personal Independence Payment (PIP) daily living component at the standard or enhanced rate or Armed Forces Independence Payment (AFIP) or Attendance Allowance (AA) 8. Payment of Carer s Allowance (CA) or Carer Element (CE) of Universal Credit (UC) may affect entitlement to SDP. Underlying entitlement to CA or the CE of UC does not affect SDP. 9. SDP is paid at either the: single - lower rate or couple lower rate or couple - higher rate 10. See Eligibility table. 11. For further information see Decision Maker's Guide Chapter 44. Consequences: Failure to consider the SDP can result in the claimant s entitlement to ESA not being correctly established and: not receiving the correct amount of benefit, being underpaid not getting the passported benefits they might be entitled to such as Housing Benefit placing claimants in difficult financial circumstances may cause deprivation Claimants without accommodation

3 12. Claimants who are Persons Without Accommodation (PWA) are not entitled to any premiums. Claimants with No Fixed Address 13. Claimants with No Fixed Address (NFA) are allowed the same premiums as any other ESA claimant. Consideration must be given to whether the claimant is living alone or treated as living alone. Cases may need to be referred to the complex decision maker to decide entitlement to SDP. No Entitlement to Severe Disability Premium (SDP) 14. Claimants who do not satisfy the eligibility criteria are not entitled to SDP. The tables below can help you determine if the claimant is not entitled to SDP. See also Eligibility Table. 15. A single claimant, living alone is not entitled to SDP if they receive: DLA care component at the middle or highest rate or PIP daily living component at the standard or enhanced rate or Attendance Allowance or Armed Forces Independent Payment And Carers Allowance (CA) or Carer receiving Carers Element (CE) of UC is in payment to anyone caring for them. 16. A claimant who is a member of a couple living alone is not entitled to SDP if both partners receive: DLA care component at the middle or highest rate or PIP daily living component at the standard or enhanced rate or Attendance Allowance or Armed Forces Independent Payment And both partners receive Carers Allowance (CA) or

4 Carers Element (CE) of UC 17. A single claimant living alone and in receipt of: DLA care component at the middle or highest rate or PIP daily living component at the standard or enhanced rate or Attendance Allowance or Armed Forces Independent Payment Is not entitled to SDP if Carers Allowance (CA) or Carer receiving Carers Element (CE) of UC is in payment to anyone caring for them 18. A claimant who is a member of a couple living alone where both partners receive DLA care component at the middle or highest rate or PIP daily living component at the standard or enhanced rate or Attendance Allowance or Armed Forces Independent Payment is not entitled to SDP if both partners receive Carers Allowance (CA) or Carers Element (CE) of UC Entitled to Severe Disability Premium (SDP) 19. Claimants who satisfy the eligibility criteria are entitled to SDP. The tables below help you determine if the claimant is entitled to SDP. See also Eligibility Table. 20. Single claimants and lone parents living alone may qualify for the lower rate of SDP if they receive: DLA care component at the middle or highest rate or PIP daily living component at the standard or enhanced rate or Attendance Allowance (AA) or Armed Forces Independence Payment (AFIP), And either Carers Allowance (CA) or the Carer Element (CE) of Universal Credit (UC) is not in payment to anyone caring for them 21. A claimant who is a member of a couple living alone may qualify for the lower rate SDP if both members are in receipt of one of the following:

5 the middle or higher care component of DLA, or the standard or enhanced rate of the daily living component of PIP, or Attendance Allowance AA or Armed Forces Independence Payment AFIP, or the partner does not receive the benefits listed above but is blind or is treated as blind, And either CA or CE of UC is in payment to a carer in respect of providing care for one member of the couple 22. A claimant who is a member of a couple living alone may qualify for higher rate SDP if both members are in receipt of one of the following: the middle or higher rate of care component of DLA, or the enhanced or standard rate of the daily living component of PIP, or Attendance Allowance AA or, Armed Forces Independence Payment AFIP, And either CA or CE of UC is not in payment to anyone caring for either member of the couple How to decide if the claimant lives alone 23. Claimants and their partners are considered to be living alone where there are no non-dependants aged 18 or over who normally reside with the claimant or who the claimant normally resides with. See DMG for a definition of non-dependants. 24. Disregard the following people when deciding if a person is a non-dependant: dependants (including qualifying young persons under 20). See DMG anyone aged less than 18 anyone receiving o Attendance Allowance (AA)

6 o o o the middle or higher rate of Disability Living Allowance (DLA) care component the enhance or standard rate of Personal Independence Payment (PIP) daily living component Armed Forces Independant Payment (AFIP) boarders, other than a close relative subtenants, other than a close relative anyone who shares only a bathroom, toilet, hall or stairway anyone who is separately liable to make payments to the landlord certain joint tenants/owner occupiers certain volunteers from charitable organisations landlords/landladies and their families, other than a close relative anyone who is registered blind or who has recently been on the register see DMG anyone who joined the household to care for the claimant or partner, and immediately before this, the claimant or partner was treated as a severely disabled person. This applies for the first 12 weeks after the person joined the household for the first time. Note: For the full qualifying conditions for Severe Disability Premium (SDP) see DMG Consequences: Establishing the claimants living circumstances is important, not doing so can mean: SDP is paid inappropriately resulting in an overpayment loss of SDP would also result in loss of pass ported benefits, with potential significant overpayments for the claimant to repay results in rework to correct the claim and possible overpayment recovery work can increase official error Entitlement or potential entitlement identified at new claim stage 25. If entitlement or potential entitlement to SDP is identified on a new claim prior to an ESA (IR) claim being pushed from the CAM to JSAPS, follow instructions in recording exceptional conditions on CAM. 26. If entitlement to SDP is identified after the assess award action has been taken in CAM, JSAPS will not automatically award the appropriate SDP but it will recognise potential entitlement if the claimant is in receipt of Disability Living Allowance care component at the highest or middle rate

7 Personal Independence Payment daily living component at the standard or enhanced rate Note: Where SDP is not automatically awarded by JSAPS error message(s) will show: E6772 occurs when JSAPs has identified a potential entitlement however there is no 03 or 04 code in the exceptional conditions to determine the award. E6780 occurs where code 03 or 04 has been used to award SDP however there is no corresponding appropriate rate of DLA/PIP in the other benefits screen for the customer (and partner if applicable) Checking Benefit Systems to help determine entitlement 27. All the information to make a decision on SDP should have been gathered on CAM and recorded in the Other Benefits screen on JSAPS. Check CAM/JSAPS/CIS as appropriate, for information to determine entitlement to SDP. The following screens/dialogues are useful: Benefit System CAM - Partner Details JSAPS - JA761 Partner Details CIS Relationship History (can confirm if there are details of a partner recorded that have not been put in either CAM, the ESA1 or declared during a change of circumstance using Information Capture Tool) CAM - Other Benefits/Credits/Allowances CIS Award History CAM Hospital Details JSAPS - check the DLA screens Information Check whether or not there is a partner Note: there could be an expartner from whom the claimant recently separated and who was not declared during the data gather process or the agent did not record if the ex-partner is still in the household, the claimant may not be entitled to SDP Check if DLA/AA/Constant Attendance Allowance (CAA)/PIP/AFIP or CA or CE of UC has been recorded for claimant or partner Note: see Consequences Check whether claimant has been in hospital for 28 days or more, and if DLA/PIP has been suspended

8 through CE1 CAM - Housing Cost Details Check whether claimant is living with parents/relatives/friends check whether housing costs are shared CAM - Task and Notepad check whether claimant is No Fixed Address (NFA) but see NFA exception Check whether a task type Other has been set by the Contact Centre (CC) agent as this will confirm whether the claimant has recently separated from their partner. Note: The details can be viewed by scrolling across to the comments column override Dependants and non-dependants 28. Check if anyone aged 18 or over is recorded as living with the claimant: if they are recorded as living with the claimant and receiving DLA/PIP/AA at the appropriate rate, they will not count as a nondependant for SDP purposes a CIS address search must be done if there is any doubt about who lives with the claimant 29. See DMG44119 for non-dependants and DMG for people who will not count as a non-dependants. Consequences: Not checking CIS for other benefits can result in: overpayment if other benefits are not taken into account when they should be possible continued deduction of benefits financial loss to claimant if WTC are overpaid and recovered by HMRC and when ESA would not be recalculated Action to take when deciding entitlement to Severe Disability Premium 30. If you have enough information to make a decision on entitlement to SDP

9 Step Access dialogue JA060 Access dialogue JA610 and access Exceptional Conditions screen Action register the event Input the date of change as the date the qualifying benefit was recorded in JSAPS or from the start of the claim, whichever is later. Input exceptional condition code (03) for single/lower rate SDP or (04) for higher rate SDP. Input (NE) for not entitled in the Verification field if the claimant is not entitled to SDP or input (V) for verified in the Verification field if the claimant is entitled to SDP. Note: JSAPS will award the correct rate of SDP 31. If you do not have enough evidence to make a decision on entitlement to SDP: Step Contact the claimant by phone Action record all details on an IS10 and decide whether the claimant is entitled to SDP 32. If contact by phone is not possible issue an IS10. IS10 must only be used as a last resort: Step Access dialogue JA60 Access dialogue JA610 and access Exceptional Conditions screen Action register the event Input the date of change as the date the qualifying benefit was recorded in JSAPS or from the start of the claim, whichever is later. Input exceptional condition code (03) for single/lower rate SDP or (04) for higher rate SDP. Input (RV) request verification in the Verification field. Note: JSAPS does not issue an IS10 when NV is input; however it will calculate and pay the SDP resulting in

10 Access JA530 IS10 not returned Consequences: a potential overpayment set a Case Control for 10 Working Days (WD) Note: if the IS10 is not returned within this period issue a further IS10 and set a Case Control in JA530 for a further 10WD Refer for a core visit using MF47 if no contact from claimant on IS10 or by phone Establish entitlement to Severe Disability Premium as soon as possible, every attempt must be made to obtain the information by phone it removes delays and potential underpayments. Sending an IS10 can: cause delays and cause underpayments to the claimant add in additional processing steps, increase processing times and delay payment of benefit IS10 s frequently get sent to IS and are lost, delaying the SDP decision and entitlement 33. Action to take when the IS10 is returned and enough evidence held to award SDP : Step Access dialogue JA060 Access dialogue JA610 and access Exceptional Conditions screen Action register the event Input the date of change as the date the qualifying benefit was recorded in JSAPS or from the start of the claim, whichever is later. Access dialogue JA200 and access the Evidence Summary screen Input exceptional condition code (03) for single/lower rate SDP or (04) for higher rate SDP. Input (NE) for not entitled in the Verification field if the claimant is not entitled to SDP or input (V) for verified in the Verification field if the claimant is entitled to SDP. Check the evidence displayed on all pages of the evidence summary screen is complete and accurate then press

11 F24 and check details are correct and issue payment 34. If you have enough evidence that the claimant is not entitled to SDP: Step Access dialogue JA060 Access dialogue JA610 Exceptional Conditions Action register the event input exceptional condition code: (03) for single/lower rate SDP (04) for higher rate SDP input (NE) for not entitled in the verification field Note: JSAPS will not award SDP Change of circumstances The following change of circumstances may affect entitlement to SDP. Change of address when Severe Disability Premium is in payment Action to take on a change of address when Severe Disability Premium is in payment Step Access JA610: Change of Circumstances personal details screen To establish continuing eligibility Unable to contact by phone Claimant is no longer entitled to SDP Access dialogue JA610 Action Enter the start date of the new address Note: SDP will remain in payment until continuing entitlement is established Contact the claimant by phone to confirm the details if you do not have enough information to decide whether or not a claimant has continuing eligibility to SDP Issue an IS10 input (NE) for not entitled in the verification field Note: JSAPS will not award SDP The end date is the date of their change of address

12 The effect of Disability Living Allowance to Personal Independence Payment reassessment on the Severe Disability Premium 35. When a Disability Living Allowance (DLA) claimant is reassessed and awarded Personal Independence Payment (PIP) it must be a seamless process. 36. PIP daily living component at the standard or enhanced rate is a qualifying benefit for SDP. 37. If the claimant has an SDP in their ESA (IR) award because of DLA and they are reassessed and awarded PIP daily living component at the standard or enhanced rate, the SDP must continue without a break. Do not send out an IS10 or phone the claimant to recheck entitlement when the award of PIP is downloaded to Jobseekers Allowance Payment System (JSAPS). The claimant should only be contacted/is10 issued if they have had another change in their circumstance at the same time, such as a change of address that puts entitlement in doubt. All PIP transactions must be actioned promptly to prevent delays in the payment of benefit, this includes any downloads as SDP is not automatically awarded. Action to take following Personal Independence Payment download on Jobseekers Allowance Payment System (JSAPS) Step Access dialogue JA610 ESA C & IR Picklist screen Access the Exceptional Conditions screen Return to the picklist by pressing F1 Action Record the effective date as the date the DLA has ended Input an end date for the previous award of SDP to correspond with the date that DLA has ended Record the effective date as the start date of the PIP award and press F24 and return to the exceptional conditions screen Input the relevant person number in the Person No field. Input exceptional condition code (03) for single/lower rate SDP or (04) for higher rate SDP. Input the start date of the entitlement to SDP in the S/Date field as the start date of the PIP award. Input (V) for verified in the final column

13 Return to the picklist by pressing F1 Enter dialogue JA200 Award and Decision Complete the relevant fields for Evidence Complete Adjudicate on the claim and press F24 check details are correct and issue payment Other change of circumstances 38. When a change of circumstance happens consideration must be given to the eligibility to: a new award of SDP and/or continued entitlement on an existing award. 39. For example when a child turns 18 years old claimant and spouse/partner separate PIP awarded 40. Where appropriate refer cases to the complex decision maker. Setting case controls JSAPS does not set SDP review periods automatically. Case controls for the review of SDP must be set manually depending on the circumstances of the claim (that is for any known potential changes). 41. Failure to set case controls for the following circumstances will constitute error: to check status of dependents on reaching 18 a known end date for DLA/PIP award a known end date for DLA/PIP award of a non dependant non dependant reaching 18 carer moving into household 12 weeks SDP entitlement hospital admission/discharge This list is not exhaustive. Consequences: Case control is important, not using correctly means: risk that SDP is not established or paid until, if and when the case is uncovered prolonged error within the system prolonged underpayment and not passported to other benefits

14 you may be placing claimants in difficult financial circumstances, with potential for special payments and possible compensation as a result of the prolonged delay. risk attached to off-line payments, with additional administrative expense potential need for safe guarding visit if a vulnerable customer that could be avoided Eligibility Table 42. Consider entitlement to SDP for ESA (IR) claimants who satisfy the eligibility criteria. The following table can help determine entitlement. Eligibility Claimant is entitled to ESA(IR) and living alone/treated as living alone, AND Single claimant Receives DLA care component at the highest or middle rate or PIP daily living at the standard or enhanced rate or Carer s Entitled to Allowance SDP? (CA) or the Carer Element (CE) of Universal Credit (UC) Is in payment to the carer Is not in payment to anyone caring for them NO YES SDP rate N/A Lower rate AFIP Claimants who have a partner Both partners receive DLA care component at the highest or middle rate or Is in payment for both partners NO N/A PIP daily living at the standard or enhanced

15 rate) or AFIP or AA Both partners receive Is in payment for only one partner YES Lower rate DLA care component at the higher or middle rate or PIP daily living at the standard or enhanced rate or AFIP or AA, or the partner does not receive the benefits listed above but is blind or is treated as blind Both partners receive DLA care component at the highest or middle rate or PIP daily living at the standard or enhanced rate AFIP or AA Not in payment for either partner YES Higher rate

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17 Enhanced Disability Premium 43. Enhanced Disability Premium (EDP) is payable to Employment and Support Allowance Income Related (ESA (IR)) claimants who are in the support group or they receive: (or, if they are a member of a couple, their partner receives) the higher rate care component (HRCC) of Disability Living Allowance (DLA), or the enhanced rate of Personal Independence Payment (PIP) daily living component, or Armed Forces Independent Payment (AFIP) 44. EDP is payable at two rates: single person rate couple rate Awarding single rate Enhanced Disability Premium 45. Award single rate EDP when the claimant: is single or is a lone parent, and is in the support group, or DLA HRCC or the enhanced rate of PIP daily living component is payable or would be payable had it not been suspended as a result of hospitalisation, or AFIP is payable Awarding couple rate Enhanced Disability Premium 46. Award the couple rate EDP when the claimant: o o is a member of a married or unmarried couple, or is a member of a polygamous marriage, and is in the support group, or AFIP is payable, or DLA HRCC or the enhanced rate of PIP daily living component is payable or be payable had it not been suspended as a result of hospitalisation in respect of: the claimant, or the claimants partner (provided they are under the age for getting Pension Credit) 47. EDP cannot be paid if there is entitlement to Pensioner Premium (PP). 48. Entitlement to the EDP continues throughout the stay in hospital if one member of a couple or polygamous marriage is a patient. 49. The EDP will stop when:

18 a single person or a lone parent is in hospital for more than 52 weeks each member of a couple or polygamous marriage is in hospital for more than 52 weeks 50. If a claimant is in a care home and continues to receive AFIP, DLA HRCC or the enhanced rate of PIP daily living component after admission, the EDP will continue in payment Note: AFIP is a life time award and only stops on admission to the Royal Hospital Chelsea. 51. JSAPS will automatically award the appropriate EDP where the claimant and/or their partner meet the above qualifying conditions. 52. If the claim is maintained clerically, you must show the award of the EDP on form ESA14.

19 Carer Premium 53. Carer Premium (CP) is paid to the claimant when they or their partner are a carer or have been treated as a carer. 54. CP is paid at one rate and can be awarded with other premiums. 55. More than one carer premium may be awarded if both the claimant and their partner satisfy the qualifying conditions. Qualifying conditions 56. To qualify for the CP, the claimant, their partner or both must: o o be in receipt of Carers Allowance (CA) have underlying entitlement to CA the claimant or their partner may be entitled to CA but do not receive it because they receive an overlapping benefit. If this underlying entitlement applies, the CP can be awarded CA unit send a notification to the Benefit Centre (BC) when a person has underlying entitlement to CA 57. JSAPS automatically awards the CP if CA is input as received in the other benefits screen or if underlying entitlement is input in the exceptional conditions screen. Eight week extension period 58. CP is extended for 8 weeks following the date that either: the person being cared for dies; or CA ceases for reasons other than the death of the person being cared for if CA ends for reasons other than the death of the person being cared for, JSAPS will automatically award the CP for a further 8 weeks if the person being cared for dies, CA is extended for 8 weeks and JSAPS will continue to award CP for this period the CP will then be awarded for a further 8 week period. User intervention is required to prevent this from happening see Action to take to prevent the CP from being awarded for a further 8 weeks Action taken to prevent the Carer Premium from being awarded for a further 8 week period: Access dialogue JA610 ESA C & IR Picklist screen.. Record the effective date as the date the CA ceases, this is the last day of the 8 week extension period. Access Other Benefit screen. Remove the (Y) or the (U) in the Rec d field and replace with an (X).

20 Record the end date as the date the CA ceases, this is the last day of the 8 week extension period in the D/End field. Return to the picklist by pressing F1. Complete the relevant fields for Evidence Complete. Enter dialogue JA200 Award and Decision then dialogue JA405 Compute Payment to adjudicate and decide on the claim. Record the award of CP on form ESA14 if the claim is maintained clerically

21 Pensioner Premium 59. Pensioner Premium (PP) is payable to claimants who are receiving Employment Support Allowance Income Related (ESA(IR)) and they or their partner are Pension Credit (PC) age or over. 60. It can be paid at one of two rates: single person rate, for single claimants couple rate, where either the claimant or their partner satisfies the qualifying conditions 61. Jobseekers Allowance Payment System (JSAPS) automatically awards the appropriate PP where the claimant and/or their partner meet the above qualifying conditions. 62. If the claim is maintained clerically, show the award of the PP on form ESA14. Rate of PP payable 63. The amount of PP payable to a single claimant or a claimant who is a member of a couple depends if there is: entitlement to the Work Related Activity Component (WRAC), or entitlement to the Support Component, or no entitlement to either component 64. A claimant who qualifies for PP receives the full amount during the assessment phase. 65. PP is reduced by the amount of the WRAC or Support component if they are payable. 66. From 3 April 2017, the WRAC component will no longer be paid to new ESA claims starting on or after 3 April Claimants qualifying for PP will continue to be paid at the full PP rate. Pensioner Premium example scenarios These example scenarios are for illustrative purposes only. Scenario A Claimant makes a new claim to ESA on 29/05/2017 and qualifies for pensioner premium. During the assessment phase they receive the full amount. Following the Work Capability Assessment they are placed in the Work Related Activity Group. As the claim started after 03/04/2017 the WRAC is not payable therefore the pensioner premium is paid in full. Scenario B

22 Claimant makes a new claim to ESA on 30/01/2017 and qualifies for pensioner premium. During the assessment phase they receive the full amount. Following the WCA they are placed in the WRAG. As the claim started before 03/04/2017 the WRAC is payable and the pensioner premium is reduced by the amount of the WRAC.