Determining claim type and claim sub-type

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Amice Clementine Rose
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1 Determining claim type and claim sub-type Summary There are several different claim and sub types for Employment and Support Allowance (ESA). These instructions provide clarification on what these are and the action to take on the Customer Account Management (CAM) system. Claim types New claim This claim type applies to a claimant who has not previously received Employment and Support Allowance (ESA). Reclaim gather This claim type applies to a claimant who has previously received ESA and the end date of that claim falls within the 12 weeks prior to the date of any subsequent claim made. Note: If the claimant received Income Support (IS) or Jobseekers Allowance (JSA) in between their last ESA claim and the current ESA claim made, a reclaim gather cannot be taken and the claimant must make a new claim. Repeat claim This claim type applies where the claimant s previous ESA claim falls outside of the 12 weeks prior to the date the current claim has been made. Where the claimant s previous ESA claim was an Incapacity Benefit (IB) Income Support (IS) reassessment claim, an M will display at the top of the screen in Jobseekers Allowance Payment System (JSAPS), next to the status of the claim. Determining claim type Record the claim type on the Customer Account Management (CAM) system using the 'ESA Claim Type' applet. This records and validates basic information about the claim, e.g. date of birth, previous benefits. CAM automatically populates the ESA Claim Type field depending on information held on other systems. Note: For telephony claims, CAM will automatically complete the Date Claim Made field. The following action in CAM must be taken: 1. Complete the Date Claiming From field by using either the calendar icon at the end of that field or typing it in. Note: The Date Claim Made is the Initial Date Of Contact (IDOC) and the Date Claiming From is the date the claimant wishes to claim from. In a repeat claim, you must ensure that these dates are refreshed for the current claim. 2. Select the Determine ESA Claim Type button to populate

2 the ESA Claim Type field, this will pull any details from the Customer Information System (CIS). 3. Check the existing information, e.g. claimant s details, previous claim to benefit. 4. If a validation or error message displays, refer to CAM System Reference Guide Note: For claimants who wish to make a claim more than 3 months before the Date Claim Made, claim in advance, see Advanced/Late Claims. Once the ESA claim type has been established, the user should then launch the 'Income Related Smart Script' by clicking on the Income Related Interest button, which initiates the Determine ESA Claim Sub-Type process. Claim sub-types There are two ESA Claim Sub Types: ESA Contribution based (ESA ) ESA Contribution based and Income Related (ESA (C & IR)) The claim sub type is recorded on the Customer Account Management system (CAM) using the 'ESA Claim Type' applet. This records and validates basic information about the customer s claim, e.g. date of birth, previous benefits. Note: CAM automatically populates the Claim Sub Type field on completion of the Income Related SmartScript. After the Determine ESA Claim Type action has been completed, CAM launches the Income Related SmartScript when the Income Related Interest button has been selected, this button is in the ESA Claim Type screen. Note: You must always select Income Related Interest when the customer is unsure about which type of ESA to claim, and proceed with a full C & IR data gather. The Income Related SmartScript This script enables you to ask a series of questions to establish whether the claimant wishes to proceed with an ESA (IR) claim. It also helps you to establish whether the claimant is potentially eligible for ESA (C & IR). Where: eligibility is unlikely; or the claimant is unsure about which type of ESA to claim; or insists on making an ESA claim you must always give the claimant the option to proceed with an ESA (C & IR) claim. This script also prompts you to establish with the claimant whether they are interested in claiming Housing Benefit (HB) or applying for a reduction in their Council Tax (CTr). Note: You must not get into discussions with the claimant regarding eligibility, you must only ask if the claimant wishes to proceed.

3 Following the Income Related SmartScript process, the Customer Account Management (CAM) system automatically completes the Claim Sub Type and the interested in HBCTB fields in the ESA Claim Type view. If you fail to action the Income Related SmartScript process, CAM displays an error message when you click on Create Case. The following action on the SmartScript must be taken: 1. ESA Claim Type applet Select the Income Related Interest button and follow the SmartScript. Go to step 2 2. Income Related ESA SmartScript - screen IR01 Benefits of Claiming Income Related ESA Read the first page of the Income Related SmartScript to the claimant to explain the benefits of claiming ESA (IR). Go to step 3 3. Screen IR02 Claiming Income Related ESA Ask the cclaimant whether they would like to claim ESA (IR): No select Next and CAM will set the Claim Sub Type to ESA. Yes select Next and screen IR03 displays, go to step 4 4. Ask the claimant if they have a partner: No select Next and screen IR04a displays, go to step 5 Yes select Next and screen IR05 display, go to step 7 5. Ask the claimant if they have savings and investments exceeding 16,000: No select Next and CAM sets the Claim Sub Type to ESA (IR) Yes Click Next screen IR07b displays, go to step 6 6. Screen IR07 b Would you still like to claim Income Related ESA?

4 Ask if the claimant still wishes to proceed with an ESA (C & IR) claim: Yes select Next and CAM sets the Claim Sub Type to ESA C IR No select Next and CAM sets the Claim Sub Type to ESA 7. Screen IR05 Partner & Working Hours Ask the claimant if their partner works 24 hours or more per week: Yes select Next and Screen IR06 displays, go to step 8 No select Next and screen IR04b appears, go to step Screen IR06 Partner Work Category No select Next and screen IR07a displays, go to step 9 Yes select Next and screen IR04b displays, go to step Screen IR07a Would you still like to claim Income Related ESA? Inform the claimant that some of their capital may be ignored but they might not be eligible for ESA (IR). Ask if they still wish to proceed with an ESA IR claim: Yes select Next and CAM sets the Claim Sub Type to ESA C IR No select Next and CAM sets the Claim Sub Type to ESA C 10. Ask the claimant if they or their partner have combined savings/investments of more than 16,000: No CAM sets the Claim Sub Type to ESA C IR Yes - select Next and screen IR07b displays, go to step Screen 'IR09 Housing Benefit/Council Tax Benefit

5 Ask the claimant if they are interested in claiming HB or applying for CTr: Yes CAM records this in ESA Claim Type View No CAM records this in ESA Claim Typ e View Complete the remainder of the ESA related data gather as Business As Usual (BAU) Note: After the ESA data gather has been completed, the Wrap-Up Call SmartScript is launched. You will be automatically taken into the HBCTB SmartScript due to the claimant s interest in HB/CTr. Advance claims Advance claims are allowed when a customer does not qualify for Employment and Support Allowance (ESA) on the date they apply for it, but it is clear that they will become entitled to ESA within three months of applying. Examples of this are: where surgery is scheduled Statutory Sick Pay (SSP) is due to expire within 3 months the claimant is approaching their 16th birthday If an advanced claim to ESA is received, and then subsequently the claimants post code rolls-out into a Universal Credit Full Service geographical area and the effective date is on or after the roll-out, action the claim under ESA instructions. The advanced claim to ESA will still be valid. The following action must be taken: 1. Enter the Date Claim Made. 2. Enter the Date Claiming From. 3. Enter the SSP End Date (if applicable). 4. Select the Determine ESA Claim Type button. For all claimant s who are 15 years old and 9 months and are making an advance claim, the following action must be taken: 1. Change the date in the Date Claim Made field to the customer s 16 th Birthday. 2. Click on Determine ESA Claim Type. 3. In Case More Info Details change the Date Claim Made back to the correct date. 4. Process the claim as normal

6 For telephony claims, the 'SSP End Date' will be populated automatically based on the value captured in the Strike Out Questions SmartScript. Select the Determine ESA Claim Type button and the Customer Account Management (CAM) system will validate the 'Date Claim Made' and 'Date Claiming From'. Note: For example, CAM will ensure that the 'Date Claiming From' does not precede the 'SSP End Date' and then populate the 'ESA Claim Type' field based on the customer's previous benefit details. Where the customer has been in receipt of Jobseekers Allowance (JSA), the advance ESA claim cannot be pushed into JSAPS until the JSA claim has been closed. Note: This is because we cannot hold a live JSA and ESA claim at the same time on JSAPS. Late claims The Customer Account Management (CAM) system cannot accept Employment and Support Allowance (ESA) late claim details more than 3 months earlier than the Date claim Made, however the claim must still be taken on CAM as normal. Where a claim is received more than 3 months earlier that the Date claim Made, the following action must be taken: 1. Enter the date of claim as 3 months from the Initial Date Of Contact (IDOC) into CAM. Note: For example, IDOC is 15 June 2015, claim from date is 9 February 2015, backdating can be automatically accepted for the 3 month period from 15 March 2015 to 14 June 2015 and entered into CAM as 15 March Tell the claimant that the customer statement will show a backdated claim date of no more than 3 months and this is the maximum period of backdating allowed. The earlier claim date will be noted on the system and the backdating period over 3 months will be considered by the Benefit Centre (BC) on receipt of the claim. 3. Input the correct date of claim in CAM notepad. Note: Using the example above, this would be 9 February Set a task in CAM to notify the BC of the extended backdating period. Using CAM, the BC Decision Maker (DM) will make the statutory decision on the backdating period in excess of 3 months. The decision will have to be notified to the claimant in the normal way (clerically). Wholly Retrospective claim If the claim is wholly retrospective, the reference to Work Focused Interviews in Part 17 (Wrap Up Call) of the ESA Desk Aide must not be read. The last paragraph of Part 17 contains the mention of WFI and must be read as below:

7 You may have to attend an appointment to assess your capability for work. Failure to return the ESA50 or attend or participate in the appointments may affect your benefit. In addition record the date the claimant wishes to end their claim in CAM notepad ESA reclaim gathers If an Employment and Support Allowance (ESA) interest exists that ended within 12 weeks of the date claim made and the claim sub type, customer / partner (where appropriate) are the same as the new claim made, the Customer Account Management system (CAM) sets the claim type to Rapid Reclaim and retrieves ESA claim information from the Jobseekers Allowance Payment System (JSAPS). If the previous claim sub type was ESA Income Related (IR), but has now changed to ESA Contribution based (C), CAM will set the claim as a Rapid Reclaim. However, if the previous claim was ESA (C) and the new claim is for ESA (IR), CAM will set the claim type to repeat claim. This is to ensure the CS Agent also completes the IR data gather. This data populates the individual applets in CAM, enabling the CS Agent to check whether any changes in circumstance have taken place since the last claim. Changes in the claimant s circumstances that have taken place since the last claim ended do not stop a claim being a reclaim gather for ESA. Repeat claim If there was an Employment and Support Allowance (ESA) interest that ended more than 12 weeks before the date claim made, the Customer Account Management system (CAM) sets the Claim Type to Repeat Claim. CAM re-uses the information from the Income Support Computer System (ISCS) or the Jobseekers Allowance Payment System (JSAPS), Jobseekers Allowance (JSA) or ESA claim data, to populate the individual applets in CAM and flags the claim for previous Interest Data Retrieval. Follow the same process and ask the customer the same questions as for a new claim, some re-keying of data may be avoided in a repeat claim where existing data can be re-used. Note: This action is required as some of the information transferred from ISCS or JSAPS may be out of date. Repeat claim made before 30 March 2015 Before 30 March 2015, a decision based on a Work Capability Assessment (WCA) was valid for 6 months. Where a repeat claim was made within that 6 months, the claimant could not be treated as having Limited Capability for Work (LCW) unless their condition had significantly worsened or they had developed a new health condition.

8 When a repeat claim was made after the 6 months had passed, a new award of ESA could be made even if there was no evidence that the claimant s condition had significantly worsened or that they had a new health condition. Repeat claim made on or after 30 March 2015 Due to regulations which came into force on 30 March 2015, repeat claims to ESA which are made or treated as made from the above date, are dealt with differently. If a claimant was found not to have Limited Capability for Work (LCW) following a Work Capability Assessment (WCA) on their previous claim and then makes a repeat claim, they will have to show that their health condition has: significantly worsened; or they have a new health condition before they can be awarded the assessment phase rate of ESA, pending the outcome of their WCA. This applies to all repeat claims where a claimant has previously not been found to have LCW following a WCA. Note: The amended regulations do not apply to repeat claims where a claimant was treated as not having LCW because they failed to attend a WCA or return an ESA50 questionnaire. They have also removed the 6 month time limit where a new award of ESA could be made even if there was no evidence that the claimant s condition had significantly worsened or that they had a new health condition. Payment pending appeal Where a claimant is found not to have LCW in a repeat claim which was made, or treated as made, before 30 March 2015 and their previous claim was disallowed due to not having LCW, they can be entitled to ESA pending an appeal in respect of the repeat claim. Claimants will have no entitlement to ESA pending the outcome of an appeal when they have had 2 consecutive decisions that they did not have LCW, if their repeat claim is made or treated as made on or after 30 March If a claimant still needs to claim benefit, they may choose to claim JSA/Universal Credit (UC) where they would be subject to normal JSA/UC conditionality rules which can be modified to take account of the claimant s health or disability. Existing claim held on the JSAPS If the claimant has made a new claim and there is an existing claim held on the Jobseekers Allowance Payment System (JSAPS) which has not been closed, issue an ESA1 clerical claim form for completion by the claimant as follows:

9 1. Navigate to the Contact History view to record the Contact Outcome as Blank Claim Form Issued. 2. Generate and print a Clerical Claim Cover Note from the Factual Information Network Database (FIND). 3. Issue the cover note and claim form to the claimant along with a claim form for Housing Benefit (HB) and a reply envelope. (This must be completed by the contact centre). 4. Update the Customer Account Management System (CAM) Contact History regarding forms issued. Note: If a new claim is not appropriate, handoff, signpost or transfer the claimant accordingly, update the Contact History in the Customer Account Management (CAM) system and end the call. Claims to ESA where an IB appeal is outstanding Where a claimant has previously claimed Incapacity Benefit (IB) but has now been found capable due to having failed their Personal Capability Assessment (PCA), they may choose to make a claim to Employment and Support Allowance (ESA). Note: They can do so with or without making an appeal against the IB decision. There is no longer a requirement for the claimant to claim Jobseekers Allowance (JSA) whilst their appeal is being heard. Claimants will be advised by the Benefit Centre (BC) to make a new claim for ESA via the Contact Centre (CC). However, under ESA they will still be expected to provide Statement of Fitness For Work (SoFFW) / medical evidence of their illness/disability. Claimants may contact as: their IB has been disallowed due to a failed PCA they are now appealing against that decision; and they wish to make a new claim to ESA Assuming they are still claiming as a result of an illness/disability, these claimants should be taken through the normal process via the Customer Account Management System (CAM). CAM will identify whether or not to progress the claim as ESA or IB. If CAM identifies a Handover to CMS and it becomes apparent that the claimant is still receiving Income Support (IS), a new claim to IS is not required but an IB only claim must be gathered. If the claimant is unsure whether or not IS is in payment, a claim for IB and IS must be taken. For the majority of claimants who are appealing, CIS will still hold an open IB record. This means that CAM will error at Determine Claim Type with the message E1029 Live Incompatible Benefit exists for this customer, this will change at r1.1 to read E0013 Live Incapacity Benefit or Severe

10 Disablement Allowance exists for this customer, if this occurs, an ESA1 clerical claim form must be issued. Note: In the unlikely event that these customers do not identify themselves as ill or disabled, a claim to IS or Jobseekers Allowance (JSA) must be taken by the First Contact (FC) Agent. In order for this action to be taken, the call must be transferred link to transfer action to an FC IS/JSA Agent. Linked IB or SDA claims If a previous Incapacity Benefit (IB)/Severe Disablement Allowance (SDA) claim exists and an end date is not recorded for that claim, CAM displays error message CAM Error 1029 Live Incompatible Benefit exists for this customer. Note: From 31 January 2011 there can be no new or linking claims for IB or SDA. Ask the claimant if the previous IB/SDA claim has ended and take the appropriate action depending on the response. If the claimant confirms that the IB/SDA claim has ended or does not know, issue a clerical ESA1 and HCTB1 claim form to be completed by the claimant as follows: 1. Select the Send Correspondence screen button which is located in the following applets: Case More Info Details ; HB/CTB Case Summary ; Application Summary and Personal Address. 2. Select ESA Cover Letter for ESA Claim Form and HCTB1 Form (GB) from the dropdown list. 3. This will trigger the issue of the following from the service delivery centre: ESA clerical claim cover letter blank ESA1 claim form blank HBCT1 claim form ESA 40 HBCT1 notes; and A Business Reply Envelope (BRE) for the appropriate BC Note: CTB ceased from 1 April 2013 and was replaced by Council Tax reduction (CTr), however benefit computer systems such as the Jobseekers Allowance Payment System (JSAPS) and the Customer Account Management (CAM) system will continue to display CTB This will create one Contact History record to show that an ESA claim form has been issued. When a blank ESA claim form is sent, an HCTB1 form will also be sent automatically, but this will not be detailed in the Contact History record. If the claimant states that the IB/SDA claim has not ended: 1. Signpost the claimant to the relevant Benefit Centre and give them the contact telephone number from the Factual

11 Information Network Database (FIND) 2. End the call and set your status to Available to enable you to receive your next call Live ESA claim held on the CAM If a live claim is already held on the Customer Account Management system (CAM) and the claimant contacts to make a new claim, establish the reason why a new claim is being made. If there is a valid reason for the new claim, find out if the claimant is making a new claim under special rules, is terminally ill or is vulnerable. If the claimant is claiming under special rules, terminally ill or vulnerable offer to complete the ESA1 over the phone. Note: Do not send out a clerical ESA1 claim form for completion unless specifically requested by the claimant. 1. Select the Send Correspondence screen button which is located in the following applets: Case More Info Details ; HB/CTB Case Summary ; Application Summary and Personal Address. 2. Select ESA Cover Letter for ESA Claim Form and HCTB1 Form (GB) from the dropdown list. 3. This will trigger the issue of the following from the service delivery centre: ESA clerical claim cover letter blank ESA1 claim form blank HBCT1 claim form ESA 40 HBCT1 notes; and A Business Reply Envelope (BRE) for the appropriate BC Where the claimant is not claiming under special rules, terminally ill or vulnerable, issue the ESA1 and HCTB1 claim forms to the claimant for completion as follows: This will create one Contact History record to show that an ESA claim form has been issued. When a blank ESA claim form is sent, an HCTB1 form will also be sent automatically, but this will not be detailed in the Contact History record. If a new claim is not appropriate: 1. Signpost the claimant to the relevant Benefit Centre and give them the contact telephone number from the Factual Information Network Database (FIND) 2. Update the Contact History in CAM and end the call New claim within 6 months of a WCA disallowance If the Contact Centre (CC) identifies that a new claim to Employment and Support Allowance (ESA) is made within 6 months of a Work Capability

12 Assessment (WCA) disallowance due to the claimant failing to return their ESA50 questionnaire form, they must: 1. Ask the claimant if they still have their ESA50 questionnaire. If Yes, go to step 2 If No go to step 4 2. Tell the claimant to return it to the Benefit Centre (BC) immediately and provide them with the relevant BC address using the Factual Information Network Database (FIND) 3. Set a Customer Account Management system (CAM) task to tell the BC to expect the ESA50 shortly 4. Tell the claimant that you can issue a duplicate or they can download it from GOV.UK. Tell them to complete all relevant sections and post it to the BC. 5. Input a note in CAM regarding the action taken. Note: BC staff will not make a decision on the new ESA claim until the outstanding ESA50 questionnaire has been supplied.

Initial Assessment Action

Initial Assessment Action Main benefit reply received 1. When JSAPS receives the Main Benefit reply (MBR), if it is: the same as the information retrieved by Customer Information System (CIS), JSAPS calculates