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WCA outcome Summary 1. The Healthcare Professional (HCP) role is to provide advice to the DWP Decision Maker (DM) on a claimant’s functional ability, which is objective, fully justified and evidence based.
2. The DWP DM role is to use all the documented evidence available, including recommendations provided by the HCP, to make a decision on a claimant’s entitlement to Employment and Support Allowance (ESA).
3. The final decision on a claimant's entitlement to ESA lies with the DWP DM. Potential outcomes Terminally Ill (TI) Limited Capability for Work (LCW) outcome following a previous LCW and Limited Capability for Work Related Activity (LCWRA) outcome LCW LCWRA LCW not met Failure to return questionnaire (FTRQ) Did Not Attend (DNA) WCA Receiving WCA Outcomes
4. Several different outcomes can be notified during the WCA process. Outcomes will usually be electronically available to the Benefit Centre (BC) via MSRS.
5. Any associated paperwork will be sent separately in an ESA55 to the BC.
6. When all relevant documentation/information has been received and considered (this may include any information received during the Decision Assurance Call) all WCA outcome action must be recorded on the ESA56. This is to keep track of the Decision Making Process and is a legal requirement. The ESA56 is available within DMACR. See Assessing WCA Outcomes. Note: The only exception is Did Not Attend WCA (DNA) and Failed To Return Questionnaire (FTRQ).
7. The BC will be required to update JSAPS with the outcomes of the WCA. This ensures that the WCA outcome is available for Work Coaches and the Disputes Resolution Teams. If the incapacities recorded on JSAPS do not correspond to the MSRS Report (ESA85/85a), the DM will update JSAPS accordingly.
8. The Assessment report must be checked to ensure it is fit for purpose before a WCA decision is made. If the report is not fit for purpose, take rework action.
9. Full details of how to manage WCA outcomes on MSRS are shown in the ESA MSRS User Guide.
10.Once a WCA outcome appears in the MSRS (BNRL) S372 (WCA Result Available) case control is produced. This case control alerts DWP staff that a WCA outcome is available in the MSRS BNRL.
11.All WCA outcomes will produce a S372 WAR, unless it’s a clerical referral.
12.The S372 case control matures overnight and will appear on the WAR until cleared. The case control will not appear on the Overdue Work Return (OWR).
13.The S372 case control WCA outcome reasons shown on the WAR are: 01 = ESA50 not returned 02 = Did not attend 03 = Did not attend (Mental Health) 04 = ESA50 returned late 07 = WCA outcome 09 = User Rejection 10 = Withdrawal
14.Depending on the BC operational set up, teams can either manage WCA outcomes using the S372 (WCA Outcome) WAR or by managing the BNRL daily. In all cases staff must: Step Action 1 Access MSRS to view the Assessment report. 2 Clear the customer action. 3 Input the WCA outcome result in JA674, this will clear the S372 case control. This should always be done by a DM. Viewing Electronic Output from MSRS
15.Access MSRS Browse New Response List (BNRL) on a daily basis to view the list of available outcome or notification reports The BNRL will only contain ‘authorised’ Assessment reports. Where the claimant’s NINO is entered any ‘Assessment’ reports may be visible on MSRS. A draft report is where the report is undergoing audit following an assessment. Do not use the draft report. If this is a Centre for Health and Disability (CHDA) audit then it will be clearly marked as an audit. Receiving the ESA55 Supporting Case File
16.Where MSRS indicates that there is a Supporting Case File (SCF), do not action the electronic Assessment report until you receive the paperwork. If you do not receive the SCF within five working days contact the Health Assessment Advisory Service by telephone to check status.
17.When you receive the SCF, or MSRS indicates there is no SCF, take the following action: Step Action 1. Access the individual claimant’s account in MSRS. 2. Review MSRS Assessment reports along with the SCF and refer the case to the relevant DM, if a decision can be made at this time. Note: If a decision cant be made at this time, as the case is a DNA case and further evidence is required, see Did Not Attend (DNA). 3. Clear ‘customer action’ on MSRS. 4. Access the claimant’s account in JSAPS screen JA674693 ‘PCA Assessment Details’ and record the return date in ‘Return from MSRS Date’ as follows: if no SCF, record the date the outcome was received in the BNRL if SCF, record the date of receipt Claimant within 91 days of State Pension Age
18.When it has been confirmed the claimant has LCW or LCW and LCWRA, the following action must be taken: Step Action 1. Check if the claimant’s next review WCA will be within 91 days of their State Pension Age (SPA), before inputting the prognosis. This can be calculated by using the State Pension Calculator. 2. If not within 91 days of their SPA input details as normal. 3. If the claimant is within 91 days of their SPA, extend the prognosis by 3 months. Note: the WCA commences 2 months before the end of the prognosis period. 4. Note JSAPS to explain the extension of prognosis. Example - Claimant was born 01/07/1951. Claimant’s face to face conducted 16/03/2016.Prognosis 3 months which will take them to 15/06/2016. Using the SPA calculator the claimant will become entitled to their state pension on 1/07/2016, therefore the review would commence within 91days of their SPA. You should advance the prognosis period to 6 months. Missing or lost Supporting Case File between Health Assessment Advisory Service and DWP WCA Team Action
19.The Supporting Case File (SCF) or ESA55 should be received by WCA Teams within 5 working days of appearing on the Browse New Response List (BNRL). The first working day following the SCF entry in the BNRL is day one. Note: It is not always the medical advice outcome date, for example the case was selected for Quality Audit check. 20.On day 6 the WCA Team should notify the Health Assessment Advisory Service Team Leader if the SCF has not been received. A local search should be requested to establish its whereabouts and forward to the WCA Team
21.If by day 11 the SCF has still not been received by the WCA Team, the
matter should be referred to the Health Services Directorate (HSD)
Performance Manager (PM).
22.If the SCF cannot be found the Health Assessment Advisory Service Site
Security Manager should investigate the matter by taking the following
action:
arrange full Office Stop and Search
identify courier service issues for escalation with TNT
contact the DWP Nominated Site Manager to request full Benefit Centre
(BC) Stop and Search and FARIO check
23.If the SCF cannot be found by day 20 but is still considered to be within
the office environment, the HSD PM should agree responsibility for
rebuilding the case with the DWP.
24. It is for the DWP to rebuild the case as they own the ESA Customer
Journey.
25.The HSD PM should advise the DWP Nominated Site Security Manager
for a decision to be taken when missing SCF action is taken.
Action to be taken by WCA Team Manager (Band C)
26.The following action should be taken by the Band C Manager:
Step Action
1. Clear the ‘customer action’ in BNRL.
2. Refer to the Decision Maker (DM) to determine if there is
enough information to determine the outcome or if another
ESA50 is required.
3. Refer case to the Operational Security Team In-Box for
background checks to identify any irregularities.
Missing Supporting Case File found
27.If a missing SCF is found at a later date, notify the nominated DWP Site
Security Manager for them to take the following action:
Step Action
1. Advise the HSD (PM).
2. Update the Missing document Control record.
3. Arrange for duplicate file and original file to be amalgamated.
4. Email the Operational Security Team In-Box to inform them
the missing case has been found.
Requesting Rework and Reconsiderations
28.See: Reconsideration and Rework Good Practice Guidance
Assessing WCA Outcomes
Terminally Ill outcome report received
29.The processor will check if it is a Special Rules (SR) referral or a
Terminally Ill(TI) referral:
Special Rules- This only applies when you are notified at the beginning
of a new claim or within the initial claim referral period
Terminally ill- A claimant can report they are terminally ill at any point
throughout the life of their claim. If it is after the initial WCA they are
still referred as TI but they do not have the benefit of the SRTI cases
as they do not get their waiting days repaid
30.If the Health Assessment Advisory Service confirms the claimant fits the
criteria to be classed as TI then an immediate response will be returned
to the Benefit Centre (BC). The Decision Maker (DM) will decide if SR or
TI applies. This will be normally notified via the BNRL of an outcome. The
report form will be an ESA85A.
31.The Health Assessment Advisory Service will return all documentary
evidence to the BC in an ESA55. The Assessment report will be retrieved
from MSRS by the DM, who will decide the claimant's classification
based on:
a DS1500 if one is held (this may be held by PIP)
ESA85A
any other medical evidence available
32.Where the DM awards support group under Special rules, the DM will
record the decision type and decision effective date on Jobseekers
Allowance Payment System (JSAPS). This will allow the claimant to have
the first seven waiting days removed, if the decision is that they are
considered to be SRTI from day one of the claim, and also allow payment
of ESA at the Support Group rate to be paid immediately from the
decision effective date (in this instance the date of claim.)
33.Where Support Group is awarded from the outset of the claim, take the
following action in JSAPS:
Step Action
1. Register a change of circumstance event in JA60, in JA060062
input event type 02 (CoC) and subtype 18 (multiple/others)
2. Access JA610636 ‘pick list’ and select ‘Health Details’.
3. Remove the Special Rules indicator.
Note: It is important to remove the Special Rules indicator from
JA610636 before the WCA outcome is recorded, to ensure the
assessment is processed correctly.
4. Assess claim through JA200 and JA405, then access
JA674693 and input return from MSRS date.
5. Access JA674694 and input:
Decision date
Decision type 01 for LCW and 03 for Terminally Ill
Decision effective from date
6. Input the next WCA date for 3 years.
7. Note Destruction Date on ESA55 when received, see archiving
Medical Evidence.
34.Where a terminal illness is identified but a claim has not been made
under Special Rules the Support Group component is awarded from the
92nd day.
Note: You must always check if the claimant has had a JSA Extended Period
of Sickness (EPS)
Harmful Information
35.A claimant may be classed as TI without claiming under Special Rules.
Usually in these circumstances the claimant and, or their representative
is unaware of the claimant’s terminally ill status.
36.Where a claimant and, or representative request a copy or details of the
assessment report, Benefit Centre (BC) staff must check the ’Harmful
Information’ section and the main body of the medical report for any
reference to terminal illness. Do not make the claimant and, or
representative aware of terminal illness where they are not already aware
of the diagnosis.
37.If there is reference to the claimant being TI within the report, not just on
the Harmful Information page, you must ask the HAAS to remove all
references to the claimant being TI before issuing it.
38.Harmful information must not be disclosed to the claimant and, or
representative. When sending a copy of the assessment report to a
claimant or representative never print out the ‘Harmful Information’ page,
even if the page is blank.
Important final action on all SRTI & TI cases
39.All cases where TI has been accepted the Special Rules flag must be set
in JA674. If the 3 year period is exceeded they become LCWRA.
40.Where the SR flag has been removed to allow full award from the outset
of the claim as user set case control needs to be set for the next working
day to open a new event in JA674, restate the WCA outcome, 3 year
prognosis and reset the SG flag.
41.On maturity of the 3 year WCA referral the case should be referred on
MSRS as an LCWRA ref, noting a previously TI marker held.
LCW or LCW and LCWRA Met Under WCA (WRAG or SG)
42.Claimants can be recommended for WRAG or SG by demonstrating
functional impairment, as determined by the WCA descriptors, or by
applying Regulation 29(2) for WRAG or Regulation 35(2) for SG.
43.ESA Regulations 29(2) and 35(2) were developed for “exceptional
circumstances” where claimants who do not have functional impairment
as determined by the WCA descriptors, can be placed in the work-related
activity group (Regulation 29) or support group (Regulation 35) if there
would otherwise be a substantial risk to the mental or physical health of
any person. Substantial risk is taken to include significant deterioration in
a claimant’s health condition and violence to others or a risk of self-harm
or suicide. See: Reg 29 and Reg 35 changes to Health Care Professional
(HCP) instructions from 11.1.16
44.Where the DM makes a decision that the claimant has LCW and is in the
Work Related Activity Group or has Limited Capability for Work Related
Soz, I can see what you mean that was just the way it was copied and pasted, will try and format following pages (as did previously) into something a bit more readable.
Perhaps Debbie is privy to the full document and could post a workable link?
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