MEDICAL SERVICES 
PROVIDED ON BEHALF OF THE DEPARTMENT FOR WORK AND PENSIONS 
 
 
 
 
 
Training & Development  
 
ESA Filework Guidelines 
(For Health Care Professionals) 
 
 
MED-ESAFWG~001 
 
Version: 7 Final  
 
 1 June 2012 
 
 
 
 
 
 
 
 
 
 
 

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Medical Services 
 
Foreword  
 
This document has been produced as part of a training programme for Health 
Care Professionals approved by the Department for Work and Pensions Chief 
Medical Adviser to carry out benefit assessment work. 
All Health Care Professionals undertaking medical assessments must be 
registered medical or nursing practitioners, or physiotherapists who in addition, 
have undergone training in disability assessment medicine and specific training in 
the relevant benefit areas. The training includes theory training in a classroom 
setting, supervised practical training, and a demonstration of understanding as 
assessed by quality audit. 
This document must be read with the understanding that, as experienced 
practitioners and disability analysts, the Health Care Professionals will have 
detailed knowledge of the principles and practice of relevant diagnostic 
techniques and therefore such information is not contained in this training 
module. 
In addition, the document is not a stand-alone document, and forms only a part of 
the training and written documentation that a Health Care Professional receives. 
As disability assessment is a practical occupation, much of the guidance also 
involves verbal information and coaching. 
Thus, although the document may be of interest to non-medical readers, it must 
be remembered that some of the information may not be readily understood 
without background medical knowledge and an awareness of the other training 
given to Health Care Professionals. 
 
Office of the Chief Medical Adviser 
June 2012 
 
 
ESA Filework Guidelines 
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Document control 
Superseded documents  
          Version history 
Version Date 
Comments 
7 Final 
1 June2012 
Signed off by CMMS 
7c draft 
28th March 2012 
External QA comments HWD & further internal 
comments incorporated and updates to 
standards 
7b draft 
25th January 2012 
Internal QA comments Medical Training & 
Development incorporated 
7a draft 
05 January 2012 
Schedule 28 Review Medical Training & 
Development 
6 Final 
16th December 2010 
Signed off by CMMS 
Changes since last version 
Key Additions & Clarification 
  Addition of new appendices and change in order: 
Appendix A: Revised WCA 2011 Support Groups 
Appendix B: Revised WCA 2011 LCW Descriptors 
Appendix C: ESA 2008 Support Groups 
Appendix D: ESA 2008 LCW Descriptors 
Appendix E: IB \ PCA Descriptors & Exemption Categories 
Appendix F: Prognosis Matrix  
Appendix G (Previously appendix A): Glossary of Terms.  
  Section 2.3.1 FRR4 details and PV status to list of available MSRS information 
/evidence. 
  Section 2.3.2 after first set of bullet points - reason for recording key clerical points of 
evidence on MSRS. 
  New Sub section 2.4.1 added – information previously in 6.2.4 Medical Knowledge of 
Condition. 
  2.5.2 Under Potential Review Criteria – emphasis on recording FRR4 electronically 
except in sensitive cases. 
  Section 3 Text box added to reflect Update to Standards 13/2012 and the process for 
IBR TI cases 
  Section 5 subdivided into 2 sections; 
5.1 General LCWRA only Referrals & 5.2 Income Related ESA LCWRA Only 
Referrals (to reflect UTS 38/2011). 
  In new Section 5.1 – updated how to handle situation where new evidence conflicts 
with DM decision to treat as LCW. 
  In new Section 5.1 - added reference to special support groups. 
  Section 6.1 ESA Re-referral Scrutiny- added clarification that full reports may not 
always be visible. 
 
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  Section 6.1 ESA Re-referral Scrutiny – added clarification of need to satisfy self that 
LCW threshold was likely to have been met and is still appropriate when ESA 85 not 
available at re-referral. Added a summary box of key points in re –referral advice. 
  Section 6.2.1 MSRS Information – added comment about evidence available from 
reconsiderations. (UTS14/2001) 
  Section 6.2.3 MSRS/ESA 55 information – deleting reference to section 3.3 and 
adding correct section reference (2.4 Analysis of the Evidence & 2.5 Deferring for 
FME in ESA Filework). 
  Section 6.2.3 Case scenarios updated to make more applicable to 2011 regulations. 
  New Section 8.3 The Work Programme added. 
  New Section 10.5 Miscellaneous ESA Filework. (Covering aspects of CZ and CN 
advice referrals). 
 
The following is a list of key deletions made to these guidelines: 
 
  Removal of references to 2008 regulations 
Section 1.1 paragraph1; Section 2.1.1 throughout; Section 4.1 paragraph 10; Section 
5 throughout. 
 
  Removal of references to the IB Handbook (obsolete) 
Section 1.1 last paragraph; Section 7.3.3 
 
  Removal of reference to the ESA Handbook 
1.1 final paragraph; 2.1.1 throughout; Section 3; Section 5 throughout. 
 
  Section 11.3 Doctor Approval removed. Users can now refer to  
  Removed - Appendix B:Users can refer to the full standalone document on LiveLink  
(MED-NEURODA~001 Neurological Condition List by Practitioner Type) 
 
Outstanding issues and omissions 
Updates to Standards incorporated 
Update to Standard 09/2012, 12/2012 &13/2012,  incorporated 
Issue control 
Author: 
Medical Training and Development Team 
 
Owner and approver: 
The National Clinical Manager (Performance) 
 
Signature: Date: 
 
Distribution: 
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Medical Services 
 
Contents 
1. 
 
Introduction
6 
2. 
General Principles of ESA File
 
work
9 
3. 
The Speci
 21
al Rules Check (TI check)
 
4. 
 24
The Pre-Board Check
 
5. 
LCWRA Only Referr
 26
als
 
6. 
ESA Re-referral File
 29
work
 
7. 
IB Re-assessment Scrutin  36
y
 
8. 
Prognosis 41 
9. 
 47
Justification
 
10. 
Miscellaneous 49 
11. 
 57
Medical Quality
 
Appendix A -  Revised WCA 2011 Support Group Functional 
  
Categories
58 
Appendix B -  Revised WCA 2011 LC
 61
W Descriptors
 
Appendix C - 
 67
ESA 2008 Functional Support Group Categories
 
Appendix D - 
 71
ESA 2008 LCW Descriptors
 
Appendix E -  IB \ PCA Descriptors & Exemption Catego
 82
ries
 
Appendix F - 
 87
Prognosis Matrix
 
Appendix G -  Glossary
 88
 of Terms
 
Observation form 91 
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1.  Introduction 
1.1  Introduction 
The Employment and Support Allowance was introduced in 2008. A process of 
review of the ESA 2008 regulations was carried out and revised regulations 
implemented in March 2011. From that period, most claims were assessed under 
the new regulations. The new assessment is referred to as the Revised Work 
Capability Assessment (WCA).There was a period of transition lasting 6 months 
where some claimants will continue to be assessed under the 2008 regulations until 
these were phased out in September 2011. All referrals are now considered under 
the 2011 Regulations. 
This guideline will refer to filework under the 2011 Regulations. Only where relevant 
will reference be made to other regulations. (For reference the 2008 regulations 
functional support group criteria are listed in Appendix C. The 2008 LCW descriptors 
are listed in Appendices D. Similarly, IB descriptors and exemption categories are 
listed in Appendix E.) 
The purpose of the Employment and Support Allowance (ESA) filework process is to 
identify those individuals for whom advice on limited capability for work / work 
related activity can be provided without the need for a face to face examination. 
There are 4 such categories where the available evidence suggests that the 
claimant: 
1.  has severe functional restriction fulfilling criteria for inclusion in the Support 
Group. 
2.  meets the criteria for inclusion in the Support Group on other grounds that don’t 
directly measure function (such as terminal illness). 
3.  fulfils criteria for being treated as having limited capability for work (LCW) where 
adequate evidence is also available to advise on limited capability for work 
related activity (LCWRA). 
4.  continues to meet the threshold of LCW in cases where they have previously 
been identified as having LCW at a medical examination or those who have 
previously been accepted to be unfit for work under the PCA regulations where 
the evidence suggests they are likely to reach the threshold of LCW\LCWRA 
under the 2011 regulations. 
 
These areas are covered in more detail in the next section (2.1.1) 
These Filework Guidelines have been written to support existing and New Entrant 
Health Care Professionals (HCPs) in their training and in carrying out Filework 
related to Employment and Support Allowance (ESA). Before HCPs can provide 
filework advice to Decision Makers, they must be fully approved in ESA 
examinations, and they must have completed an appropriate approved filework 
training course and demonstrated competency during this course. 
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 This document provides guidance for HCPs undertaking all ESA filework activities. 
It is not intended to provide HCPs with a comprehensive overview of ESA.  
HCPs undertaking filework will be expected to be familiar with the content of the 
Revised WCA Handbook to understand the ethos, structure and fundamental 
principles of Employment and Support Allowance. Therefore throughout this 
document, references will be made to guidance in the Revised WCA Handbook. 
This document will also make reference to Atos Healthcare “Livelink” for accessing 
the most up to date copies of various forms that may be referred to in this guidance. 
HCPs are also expected to be familiar with the EBM protocols and should provide 
advice in keeping with these guidelines. It is expected that all HCPs providing ESA 
Filework advice will have access to the Revised WCA Handbook, Technical guides, 
EBM protocols and the LiMA Repository to refer to as required. A Glossary is 
provided at Appendix G listing some abbreviations used throughout this document. 
1.2  Categories of ESA Filework 
This document will provide guidance on the various categories of filework. These 
are: 
  The Terminal Illness (TI) check (or Special Rules (SR) check). 
You will hear the process referred to by both names. For the remainder of this 
document this process will be referred to as the TI check to avoid confusion. 
This process requires urgent attention and rapid progression of the claim as 
the main purpose of this stage of filework is to identify those with a 
terminal illness. Further details of this process can be found in the TI check 
section of this document. 
   The Pre-Board Check  
This process aims to identify those with the most serious problems who 
satisfy criteria for entry into the Support Group. Some other outcomes are 
possible at this stage and will be considered in the Pre-board Check section of 
this document. 
  LCWRA only advice referrals  
This process relates to circumstances where the DM has already accepted 
that the client can be treated as having limited capability for work due to 
specific circumstances such as pregnancy around date of confinement, 
Public Health Order, regular treatment, hospital inpatient treatment or special 
income related circumstances. The DM will require advice at this stage 
about whether or not the claimant meets criteria for Support Group 
inclusion. Further detail of this process can be found in the section “LCWRA 
Only Referrals”.  
 
 
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  Re-referral scrutiny 
This process relates to claimants who have previously had a face to face 
examination for ESA. There are a number of different outcomes possible at 
re-referral scrutiny and these will be considered in the re-referral scrutiny 
section of this document.  
  IB Re-assessment scrutiny 
This process relates to claimants who have previously been assessed 
under the Incapacity Benefit Regulations.  From March 2011 assessment 
under the Revised WCA regulations commenced for claimants on Incapacity 
Benefit. Further detail of this process can be found in the section “IB 
Reassessment  Scrutiny”. 
1.3  Objectives 
The specific objective for the ESA Filework Guidelines is: 
  To ensure that HCPs adopt a nationally agreed framework for providing the 
ESA filework service, which is common to all business units. 
Adherence to the ESA Filework Guidelines will ensure that medical advice is: 
 Consistent 
 Auditable 
 
  In keeping with the policy requirement. 
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2.  General Principles of ESA Filework 
2.1  Purpose of ESA Filework 
2.1.1 
General Considerations 
As part of the Welfare Reform Act 2007, the Department for Work and Pensions 
introduced Employment and Support Allowance (ESA).  
The intention of Employment and Support Allowance is to identify individuals who 
have: 
1.  Limited Capability for Work (LCW) 
 
Individuals with limited capability for work have a level of disability, defined in 
the legislation, at which it is unreasonable to require them to work. This may be 
due to functional restriction or by meeting certain specific criteria, for example 
undergoing radiotherapy. 
 
Further guidance on criteria for “treat as LCW” and the functional criteria for LCW 
(2011 Regulations) can be found in the Revised WCA Handbook. 
2.  Limited Capability for Work Related Activity (LCWRA) 
Individuals with Limited Capability for Work Related Activity have a severe level 
of disability such that it would be unreasonable to require them to work or 
participate in activities such as training or rehabilitation to help them return to the 
workplace. Those individuals who have LCWRA are considered to be in the 
“Support Group”. This may be due to severe functional restriction or by meeting 
certain specific criteria such as undergoing certain types of chemotherapy or 
being diagnosed with a terminal illness. 
Further guidance on criteria for the Support Group (2011 Regulations) can be 
found in the Revised WCA Handbook. 
The assessment of capability for work and ability to undertake work related 
activity (LCW/LCWRA status) will be determined by the JobCentre Plus (JCP) 
Decision Maker (DM). The DM will consider all the available evidence. In some 
circumstances, the Decision Maker may be able to determine that the claimant 
can be “treated as having LCW” where specific criteria apply, however in most 
cases, the DM will refer the case to Atos Healthcare for advice on whether the 
claimant fulfils criteria to be considered as having Limited Capability for Work and 
whether they have Limited Capability for Work Related Activity. 
LCW and LCWRA status may be established through advice given at the initial 
filework stage without the need for a face to face medical examination, however 
in the majority of cases, a face to face examination (LCW/LCWRA medical 
examination) will be required to assess functional abilities and limitations in areas 
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of physical, mental, cognitive and intellectual function. The DM will review advice 
provided by Atos Healthcare before determining benefit entitlement. 
 
Although most claimants will be seen for an initial referral, there are some whose 
level of disability is such that it would not be appropriate to require them to attend 
for an examination. This is usually due to them having very severe illness or 
disability resulting in inclusion in the Support Group. 
 
In re-referral cases (ESA or IB re-assessment), not all claimants will need a 
further exam. If there is evidence that the claimant would meet criteria to be 
considered as having LCW or LCWRA, it may be possible to advise, without the 
need for a face to face examination, that it is likely that the claimant has LCW or 
indeed LCWRA.  
The initial assessment process is intended to be carried out between weeks 8 
and 12 after the first date of claim. 
In each type of filework, there are different possible outcomes. Each “type” of 
filework and the advice that can be given will be considered in greater detail in 
appropriate sections of this document. 
2.2  Overview 
The majority of ESA filework is accessed, completed and advice submitted to the 
Decision Maker electronically via MSRS (Medical Services Referral System) an 
automated case management and workflow system. The advice is completed on the 
form ESA85A through the LiMA application and submitted electronically to the 
Decision Maker. The only exception to this is certain highly sensitive cases, for 
example, MPs, gender reassignment, VIPs, members of the Royal household or 
people in witness protection. 
In each type of filework advice, the HCP will have to consider the information and 
evidence available to them, determine whether further evidence is required and then 
provide and justify their advice to the Decision Maker. 
In each case, the advice provided must be objective and impartial, in keeping with 
the consensus of medical opinion and on the balance of probability. 
2.3  Sources of Evidence/ Information 
The HCP, when providing advice, must consider all the evidence available. 
This may be found in:  
1. The MSRS application 
2.  The ESA 55 jacket 
 
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2.3.1  MSRS Information 
Within the MSRS application, all the evidence must be considered in order to 
provide an opinion. Some examples of evidence that may be available include: 
  The claimant’s age 
 Appointee 
status 
  Certified cause of incapacity 
  Previous filework advice outputs (ESA 85As & IB85As) 
  Previous LCW/LCWRA examination reports (ESA 85s) 
  Previous Personal Capability Assessment reports (IB85s) 
 FRR4 
details 
 UCB 
status 
Claimant Age 
The claimant’s age must be considered as this may impact upon the likely level of 
disability caused by their medical problem.  
Appointee Status 
It is important to check whether or not the claimant has an appointee as this may 
impact on the requirement to obtain further medical evidence. This may be 
extremely important in Mental Function problems suggesting that the claimant has a 
significant level of impairment. 
Cause of Incapacity 
The cause of incapacity noted on MSRS must be considered. This may be listed as 
“MED3” or “FRR4”. Information noted on MSRS as MED 3 implies that this is 
information provided by a Healthcare Provider. Information provided as FRR4 
details is information that has been provided by the claimant. Further detail may be 
obtained by referring to the technical guide available on LiveLink 
Previous ESA 85As/Previous IB85As 
Previous ESA 85As should be considered in every case where they are available as 
they may provide useful information from previous referrals. IB85As may provide 
information of relevance when considering whether the person may meet the 
LCW/LCWRA threshold of the Revised WCA.  
Previous ESA 85s 
If the case has been referred for re-referral scrutiny, previous ESA 85 reports should 
be available for review. A well completed, and well justified ESA 85 report will often 
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provide the best source of evidence for the scrutinising HCP but care must be taken 
to review the report with care checking for listed conditions and consistency within 
the report. More detail will be provided on evaluating the ESA 85 in the section of 
this handbook looking at “Re-referral Scrutiny”. The ESA 85 may have been 
completed under the 2008 Regulations and care must be taken to consider the 
application of this report in the context of the 2011 Regulations. 
An ESA 85 may also be available where the claimant has been examined and found 
to be in the Support Group. These cases will be referred back to Atos Healthcare for 
a Pre-board check. Although the ESA 85 may not be fully completed, there may still 
be valuable information in the report. 
Previous IB 85s 
A person may previously have been assessed under the Incapacity Benefit 
regulations and then referred under the WCA regulations. Although the descriptors 
are very different in IB, the report may still contain evidence that suggests they may 
meet criteria to be considered as LCW/LCWRA in the context of the Revised WCA. 
(See Appendix E for IB\PCA descriptors.) 
FRR4 details 
MSRS allows the HCP to record any telephone contact with the GP/ Consultant etc 
electronically. This information may be of use in many types of Filework and must be 
carefully considered. 
UCB Status 
Careful consideration should be given to the reason for UCB status. If this is likely 
due to the medical condition, this should be taken into consideration in evaluating 
the evidence and giving advice. The safety of colleagues also needs to be 
considered. All the UCB documentation must be viewed before calling for exam 
(MEC or DV). If the UCB documentation is not available on MSRS, the file must be 
returned to the Administration Section to obtain a full account of the reasons for the 
UCB status. (Refer to the latest update to standards Issue 12/2012 available on 
LiveLink. The former PV procedures have are under review and as 19/03/2012 the 
DWP no longer refer to PV procedures.) 
2.3.2  Evidence/Information contained in the ESA 55 Jacket 
The amount of information in the ESA 55 will vary in each case. If a case has been 
referred clerically – for example a sensitive case – there will be no MSRS record 
and all documents will be held clerically in the ESA55. All information must be 
considered and evaluated. The information could include: 
  Information provided by the claimant on form ESA 50 or ESA 50A 
  Further Medical Evidence (FME) on form 113, FRR2, FRR3, or letters from 
health care professionals involved in the claimant’s treatment 
  Notes of telephone contacts from a Healthcare Provider or the claimant on 
form FRR4 
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  Documentation from JCP 
Remember that in non-sensitive cases, where clerical information is present and 
used in giving advice, it is very important to record the key points of this evidence \ 
information in any electronic justification. This allows makes the key features 
available for future reference. For example, key features such as type of treatment 
and length of any planned therapy, prominent clinical signs that may be recorded in 
the 113. 
ESA50 /ESA50A Information 
The ESA 50 or ESA 50A (where the referral is LCWRA only) is the claimant’s form, 
and provides them with the opportunity to provide details about their medical 
conditions, functional problems and abilities. An ESA 50 or ESA 50A may not 
always be present since claimants with Mental Function problems cannot be 
compelled to complete either form. Where completed, the information must be 
carefully considered. Within the ESA 50/50A you may find copies of hospital letters, 
repeat prescription sheets, details of whether or not they are in receipt of DLA etc. 
All this information must be considered. 
Further Medical Evidence (FME) 
FME may be present in the file. This may have been requested during the current 
referral when another HCP felt FME was essential in order to provide advice on the 
case. In most cases, this will be form 113 sent to the GP or form FRR3 sent to 
another Health Care Professional. In some cases, where specific information is 
being sought, form FRR2 may have been sent out to a Healthcare Provider involved 
in the patient’s care. (Copies of forms 113, FRR3 and FRR2 can be found on 
Livelink). From time to time health care professionals involved in the claimant’s care 
may submit letters containing information about the claimant.  
 
FRR4 – Telephone advice minute 
Form FRR4 is a telephone advice minute. Details of conversations must be 
recorded on this form. This is used to document any communication with the 
claimant, GP or any Healthcare Provider involved in the claimant’s care. In most 
cases, the electronic version of this form will be used, but clerical forms may be 
available in sensitive cases or on occasion from a previous referral. 
 
Documentation from JCP 
Sometimes, JCP attaches information relevant to a case. This could be where a 
claimant has failed to attend an allocated appointment. Often this will be due to 
administrative issues such as the appointment letter arriving late or the claimant 
having problems with mail delivery, however, at times the claimant will have 
provided detail that they were unwell or admitted to hospital at the time of the 
appointment. You should consider whether it may indicate a serious problem or 
deterioration in their condition, where FME may be appropriate. 
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2.4  Analysis of the Evidence 
 
When undertaking filework, you must be able to evaluate evidence and weigh up the 
different types of evidence available to you. There may well be conflicting pieces of 
evidence on file and your role, as the scrutinising HCP, is to consider each piece of 
evidence carefully and advise based on the strongest evidence. 
 
When scrutinising filework cases there are 5 fundamental areas of documentary 
evidence where the HCP has to apply evaluation skills.  These are: 
 
1.  Medical Knowledge 
This is what is learnt through training and experience (the consensus of medical 
opinion). It is important to recognise that there are limitations to the extent of the 
usefulness of this element in the evaluation process.  It provides a reliable indicator to 
the HCP about the level of disability that might reasonably be expected but its 
usefulness may be limited by providing generalised “broad brush” advice which is not 
directly relevant to an individual. 
 
2.  Independent Medical Evidence (IME) 
 
This is information which has been provided by a Healthcare Provider such as the 
claimant’s GP or a member of the Community Mental Health Team.  They can be 
seen to be independent because they are not representing only the customer's 
perspective.  Primarily the information will be factual; it may be derived from the Med 
3, 113 or even the ESA50 / 50A.   
IME may also be taken from a previous, well completed and justified ESA85. 
 
3.  Independent Medical Opinion (IMO) 
 
Within IME on occasions an opinion may be offered (e.g. "unable to work"); the value 
of such opinions need to considered in the context in which they are given and may 
on occasion be overridden by the Disability Analyst HCP. However, it may include 
useful information about function. It is obtained from a variety of sources, usually a 
Healthcare Provider who is involved in the management of the claimant’s medical 
condition(s). It can assist the HCP in formulating a more holistic view about the 
claimant’s medical conditions, their interaction, how they respond to treatment and 
their effect on the individual’s function; not only from a medical model, but also from a 
psychosocial aspect. 
 
4.  Medical Information (MI) 
This comes from a non-medical source, e.g. the claimant or their representative. It 
includes details of symptoms, medication, hospital attendance, etc. For example, 
they may indicate a BMI of 36 or may list their daily peak flows.  Normally the 
information provided does not directly describe functional loss, although on 
occasions it may do. For example, a claimant may indicate “I had a treadmill test for 
angina and only managed on the machine for 6 minutes”.  
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 It may not and does not have to be verified but could be verifiable if we chose to 
ask for IME.  For it to be used effectively it has to be both internally consistent with 
itself and with the IME and IMO on file.  It is important to note that “consistent with” 
does not mean “supported by”. If the information is consistent, there is no need to 
doubt or exclude it. In terms of IME, in many cases you will have the Med 3 
diagnosis, on MSRS.  In most circumstances the evidence will not be strong enough 
to stand alone.  However, in many instances it will indicate the presence of a 
condition in which there is a possible wide range of disability, from mild to severe.   
Where the other aspects of the evidence – both the CPO and MI – support severe 
restriction, it may well be possible to accept physical incapacity leading to Support 
Group inclusion without further evidence, even in a first referral.  Further medical 
evidence – such as a 113 – is then not essential. Medical Information and claimant 
provided opinion will often be present in an ESA 50 and both types of evidence 
should be considered when forming an opinion on likely level of function.  
 
5.  Claimant Provided Opinion (CPO) 
 
This refers to reported symptoms and functional loss and is usually derived from 
documentation provided by the claimant.  It may include opinion from a relative or 
carer who is representing the claimant.  This evidence is therefore not independent.   
Remember that the claimant may have understated or overstated their problems. 
However, this evidence still forms an important part of the overall evidence that 
requires evaluation in the Disability Analysis process. 
With CPO, additional MI may be provided.  For example, a claimant may have 
detailed in the ESA 50 that they cannot walk more than about 5 metres without 
getting breathless. They are breathless even on washing and dressing. This would 
be CPO.  
The claimant may indicate they are on home nebulisers 4 times daily for COPD and 
require home oxygen. They indicate they have been provided with a wheelchair by 
their Respiratory Consultant for their daughter to push them in outdoors. They have 
had an Occupational Therapy review and hoists and bathing aids have been 
installed in the home. They have been provided with a carer by social services to 
help with bathing as they are too breathless to mange this alone. This would be 
Medical Fact that would be potentially consistent with the CPO. 
The Med 3 information may indicate “severe COPD – oxygen dependent”. This 
Independent medical evidence would be reasonably consistent with the MF and 
CPO and a high level of disability could be accepted. 
Even in cases where the Med 3 diagnosis suggests Severe Mental Illness or Severe 
Learning Disability, where the ESA50 indicates a high level of symptoms, treatment 
and community or hospital support, and this is supported by Medical Fact, you still 
need consider whether there is sufficient information about function for you to advise 
Support Group inclusion or acceptance at re-referral scrutiny.   
In those instances where the situation is unclear, in order to give robust advice from 
a position of strength, you may need to consider obtaining further Medical Evidence.  
Medical evidence including that from the claimant's own GP or other Doctor(s) can 
be very useful in forming a decision not to call the claimant for examination.  The 
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best medical evidence in a re-referral case will normally be a good ESA85 report 
completed at a previous referral during that spell of incapacity for work. Where there 
is a previous LiMA report you can access this through MSRS.   
Sometimes the ESA50 will indicate that DLA is in payment.  This information should 
not be considered to be sufficient to allow you to accept incapacity.  You have not 
had the opportunity to evaluate the evidence used to make the decision. You should 
use it rather as an indicator of possible severity; it may prompt you to go for further 
evidence in a case where you would otherwise call for examination. 
Rarely the ESA50 may contain information that has not been revealed to, or 
reported by, the GP. You will have to decide how much weight to place on each item 
of evidence, given the circumstances of the case under consideration, in order to 
provide advice in accordance with the guidelines.  
2.4.1  Using Medical Knowledge of Condition 
In all types of filework, the decision to “call”,” accept” or “request FME” must be 
based on the evidence available and with a background of knowledge of the medical 
conditions claimed. All HCPs must provide advice which is evidence based and in 
keeping with the consensus of medical opinion. 
HCPs are referred to the EBM protocols and the LiMA Repository for further 
guidance. 
2.5  Deferring for FME in ESA Filework 
Atos Healthcare HCPs are best placed to determine when it is appropriate to 
request fresh medical evidence from the claimant’s GP or other Healthcare Provider. 
HCPs must be aware of the issue of consent when requesting FME. 
2.5.1  Consent for Further Medical Evidence in ESA 
 
Claims for Employment and Support Allowance (ESA) are made over the telephone.  
As part of the claims process, a declaration is read to the claimant.  They must agree 
this declaration before the claim is accepted.  An audio recording is made of this 
verbal consent. This will be retained by the Department for Work and Pensions 
(DWP) as a documentary record of consent for the life of the claim.   
 
As consent will be held in every case, FME can be requested whether or not an ESA 
declaration has been signed. 
 
FME gathered by telephone 
 
In urgent cases, for example terminally ill (TI) cases, the Health Care Professional 
may well need to phone the GP or other Healthcare Provider to obtain evidence.  
From time to time you will be asked to provide evidence that consent is held. 
 
If such a request is made, the HCP should undertake to fax this evidence of consent.  
Request details of a fax number and then complete form ESAC* and fax this with a 
cover sheet.   
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Once this has been faxed, the HCP should call the Healthcare Provider again.  If the 
Healthcare Provider remains unwilling to divulge clinical details then an ESA 113 
should be despatched via MSRS. The HCP should ensure that any fax sent with 
claimant details is in accordance with the current Atos Healthcare security policies. 
*Note: The ESAC is available on, and should be accessed from, LiveLink. 
 
You should use this same process where an ESA113 has been issued but the 
Healthcare Provider calls you to request evidence of consent. 
 
Consent requested by written correspondence 
 
When a request for consent is received by post, the administrator or HCP should 
access MSRS to establish the current status of the referral. 
 
If the referral has progressed to ‘workstack’ or beyond, then the request should be 
disposed of in confidential waste and no further action taken. 
 
If the referral is awaiting the return of the ESA 113, at Pre-board Check, then the 
request should be passed to a Team Leader.  The Team Leader should contact the 
healthcare provider’s location and explain that they have received the request and 
that they will fax the above consent letter along with a further manual ESA 113.  The 
Team Leader will request that, since significant time has already passed, the 
completed ESA113 is faxed back as soon as possible. 
 
Once the return fax is received, the process continues as normal for receipt of an 
ESA 113.   
 
If a return fax is not received or is not completed, the process continues as normal for 
a non-return of an ESA 113. 
2.5.2  Requests for FME 
FME should be obtained in those cases where there is a strong probability that such 
evidence will confirm a level of claimed disability where Support Group criteria may 
be established or “treat as LCW” may be confirmed. In re-referral cases, FME may 
confirm that there has been no improvement in the condition resulting in ongoing 
functional restriction or may even confirm further deterioration such that Support 
Group advice may be applicable. Where, in the scrutinising practitioner’s judgement, 
there is a clear possibility that an examination may be avoided they should make 
reasonable attempts to seek further evidence. FME should not be requested simply 
to confirm that an examination is required or to obtain further information to assist 
the examining HCP. In all cases, the reason for adjourning for FME must to be 
clearly documented. 
In certain cases, where evidence in addition to the certified diagnosis is not 
available, it may be appropriate to try to obtain it, for example, by: 
 
  Making a further attempt to obtain evidence from the GP by phone. 
 
  Requesting the completion of an ESA 113 report. 
 
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  Requesting a factual report from the GP, specialist or other Healthcare Provider. 
 
  Contacting the claimant by telephone for further information. 
 
If information from the GP is needed, usually an ESA 113 will be sent. However, 
there may be occasions when a specific issue needs to be addressed and form 
FRR2 is more appropriate (e.g. when information about the frequency of epileptic 
fits is required).  
FME should always be requested before calling for examination a claimant who is 
noted to have an appointee. 
Where there is evidence of a previous suicide attempt, suicidal ideation or self harm 
expressed in the ESA 50/50A, the HCP must request FME. 
When you request FME, at the time of initiating the FME request you need to 
determine whether: 
 
  The case requires further review if FME is not returned 
  The case requires examination if FME is not returned 
 
Therefore where FME is not returned only those cases where review is indicated will 
be submitted for further review. The remaining cases will automatically be submitted 
for examination.  
At the time of calling for FME, if examination on non-return is selected, you must 
also indicate whether the case is “Dr only” and whether a DV is required. (See 
Section 10.3 for information on DVs and Appendix G for a list of Dr only conditions). 
If and when FME is returned, the case will always be reviewed with this further 
information. 
 
Potential Review Criteria 
Each case must be considered on its individual merits. However, in deciding the 
appropriate course of action, you may wish to consider the following points: 
 
  Where a claimant is likely to have a terminal illness, a phone call to the GP will 
almost always be the most appropriate method of obtaining further evidence in 
the first instance, however, if an ESA 113 is sent and not returned, the case 
should be reviewed further. 
 
  Where a claimant reports that they are undergoing chemotherapy then the case 
will benefit from further review. 
 
  Where a claimant is likely to be so distressed by being called for an examination 
or have such a high level of disability that an examination will only be considered 
when all evidence gathering has failed, the case should be reviewed further.        
In particular consider those claimants with major mental health conditions such as 
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psychotic illnesses and claimants who, for example, are oxygen dependant, or 
quadriplegic etc. 
 
This list is not intended to be exhaustive and, as indicated above, you should 
consider each case on its own individual merits. 
If there was no response, or an inadequate response, to an ESA 113 request 
despatched previously, a second written request from the scrutiny desk is unlikely to 
meet with success and should not be made. If FME from the GP is considered 
essential in a case of this type, you should make a telephone call to the GP, 
although in practice this situation should arise infrequently. Any record of a 
telephone conversation with the GP or any other Healthcare Provider involved in the 
claimant’s care should be made on form FRR4 (This is usually recorded 
electronically on MSRS except in sensitive cases where recording is done on the 
clerical form.). 
Examples of cases where it might be appropriate to seek further evidence (when 
there is insufficient evidence on file) as an alternative to calling the claimant for an 
examination: 
  A first referral where, in the scrutinising practitioner’s clinical judgement, there 
may be a severe medical condition or disability present suggesting inclusion in 
the Support Group  
  Where in a re-referral or IB re-assessment case there appears to be a level of 
functional disability that would meet the LCW criteria.  
Scrutinising practitioners may use their professional judgement to decide when to 
contact the claimant by telephone for further information, but the following examples 
may be helpful: 
 
  The claimant appears to be undergoing regular treatment but details and current 
status are not given. 
 
  The claimant has fits but details of frequency and nature are not given (in re-
referral/IB re-assessment cases). 
 
  Contact details of a Healthcare Provider who may be able to supply a report, are 
not given on the ESA50.  
Evidence may be obtained from a Healthcare Provider by using form FRR3 or by a 
telephone call to the claimant using form FRR4.  For example, where there is 
evidence of a significant and enduring mental health condition, and the claimant 
reports frequent contact with the Community Mental Health team, the CPN may well 
be the person best placed to provide information about the claimant’s current 
condition.  
If you decide that that an approach to a Healthcare Provider is the appropriate 
course of action, you should request that form FRR3 is dispatched.  You must 
complete the details of the claimant and the Healthcare Provider, and include all of 
the relevant questions. 
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If you decide that an approach to the claimant is the appropriate course of action, 
you may telephone the claimant or ask an administrative colleague to make the call.  
In either event, form FRR4 must be completed to provide the claimant’s details and 
the nature of the information required from the claimant. When making the 
telephone call it is essential that you or your administrative colleag```ue establishes 
the identity of the person to whom they are talking at the outset. 
The following script or something very similar must be used: 
“I’m Dr/HCP (name)/ (practitioner’s name) Medical Services and I would like to 
speak to Mr Y”.  No further details should be given until the claimant has been 
positively identified. 
Further evidence of identity should be sought (e.g. date of birth or NINO) to make a 
positive identification. If you are uncertain that the person speaking is the claimant, 
you should terminate the call and note this on the form. If the claimant is 
unavailable, arrangements should be made to call back.  
 If that is not possible, note this on the form. You will then have to reconsider the file 
to decide on an appropriate alternative course of action. 
Having established the identity of the claimant, you need to explain why the 
telephone call is being made. The following form of words should be used, 
dependent upon whether it is the scrutinising practitioner or administrative staff 
making the call: 
“I am one of the doctors/ practitioners providing medical advice to the Department 
for Work and Pensions” or “I have been asked by one of the doctors/ practitioners 
who advises the Department for Work and Pensions to obtain further information” 
The following form of words is then used: “You have recently completed an ESA50 
questionnaire for the Department for Work and Pensions Decision Maker. I wonder if 
I could ask you some additional questions about your health problems, so that we 
can decide whether it is necessary to examine you?”  
If the claimant agrees, the questions identified by the scrutinising practitioner in the 
form are asked and the answers are recorded, using the claimant’s own words as 
precisely as possible. The person phoning should always ask if there is anything 
else that the claimant wishes to say before concluding the call. The person making 
the call should conclude by reading back what has been documented. The 
scrutinising practitioner /administrative colleague should advise the claimant that this 
information will be added as evidence to the file. 
If the claimant does not agree to talk on the telephone, the call is terminated and the 
form completed.  If a member of the administrative staff has made the call, the form 
should be returned to the scrutinising practitioner forthwith. 
Under no circumstances should any likely outcome of the claim be indicated. 
Similarly, no indication should be given as to whether the claimant will or will not be 
asked to attend for examination. 
In all cases, the form must be signed and dated by the person who made the call. 
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3.  The Special Rules Check (TI check)     
When a claimant applies for ESA they may state that they are terminally ill. The 
definition of terminal illness in legislation is: 
“That he is suffering from a progressive disease and his death in 
consequence of that disease can reasonably be expected within 6 months.”  
When a claimant is considered to be potentially terminally ill, a referral will be 
sent to Atos Healthcare for advice.  
These referrals must be treated with great urgency.  
This referral will be accessed using MSRS. The HCP will access the case and 
follow a process which has been agreed by the customer. The advice provided to 
the Decision Maker will be generated using the LiMA application. 
The advice given must be current and in keeping with the balance of medical 
probability with regard to prognosis in the diagnosed condition. 
Some TI checks will be submitted with a faxed DS1500, which will be passed to 
the CSD HCP within an ESA55. In that circumstance, the HCP should consider 
the TI question based on that evidence. The DS1500 form is used in Disability 
Living Allowance and Attendance Allowance (See Glossary) to consider 
applicants for DLA/AA under the Special Rules for the terminally ill. As in ESA, 
the definition of terminal illness is that life expectancy is likely to be less than 6 
months. The DS1500 is completed by a Healthcare Provider involved in the 
claimant’s care. The DS1500 allows the HCP to record medical details of the 
diagnosis, date of diagnosis, treatment and general condition of the patient. 
At times the detail in the DS1500 may not be adequate to confirm TI and a phone 
call should then be made to the author of the DS1500 for further clarification. The 
record of the telephone conversation should be recorded on form FRR4. 
If no DS1500 is submitted with the claim, the HCP should check whether the 
claimant has been accepted under the Special Rules provisions for Disability 
Living Allowance/Attendance Allowance. This information can be accessed by 
administration colleagues through the “SMART” application. SMART is an IT 
system used by administration staff. It has a variety of functions including 
recording data relating to Disability Living Allowance and Attendance Allowance 
claims. The HCP will complete section A of the SMART TI check pro-forma and 
pass it to an administration colleague, who will check to determine whether a 
DLA SR referral has previously been documented on SMART. If the claim has 
been accepted under DLA SR within the last 6 months, the HCP can consider the 
claimant as TI for the purposes of ESA. This outcome should be documented on 
the ESA 85A electronically and sent to the Decision Maker. 
If neither of the above applies, the HCP will seek further medical evidence from a 
Healthcare Provider involved in the medical care of the claimant.  
The medical evidence will usually be obtained by telephone contact to the 
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claimant’s GP, consultant, or other Healthcare Provider involved in the claimant’s 
medical care. Exceptionally, this information will be obtained by a written request 
for Further Medical Evidence (FME). It should be noted that a claimant who is 
terminally ill (as defined) will be entitled to the higher rate of benefit while still in 
the 13 week assessment phase. Therefore a phone call should be the 
preferred option to enable prompt establishment of information regarding 
their medical condition. 
The HCP will review the evidence obtained and provide advice on the body of 
evidence, indicating whether or not it is likely that the claimant is suffering a 
terminal illness as defined in the legislation. 
If the claimant is considered to be terminally ill (as defined), the HCP will submit 
that advice to the Decision Maker electronically on form ESA 85A. If the advice is 
accepted, the claimant will be placed in the Support Group and there will be no 
requirement for the claimant to complete form ESA 50, to be examined or 
participate in work related activity. 
If the claimant is not considered to be suffering from a terminal illness, the HCP 
must consider whether or not there is evidence at this stage that they satisfy one 
of the other Support Group criteria. For example, the GP may confirm that the 
claimant has breast cancer, with no evidence of metastatic disease, has had 
surgery and has now commenced IV chemotherapy. In this case Terminal Illness 
could not be advised; however the claimant fulfils the criteria for inclusion in the 
Support Group on grounds of receiving chemotherapy. For the special 
circumstances categories of Support Group inclusion i.e. (“TI,”, “pregnancy risk”, 
“chemotherapy” and “specific risk”), it is accepted that LCW will also be satisfied. 
However for those in the severe functional Support Group categories, you must 
also justify why they meet criteria for LCW.  
HCPs should refer to the Revised WCA Handbook for guidance on the Support 
Group Criteria – both Functional categories and “Special Circumstances”. All 
filework advice must be in keeping with the guidance in the Handbook. 
In some circumstances, “treat as LCW” may be confirmed at this stage. For 
example, the GP may confirm “lumpectomy for breast carcinoma. No evidence of 
metastatic disease. Now commencing radiotherapy”. In this case “treat as LCW” 
advice could be given. If you indicate “treat as LCW” at this stage, MSRS will 
issue form ESA 50A to the claimant. On receipt of this the case will then be 
further reviewed to give advice on LCWRA. 
HCPs should refer to the Revised WCA Handbook for guidance on the categories 
defined in legislation where claimants may be treated as having LCW. All advice 
must be compliant with the guidance contained in the handbook. 
If there is no evidence of Support Group or Treat as LCW being applicable, the 
case will be processed in the normal manner, i.e. Form ESA50 will be issued and 
the case will move to Pre-Board Check. 
 
 
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This process may be summarised as follows: 
  Referral for TI check received. 
  Check if DS1500 received with claim.  
  If DS1500 present advise on TI status if possible. If further detail needed, 
contact author of DS1500 for further information. 
  If no DS1500, check if recent Special Rules claim made. 
  If there has been SR claim for DLA, advise on this. 
  If no recent SR claim, phone relevant Healthcare Professional involved in 
claimant’s care. 
  Remember that even if outcome is not TI, you may have adequate evidence 
at this stage to advise Support Group inclusion or treat as LCW. 
 
It should be noted that JCP should set a control date for 3 years for TI cases (i.e. 
the case should not be re-referred for 3 years), however; some cases may be 
inappropriately re-referred earlier than this. If a referral is received for a claimant 
where TI was advised less than 3 years ago, the referral should be questioned 
with the BDC as it is possible the referral was an error. 
The Exceptions for IB (Reassessment TI WCA cases 
  For IB (Reassessment) TI WCA cases, the referral process is 
different. 
  The cases will be referred via the advice route. 
  The HCP will be notified by the scrutiny team leader   
  The number of cases is likely to be small.  
  The LiMA application will not be available to record the reply. 
The hyperlink will open a free text box within MSRS.  
  In these cases once sufficient evidence has been gathered (with 
the usual urgency for any TI case), the advice as to whether or 
not the claimant is likely TI must be completed using the free 
text box on MSRS. 
  Unlike other TI referrals where the options of other LCWRA 
categories or treat as LCW are available, the only two outcomes 
in the IBR TI cases refereed via this route will be TI or not TI.  
  The HCP must summarise the evidence underpinning the advice 
offered and justify the advice.  
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4.  The Pre-Board Check  
4.1  The Pre-Board Check 
The intention of the Pre-Board Check is to identify those claimants who are the 
most severely disabled and will be eligible for inclusion in the Support Group 
(LCWRA). The Pre-Board Check will also identify claimants, for the DM, who 
satisfy the criteria for “treat as LCW”. 
A pre-board check must be completed in all initial claims where the claimant is 
not terminally ill. 
A pre-board check must also be completed in ESA re-referral cases where the 
claimant has not previously been subject to a face to face examination. IB re-
assessment cases will not be subject to Pre Board Check, but will be considered 
as scrutiny cases. 
The case is accessed through the MSRS application and the HCP reviews the 
information available.  
At this stage, many claimants will have completed the ESA 50 (or ESA50A if 
LCW already established). This information should be looked at carefully along 
with any other information on file including the Med 3 diagnosis. HCPs should 
consider whether or not the evidence presented suggests that the claimant fulfils 
any criteria for inclusion in the Support Group or “treat as LCW”. HCPs can refer 
to the EBM Key Points for guidance on factors that suggest that severe disability 
is likely. 
 
In cases where hospital admission is pending, HCPs can recommend ‘Treat as 
LCW’ if there is firm evidence that the claimant is due to have a major procedure 
within the next 21 days. HCPs should have firm evidence that the procedure is to 
be undertaken, clearly state the nature of the anticipated procedure and be sure 
that it is consistent with the claimant’s medical condition. 
It may be possible to advise at this stage based on the evidence in ESA 50 and 
the Med 3 diagnosis. In cases where there is no evidence that any category of 
the Support Group applies nor that any of the “treat as LCW” categories apply the 
advice should be to call. 
FME should be requested in cases where there is information suggesting Support 
Group or “Treat as LCW” criteria are likely to be met. You should adhere to the 
guidance for requesting FME provided in section 2.5 of these guidelines.   
 
When reviewing a case that has previously been adjourned for Further Medical 
Evidence you need to decide whether further evidence is still required. When the 
FME was initially requested, the requesting HCP should have noted whether 
further review of the case was necessary so in most cases it will be necessary to 
make a phone call to a GP or other Healthcare Provider to obtain information. 
 
 
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As before, when justifying your advice for the Severe Functional categories of 
Support Group, you must also provide reasoning to indicate why the claimant 
satisfies LCW. This is likely to be clear in cases where the highest descriptor is a 
Support Group, for example mobilising. (Remember that this is not necessary for 
the exceptional circumstances categories although you should make it clear to 
the DM that both LCW and LCWRA criteria are met due to the exceptional 
circumstances.)  
 
When “treat as LCW” has been identified, the HCP must carefully review the case 
and provide advice for the DM on whether the LCWRA criteria also apply. 
 
In most cases, it should be possible with the current evidence to advise on 
whether the criteria for inclusion in Support Group are met. If they are met, full 
justification should be given for the specific category of Support Group inclusion. 
 
Where there is clear evidence that the claimant does not meet LCWRA criteria, 
specific justification must be provided to the DM why each Support Group 
category (both functional and non-functional) does not apply. It is not sufficient to 
say that no Support Group criteria are met. Your justification may be based on 
information from the ESA50, FME or on your medical knowledge of the certified 
cause of incapacity. 
 
In every case, a prognosis must be given. Where Support Group criteria are met, 
the prognosis given should refer to both LCW and LCWRA. The prognosis given 
must be logical and in keeping with the consensus of medical opinion. Further 
detail on prognosis can be found in section 8 of this document.  
 
Certain conditions should only be examined by Registered Medical Practitioners. 
Some neurological conditions may also be examined by a Registered Nurse 
trained in neurology or a physiotherapist. A list of these conditions can be found 
on LiveLink under “Neurological Condition List by Practitioner Type”. The ESA 50 
and all other relevant documentation should be closely scrutinised to ensure the 
case is allocated appropriately. 
  
If the HCP advises that the claimant should be called for an examination, 
‘Practitioner Type’ must be selected on MSRS to determine if the examination 
can be carried out by any healthcare practitioner or whether a medical 
practitioner is required. As with the current process, where a neurology trained 
nurse or physiotherapist is required “any” should be selected on MSRS and the 
ESA55 (case file cover) should be annotated with an “N”. 
 
 
You need to advise whether the assessment can be carried out at an 
examination centre (MEC) or whether a home assessment (DV) is required. 
Further guidance on Domiciliary Visit requests can be found in section 10.3 of 
this document. 
 
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5.  
LCWRA Only Referrals 
 
5.1  General LCWRA Only Referrals 
LCWRA only referrals are generated when the Decision Maker has already 
established that “treat as LCW” applies. 
This may be from information provided by the claimant or from the Med 3 
diagnosis where the DM identifies the claimant as being in a “treat as LCW 
category” These are: 
  Infectious disease exclusion by Public Health Order 
  Pregnancy around dates of confinement 
  Hospital INPATIENT treatment or a day of recovery from such 
  Certain regular treatment as defined in the regulations 
  (For claimants on Income Related ESA see 5.2.) 
  Further detail of each of these categories can be found in the Revised 
WCA Handbook. 
 
The Decision Maker will require advice from Atos Healthcare about the claimant’s 
ability to participate in Work Related Activity (LCWRA advice). 
The Decision Maker will submit the request for advice, providing information 
about the “treat as LCW” category and any further detail they have. For example, 
the DM may indicate they have accepted LCW on the grounds of being a hospital 
inpatient. They may also then add details of the hospital/consultant in charge of 
their care.  If no such information is included the referral should be returned to 
JCP for clarification 
As soon as the referral is received by AH, MSRS will issue form ESA50A to the 
claimant.  As LCW has already been established within the appropriate period, 
where the ESA50A is not returned the case needs to continue through the 
process. 
The role of the advising HCP is to review all the information available on file and 
to decide whether further information is required. 
Whenever possible clear advice and justification must be given to the Decision 
Maker indicating whether or not the claimant meets criteria for LCWRA. 
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The HCP must consider the ESA 50A (if returned), the diagnosis provided on the 
Med 3 as well as any information available on MSRS for example a previous ESA 
85. In many cases, there will be a requirement to obtain further information about 
the claimant’s condition. This would normally be by requesting FME. The FME 
request should be documented on MSRS. . In the event of non-return of FME, 
you should phone the GP or other Healthcare Provider for further information. 
The claimant should not be called to examination until all other evidence 
gathering options have been exhausted.  
There are 3 possible outcomes: 
1.  The evidence suggests LCWRA is applicable. In this case, the ESA 85A should 
be completed giving advice on the appropriate Support Group category.  This 
should be fully justified. 
2.  The evidence suggests that LCWRA is not applicable. In this case, the advice 
should be given to the DM detailing why none of the Support Group categories 
are applicable. Every category must be clearly justified. These categories include 
the special circumstances and the functional support groups.  
 
 Terminal 
illness 
 Chemotherapy 
  Substantial physical or mental risk 
  Specific pregnancy risk 
  lower limb functions 
  upper limb functions 
 continence 
 
  eating and drinking/chewing swallowing food 
 communication 
  learning or comprehension  
 awareness 
of 
hazard 
 personal 
action 
 coping 
with 
change 
  coping with social engagement 
  appropriateness of behaviour with other people 
 
 
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In rare circumstances, where no information is available or when level of function 
cannot be clarified by any other means, it will be necessary for the claimant to be 
examined in order to provide advice to the DM on LCWRA status; Examination 
should only be advised after every possible attempt has been made to provide 
definitive advice. You should only ever take this action after discussion the case with 
your team leader or manager. 
Rarely, the situation may arise where the HCP uncovers evidence that conflicts with 
the LCW decision made by the DM. For example, information may be uncovered to 
reveal that the claimant is no longer requiring weekly haemodialysis or that they are 
no longer a hospital inpatient. In these situations review the evidence and consider if 
Support Group or treat as LCW for another reason is appropriate or, call for exam. 
Full justification must be given. 
5.2  Income Related ESA LCWRA Only Referrals 
In addition to the above case types in 5.1, occasionally you may come across 
clerical referrals for LCWRA only filework advice for a claimant on income 
related ESA, who is also in education, is entitled to DLA award at any level and 
is not in receipt of child benefit.  
You should treat these referrals as any other LCWRA-only referral with due 
consideration to all the evidence, seeking FME as appropriate; and fully justify 
the LCWRA advice.  
You would not be expected to identify  a claimant satisfies this specific LCWRA-
only referral category in any other type of Filework as you would not have the 
relevant information available to you regarding DLA, child benefit etc. 
 As this is currently a clerical referral, all the advice needs to be completed 
clerically. The ESA 86 should be completed with full justification. 
Rarely, you may become aware that the claimant is no longer in education or 
receiving DLA. In these circumstances, you should pass the referral back to the 
administration team with a note explaining why the claimant is no longer likely 
to be “Treat as LCW” in this referral sub category. They will then arrange for this 
referral to be sent back to the DWP. 
 
                                       
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6.  ESA Re-referral Filework  
6.1  ESA Re-referral Scrutiny  
When a claimant has been accepted as having LCW by the Decision Maker  
based on a full LCW/LCWRA medical examination (ESA 2008 or 2011 
regulations), or following IB re-assessment scrutiny the case will be referred to 
Atos Healthcare after an appropriate period for further advice. This time period 
will normally be based on the advice provided by the examining HCP at the time 
of the assessment.  
The possible outcomes at re-referral scrutiny are: 
  To accept ongoing LCW 
  “Treat as LCW” 
  To advise that the Support Group criteria have been met 
  To advise that further assessment by face to face examination is required 
ESA Cases 
For ESA re-referral cases that have not been subject to the IB re-assessment 
process re-referral scrutiny allows the possibility to “accept” for a further period of 
time that the person has continuing limited capability for work as long as the 
following criteria are met: 
  The claimant has had a full LCW/LCWRA Medical Examination 
(completed ESA 85). The full report ESA 85 report may not always be 
visible, for example if it was completed clerically, however the referral 
details on MSRS should make it clear that the person has previously 
been subject to a face to face assessment. You do not have to see the 
previous case to accept at scrutiny. 
  The claimant has scored above threshold (15 points or above) either 
on Physical or Mental Function descriptors at this assessment and the 
DM has accepted LCW. (Not “treat as LCW”) 
The current available evidence suggests there has been no improvement, or 
there is evidence of deterioration in their functional capability, and it is likely that 
they will continue to score over threshold.  
The case will be referred back to Atos Healthcare Medical Services and 
accessed by an appropriately trained HCP. 
At this stage, the practitioner will review, through the MSRS application, the ESA 
85 from the previous referral, if available, and the current ESA 50, if completed. 
The HCP must carefully review any ESA 85 completed under the 2008 
regulations and consider whether the claimant would continue to be considered 
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as LCW under the 2011 regulations.  
For example, the descriptors relating to mobility are significantly revised from the 
2008 regulations where the main function considered was walking rather than 
mobilising. 
The ESA 85 will usually have been completed electronically using LiMA. Where 
the previous ESA 85 has been completed clerically, the ESA 85 will not be 
available at re-referral. Where the ESA 85 is not available, there must be 
sufficient evidence that you can satisfy yourself that LCW threshold was 
likely to have been met and is still appropriate.  
After review of all the evidence, the HCP must make a decision on whether 
FME is required. The decision on FME should be based on the current 
evidence available and must only be requested if it is likely to impact on the 
scrutiny advice. 
In cases where the claimant was accepted as satisfying the criteria for Support 
Group by the Decision Maker either as a result of filework advice or following 
examination, the case will be re-referred as a Pre-Board Check. Those 
previously in the Support Group or “Treat as LCW” cannot be “accepted” 
as having ongoing LCW. 
Re-referral of IB Re-assessment Cases 
In IB reassessment cases the principle remains the same. The evidence 
available to you may include a previous IB reassessment scrutiny or IB 85. The 
outcomes are the same as for ESA re-referrals above. There is no requirement 
for a past IB 85 to be visible to allow ongoing acceptance of the case. 
 
The key for all re-referral cases whether ESA re-referral or IBR scrutiny include: 
   Understand that a case that was previously IBR may not have a previous 
exam report available. 
  Remember that a previous report on the system is not mandatory for 
 
acceptance for any re-referral scrutiny case. 
  Review all the available evidence. 
  Advise whether or not the claimant is likely to score above threshold on the 
 
2011 WCA descriptors for acceptance. 
  Advise as to the broad areas on which acceptance is based. 
  Consider and advise if Support Group or “Treat as LCW” likely to be more 
 
appropriate. 
  If none of the above outcomes, then call for face to face assessment. 
 
6.2  Scrutiny of Evidence in Re- referral cases 
In ESA re-referral filework, the HCP must scrutinise all available evidence. This 
evidence may be on MSRS or in the ESA 55 jacket. 
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6.2.1  MSRS Information 
  Within MSRS the HCP should check for any further medical evidence such 
as Med 3 or FRR4 information to see if there is evidence of a change in the 
claimed level of functional capability. 
  Other information such as appointee status and any “Potentially Violent” 
information should be considered along with the age of the claimant as this 
may impact on likely level of disability. 
   
  Any previous filework outcomes on ESA 85As should be reviewed as this 
may provide some detail of previous level of disability. 
  Check other evidence including advice offered at reconsideration. 
  Any previous ESA 85s should be reviewed.  
6.2.2  ESA 55 Information 
The re-referral will be initiated electronically by the DM. Therefore clerical papers 
from previous referrals will not be available. 
However there may be useful information within the ESA 55 Jacket, for example the 
ESA 50. At re-referral, the claimant may have completed a new ESA 50 detailing 
their current problems. This document can be invaluable in assessing stated 
problems and comparing this evidence to the previous ESA 85. Details of changes 
to medication, any new treatment/consultant input etc should be considered. The 
claimant’s stated abilities and limitations in each functional area should be 
considered and compared to the level of ability detailed in the ESA 85. 
6.2.3  MSRS/ESA 55 information 
ESA 85 
The previous ESA 85(if available) should be accessed and reviewed on MSRS. 
This may have been completed under the 2008 or 2011 regulations. 
When considering the ESA 85, there are many aspects to consider. These 
require knowledge of both the 2008 and 2011 descriptors and scoring. (For 
descriptors and scoring see appendices B and D.) The report must also be 
reviewed and scrutinised for consistency and appropriate justification in each 
case.  
Scoring at previous LCW/LCWRA examination 
In order to be able to consider acceptance, the claimant must have been 
awarded  
  15 points or more on physical descriptors, or 
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  15 points or more in the Mental Function descriptors 
  15 points or more through a combination of physical and mental function 
descriptors 
In some cases, the ESA 85 will suggest a score of less than 15 points. The 
claimant may have in this case been awarded ESA by the Tribunals service. You 
will not have sight of the evidence considered by the Tribunals service so in 
many cases, a further examination may be necessary. 
 
Choosing Descriptors – Physical cases 
The descriptors chosen at the LCW/LCWRA examination must be considered 
with the current ESA 50 and the HCP must be aware of whether 2008 or 2011 
regulations were applicable. 
The following guidelines for reviewing the evidence must be considered in line 
with the guidance at section 2.4 - 2.5 of this document. 
In cases where the claimant has identified some improvement in one area of 
function where they were previously awarded scoring descriptors, this may 
suggest that a further examination is required to assess current level of function. 
Some examples of possible scenarios where this may occur are listed below: 
1.  A claimant was awarded 15 points for restriction in walking limited to 50m and 6 
points for standing restricted to less than 30 minutes at their previous 
assessment following a recent fractured femur under the 2008 regulations. In 
their current ESA 50 they indicate they still have some pain but their walking has 
now much improved following physiotherapy and they can manage in excess of 
200m and can stand for longer than 30 minutes. They also indicate that their 
analgesia has been reduced from high strength dihydrocodeine to paracetamol. 
In this case, as long as there was no indication of problems in any other area, the 
outcome would be to call. 
2.  A claimant was awarded 15 points at their previous LCW/LCWRA medical 
examination for weekly seizures. They had only recently been diagnosed with 
epilepsy and their consultant had been trying various medication regimes with 
little success to control their condition. Their recent ESA 50 now indicates that 
they have been tried on new medication and have only had 2 seizures in the last 
7 months. They indicate no other problems. Again, in this case there appears to 
be an improvement in the condition since the last assessment, and the likely 
outcome would be to call the claimant for examination. 
3.  A claimant was previously awarded 15 points for bowel incontinence occurring on 
a monthly basis. At this time, they had poorly controlled ulcerative colitis. Since 
then, they indicate in the ESA 50 that they have had surgery and a now have a 
stoma. They indicate they can manage this by themselves and feel their condition 
has significantly improved. They have no other medical conditions. Again, in this 
case there is no evidence in the ESA 50 of problems with the stoma, and 
therefore calling the claimant for further assessment is likely to be appropriate. 
 
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At times the evidence in the ESA 50 may suggest deterioration in the condition or 
that there is unlikely to have been a significant change since the last assessment. 
Usually there will be a requirement for supportive “Medical fact” to be 
documented to allow acceptance of ongoing LCW and at times there may be a 
requirement for FME. For example: 
1.  A claimant was awarded 15 points at their previous assessment for monthly 
bowel incontinence. The report was detailed and consistent. They had poorly 
controlled Crohn’s disease at the time of the assessment. The claimant has 
indicated on the ESA 50 that they continue to have loss of full bowel control 
every 2-3 weeks despite various changes to medication. They have also recently 
lost a lot of weight and have been prescribed “Build up drinks” by their GP. They 
have had 3 hospital admissions lasting 10-14 days in the last 6 months due to 
dehydration and they await further referral to a specialist unit to consider further 
management options. The claimant has supplied dates of hospital admissions, 
details of current medication and details of their current consultant and the 
tertiary referral centre they have been referred to. Again, in this case it may be 
reasonable to accept the stated level of disability for a further period based on 
the medical facts presented and knowledge of the diagnosed condition. 
2.  A claimant was awarded 15 points for visual impairment - cannot see 16 point 
print at 15cm and has now been referred under the 2011 regulations. They were 
waiting for bilateral cataract extraction. They have indicated that they feel the 
operation was not fully successful in one eye and the other eye has not yet been 
operated on. They indicate they still struggle to see and read and cannot read 
Braille. They have not supplied any dates of clinic appointments and have not 
submitted details of a Certificate of Visual Impairment. In this case, ongoing 
LCW may be possible depending on the extent of visual impairment. However 
the evidence represents only claimant provided opinion. In this case, further 
evidence would be required from the GP or consultant to verify the outcome of 
the surgery on one eye. Further information would be needed about their ability 
to safely navigate. This may be difficult to obtain from FME and it may be 
necessary to call the claimant for further assessment if not fully clear with the 
available information \ evidence. 
Choosing Descriptors – Mental Function cases 
The descriptors chosen at the LCW/LCWRA examination must be considered 
with the current ESA 50. The following guidelines for considering the evidence 
must be considered in line with the guidance at section 2.4 – 2.5 of this 
document.  
In cases where the claimant has identified some improvement in one area of 
function where they were previously awarded scoring descriptors, this may 
suggest that a further examination is required to assess current level of function. 
For example: 
 
1.  A claimant was awarded 18 points in Mental Function through descriptors in 
coping with change, getting about and coping with social interaction. No physical 
issues were identified. At the previous assessment, they had been recently 
assaulted and developed panic disorder as a result.  
At the time of assessment, they had just been commenced on citalopram and 
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were awaiting input from the Community Mental Health team. They have 
documented in their current ESA 50 that they have been attending anxiety 
management classes and “feel more like their old self”. They have now 
recommenced some social activities and can leave the house alone. They 
indicate no new problems. Their GP is reducing their medication. Again, in this 
case, a decision to call would be likely as there is evidence of improvement. 
2.  A claimant was awarded 18 points at their LCW/LCWRA medical examination (6 
months ago in areas of initiating and completing personal action, and coping with 
social engagement. At the time of assessment, they had been discharged from a 
psychiatric unit 4 months previously with a severe depressive episode.  They had 
fortnightly input from the psychiatrist and twice weekly input from the CPN. At the 
time of the assessment, the claimant was beginning to feel some improvement. 
In the current ESA 50, the claimant has indicated that she now sees the 
psychiatrist every 3 months and CPN on a monthly basis. She feels more 
motivated and has started some voluntary work 6 hours a week in a local charity 
shop. In this case, there appears to be evidence of improvement. FME is unlikely 
to change the outcome and “calling” the claimant for further assessment would 
seem appropriate. 
 
At times the evidence in the ESA 50 may suggest deterioration in the condition or 
that there is unlikely to have been a significant change since the last assessment. 
Usually there will be a requirement for supportive “Medical Fact” to be 
documented to allow acceptance of ongoing LCW and at times there may be a 
requirement for FME. For example: 
 
1.  A 19 year old claimant scored above threshold at the previous assessment in 
Mental Function. They had a diagnosis of learning disability and scored in the 
areas of learning or comprehension and in coping with change. The claimant at 
the time of assessment was living with their parents who provided significant 
support. They were due to start a life skills course at college. The report was 
comprehensive and well justified. The prognosis advice given was “that with input 
may improve within 18 months”. The current ESA 50 was completed by the 
claimant’s social worker. They have indicated that his progress at his life skills 
course has been slow and hampered by increasing levels of anxiety. Social work 
are now providing some respite care and the claimant has been commenced on 
citalopram for his anxiety. He is now reluctant to leave the house at all and is now 
having input on a weekly basis from the CMHT and daily support from social 
work. Details of the CMHT members have been provided and details of social 
work support workers are identified. It may be appropriate to obtain FME as the 
claimant may satisfy Support Group criteria under the 2011 Regulations – e.g. if 
abilities to cope with change have further deteriorated.  
 
2.  A claimant was awarded 18 points in Mental Function through descriptors in 
coping with change, getting about and coping with social engagement (2011 
regulations). No physical issues were identified. The report was consistent, well 
justified and indicated moderate to severe levels of anxiety. At the time of 
assessment, they had just been commenced on citalopram. A prognosis of 6 
months was given with justification that improvement in the condition would be 
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expected with medication which had only just been commenced. In the ESA 50, 
the claimant still indicates ongoing medication with no change to the dose of 
citalopram. She indicates she sees her GP every 2 months and is increasingly 
finding it more difficult to attend due to anxiety. She says she can no longer go 
outdoors alone and has panic attacks on a frequent basis. She was referred to a 
counsellor by her GP but she felt too anxious to attend. In this case, there is very 
little evidence in the way of medical fact. The evidence is mainly claimant opinion, 
however given that she had significant disability at the last assessment; she may 
well have ongoing LCW. In this case, it would be reasonable to request FME to 
attempt to ascertain whether there has been any significant change to her 
condition to allow acceptance of ongoing LCW or establish whether SG is likely to 
apply. 
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7.  IB Re-assessment Scrutiny 
7.1  Background 
In 2010 the Government announced plans to re-assess all current recipients of 
Incapacity Benefit and those in receipt of Income Support on grounds of 
incapacity in order to establish their readiness to work. 
At that time, 2.5 million people in receipt of IB had nothing in place to support 
them to re-enter the workplace. The Government felt this was not a desirable 
situation and announced that Incapacity Benefit claimants will be re-assessed 
under the revised WCA regulations over a 3 year period commencing 2011. 
In re-assessing these individuals, those who are found to have limited capability 
for work under the Revised WCA regulations will be placed in the work related 
activity group which will allow them access to the “work programme”. 
Those who are capable of work will migrate to JSA/Income Support 
The Work Programme will be a single package of support providing personalised 
help for everyone who finds themselves out of work regardless of the benefit they 
are claiming. 
7.2  IB Re-assessment Scrutiny 
The DWP will refer most claimants currently in receipt of Incapacity Benefit to 
Atos Healthcare for re-assessment under the Revised WCA regulations. Those 
who will have reached state pensionable age by the end of the process in 2014 
will not be referred.  The timing of referral of each case will be determined by JCP 
based on the date that their IB entitlement was due for review  
The claimant may be in receipt of Incapacity Benefit as: 
1.  They have been previously accepted as meeting the threshold of incapacity for 
the Personal Capability Assessment used in IB following advice from a PCA 
medical examination 
2.  They have previously been accepted as meeting the threshold of incapacity for 
the  PCA following filework scrutiny advice 
3.  They have been considered to be exempt from the PCA process following advice 
either at scrutiny or examination. 
Those on Incapacity Benefit may have been referred many times over the years and 
the Decision Maker has continued to accept they meet the threshold of incapacity. 
You may find that there are a number of previous examination and filework outputs 
to consider. 
When the IB re-assessment referral is received the Atos Healthcare HCP will apply 
the process of IB re-assessment scrutiny. This will allow them to: 
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  Accept that they meet the threshold for LCW under the Revised WCA 
Regulations 
  Advise that the Support Group criteria have been met (Revised WCA 
Regulations) 
  Advise that “treat as LCW” criteria have been met (Revised WCA 
Regulations) 
  Advise that further assessment by face to face examination is required to 
determine their level of disability 
The pre-board check process is not applicable to IB re-assessment claims. The 
Filework HCP can base their advice on any evidence available, for example 
previous Filework outputs, FME or a previous IB examination.  
7.3  Scrutiny of evidence in IB Re-assessment Cases 
In IB re-assessment filework, the HCP must scrutinise all available evidence. This 
evidence may be on MSRS or in the ESA 55 jacket. 
7.3.1  MSRS Information 
  Within MSRS the HCP should check for any further medical evidence such 
as Med 3 or FRR4 information to see if there is evidence of a new diagnosis. 
  Other information such as appointee status and any “Potentially Violent” 
information should be considered along with the age of the claimant as this 
may impact on likely level of disability. 
  Any previous filework outcomes on IB 85As should be reviewed as this may 
provide some detail of previous level of disability. 
  Any previous IB 85s should be reviewed.  
7.3.2  ESA 55 Information 
The re-referral will be initiated electronically by the DM. Therefore clerical papers 
from previous referrals will not be available. 
However there may be useful information within the ESA 55 Jacket, for example the 
ESA 50. At referral, the claimant may have completed a new ESA 50 detailing their 
current problems. This document can be invaluable in assessing stated problems 
and comparing this evidence to any previous information on file. Details of changes 
to medication, any new treatment/consultant input etc should be considered. The 
claimant’s stated abilities and limitations in each functional area should be 
considered and compared to the level of ability detailed in the IB 85 if available. 
 
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At the beginning of the reassessment process JCP will make telephone contact with 
the claimant to explain the process, and during this conversation they will encourage 
the claimant to attach any medical evidence that they hold, such as hospital reports, 
to the ESA 50. It is important that you consider any such evidence 
7.3.3  MSRS/ESA 55 information 
IB 85 
Any previous IB 85s should be accessed and reviewed on MSRS. When 
considering the IB 85, you need to consider whether the report is consistent and 
appropriately justified. You need to have knowledge of the IB descriptors and 
scoring. A list of the IB descriptors can be found in Appendix E.  
In order to achieve the threshold for incapacity under the PCA regulations, the 
claimant must have been awarded  
  15 points or more on physical descriptors, or 
  10 points or more in the mental health assessment or 
  a combination of 6 or more points on physical descriptors and 6 or more 
points on the mental health assessment. 
You must be aware of the fundamental differences between the descriptors of 
the Revised WCA and the PCA when considering their advice.  
In some cases, the IB 85 will suggest a score below threshold. The claimant 
may have in this case been awarded IB by the Tribunals Service. You will not 
have sight of the evidence considered by the Tribunals service so in most cases, 
a further examination may be necessary unless other evidence is available on 
file. 
Choosing Descriptors – Physical cases 
Although the physical descriptors are entirely different in the PCA and the Revised 
WCA, there is still scope to consider the level of function suggested by the IB 
descriptors and the IB 85 information. This should be compared against the current 
ESA 50 looking for any change in the level of disability. If the level of disability was 
very high in the IB assessment, then the claimant may well reach the threshold for 
the Revised WCA. However if the level of disability was found to be low at the IB 
assessment the claimant is unlikely to reach the threshold for the Revised WCA 
unless further evidence suggests significant deterioration. In cases where the 
claimant has identified some improvement in one area of function or no change in 
function where they were previously awarded scoring descriptors, a WCA 
examination may be required to assess the current level of function. Some 
examples of possible scenarios where this may occur are listed below: 
1.  A claimant with a diagnosis of fractured femur following a road traffic accident, 
was assessed for IB, and found to have significant limitation of function.  
 
The MSRS MED3 information states “leg problem”. He was found to have severe 
restriction of standing, walking, using stairs and bending and kneeling. No other 
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physical or mental function problems were identified. His current ESA 50 
indicates that he has had further surgery and now walks reasonable distances 
without crutches. In this case the appropriate advice would be to call for 
examination. 
2.  A claimant with a diagnosis of back pain scored a number of “3 point” descriptors 
in his previous PCA examination – through mild restriction of sitting, standing, 
walking, stairs, rising from sitting and bending /kneeling. The IB 85 indicates co-
codamol for pain with no evidence of specialist input or sciatic symptoms. In his 
current ESA 50, he indicates that his back pain has not improved at all and he is 
still as restricted as he was when previously examined. In this case, as the level 
of functional restriction at the PCA is unlikely to equate to the LCW threshold of 
the Revised WCA, with no evidence of change, the appropriate outcome would 
be to call. 
 
At times the evidence in the ESA 50 may suggest deterioration in the condition or 
that there is unlikely to have been a significant change since the last assessment. 
Usually there will be a requirement for supportive “Medical fact” to be 
documented to allow acceptance of LCW/LCWRA under the revised WCA and at 
times there may be a requirement for FME. For example: 
1.  A claimant with long standing rheumatoid arthritis (multiple joint involvement) was 
previously exempt under the PCA criteria for having an active and progressive 
form of inflammatory polyarthritis. The Med 3 indicates – “severe progressive 
rheumatoid arthritis – unresponsive to therapy” The previous IB85A indicates a 
phone call to GP confirmed very limited mobility and severe hand and wrist 
problems – awaiting immunotherapy. Her current ESA 50 indicates that despite 
input from a tertiary referral centre with immunotherapy she has become 
wheelchair bound with severe deformities of the hands and wrists. She has been 
assessed and is not considered to be safe to operate an electric wheelchair due 
to the weakness and pain in her hands. In this case the reasonable outcome 
would be to advise Support Group inclusion because of poor mobility. 
2.  A claimant has diabetic retinopathy, and was previously found to reach the 
threshold for incapacity under the PCA regulations. At the time, he was found to 
be unable to see well enough to read 16 point print at a distance greater than 20 
centimetres. In the year leading up to the reassessment of his benefit claim he 
developed bilateral retinal haemorrhages and was subsequently registered blind. 
He has attached a certificate of visual impairment with his ESA 50. In his ESA 50 
his wife indicates that he has lost his confidence and that he requires assistance 
from his wife to navigate outdoors as he has no confidence to cross the road 
safely and even struggles indoors. She also indicated that he cannot read Braille 
and has help with all written correspondence. In this case it would be appropriate 
to give advice to the DM to accept the claimant as reaching the threshold for 
incapacity under the Revised WCA regulations for navigation and even consider 
Support Group for understanding communication in view of the likely severity of 
visual impairment  
 
 
 
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Choosing Descriptors – Mental Function cases 
Unlike the Revised WCA, the Mental Health Assessment in the PCA does not 
have descriptors, so there is little obvious direct correlation between the two 
types of assessment. However, other information can be reviewed and related to 
the WCA descriptors. Where an IB85 exists, the typical day may provide 
adequate information to allow advice that the threshold of LCW may be met in 
the Revised WCA. As with physical problems, careful scrutiny of the ESA 50 or 
other evidence may provide information about possible improvement or 
deterioration since the claimant was last assessed.  
For example; 
1.  A claimant has been in receipt of Incapacity Benefit on the basis of her learning 
disability due to Down’s syndrome for several years. She is now referred for 
reassessment under the Revised WCA regulations. On MSRS there is a 
previously completed IB 85 in which the claimant comfortably achieved the 
threshold for the PCA on the areas of completion of tasks, coping with pressure 
and dealing with other people. The IB85 indicates that she lives with her mother 
and can manage simple tasks. She was subsequently accepted on filework 
scrutiny on one occasion based on information obtained from the GP at the time. 
There is a recent MED 3 which confirms that the claimant has Down’s syndrome. 
The ESA 50 and the IB 85 suggest that she would have some difficulty managing 
daily changes to routine and tends to get lost in unfamiliar locations. The 
appropriate advice would be to accept under the Revised WCA criteria on a 
combination of managing change, getting about and learning tasks.  
2.  Mr C was previously exempt under the PCA due to severe anxiety and panic 
attacks. The previous IB85A notes indicate “GP confirms true agoraphobia – 
does not leave house”. The current ESA 50 indicates that he no longer sees a 
CPN and has discontinued propanolol, diazepam and citalopram. He indicates he 
does not see the GP and that he is doing voluntary work for a local charity. The 
Med 3 indicates “debility”.  In this case, as there is evidence of likely improvement 
in the level of function, the advice should be to call to examination to ascertain 
current level of function. 
3.  Ms A was previously exempt from the PCA on the grounds of Severe Mental 
Illness at examination. The IB85 indicates she had a diagnosis of autism and she 
did not communicate at all at the assessment. Her mother provided all the history 
– indicating her daughter has severe communication problems, isolates herself in 
her room and only communicates as necessary with her parents. She attended a 
special school and has had input from the National Autistic society. She has 
severe mood swings with uncontrollable aggressive outbursts which can be 
difficult to manage. She has never made any friends and has never been 
employed. The MED 3 indicates severe autism. Her current ESA 50 was 
completed by her mother indicating social services are now involved and a 
referral has been made to the psychiatric services to consider medication as her 
violent outbursts are becoming even more problematic. In this case, Support 
Group advice would be appropriate – either Social Engagement or 
Appropriateness of Behaviour.  
 
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8.  Prognosis 
8.1  Overview 
As part of the filework process, HCPs are required to give advice on when a 
return to work / work related activity could be considered in all cases in which 
acceptance, Treat as LCW or Support Group inclusion is advised. 
The key messages are: 
  For the majority of claimants, provision of ESA should be regarded 
as a temporary measure, until  the claimant has recovered from an 
illness or adapted to disability (following appropriate interventions if 
necessary) 
  ESA is an active benefit (with Work Focussed Interviews and 
appropriate interventions) and so prognosis does not only consider 
when / if a claimant’s disability would be expected to improve, but 
also considers the provision of appropriate interventions or 
adaptations that could be made. 
Note the following: 
  Under the LCW/LCWRA medical procedures, approved HCPs are 
required to give advice on prognosis without reference to the 
outcome of the decision making process    
  When the claimant satisfies the LCW/LCWRA medical 
examination, the medical advice on prognosis provided by 
approved HCPs to Job Centre Plus  is often used by the Decision 
Maker to determine when subsequent re-referral to Atos 
Healthcare is appropriate  
  The DWP will wish to refer a claimant for reassessment of 
LCW/LCWRA at the point where there is a reasonable expectation 
that their prospects of a return to work have improved. Whether the 
outcome of the case is inclusion in the Support Group, application 
of Exceptional Circumstances or advice on a functional condition, 
the Decision Maker will require a reasonable prognosis for a return 
to work. In assessing when a return to work may be possible, the 
approved HCP should provide this advice based upon their 
assessment of the claimant, their knowledge of the natural 
progression of the identified medical conditions, and the time they 
feel a claimant may need to adapt to their condition 
  Note that the prognosis is not just about improvement in function. 
This is obviously one part of the prognosis issue, however; there 
are conditions that will be permanent with no expectation of 
functional improvement but this does not mean the claimant will be 
unable to work. Consideration of reasonable time scales to allow 
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possible retraining, support, time to adapt to disability and provision 
of work place adaptations should allow many claimants, even with 
significant functional restriction to enter into work.   
  For those deemed to be in the terminally ill group there is no 
requirement to include a prognosis 
  If there is more than one relevant functional condition, the HCP 
should aim to provide an opinion on the likely timescale for return 
to work, taking account of the effects of all conditions    
  If an early improvement is expected, a short prognosis should be 
given in all cases your opinion on when a return to work could be 
considered must be fully and comprehensively justified. It is 
important to consider each case individually and to choose and 
justify the appropriate time period (3, 6, 12 or 18 months), or to 
justify why a return to work is unlikely within 2 years or in the longer 
term. 
8.2  How to formulate prognosis advice 
Improvement Likely 
The main question the HCP must consider is: 
 
When would you expect significant improvement in the disability or in cases 
where improvement in the level of function is not anticipated, with adaptation/re-
training/aids when could a return to work be considered? 
The HCP’s response will depend on whether the key functional problems will 
improve and over what timescale:  
 With 
further 
treatment 
 With 
time 
  With the natural progress of the underlying disease 
  Or whether adjustments will result in a reasonable expectation of 
the claimant being engaged in some form of work 
The duration of prognosis must be based around the medical knowledge of 
the condition and consideration of rehabilitation and workplace adaptations. 
This will determine the duration of prognosis. 
It is difficult to give specific guidance as each case must be considered on its 
own merits. Some cases with the same functional loss may have different 
prognosis. For example: 
 
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Registration as severely sight impaired. Those who have had a gradual 
process of visual loss and have continued to work and have now become 
unemployed are more likely to be able to re-enter the workplace in a shorter 
time than a person who perhaps through trauma has become severely sight 
impaired. The person with acute visual loss is likely to need more time to 
adapt to their condition to allow safe navigation and is likely to need retraining 
or significant workplace adaptations to re-enter a workplace. 
In some cases, functional recovery cannot be expected, for example, where 
there is complete paraplegia following spinal cord transaction. This, however, 
does not mean that a long term prognosis is appropriate. With ongoing 
rehabilitation, perhaps retraining and workplace adaptations, the person may 
be able to return to work. 
In musculoskeletal cases, with advances in medicine and with adaptations in 
the work place, most cases should have some expectation of recovery of 
function and with additional support should be able to re-enter the workplace 
in the short to medium term. Again, this is not an absolute as complex 
rheumatoid cases with multiple joint involvement may require longer for their 
medical management of the condition to be optimised and they may need 
multiple adaptations to allow them to work. Therefore overall, each case must 
be considered carefully and prognosis advice fully justified to the Decision 
Maker. 
In Mental Function cases, consideration of the diagnosis, current treatment 
and medication should be considered. Guidance from the EBM Mental Health 
protocols should be followed. In mild to moderate anxiety and depression, in 
most cases, with support, a fairly short prognosis would be expected. In more 
major conditions such as first onset of a psychotic episode, the treatment and 
recovery time may be more prolonged. 
With some conditions, prognosis may be more straightforward, for example 
where LCW is accepted due to pregnancy around dates of confinement. 
Where the claimant is in the Support Group because they are having 
chemotherapy, prognosis may initially seem fairly straightforward since in 
most cases the duration of treatment will be known. However, you must also 
assess a “reasonable recovery period”. This may vary from one case to the 
next. A person who was otherwise fit and well may have a shorter recovery 
period than a person who has had significant weight loss, post operative 
complications or complications of chemotherapy. You must base your advice 
on your medical knowledge and skills as a disability analyst to provide 
reasonable advice to the DM. Where the advice provided seems to be out with 
that normally expected clear and comprehensive justification must be given. 
The timescales for improvement are: 
 3 
months 
 6 
months 
 12 
months 
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 18 
months 
Change unlikely:  
In some cases the HCP may consider change is unlikely. The timescales for advice 
in these cases are: 
  Within the next 2 years:  
If significant change is unlikely within two years but nevertheless there is still 
some possibility that improvement may occur with time or with further therapy, 
then the HCP should indicate that a return to work is unlikely for at least 2 years. 
For example, you might be considering a claimant with rheumatoid arthritis with a 
significant degree of functional disability, where you would not expect much 
improvement within 2 years but where surgery or other treatment in the medium 
term might change the clinical picture. You might reasonably advise that a return 
to work is unlikely within 2 years.  
 
Or 
A claimant has significant learning difficulties needing significant support on a 
daily basis; however is attending life skills at college and with some degree of 
further maturity may functionally improve, a 2 year prognosis may be suitable. 
Change unlikely: 
  In the longer term: 
If in your opinion there is a substantial degree of functional impairment due to a 
serious medical problem which is chronic or will inevitably deteriorate further, 
even with optimal treatment/ maximal input and adaptations, you should indicate 
that a return to work is unlikely for in the longer term.   
For example, you might reasonably advise an “in the longer term” prognosis for a 
claimant with a clearly progressive neurological condition. 
Or, in the case of a young adult with a very significant degree of learning 
disability, who has a disability in a number of functional areas because of 
cognitive impairment and a requirement for a high level of support, you may feel 
that all management and support strategies have been exhausted and that 
further adaptation is unlikely to occur. You might then reasonably advise an “in 
the longer term” prognosis. 
Other factors: 
Age:  
  This is not a medical cause of incapacity but may indicate the stage of 
the disease. 
 
 
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Duration of incapacity:  
  It is undesirable to frequently review claimants with a confirmed 
chronic or progressive disability whose capability is unlikely to improve.
 
 
 
Fluctuating conditions:  
  It may be reasonable to give a finite prognosis if the natural history of 
the condition suggests that the periodicity and duration of 
exacerbations of the condition will be significant. 
 
Multiple conditions:  
  If there is more than one relevant functional problem, your prognosis 
should be based on the overall functional prognosis. 
 
HCPs should remember the repository and the EBM Protocols. These will be 
helpful when considering prognosis. 
(See Appendix F for a Prognosis Matrix)  
 
8.3  The Work Programme 
The Work Programme is a major new payment for results welfare to work 
programme launched throughout Great Britain in June 2011. It replaces previous 
programmes such as the New Deals, Employment Zones and Flexible New Deal. It 
is delivered by a range of private and voluntary sector organisations providing 
support for people who are at long-term risk of unemployment. It represents a 
significant investment by the Government and its partners in seeking to help millions 
of people into lasting jobs. 
The design of the Work Programme seeks to address weaknesses of previous 
programmes, and brings together and simplifies the range of contracted provision 
and support. The programme supports a wide range of participants, from those who 
are at risk of long-term unemployment, to others with limited capability for work and 
who may have been out of work for several years. 
 
Individuals can access the Work Programme at different times dependent on a 
number of characteristics. These include: the type of benefit they are receiving, their 
age, their distance from the labour market and, for individuals placed in the Work-
related Activity Group (WRAG) of ESA, their WCA prognosis. Some will be required 
to attend the Work Programme, whilst others will be able to volunteer with the 
agreement of their Jobcentre Plus adviser. Whilst not on the Work Programme 
claimants will be supported by Jobcentre Plus. 
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Individuals who are placed in the WRAG and given a 3 or 6 month prognosis will be 
required to join the Work Programme. These individuals will be expected to recover 
or adapt to their condition within a relatively short period of time, so they will be 
provided with immediate support to help them back to work. They will be reassessed 
respectively at the 3 or 6 month point and if found fit for work can claim Jobseekers 
Allowance and continue to receive support through the Work Programme. This will 
place them in the best possible position to return to work once they are well enough 
to do so. Individuals placed in the WRAG and given a prognosis of greater than 6 
months will not be required to join the Work Programme. They will be able to access 
the Work Programme on a voluntary basis or receive support through Jobcentre 
Plus. 
Once on the Work Programme, claimants will be expected to stay on the 
programme for two years. During this time, some people’s circumstances and the 
nature of their participation in the programme may change. If, for example, they are 
found to be in the Support Group at reassessment, then they will no longer be 
mandated to remain in the Work Programme, but could still access the support on a 
voluntary basis.  
Work Programme providers are able to require participants in the WRAG to 
undertake work related activity. However, this activity must always be reasonable 
given the claimant’s circumstances. ESA claimants cannot be required to look for, 
apply or undertake work, nor undergo medical treatment.  
 
Claimants in the WRAG who are not on the Work Programme will be expected to 
prepare for a return to work with support from Jobcentre Plus, undertaking work-
related activity as required by their adviser.   
 
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9.  Justification  
You are required to explain and justify any advice that is given at the filework stage. 
The purpose of the justification of advice is to  
  Fully explain the advice given when advising acceptance including 
justification why LCWRA is not met when advising LCW only 
and  
  Explain prognosis advice 
In cases where the advice given is to accept, the purpose of including a 
justification in all cases is: 
  To provide the Decision Maker with a brief summary of the reasons 
why you consider the evidence to be sufficiently clear to allow you to 
advise on the level of disability without the need for an examination  
  To explain medical reasoning: 
 For subsequent audit purposes 
and  
 To inform another filework HCP who considers the case when it is 
next referred  
You may also wish to explain your reasoning if 
  The opinion appears to be out of keeping with the ESA Filework 
Guidelines 
                                 or  
  There is a need to highlight important issues for the attention of the 
examining HCP   
Justification must: 
  Be specific to the case under consideration  
  Refer to the certified cause of incapacity and to any other relevant 
conditions  
  Be succinct and in line with the IQAS quality standards  
 
 
 
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Justification for every Filework Outcome must be recorded. Justification is 
recorded as either: 
  a LiMA phrase (with use of free text box as appropriate.) 
                   or  
 Free 
text 
Both these can be entered into the Justification box. LiMA will provide a selection 
of justifications from which to choose or you can create an individual response 
using free text. You must provide enough detail to explain your opinion if the 
advice given seems to be contrary to any of the principles set out in the 
ESA Filework Guidelines. You need to justify and explain the reasoning not only 
to the Decision Maker but to a medical auditor.   
Advice should: 
  Not include embarrassing information  
  Not mention the ESA Filework Guidelines in the justification 
 
 
 
 
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10.  Miscellaneous 
10.1  Harmful Information 
Any information that is identified as harmful to the claimant can be indicated to the 
Decision Maker by entering it into the ‘Harmful Information’ box. Any information 
entered here will only be printed out onto the harmful information part of the 
ESA85A.  This may be of particular importance in TI cases. 
10.2  Unexpected Findings 
On rare occasions, you may identify information suggesting the claimant may have 
an undiagnosed illness, or information may be revealed in the ESA 50 that the GP 
may not be aware of e.g. suicidal ideation. You must consider this information 
carefully and follow the guidance provided by your professional body about breach 
of confidentiality. 
You should refer to the Revised WCA Handbook for further information and should 
consult with a senior colleague before disclosing information to a third party. 
10.3  Domiciliary visits 
Not all benefit assessments are conducted at an examination centre. Sometimes a 
claimant indicates that they are unfit to travel to or to attend the MEC and then a 
domiciliary visit (DV) may be necessary.  
Examination at a MEC is the most desirable option, as the conditions there are most 
suitable for an assessment, in terms of Health and Safety and providing a suitable 
environment to conduct a comprehensive examination. However, it is recognised 
that, at times, the examination needs to be conducted in the claimant’s home. 
It is impossible to provide specific guidance that covers all eventualities, but the 
following guidance should be considered when assessing a request for a DV. 
  Does the claimant have a medical condition that precludes them from 
travelling to the MEC? 
  Has there been medical verification of the severity of the condition that 
precludes them from attending for examination in the MEC? 
  Are there health and safety implications for a DV? e.g. the claimant or their 
representative has UCB status identified 
When considering these factors, you must ensure that there is medical confirmation 
of the condition providing the reason why the claimant cannot travel on the grounds 
of health. The request for a DV may come from a GP or other health care 
professional involved in the claimant’s care. When assessing this request you 
should consider: 
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  Whether the request is based on medical fact rather than opinion e.g. “My 
patient has severe agoraphobia and cannot leave the house” rather than “I 
feel my patient would benefit from an assessment at home” or “My patient 
tells me they are unable to travel to the examination centre” 
  Does the request relate to the claimant’s medical problems rather than social 
circumstances at home? 
  Does the information leading to the DV request suggest a severe level of 
disability where Support Group advice may now be applicable? 
In each case the evidence should be reviewed. At times it may be necessary to seek 
further clarification from the author of the report to clarify the medical facts. 
Information that may help support a DV request may be: 
  Diagnosis suggesting significant disability that may make travel 
extremely difficult – e.g. incomplete quadriplegia where LCWRA status 
cannot be established to allow Support Group inclusion without further 
assessment 
  Evidence that the claimant receives home visits or telephone 
consultations with their GP 
   Evidence that the claimant has home visits from the psychiatrist/CMHT 
The HCP may also consider whether other options may be acceptable- for 
example if travelling on public transport is the issue, could a taxi be 
considered? 
There are some circumstances where a DV may be authorised without the 
need for FME. This may be due to practical or health and safety issues. For 
example if the local MSC had no ground floor examination rooms and the 
claimant is a wheelchair user, a DV could be authorised. Each case must be 
considered carefully by the HCP taking into account all the information 
available and health and safety issues. 
In many cases, the HCP may wish to consult with an experienced colleague 
when considering whether a DV is appropriate. 
10.4  Practitioner type 
In all cases where examination is required, you must advise on “practitioner type”. 
All information in the current ESA 50 and the previous documents including the ESA 
85/IB 85 must be scrutinised to ensure that no condition is present that requires 
examination by a medical practitioner or a practitioner trained in neurological 
assessment. 
A list of conditions suitable for assessment by neurology trained nurses and 
physiotherapists and those suitable for assessment only by a registered medical 
practitioner is available on LiveLink under “Neurological Condition List by 
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Practitioner Type”. 
10.5  Miscellaneous ESA filework 
From time to time the DM may send other types of filework referrals for advice. The 
vast majority of these are done electronically. A clerical ESA 55 may be available, 
but the advice request and response is usually given via MSRS. These are usually 
dealt with by an experienced practitioner at CSD. As the advice offered will be 
available online (MSRS), HCP s doing re-referral filework may also access this as 
evidence. 
Occasionally, the DM may submit a referral with a query concerning the diagnosed 
cause of incapacity. The DM may need clarification as to what class of incapacity is 
appropriate based on the IRG. The filework HCP should review the information 
submitted and provide a response to the DM making it clear which IRG diagnosis is 
clinically equivalent. The IRG is available on LiveLink. 
For example; 
DM query 
Retinopathy. Not on IRG, please advise on equivalent category. 
HCP response  
Thanks for this referral. Retinopathy is an eye condition. Please consider using IRG 
number 0788 (Eye, condition, disease or injury).  
These referrals may also include advice cases following receipt of new evidence or 
information by the DM after examination was done. The DM may seek clarification of 
a specific issue prior to making a decision. This is separate from rework. The 
majority of cases are reconsiderations with or without an appeal after the decision 
has been made. The DM would usually have specific questions concerning the 
impact of the new evidence or information on the original examination advice. The 
role of the filework HCP is to evaluate all the available evidence, highlight the 
evidence that underpins the advice offered, and give appropriate advice in response 
to the question (s) raised. The replies should be in keeping with the consensus of 
medical opinion. 
The HCP can advise the DM in a number of ways: 
  Interpreting and explaining medical terminology in claim packs and 
medical reports. This can include the nature of diagnoses, the use of 
medication, the interpretation of clinical examination findings, the 
significance of special investigations and the nature of surgical or other 
treatments. 
  Giving advice of a general nature to the DM on the likely restrictions and 
sequelae arising from specific physical or mental health conditions. 
  Identifying and explaining limitations, inconsistencies or contradictions in 
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the evidence, and advising whether further evidence is likely to be useful. 
  Advising on response to treatment and prognosis of the disabling 
condition (s). 
  Advising on prognosis in relation to descriptor choices. 
For example; 
 
Case 1 
A 55-year-old woman with multiple medical problems including Angina, Arthritis and 
Chronic Fatigue Syndrome states in her ESA50 that she cannot walk more than 100 
metres because of fatigue, painful joints and back pain.  She reports she has 
problems with prolonged sitting/standing and climbing stairs.  
She uses paracetamol and ibuprofen gel as analgesia.  She appears not to be 
attending any hospital specialist or clinic currently. 
She has been assessed by a HCP who documents that she lives alone, apart from a 
pet cat, in a house with stairs, where the toilet and bedroom is upstairs.  She sleeps 
well, rising without difficulty.  She has a shower, standing in the bath without 
difficulty for 15 minutes.  She climbs into the bath using a stool.  She cooks her own 
meals and does all her own housework including vacuuming and changing bed, but 
says everything takes her ages.  She feeds and cares for the cat.  She enjoys 
watching TV including all the soaps the news and occasionally films.  She reads a 
good deal, mainly religious texts.  She is involved with her local church; she visits 
weekly for counselling, and attends services every Sunday, which she never misses.  
She has been attending yoga classes weekly for the last year. Six weeks ago, she 
started to attend swimming classes at the local pool with her friend from the yoga 
class. Initially she found it very tiring but now spends 20 minutes in the pool doing a 
few laps and stretches with her friend.  She visits her mother once a week and also 
sees friends from church.  She says she is too stiff and sore to garden any more, 
which she used to enjoy.  She drives her own manual car and travelled 20 minutes 
to examination centre without difficulty. No significant variability reported throughout 
the week or during the day. 
Findings at exam include: 
Performed neck exam slowly but all movements at the neck were in the normal 
range. She reported pain on moving the shoulders and declined further upper limb 
examination due to reported discomfort. Started straight leg raise on the left leg but 
stopped after about 20 degrees and reported legs heavy and felt discomfort in 
thighs. Declined squat and rise as reported too weak and would be painful. When 
asked to perform other lower limb examination of hips, knees and ankle, declined 
due to reported pain and discomfort.  
Sat up on couch with outstretched legs. 
Blood pressure (sitting) 126/ 74. Not breathless at examination. 
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Informal Observations: 
Sat without obvious discomfort for 40 minutes in upright chair with knees and hips 
bent to about 90 degrees.  
Rose from chair using arms of chair to push self up. 
Bent to pull step out from under examination couch, as well as to pick up handbag 
from floor. 
Used both hands to get medication and spectacles from the handbag. Reached up 
to head with both hands to put on spectacles. 
Got on the couch swinging both legs onto it without obvious difficulty. Used the step 
to get on couch. Walked about 20 metres to the examination room with walking stick 
and slight limp.  Noted to walk around examination room without stick. 
The advice following assessment was that none apply for all the physical descriptors 
including: mobilise, sit/stand, picking up and moving, reaching, manual dexterity.   
Following disallowance of ESA she submitted a report from a DLA assessment, 
carried out 3 weeks after the WCA assessment. 
In it she claimed that she could walk only 50 – 75 yards due to pain, breathlessness, 
poor balance and co-ordination and that she dresses and bathes slowly, and 
manages stairs with an effort.  She does not report urinary or faecal incontinence at 
all. 
At assessment she was noted to walk using a stick and with a waddling gait and 
stooped posture.  She was able to demonstrate 30 degrees of SLR, restricted by 
back and hip pain.  She demonstrated spinal flexion to touch knees. 
In this case the EMP offered the opinion that she could only walk 50 metres, very 
slowly, before stopping and that she would benefit from support from another person 
on uneven ground or hills .The EMP reported she is worse in the afternoons when 
she is more fatigued, and that she was at increased risk of falls. 
 
Model DM submission 
 
WCA examination carried out on 01st  November, zero points awarded  for physical 
descriptors.  Has now appealed stating should be in mobilising Support Group. 
 
“The descriptors on which I would welcome your advice are…. 
 
1. Mobility…… 
 
With her appeal she has enclosed a copy of DLA report dated 22nd  November 
(three weeks after the WCA assessment).She was awarded HR mobility and LR 
care for life. 
 
 In the WCA assessment the HCP has advised that she should be able to mobilise 
more than 200m and advised none apply for the mobilising descriptor.  The EMP 
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has advised that her mobility is severely restricted and that she would be able to 
walk no more than 50m.  I would be grateful if you could advise which of the 2 
reports appear consistent in this area with her medical history. 
 
In order for me to carry out reconsideration I would appreciate any comments you 
are able to make on the 2 contemporaneous reports. 
 
 
Model HCP response 
 
Thank you for this referral.  This 55 yr old lady was assessed separately by 2 
approved Disability Analysts over a 21-day period, and as you have indicated, there 
is marked inconsistency between the 2 reports.  
 
 
Summary 
 
In the WCA report, the HCP has taken a detailed history, identifying that the 
principle restrictions reported are due to back pain and fatigue.  However, the 
activities of daily living reveal that she is able to manage quite an active lifestyle.  
She drives a car, attends yoga and now goes to the pool every week.  She does all 
of her own housework.  This suggests reasonable upper and lower limb function. 
Formal clinical examination was limited by the claimant’s reported pain, discomfort 
and weakness. However, detailed observations made by the HCP demonstrate a far 
greater degree of functional ability than formal clinical findings suggest, and that 
would be more in keeping with her typical day history. 
 
In the DLA report, the examining doctor has taken a far less detailed history, 
documenting only what the claimant reported directly and focussing on what she 
reports she cannot do.  The formal clinical findings appear more complete, and 
seem to demonstrate substantial restriction of back and hip function.  However, in 
this report the examiner has failed to document any informal observations to validate 
the formally demonstrated findings. 
  
Medical Advice 
 
The main disabling conditions are back and hip pain, and CFS.  Given the level of 
analgesia taken, the level of specialist involvement and the activities reported, 
severe disability seems unlikely.  Since the detailed history of activities and the 
documented informal observations in the WCA report seem to support a level of 
mobility well in excess of that identified in the DLA report, the WCA seems to be the 
more sustainable opinion. 
 
 
Case 2 
 
A 19 year old lady with learning difficulties who attended the examination alone. The 
ESA 50 was completed by the social worker and had indicated problems by ticking 
“it varies” with all mental function descriptors except appropriateness of behaviour 
(no problem). She reports that the claimant can be shy and does not always speak 
up. Now living in supported accommodation and attends a Life Skills course at 
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College. 
 
 
At assessment, the claimant stated she came to the centre alone and got the bus 
there. The supported house is only 5 minutes away. She reported that she usually 
manages to wash and dress herself alone every day and cooks meals. She does not 
like doing housework, but has to do tidying duties in the house. The support workers 
always encourage them to do the tidying up. She indicated that she likes to go to the 
shop alone for things to eat and to get sweets. She goes to the supermarket with the 
support worker and two of the other residents. The support worker drives them 
there. Gets picked up by the college bus and attends a Life Skills course 4 days a 
week. She likes to be with her other friends from college and they chat and play 
games on the computer most afternoons. On Thursdays she goes to a charity shop 
where she helps with unpacking items. There is a nice lady at the shop who looks 
after her there and stays with her whole day. She wants to work in the shop at the 
counter with the customers and use the computer at the counter to sell items. 
 
Exam Findings 
Alert at exam. Dressed casually in clean clothing. Smiled a lot during the exam. 
Appeared friendly and gave answers to all questions with no prompting. Was fiddling 
fingers throughout the exam. Knew the day of week and the city but did not 
remember the exact date.  Was unable to make change £1-75 p. Able to register 3 
items but only able to recall 2 after 5 minutes and three attempts. Adequate 
concentration. Not anxious. 
 
The advice following assessment was none apply for all the mental health 
descriptors. 
 
Following disallowance of ESA, the social worker sent a letter seeking 
reconsideration. She also sent a supporting letter from the learning disability nurse 
at the college. In the letter the social worker stated that the claimant tends to 
overstate her abilities and although very proud of living away from elderly parents 
now, she receives lots of support at the house. The support workers are currently 
teaching “dressing skills” at the home and at the college as the claimant continues to 
be unreliable when performing all the activities on her. The social worker indicates 
that the claimant still often “gets it wrong” for example choosing summer clothes on 
a cold winter day.  She likes colourful clothing preferring orange and green and 
would not want to change clothes at times when wearing these colours. Every few 
days she has to be reminded to get washed and dressed appropriately and although 
she makes snacks in the kitchen she has difficulties with doing simple meals as 
cannot tell when things are cooked properly and has also set the pans on fire. She 
now knows not to use cooker unless the support and activity workers are in the 
kitchen. The support worker also prompts the residents to clean up the house. The 
claimant is only able to go to the local shops as she has had travel training for this 
route which is less than 200 metres from the house. She is unable to go to the 
supermarket just over 1 kilometre away as she gets lost and would cry and get very 
upset. She was only able to come to the MEC alone as she was prepared for the 
journey over the 4 weeks prior to the assessment and it is only 5 stops from the 
home. The support worker actually shadowed her for a few practice trips. 
 
The letter from the learning disability nurse stated that the claimant is now practising 
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lots of life skills but is slow at taking up activities. The nurse is concerned that the 
claimant may have overstated her ability as she tends to give the answers she 
thinks the person wants to hear and is somewhat vulnerable. All computing activity 
is supervised and the programme that the claimant plays games on is set up and 
loaded for her to use with her classmate. When the system had a glitch a few weeks 
ago, the programme stopped working and she became extremely distressed as she 
could not reload the game. The activity worker calmed the situation and reloaded 
the programme which just required clicking on one icon. A part of the college 
activities involves planning travel training, however; despite this the claimant found it 
difficult to manage the trip from the house to the college which is 15 minutes away 
by bus. She became upset when the bus was crowded and felt really lost when the 
bus got past the usual supermarket. The shop work is part of the supported work in 
a charity shop the college uses as part of the Life Skills programme. All the 
claimant’s activities there are supervised and she has the main task of packing away 
two sets of items on the stock shelves. Recently, when the colour of the packaging 
of the items was changed she became very upset and had to be calmed down. She 
had to leave the shop for the remainder of the day.  
 
DM submission 
 
WCA exam carried out on 04th January. No points advised for initiating personal 
action, going out and coping with change. The social worker letter and the letter 
from the nurse are casting some doubt now. Kindly advise if this new information is 
likely to alter the advice. I have already reconsidered the learning tasks and coping 
with change descriptors. The other descriptors I am concerned about are personal 
action and going out. 
 
Model HCP response 
 
Thanks for your referral. 
 
The WCA report has provided some information on the activities undertaken. 
However, the claimant seems to be somewhat vulnerable and overstated her 
abilities. Given the additional information from the social worker and the nurse about 
reliability of information given at exam, there are some issues with the descriptors in 
question. The reliability in personal activities such as dressing appears to be under 
assessed in this case as frequent prompting is a feature. She appears to only 
manage very familiar routes and managed to come to the MEC which is close to the 
house after travel training and preparation. The difficulties with travel are further 
supported by the letter from the nurse. 
 
Advice 
The main disabling condition is learning disability. The claimant is attending a Life 
Skills course at College. The additional information suggests that although 
participates in dressing activities this is with frequent prompting. Although able to 
travel to very familiar locations with travel training, she is unable to manage 
unfamiliar locations unaccompanied. 
 
You may wish to consider IA(c) and GA(c). 
 
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11.  Medical Quality 
11.1  Audit 
Prior to approval, all filework is audited. Subsequent filework may be subject to 
audit at anytime. The quality of medical advice provided by approved HCPs on 
ESA filework will be assessed against defined quality standards. Further details 
are available.  
It is important to note that sufficient justification for the advice given must be 
provided by the filework HCP in all cases where the advice is not to call the 
claimant for examination or request FME.   
The quality of the medical advice on ESA filework will be reviewed on the basis of 
the evidence which was available to the HCP at the time the advice was 
provided.  
In general terms, advice must be: 
  In keeping with the consensus of medical opinion on the expected level 
of disability from the underlying medical condition(s) present 
                                                          and  
  Justified in a manner which a decision maker will understand and will 
withstand medical peer review. 
11.2  Amending filework reports 
If a case has been audited and the HCP wishes to make amendments to a report, 
this can be done through MSRS. The HCP can make any necessary 
amendments to the report, review the details carefully, and then complete the 
case. Please refer to the LiMA ESA Filework technical guide for specific 
instructions about audit amendment if required. 
 
 
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Appendix A -  Revised WCA 2011 Support Group 
Functional Categories 
Activity Descriptors 
1. Mobilising unaided by another 
Cannot either: 
person with or without a walking stick, 
(i) mobilise more than 50 metres on level ground without 
manual wheelchair or other aid if such 
stopping in order to avoid significant discomfort or 
aid can reasonably be used. 
exhaustion 
or 
(ii) repeatedly mobilise 50 metres within a reasonable 
timescale because of significant discomfort or exhaustion. 
2. Transferring from one seated 
Cannot move between one seated position and another 
position to another. 
seated position located next to one another without receiving 
physical assistance from another person. 
3. Reaching. 
Cannot raise either arm as if to put 
something in the top pocket of a coat or 
jacket. 
4. Picking up and moving or 
Cannot pick up and move 0.5 litre carton 
transferring by the use of the upper 
full of liquid. 
body and arms (excluding standing, 
sitting, bending or kneeling and all 
other activities specified in this 
Schedule). 
5. Manual dexterity. 
Cannot either - 
 
(a) press a button, such as a telephone keypad or; 
(b) turn the pages of a book 
 
with either hand. 
 
6. Making self understood through 
Cannot convey a simple message, such as the presence of 
speaking, writing, typing, or other 
a hazard. 
means normally used. 
 
7. Understanding communication by 
Cannot understand a simple message due to sensory 
hearing, lip reading, reading 16 point 
impairment, such as the location of a fire escape. 
print or using any aid if reasonably 
 
used. 
 
8. Absence or loss of control over 
At least once a week experiences 
extensive evacuation of the bowel 
 
and/or voiding of the bladder, other 
(i) loss of control leading to extensive evacuation of the 
than enuresis (bed-wetting), despite 
bowel and/or voiding of the bladder; or 
the presence of any aids or 
(ii) substantial leakage of the contents of a collecting device; 
adaptations normally used. 
 
sufficient to require the individual to clean themselves and 
change clothing 
 
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Activity Descriptors 
9. Learning tasks. 
Cannot learn how to complete a simple task, such as setting 
an alarm clock, due to cognitive impairment or mental 
disorder. 
 
10. Awareness of hazard. 
Reduced awareness of everyday hazards, due to cognitive 
impairment or mental disorder, leads to a significant risk of: 
 
(i) injury to self or others; or 
(ii) damage to property or possessions, 
 
such that they require supervision for the majority of the time 
to maintain safety. 
 
11. Initiating and completing personal 
Cannot, due to impaired mental function, reliably initiate or 
action (which means planning, 
complete at least 2 sequential personal actions. 
organisation, problem solving, 
prioritising or switching tasks). 
 
12. Coping with change 
Cannot cope with any change, due to cognitive impairment 
or mental disorder, to the extent that day to day life cannot 
be managed. 
 
13. Coping with social engagement, 
Engagement in social contact is always precluded due to 
due to cognitive impairment or mental 
difficulty relating to others or significant distress experienced 
disorder 
by the individual. 
14. Appropriateness of behaviour with 
Has, on a daily basis, uncontrollable episodes of aggressive 
other people, due to cognitive 
or disinhibited behaviour that would be unreasonable in any 
impairment or mental disorder 
workplace. 
 
15. Conveying food or drink to the 
(a) Cannot convey food or drink to the claimant’s own mouth 
mouth. 
without receiving physical assistance from someone else; 
(b) Cannot convey food or drink to the claimant’s own mouth 
without repeatedly stopping, experiencing breathlessness or 
severe discomfort; 
(c) Cannot convey food or drink to the claimant’s own mouth 
without receiving regular prompting given by someone else 
in the claimant’s physical presence; or 
(d) Owing to a severe disorder of mood or behaviour, fails to 
convey food or drink to the claimant’s own mouth without 
receiving— 
(i) physical assistance from someone else; or 
(ii) regular prompting given by someone else in the 
claimant’s presence. 
 
16.  Chewing or swallowing food or  (a) Cannot chew or swallow food or drink; 
drink. 
(b) Cannot chew or swallow food or drink without repeatedly 
stopping, experiencing breathlessness or severe discomfort; 
(c) Cannot chew or swallow food or drink without repeatedly 
receiving regular prompting given by someone else in the 
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Activity Descriptors 
claimant’s presence; or 
(d) Owing to a severe disorder of mood or behaviour, fails 
to— 
 
(i) chew or swallow food or drink; or 
(ii) chew or swallow food or drink without regular prompting 
given by someone else in the claimant’s presence. 
 
 
Support Group Criteria – Special Circumstances 
The following is a list of the other circumstances that may result in a claimant 
being treated as having limited capability for work-related activity: 
1.  “The claimant is terminally ill” 
2.  “Where the claimant is a woman, she is pregnant and there is a serious risk of 
damage to her health or to the health of her unborn child if she does not refrain 
from work-related activity”. 
3.  “A claimant  who does not have limited activity for work related activity as 
determined in accordance with regulation 34 (1)” (Support Group Descriptors) “is 
to be treated as having limited capability for work related activity  if - 
(a)  The claimant “suffers from some specific disease or bodily or mental 
disablement and; 
(b)  by reasons of such disease or disablement, there would be a substantial 
risk to the mental or physical health of any person if he were found not to 
have limited capability for work-related activity”;  
4.   The claimant is receiving treatment by way of intravenous, intraperitoneal, or 
intrathecal, chemotherapy or recovering from that treatment or is likely to receive 
such treatment within 6 months of the date of the determination of capability for 
work will be treated as having limited capability for work related activity  
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Appendix B -  Revised WCA 2011 LCW 
Descriptors 
Physical Function Descriptors 
 
Activity  
Descriptors 
Points 
1. Mobilising unaided by 
Wa 
Cannot either 
15 
another person with or 
 
 
without a walking stick, 
(i) mobilise more than 50 metres on level ground 
manual wheelchair or  
without stopping in order to avoid significant 
other aid if such aid can 
discomfort or exhaustion  
reasonably be used 
or  
(ii) repeatedly mobilise 50 metres within a 
reasonable timescale because of significant 
discomfort or exhaustion. 
 
 Wb 
Cannot mount or descend two steps unaided by 
9 
another person even with the support of a 
handrail. 
 
 Wc 
Cannot 
either 
9 
 
(i) mobilise more than 100 metres on level ground 
without stopping in order to avoid significant discomfort 
or exhaustion  
or  
(ii) repeatedly mobilise 100 metres within a reasonable 
timescale because of significant discomfort or 
exhaustion. 
 
 Wd 
Cannot 
either 
6 
 
(i) mobilise more than 200 metres on level ground 
without stopping in order to avoid significant discomfort 
or exhaustion  
or  
(ii) repeatedly mobilise 200 metres within a reasonable 
timescale because of significant discomfort or 
exhaustion. 
 
 
We 
None of the above apply. 
0 
 
2. Standing and sitting 
Sa 
Cannot move between one seated position and 
15 
another seated position located next to one 
another without receiving physical assistance from 
another person. 
 
 
Sb 
Cannot, for the majority of the time, remain at a work 
9 
station, either: 
 
(i) standing unassisted by another person (even if free 
to move around) or;  
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Activity  
Descriptors 
Points 
(ii) sitting (even in an adjustable chair)  
 
for more than 30 minutes, before needing to move 
away in order to avoid significant discomfort or 
exhaustion. 
 
 
Sc 
Cannot, for the majority of the time, remain at a work 
6 
station, either:  
 
 
 
(i) standing unassisted by another person (even if free 
 
to move around) or; 
 
(ii) sitting (even in an adjustable chair) 
 
 
for more than an hour before needing to move away in 
order to avoid significant discomfort or exhaustion. 
 
 
Sd 
None of the above apply 
0 
 
3. Reaching 
Ra 
Cannot raise either arm as if to put something in 
15 
the top pocket of a coat or jacket. 
 
 
Rb 
Cannot raise either arm to top of head as if to put on a 
9 
hat. 
 
 
Rc 
Cannot raise either arm above head height as if to 
6 
reach for something. 
 
 
Rd 
None of the above apply. 
0 
 
4. Picking up and moving 
Pa 
Cannot pick up and move a 0.5 litre carton full of 
15 
or transferring by the use 
liquid. 
of the upper body and 
 
arms  
 
Pb 
Cannot pick up and move a one litre carton full of 
9 
liquid. 
 
 
 
Pc 
Cannot transfer a light but bulky object such as an 
6 
empty cardboard box. 
 
 
Pd 
None of the above apply. 
0 
 
5. Manual dexterity 
Ma 
Cannot either: 
15 
 
(i) press a button, such as a telephone keypad 
or 
(ii) turn the pages of a book 
with either hand. 
 
 
Mb 
Cannot pick up a £1 coin or equivalent with either 
15 
hand. 
 
 
Mc 
Cannot use a pen or pencil to make a meaningful 
9 
mark. 
 
 
Md 
Cannot use a suitable keyboard or mouse. 
9 
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Activity  
Descriptors 
Points 
 
Me 
None of the above apply. 
0 
 
6. Making self understood  SPa 
Cannot convey a simple message, such as the 
15 
through speaking, writing, 
presence of a hazard. 
typing, or other means 
 
normally used; unaided 
 
by another person 
 
 
 
SPb 
Has significant difficulty conveying a simple message 
15 
to strangers. 
 
 
SPc 
Has some difficulty conveying a simple message to 
6 
strangers.  
 
 
SPd 
None of the above apply. 
0 
 
7. Understanding 
Ha 
Cannot understand a simple message due to 
15 
communication by both 
sensory impairment, such as the location of a fire 
verbal means (such as 
escape. 
hearing or lip reading) 
 
and non-verbal means 
 
(such as reading 16 point 
 
print) using any aid it is 
 
reasonable to expect 
 
them to use; unaided by 
 
another person 
 
 
Hb 
Has significant difficulty understanding a simple 
15 
message from a stranger due to sensory impairment. 
 
 
Hc 
Has some difficulty understanding a simple message 
6 
from a stranger due to sensory impairment. 
 
 
Hd 
None of the above apply. 
0 
 
8. Navigation and 
Va 
Unable to navigate around familiar surroundings, 
15 
maintaining safety, using 
without being accompanied by another person, due to 
a guide dog or other aid if 
sensory impairment. 
normally used 
 
 
Vb 
Cannot safely complete a potentially hazardous task 
15 
such as crossing the road, without being accompanied 
by another person, due to sensory impairment. 
 
 
Vc 
Unable to navigate around unfamiliar surroundings, 
9 
without being accompanied by another person, due to 
sensory impairment. 
 
 
Vd 
None of the above apply. 
0 
 
9. Absence or loss of 
Ca 
At least once a month experiences 
15 
control leading to 
 
 
extensive evacuation of 
(i) loss of control leading to extensive evacuation of the 
the bowel and/or bladder, 
bowel and/or voiding of the bladder; or 
other than enuresis (bed-
(ii) substantial leakage of the contents of a collecting 
wetting) despite the 
device; 
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Activity  
Descriptors 
Points 
presence of any aids or 
 
adaptations normally 
sufficient to require the individual to clean themselves 
used 
and change clothing. 
 
 
Cb 
At risk of loss of control leading to extensive 
6 
evacuation of the bowel and/or voiding of the bladder, 
 
sufficient to require cleaning and a change in clothing, 
if not able to reach a toilet quickly. 
 
 
Cc 
None of the above apply. 
0 
10. Consciousness during  Fa 
At least once a week, has an involuntary episode of 
15 
waking moments 
lost or altered consciousness, resulting in significantly 
disrupted awareness or concentration. 
 
 
Fb 
At least once a month, has an involuntary episode of 
6 
lost or altered consciousness, resulting in significantly 
disrupted awareness or concentration. 
 
Mental Function Descriptors 
 
Activity  
Descriptors 
Points 
11. Learning tasks 
LTa 
Cannot learn how to complete a simple task, such 
15 
as setting an alarm clock. 
 
 
LTb 
Cannot learn anything beyond a simple task, such as 
9 
setting an alarm clock. 
 
 
LTc 
Cannot learn anything beyond a moderately complex 
6 
task, such as the steps involved in operating a washing 
machine to clean clothes. 
 
 
LTd 
None of the above apply. 
0 
 
12. Awareness of 
AHa 
Reduced awareness of everyday hazards leads to a  15 
everyday hazards (such 
significant risk of:  
as boiling water or sharp 
 
objects) 
(i) injury to self or others; or 
(ii) damage to property or possessions, 
 
such that they require supervision for the majority 
of the time to maintain safety. 
 
 
AHb 
Reduced awareness of everyday hazards leads to a 
9 
significant risk of 
  
(i) injury to self or others; or 
(ii) damage to property or possessions, 
 
such that they frequently require supervision to 
maintain safety. 
 
ESA Filework Guidelines 
7 Final 
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Page  64 
 
 

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Medical Services 
 
Activity  
Descriptors 
Points 
 
AHc 
Reduced awareness of everyday hazards leads to a 
6 
significant risk of: 
 
(i) injury to self or others; or 
(ii) damage to property or possessions, 
 
such that they occasionally require supervision to 
maintain safety. 
 
 
AHd 
None of the above apply. 
0 
 
13. Initiating and 
IAa 
Cannot, due to impaired mental function, reliably 
15 
completing personal 
initiate or complete at least 2 sequential personal 
action (which means 
actions. 
planning, organisation, 
 
problem solving, 
 
prioritising or switching 
 
tasks) 
 
IAb 
Cannot, due to impaired mental function, reliably 
9 
initiate or complete at least 2 personal actions for the 
majority of the time. 
 
 
IAc 
Frequently cannot, due to impaired mental function, 
6 
reliably initiate or complete at least 2 personal actions. 
 
 
IAd 
None of the above apply. 
0 
 
14. Coping with change 
CCa 
Cannot cope with any change to the extent that 
15 
day to day life cannot be managed. 
 
 
CCb 
Cannot cope with minor planned change (such as a 
9 
pre-arranged change to the routine time scheduled for 
a lunch break), to the extent that overall day to day life 
is made significantly more difficult. 
 
 
CCc 
Cannot cope with minor unplanned change (such as 
6 
the timing of an appointment on the day it is due to 
occur), to the extent that overall, day to day life is 
made significantly more difficult. 
 
 
CCd 
None of the above apply. 
0 
 
15. Getting about 
GAa 
Cannot get to any specified place with which the 
15 
claimant is familiar. 
 
 
GAb 
Is unable to get to a specified place with which the 
9 
claimant is familiar, without being accompanied by 
another person. 
 
GAc 
Is unable to get to a specified place with which the 
6 
claimant is unfamiliar without being accompanied by 
another person. 
 
 
GAe 
None of the above apply. 
0 
ESA Filework Guidelines 
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Page  65 
 
 

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Medical Services 
 
Activity  
Descriptors 
Points 
 
16. Coping with social 
CSa 
Engagement in social contact is always precluded 
15 
engagement due to 
due to difficulty relating to others or significant 
cognitive impairment or 
distress experienced by the individual. 
mental disorder 
 
 
CSb 
Engagement in social contact with someone unfamiliar 
9 
to the claimant is always precluded due to difficulty 
relating to others or significant distress experienced by 
the individual. 
 
 
CSc 
Engagement in social contact with someone unfamiliar 
6 
to the claimant is not possible for the majority of the 
time due to difficulty relating to others or significant 
distress experienced by the individual. 
 
 
CSd 
None of the above apply. 
0 
 
17. Appropriateness of 
IBa 
Has, on a daily basis, uncontrollable episodes of 
15 
behaviour with other 
aggressive or disinhibited behaviour that would be 
people, due to cognitive 
unreasonable in any workplace. 
impairment or mental 
 
disorder 
 
 
IBb 
Frequently has uncontrollable episodes of aggressive 
15 
or disinhibited behaviour that would be unreasonable 
in any workplace. 
 
 
IBc 
Occasionally has uncontrollable episodes of 
9 
aggressive or disinhibited behaviour that would be 
unreasonable in any workplace. 
 
 
IBd 
None of the above apply. 
0 
 
 
 
ESA Filework Guidelines 
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Page  66 
 
 

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Medical Services 
 
Appendix C -  ESA 2008 Functional Support 
Group Categories  
 
Activity Descriptors 
 
 
1. Walking or moving on level ground. 
Cannot— 
(a) walk (with a walking stick or other aid if such aid 
is normally used); 
(b) move (with the aid of crutches if crutches are 
normally used); or 
(c) manually propel his wheelchair; 
more than 30 metres without repeatedly stopping, 
experiencing breathlessness or severe discomfort. 
 
2. Rising from sitting and transferring from 
Cannot complete both of the following— 
one seated position to another.  
(a) rise to standing from sitting in an upright chair 
 
without receiving physical assistance from someone 
else; and 
(b) move between one seated position and another 
seated position located next to one another without 
receiving physical assistance from someone else 
 
3. Picking up and moving or transferring by 
Cannot pick up and move 0.5 litre carton full of liquid 
the use of the upper body and arms 
with either hand.  
(excluding standing, sitting, bending or 
 
kneeling and all other activities specified in 
this Schedule). 
 
4. Reaching. 
Cannot raise either arm as if to put something in the 
top pocket of a coat or jacket. 
 
5. Manual dexterity. 
Cannot— 
(a) turn a “star-headed” sink tap with either hand; or 
(b) pick up a £1 coin or equivalent with either hand. 
 
6. Continence— 
(a) Has no voluntary control over  the evacuation of 
(a) Continence other than enuresis (bed 
the bowel; 
wetting) where claimant does not have an 
(b) Has no voluntary control over the voiding of 
artificial stoma or urinary collecting device 
bladder; 
 
(c)At least once a week, loses control of bowels so 
 
that the claimant cannot control the full evacuation of 
 
the bowel; 
 
(d) At least once a week loses control of bladder so 
 
that the claimant cannot control the full voiding of the 
 
bladder; 
 
(e) At least once a week fails to control full 
evacuation of the bowel, owing to  a severe disorder 
 
of  mood or behaviour; or 
 
(f) At least once a week fails to control full voiding of 
 
the bladder, owing to a severe disorder of mood or 
 
behaviour. 
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Medical Services 
 
Activity Descriptors 
 
 
 
 
(b) Continence where claimant uses a urinary 
(a) Is unable to affix, remove or empty the catheter 
collecting device, worn for the majority of the 
bag or other collecting device without receiving 
time including an indwelling urethral or 
physical assistance from another person;  
suprapubic catheter 
(b) Is unable to affix, remove or empty the catheter 
 
bag or other collecting device without causing 
 
leakage of contents; 
 
(c) Has no voluntary control over bowel evacuation; 
 
(d) At least once a week loses control of bowels so 
 
that the claimant cannot control the full evacuation of 
 
the bowel; or 
 
(e) At least once a week fails to control full 
 
evacuation of the bowel, owing to a severe disorder 
of mood or behaviour. 
 
 
 
 
 
(a) Is unable to affix, remove or empty stoma 
 
appliance without receiving physical assistance from 
 
another person;  
 
(b) Is unable to affix, remove or empty stoma 
(c) Continence other than enuresis (bed 
appliance without causing leakage of contents; 
wetting) where claimant has an artificial 
(c) Where the claimant’s artificial stoma relates 
stoma appliance   
solely to the evacuation of the bowel, has no 
 
voluntary control over voiding of bladder; 
(d) Where the claimant’s artificial stoma relates 
solely to the evacuation of the bowel, at least once a 
week loses control of the bladder so that the 
claimant cannot control the full voiding of the 
bladder; or 
(e) Where the claimant’s artificial stoma relates 
solely to the evacuation of the bowel, at least once a 
week, fails to control the full voiding of the bladder, 
owing to a severe disorder of mood or behaviour. 
 
7. Maintaining personal hygiene 
(a) Cannot clean own torso (excluding own back) 
 
without receiving physical assistance from someone 
 
else; 
 
(b) Cannot clean own torso (excluding back) without 
 
repeatedly stopping, experiencing breathlessness or 
 
severe discomfort; 
 
(c) Cannot clean own torso (excluding back) without 
receiving regular prompting given by someone else 
 
in the claimant’s presence; or 
 
(d) Owing to a severe disorder of mood or behaviour, 
 
fails to clean own torso (excluding own back) without 
 
receiving— 
 
(i) physical assistance from someone else, or  
 
(ii) regular prompting given by someone else in the 
 
claimant’s presence. 
 
 
 
 
 
ESA Filework Guidelines 
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Page  68 
 
 

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Medical Services 
 
Activity Descriptors 
8. Eating and drinking 
 
(a)  Conveying food or drink to the mouth. 
(a) Cannot convey food or drink to the claimant’s 
 
own mouth without receiving physical assistance 
 
from someone else; 
 
(b) Cannot convey food or drink to the claimant’s 
 
own mouth without repeatedly stopping, 
 
experiencing breathlessness or severe discomfort;  
 
(c) Cannot convey food or drink to the claimant’s 
own his mouth without receiving regular prompting 
 
given by someone else in the claimant’s physical 
 
presence; or 
 
(d) Owing to a severe disorder of mood or behaviour, 
 
fails to convey food or drink to the claimants own 
 
mouth without receiving— 
 
(i) physical assistance from someone else, or  
 
(ii) regular prompting given by someone else in the 
 
claimant’s presence. 
 
 
 
(a) Cannot chew or swallow food or drink; 
 
(b) Cannot chew  or swallow food or drink without 
 
repeatedly stopping, experiencing breathlessness or 
(b) Chewing or swallowing food or drink 
severe discomfort; 
 
(c) Cannot chew or swallow food or drink without 
repeatedly receiving regular prompting given by 
someone else in the claimant’s presence; or 
(d) Owing to a severe disorder of mood or behaviour, 
fails to—  
(i) chew or swallow food or drink; or 
(ii) chew or swallow food or drink without regular 
prompting given by someone else in the claimant’s 
presence.  
 
9. Learning or comprehension in the 
(a) Cannot learn or understand how to successfully 
completion of tasks 
complete a simple task, such as the preparation of a 
 
hot drink, at all; 
 (b) Needs to witness a demonstration, given more 
than once on the same occasion of how to carry out 
a simple task before the claimant is able to learn or 
understand how to complete the task successfully, 
but would be unable to successfully complete the 
task the following day without receiving a further 
demonstration of how to complete it; 
or 
(c) Fails to do any of the matters referred to in (a) or 
(b) owing to a severe disorder of mood or behaviour. 
 
10. Personal action  
(a) Cannot initiate or sustain any personal action 
(which involves planning, organisation, problem 
solving, prioritising or switching tasks); 
(b) Cannot initiate or sustain personal action without 
requiring daily verbal prompting given by someone 
else in the claimant’s presence; or 
 
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Medical Services 
 
Activity Descriptors 
(c) Fails to initiate or sustain basic personal action 
without requiring daily verbal prompting given by 
someone else in the claimant’s presence, owing to a 
severe disorder of mood or behaviour. 
 
11. Communication 
(a) none of the following forms of communication can 
 
be achieved by the claimant— 
 
(i) speaking (to a standard that may be understood 
by strangers); 
(ii) writing (to a standard that may be understood by 
strangers); 
(iii) typing (to a standard that may be understood by 
strangers) 
(iv) sign language to a standard equivalent to Level 3 
British Sign Language; 
(b) none of the forms of communication referred to in 
(a) are achieved by the claimant, owing to a severe 
disorder of  mood or behaviour; 
(c) Misinterprets verbal or non-verbal communication 
to the extent of causing distress to himself or herself 
on a daily basis; or  
(d) Effectively cannot make himself or herself 
understood to others because of his disassociation 
from reality owing to a severe disorder of mood or 
behaviour. 
 
Support Group Criteria – Special Circumstances 
The following is a list of the other circumstances that may result in a claimant being 
treated as having limited capability for work-related activity: 
  “The claimant is terminally ill” 
  The claimant is a woman, she is pregnant and there is a serious risk of 
damage to her health or to the health of her unborn child if she does not 
refrain from work-related activity”. 
   “A claimant  who does not have limited activity for work related activity 
as determined in accordance with regulation 34 (1)” (Support Group 
Descriptors) “is to be treated as having limited capability for work related 
activity  if - 
o  The claimant “suffers from some specific disease or bodily or 
mental disablement and; 
o  by reasons of such disease or disablement, there would be a 
substantial risk to the mental or physical health of any person if 
he were found not to have limited capability for work-related 
activity”;  
  People receiving intravenous, intraperitoneal, or intrathecal, 
chemotherapy (for whatever reason) will be treated as having limited 
capability for work related activity (i.e. in the support group), while they 
are receiving treatment and during a subsequent “period of recovery”. 
ESA Filework Guidelines 
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Medical Services 
 
Appendix D -  ESA 2008 LCW Descriptors 
Physical Function Descriptors 
 
Activity  
Descriptors 
Points 
1. Walking with a walking 
Wa 
Cannot walk at all. 
15 
stick or other aid if such aid is   
 
normally used. 
 
 
 
 
Wb 
Cannot walk more than 50 metres on level ground 
15 
without repeatedly stopping or severe discomfort. 
 
 
Wc 
Cannot walk up or down two steps even with the 
15 
support of a handrail. 
 
 
Wd 
Cannot walk more than 100 metres on level ground 
9 
without stopping or severe discomfort. 
 
 
We 
Cannot walk more than 200 metres on level ground 
6 
without stopping or severe discomfort. 
 
 
Wf 
None of the above apply. 
0 
 
2. Standing and sitting. 
Sa 
Cannot stand for more than 10 minutes, unassisted 
15 
by another person, even if free to move around, 
before needing to sit down. 
 
 
Sb 
Cannot sit in a chair with a high back and no arms 
15 
for more than 10 minutes before needing to move 
from the chair because the degree of discomfort 
experienced makes it impossible to continue sitting. 
 
 
Sc 
Cannot rise to standing from sitting in an upright 
15 
chair without physical assistance from another 
 
person. 
 
 
 
Sd 
Cannot move between one seated position and 
15 
another seated position located next to one another 
without receiving physical assistance from another 
person. 
 
 
Se 
Cannot stand for more than 30 minutes, even if free 
6 
to move around, before needing to sit down. 
 
 
Sf 
Cannot sit in a chair with a high back and no arms 
6 
for more than 30 minutes without needing to move 
from the chair because the degree of discomfort 
makes it impossible to continue sitting. 
 
 
Sg 
None of the above apply. 
0 
 
 
ESA Filework Guidelines 
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Medical Services 
 
Activity  
Descriptors 
Points 
3. Bending or kneeling. 
Ba 
Cannot bend to touch knees and straighten up 
15 
again. 
 
Bb 
Cannot bend, kneel or squat, as if to pick a light 
9 
object, such as a piece of paper, situated 15cm 
from the floor on a low shelf, and to move it and 
straighten up again without the help of another 
person. 
 
 
Bc 
Cannot bend, kneel or squat, as if to pick a light 
6 
object off the floor and straighten up again without 
the help of another person. 
 
 
Bd 
None of the above apply. 
0 
 
4. Reaching. 
Ra 
Cannot raise either arm as if to put something in the 
15 
top pocket of a coat or jacket. 
 
 
Rb 
Cannot put either arm behind back as if to put on a 
15 
coat or jacket. 
 
 
Rc 
Cannot raise either arm to top of head as if to put 
9 
on a hat. 
 
Rd 
Cannot raise either arm above head height as if to 
6 
reach for something. 
 
 
Re 
None of the above apply. 
0 
 
5. Picking up and moving or 
Pa 
Cannot pick up and move a 0.5 litre carton full of 
15 
transferring by the use of the 
liquid with either hand. 
upper body and arms  
 
 
 
Pb 
Cannot pick up and move a one litre carton full of 
9 
liquid with either hand. 
 
 
Pc 
Cannot pick up and move a light but bulky object 
6 
such as an empty cardboard box, requiring the use 
of both hands together. 
 
 
Pd 
None of the above apply. 
0 
 
6. Manual dexterity. 
Ma 
Cannot turn a “star-headed” sink tap with either 
15 
hand. 
 
 
Mb 
Cannot pick up a £1 coin or equivalent with either 
15 
hand. 
 
 
Mc 
Cannot turn the pages of a book with either hand. 
15 
 
 
Md 
Cannot physically use a pen or pencil. 
9 
 
 
Me 
Cannot physically use a conventional keyboard or 
9 
mouse. 
ESA Filework Guidelines 
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Page  72 
 
 

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Medical Services 
 
Activity  
Descriptors 
Points 
 
Mf 
Cannot do up / undo small buttons, such as shirt or 
9 
blouse buttons. 
 
 
Mg 
Cannot turn a “star-headed” sink tap with one hand 
6 
but can with the other. 
 
 
Mh 
Cannot pick up a £1 coin or equivalent with one 
6 
hand but can with the other. 
 
 
       
Cannot pour from an open 0.5 litre carton full of 
6 
Mi 
liquid. 
 
 
Mj 
None of the above apply. 
0 
 
7. Speech. 
SPa 
Cannot speak at all. 
15 
 
 
SPb 
Speech cannot be understood by strangers. 
15 
 
 
SPc 
Strangers have great difficulty understanding 
9 
speech.  
 
 
SPd 
Strangers have some difficulty understanding 
6 
speech.  
 
 
SPe 
None of the above apply. 
0 
 
8. Hearing with a hearing aid 
Ha 
Cannot hear at all.  
15 
or other aid if normally worn 
 
 
 
Hb 
Cannot hear well enough to be able to hear 
15 
someone talking in a loud voice in a quiet room, 
sufficiently clearly to distinguish the words being 
spoken. 
 
 
Hc 
Cannot hear someone talking in a normal voice in a 
9 
quiet room, sufficiently clearly to distinguish the 
words being spoken. 
 
 
Hd 
Cannot hear someone talking in a loud voice in a 
6 
busy street, sufficiently clearly to distinguish the 
words being spoken. 
 
 
He 
None of the above apply. 
0 
 
9. Vision including visual 
Va 
Cannot see at all. 
15 
acuity and visual fields, in 
 
normal daylight or bright 
 
electric light, with glasses or 
 
other aid to vision if such aid 
 
is normally worn. 
 
 
Vb 
Cannot see well enough to read 16 point print at a 
15 
distance of greater than 20cm. 
ESA Filework Guidelines 
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Medical Services 
 
Activity  
Descriptors 
Points 
 
Vc 
Has 50% or greater reduction of visual fields. 
15 
 
 
Vd 
Cannot see well enough to recognise a friend at a 
9 
distance of at least 5 metres. 
 
 
Ve 
Has 25% or more but less than 50% reduction of 
6 
visual fields. 
 
 
Vf 
Cannot see well enough to recognise a friend at a 
6 
distance of at least 15 metres. 
 
 
Vg 
None of the above apply. 
0 
 
10 (a) Continence other than 
Ca 
Has no voluntary control of the evacuation of the 
15 
enuresis (bed wetting) where 
bowel. 
 
the person does not have an 
 
artificial stoma or urinary 
 
collecting device. 
 
 
 
Cb 
Has no voluntary control of the voiding of the 
15 
bladder. 
 
 
 
Cc 
At least once a month loses control of bowels so 
15 
that the person cannot control the full evacuation of 
the bowel. 
 
 
Cd 
At least once a week loses control of bladder so 
15 
that the person cannot control the full voiding of the 
bladder. 
 
 
Ce 
Occasionally loses control of bowels so that the 
9 
person cannot control the full evacuation of the 
bowel. 
 
 
Cf 
At least once a month loses control of bladder so 
6 
that the person cannot control the full voiding of the 
bladder. 
 
 
Cg 
Risks losing control of bowels or bladder so that the 
6 
person cannot control the full evacuation of the 
bowel or the full voiding of the bladder if not able to 
reach a toilet quickly. 
 
 
Ch 
None of the above apply. 
0 
 
10(b) Continence where the 
CUa 
Is unable to affix, remove or empty the catheter bag 
15 
person uses a urinary 
or other collecting device without receiving physical 
collecting device, worn for the 
assistance from another person. 
majority of the time including 
an indwelling urethral or 
suprapubic catheter. 
 
 
ESA Filework Guidelines 
7 Final 
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Page  74 
 
 

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Medical Services 
 
Activity  
Descriptors 
Points 
 
CUb 
Is unable to affix, remove or empty the catheter bag 
15 
or other collecting device without causing leakage 
of contents. 
 
 
CUc 
Has no voluntary control over the evacuation of the 
15 
bowel. 
 
 
CUd 
At least once a month loses control of bowels so 
15 
that the person cannot control the full evacuation of 
the bowel. 
 
 
CUe 
Occasionally loses control of bowels so that the 
9 
person cannot control the full evacuation of the 
bowel. 
 
 
     
Risks losing control of the bowels so that the 
6 
CUf 
person cannot control the full evacuation of the 
bowel if not able to reach a toilet quickly. 
 
 
CUg 
None of the above apply. 
0 
 
10(c) Continence other than 
CBa 
Is unable to affix, remove or empty stoma appliance 
15 
enuresis (bed wetting) where 
without receiving physical assistance from another 
the person has an artificial 
person. 
stoma. 
 
 
CBb 
Is unable to affix, remove or empty stoma appliance 
15 
without causing leakage of contents. 
 
 
CBc 
Where the person’s artificial stoma relates solely to 
15 
the evacuation of the bowel, at least once a week, 
loses control of bladder so that the person cannot 
control the full voiding of the bladder. 
 
 
    
Where the person’s artificial stoma relates solely to 
9 
CBd 
the evacuation of the bowel, at least once a month, 
loses control of bladder so that the person cannot 
control the full voiding of the bladder. 
 
 
CBe 
Where the person’s artificial stoma relates solely to 
6 
the evacuation of the bowel, risks losing control of 
the bladder so that the person cannot control the 
full voiding of the bladder if not able to reach a toilet 
quickly. 
 
 
CBf 
None of the above apply. 
0 
 
11. Remaining conscious 
Fa 
At least once a week, has an involuntary episode of 
15 
during waking moments. 
lost or altered consciousness, resulting in 
significantly disrupted awareness or concentration. 
 
 
Fb 
At least once a month, has an involuntary episode 
9 
of lost or altered consciousness, resulting in 
significantly disrupted awareness or concentration. 
ESA Filework Guidelines 
7 Final 
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Page  75 
 
 

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Medical Services 
 
Activity  
Descriptors 
Points 
 
Fc 
At least twice in the six months immediately 
6 
preceding the assessment, has had an involuntary 
episode of lost or altered consciousness, resulting 
in significantly disrupted awareness or 
concentration. 
 
 
Fd 
None of the above apply. 
0 
 
Mental Function Descriptors 
 
Activity  
Descriptors 
Points 
12. Learning or 
 
Cannot learn or understand how to successfully 
 
comprehension in the 
LTa 
complete a simple task, such as setting an alarm 
15 
completion of tasks. 
clock, at all. 
 
 
LTb 
Needs to witness a demonstration, given more than 
15 
once on the same occasion, of how to carry out a 
simple task before the person is able to learn or 
understand how to complete the task successfully, 
but would be unable to successfully complete the 
task the following day without receiving a further 
demonstration of how to complete it. 
 
 
LTc 
Needs to witness a demonstration of how to carry 
9 
out a simple task, before the person is able to learn 
or understand how to complete the task 
successfully, but would be unable to successfully 
complete the task the following day without 
receiving a verbal prompt from another person. 
 
 
LTd 
Needs to witness a demonstration of how to carry 
9 
out a moderately complex task, such as the steps 
involved in operating a washing machine to 
correctly clean clothes, before the person is able to 
learn or understand how to complete the task 
successfully, but would be unable to successfully 
complete the task the following day without 
receiving a verbal prompt from another person. 
 
 
LTe 
Needs verbal instructions as to how to carry out a 
6 
simple task before the person is able to learn or 
understand how to complete the task successfully, 
but would be unable, within a period of less than 
one week, to successfully complete the task without 
receiving a verbal prompt from another person. 
 
 
LTf 
None of the above apply. 
0 
 
 
 
 
ESA Filework Guidelines 
7 Final 
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Page  76 
 
 

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Medical Services 
 
Activity  
Descriptors 
Points 
13. Awareness of hazard. 
Aha 
Reduced awareness of the risks of everyday 
15 
hazards (such as boiling water or sharp objects) 
would lead to daily instances of or to near-
avoidance of: 
(i) injury to self or others; or 
(ii) significant damage to property or possessions, 
to such an extent that overall day to day life cannot 
successfully be managed. 
 
 
AHb 
Reduced awareness of the risks of everyday 
9 
hazards would lead for the majority of the time to 
instances of or to near-avoidance of: 
(i) injury to self or others; or 
(ii) significant damage to property or possessions, 
to such an extent that overall day to day life cannot 
successfully be managed without supervision from 
another person. 
 
 
AHc 
Reduced awareness of the risks of everyday 
6 
hazards has led or would lead to frequent instances 
of or to near-avoidance of: 
(i) injury to self or others; or 
(ii) significant damage to property or possessions, 
but not to such an extent that overall day to day life 
cannot be managed when such incidents occur. 
 
 
AHd 
None of the above apply 
0 
 
14. Memory and 
MCa 
On a daily basis, forgets or loses concentration to 
15 
concentration. 
such an extent that overall day to day life cannot be 
successfully managed without receiving verbal 
prompting, given by someone else in the person’s 
presence. 
 
 
MCb 
For the majority of the time, forgets or loses 
9 
concentration to such an extent that overall day to 
day life cannot be successfully managed without 
receiving verbal prompting, given by someone else 
in the claimant’s presence. 
 
 
MCc 
Frequently forgets or loses concentration to such an 
6 
extent that overall day to day life can only be 
successfully managed with pre-planning, such as 
making a daily written list of all tasks forming part of 
daily life that are to be completed. 
 
 
MCd 
None of the above apply. 
0 
 
15. Execution of tasks. 
ETa 
Is unable to successfully complete any everyday 
15 
task. 
 
 
 
ESA Filework Guidelines 
7 Final 
MED-ESAFWG~001 
Page  77 
 
 

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Medical Services 
 
Activity  
Descriptors 
Points 
 
ETb 
Takes more than twice the length of time it would 
15 
take a person without any form of mental 
disablement, to successfully complete an everyday 
task with which the claimant is familiar. 
 
 
ETc 
Takes more than one and a half times but no more 
9 
than twice the length of time it would take a person 
without any form of mental disablement to 
successfully complete an everyday task with which 
the claimant is familiar. 
 
ETd 
Takes one and a half times the length of time it 
6 
would take a person without any form of mental 
disablement to successfully complete an everyday 
task with which the claimant is familiar. 
 
 
ETe 
None of the above apply, 
0 
 
16. Initiating and sustaining 
IAa 
Cannot, due to cognitive impairment or due to a 
15 
personal action. 
severe disorder of mood or behaviour, initiate or 
sustain any personal action (which means planning, 
organisation, problem solving, prioritising or 
switching tasks). 
 
 
IAb 
Cannot, due to cognitive impairment or due to a 
15 
severe disorder of mood or behaviour, initiate or 
sustain personal action without requiring daily 
verbal prompting given by another person in the 
person’s presence. 
 
 
IAc 
Cannot, due to cognitive impairment or due to a 
9 
severe disorder of mood or behaviour, initiate or 
sustain personal action without requiring verbal 
prompting given by another person in the person’s 
presence for the majority of the time. 
 
 
IAd 
Cannot, due to cognitive impairment or due to a 
6 
severe disorder of mood or behaviour, initiate or 
sustain personal action without requiring frequent 
verbal prompting given by another person in the 
person’s presence. 
 
 
IAe 
None of the above apply. 
0 
 
17. Coping with change. 
CCa 
Cannot cope with very minor, expected changes in 
15 
routine, to the extent that overall day to day life 
cannot be managed. 
 
 
CCb 
Cannot cope with expected changes in routine 
9 
(such as a pre-arranged permanent change to the 
routine time scheduled for a lunch break), to the 
extent that overall day to day life is made 
significantly more difficult. 
 
 
ESA Filework Guidelines 
7 Final 
MED-ESAFWG~001 
Page  78 
 
 

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Medical Services 
 
Activity  
Descriptors 
Points 
 
CCc 
Cannot cope with minor, unforeseen changes in 
6 
routine (such as an unexpected change of the 
timing of an appointment on the day it is due to 
occur), to the extent that overall, day to day life is 
made significantly more difficult. 
 
CCd 
None of the above apply. 
0 
 
18. Getting about. 
GAa 
Cannot get to any specified place with which the 
15 
person is, or would be, familiar. 
 
 
Gab 
Is unable to get to a specified place with which the 
15 
person is familiar, without being accompanied by 
another person on each occasion. 
 
 
GAc 
For the majority of the time is unable to get to a 
9 
specified place with which the person is familiar 
without being accompanied by another person. 
 
 
GAd 
Is frequently unable to get to a specified place with 
6 
which the person is familiar without being 
accompanied by another person. 
 
 
GAe 
None of the above apply. 
0 
 
19. Coping with social 
CSa 
Normal activities, for example, visiting new places 
15 
situations. 
or engaging in social contact, are precluded 
because of overwhelming fear or anxiety. 
 
 
CSb 
Normal activities, for example, visiting new places 
9 
or engaging in social contact, are precluded for the 
majority of the time due to overwhelming fear or 
anxiety. 
 
 
CSc 
Normal activities, for example, visiting new places 
6 
or engaging in social contact, are frequently 
precluded, due to overwhelming fear or anxiety. 
 
 
CSd 
None of the above apply. 
0 
 
20. Propriety of behaviour 
IBa 
Has unpredictable outbursts of, aggressive, 
15 
with other people. 
disinhibited, or bizarre behaviour, being either: 
(i) sufficient to cause disruption to others on a daily 
basis; or 
(ii) of such severity that although occurring less 
frequently than on a daily basis, no reasonable 
person would be expected to tolerate them. 
 
 
IBb 
Has a completely disproportionate reaction to minor 
15 
events or to criticism to the extent that the person 
has an extreme violent outburst leading to 
threatening behaviour or actual physical violence. 
 
 
ESA Filework Guidelines 
7 Final 
MED-ESAFWG~001 
Page  79 
 
 

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Medical Services 
 
Activity  
Descriptors 
Points 
 
IBc 
Has unpredictable outbursts of, aggressive, 
9 
disinhibited or bizarre behaviour, sufficient in 
severity and frequency to cause disruption for the 
majority of the time. 
 
 
 
IBd 
Has a strongly disproportionate reaction to minor 
9 
events or to criticism, to the extent that the person 
cannot manage overall day to day life when such 
events or criticism occur. 
 
 
IBe 
Has unpredictable outbursts of aggressive, 
6 
disinhibited or bizarre behaviour, sufficient to cause 
frequent disruption. 
 
 
IBf 
Frequently demonstrates a moderately 
6 
disproportionate reaction to minor events or to 
criticism but not to such an extent that the person 
cannot manage overall day to day life when such 
events or criticism occur. 
 
 
IBg 
None of the above apply. 
0 
 
21. Dealing with other 
DPa 
Is unaware of impact of own behaviour to the extent 
15 
people. 
that: 
   (i) has difficulty relating to others even for brief 
periods, such as a few hours; or 
   (ii) causes distress to others on a daily basis. 
 
 
DPb 
The person misinterprets verbal or non-verbal 
15 
communication to the extent of causing himself or 
herself significant distress on a daily basis. 
 
 
DPc 
Is unaware of impact of own behaviour to the extent 
9 
that: 
   (i) has difficulty relating to others for  longer 
periods, such as a day or two; or 
   (iii) causes distress to others for the majority of 
the time. 
 
 
DPd 
The person misinterprets verbal or non-verbal 
9 
communication to the extent of causing the person 
significant distress to themselves for the majority of 
the time. 
 
 
DPe 
Is unaware of impact of own behaviour to the extent 
6 
that: 
   (i) has difficulty relating to others      for prolonged 
periods, such as a         week; or 
   (ii) frequently causes distress to  
    others. 
 
 
ESA Filework Guidelines 
7 Final 
MED-ESAFWG~001 
Page  80 
 
 

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Medical Services 
 
Activity  
Descriptors 
Points 
 
DPf 
The person misinterprets verbal or non-verbal 
6 
communication to the extent of causing the person 
significant distress to themselves on a frequent 
basis. 
 
 
DPg 
None of the above apply. 
0 
 
 
ESA Filework Guidelines 
7 Final 
MED-ESAFWG~001 
Page  81 
 
 

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Medical Services 
 
Appendix E -  IB \ PCA Descriptors & Exemption 
Categories 
PHYSICAL DESCRIPTORS 
Activity  
Descriptors 
Points 
WALKING ON 
a 
Cannot walk at all 
15 
LEVEL GROUND 
b 
Cannot walk more than a few steps without stopping or 
15 
WITH A WALKING 
severe discomfort 
STICK OR OTHER 
c 
Cannot walk more than 50 metres without stopping or severe 
15 
AID IF NORMALLY 
discomfort 
USED* 
d 
Cannot walk more than 200 metres without stopping or 
7 
severe discomfort 
e 
Cannot walk more than 400 metres without stopping or 
3 
severe discomfort 
f 
Cannot walk more than 800 metres without stopping or 
0 
severe discomfort 
g 
No walking problem 
0 
 
 
 
 
WALKING UP AND 
a 
Cannot walk up and down one stair 
15 
DOWN STAIRS* 
b 
Cannot walk up and down a flight of 12 stairs 
15 
c 
Cannot walk up and down a flight of 12 stairs without holding 
7 
or taking a rest 
d 
Cannot walk up and down a flight of 12 stairs without holding 
3 
on 
e 
Can only walk up and down a flight of 12 stairs if goes 
3 
sideways or one step at a time 
f 
No problem in walking up and down stairs 
0 
 
 
 
 
SITTING IN AN 
a 
Cannot sit comfortably 
15 
UPRIGHT CHAIR 
b 
Cannot sit comfortably for more than 10 minutes without 
15 
WITH A BACK BUT 
having to move from the chair 
NO ARMS 
c 
Cannot sit comfortably for more than 30 minutes without 
7 
having to move from the chair 
d 
Cannot sit comfortably for more than one hour without having 
3 
to move from the chair 
e 
Cannot sit comfortably for more than two hours without 
0 
having to move from the chair 
f 
No problem with sitting 
0 
 
 
 
 
STANDING 
a 
Cannot stand unassisted 
15 
WITHOUT THE 
b 
Cannot stand for more than a minute before needing to sit 
15 
SUPPORT OF 
down 
ANOTHER 
c 
Cannot stand for more than 10 minutes before needing to sit 
15 
PERSON; MAY 
down 
USE A WALKING 
d 
Cannot stand for more than 30 minutes before needing to sit 
7 
STICK 
down 
e 
Cannot stand for more than 10 minutes before needing to 
7 
move around 
f 
Cannot stand for more than 30 minutes before needing to 
3 
move around 
g 
No problem standing 
0 
 
 
 
 
ESA Filework Guidelines 
7 Final 
MED-ESAFWG~001 
Page  82 
 
 

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Medical Services 
 
Activity  
Descriptors 
Points 
RISING FROM 
a 
Cannot rise from sitting to standing 
15 
SITTING FROM AN 
b 
Cannot rise from sitting to standing without holding on to 
7 
UPRIGHT CHAIR 
something 
c 
Sometimes cannot rise from sitting to standing without 
3 
holding on to something 
d 
No problem with rising from sitting to standing 
0 
 
 
 
 
BENDING AND 
a 
Cannot bend to touch knees and straighten up again 
15 
KNEELING 
b 
Cannot bend or kneel as if to pick up a piece of paper from 
15 
the floor and straighten up again 
c 
Sometimes cannot bend or kneel as if to pick up a piece of 
3 
paper from the floor and straighten up again 
d 
No problem with bending and kneeling 
0 
 
 
 
 
MANUAL 
a 
Cannot turn the pages of a book with either hand 
15 
DEXTERITY 
b 
Cannot turn a tap or control knobs on a cooker with either 
15 
hand 
c 
Cannot pick up a coin which is 2.5 centimetres or less in 
15 
diameter with either hand 
d 
Cannot use a pen or pencil 
15 
e 
Cannot tie a bow in laces or string 
10 
f 
Cannot turn a tap or control knobs on a cooker with one hand 
6 
g 
Cannot pick up a coin which is 2.5 centimetres or less in 
6 
diameter with one hand 
h 
No problem with manual dexterity 
0 
 
 
 
 
LIFTING AND 
a 
Cannot pick up a paperback book, with either hand 
15 
CARRYING 
b 
Cannot pick up and carry a 0.5 litre carton of milk with either 
15 
hand 
c 
Cannot pick up and pour from a full saucepan or kettle of 1.7 
15 
litre capacity with either hand 
d 
Cannot pick up and carry a 2.5 kilogramme bag of potatoes 
8 
with either hand 
e 
Cannot pick up and carry a 0.5 litre carton of milk with one 
6 
hand 
f 
Cannot pick up and carry a 2.5 kilogramme bag of potatoes 
0 
with one hand 
g 
No problem with lifting and carrying 
0 
 
 
 
 
REACHING 
a 
Cannot raise either arm to put something in the top pocket of 
15 
a coat or jacket 
b 
Cannot raise either arm to his/her head to put on a hat 
15 
c 
Cannot put either arm behind his/her back to put on a coat or 
15 
jacket 
d 
Cannot raise either arm above his/her head to reach for 
15 
something 
e 
Cannot raise one arm to his/her head to put on a hat 
6 
f 
Cannot raise one arm above his/her head to reach for 
0 
something 
g 
No problem with reaching 
0 
 
 
ESA Filework Guidelines 
7 Final 
MED-ESAFWG~001 
Page  83 
 
 

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Medical Services 
 
Activity  
Descriptors 
Points 
SPEECH 
a Cannot 
speak 
15 
b 
Speech cannot be understood by family or friends 
15 
c 
Speech cannot be understood by strangers 
15 
d 
Strangers have great difficulty understanding speech 
10 
e 
Strangers have some difficulty understanding speech 
8 
f 
No problem with speech 
0 
 
 
 
 
HEARING WITH A 
a 
Cannot hear sounds at all 
15 
HEARING AID IF 
b 
Cannot hear well enough to follow a television programme 
15 
USED 
with the volume turned up 
c 
Cannot hear well enough to understand someone talking in a 
15 
loud voice in a quiet room 
d 
Cannot hear well enough to understand someone talking in a 
10 
normal voice in a quiet room 
e 
Cannot hear well enough to understand someone talking in a 
8 
normal voice in a busy street 
f 
No problem with hearing 
0 
 
 
 
 
VISION IN 
a 
Cannot tell light from dark 
15 
NORMAL 
b 
Cannot see the shape of furniture in the room 
15 
DAYLIGHT WITH 
c 
Cannot see well enough to read 16 point print at a distance 
15 
GLASSES 
greater than 20 centimetres 
d 
Cannot see well enough to recognise a friend across the 
12 
room 
e 
Cannot see well enough to recognise a friend across the road 
8 
f 
No problem with vision 
0 
 
 
 
 
CONTINENCE 
a 
No voluntary control over bowels 
15 
b 
No voluntary control over bladder 
15 
c 
Loses control of bowels at least once a week 
15 
d 
Loses control of bowels at least once a month 
15 
e 
Loses control of bowels occasionally 
9 
f 
Loses control of bladder at least once a month 
3 
g 
Loses control of bladder occasionally 
0 
h 
No problem with continence 
0 
 
 
 
 
REMAINING 
a 
Has an involuntary episode of lost or altered consciousness 
15 
CONSCIOUS 
at least once a day 
OTHER THAN FOR 
b 
Has (above) at least once a week 
15 
NORMAL PERIODS  c 
Has (above) at least once a month 
15 
OF SLEEP 
d 
Has had (above) at least twice, in the six months before the 
12 
test is applied 
e 
Has had (above) once in the six months before the test is 
8 
applied 
f 
Has had (above) once in the three years before the test is 
0 
applied 
g 
No problems with consciousness 
0 
 
 
 
 
* Only take the highest descriptor from walking or stairs, not both 
 
 
ESA Filework Guidelines 
7 Final 
MED-ESAFWG~001 
Page  84 
 
 

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Medical Services 
 
MENTAL HEALTH DESCRIPTORS 
 
 
Activity  
Descriptors 
Points 
COMPLETION OF 
a 
Cannot answer the telephone and reliably take a message 
2 
TASKS 
b 
Often sits for hours doing nothing 
2 
c 
Cannot concentrate to read a magazine article or follow a radio 
1 
programme 
d 
Cannot use a telephone book or other directory to find a 
1 
number 
e 
Mental conditions prevents them from undertaking leisure 
1 
activities previously enjoyed 
F 
Overlooks or forgets the risk posed by domestic appliances or 
1 
common hazards due to poor concentration 
g 
Agitation, confusion or forgetfulness has resulted is mishaps or 
1 
accidents in the 3 months before the test is applied 
 
 h 
Concentration can only be sustained by prompting 
1 
 
 
 
 
DAILY LIVING 
a 
Needs encouragement to get up and dress 
2 
b 
Needs alcohol before midday 
2 
c 
Is frequently distresses at some time of the day due to 
1 
fluctuation of mood 
d 
Does not care about his appearance and living conditions 
1 
e 
Sleep problems interfere with his daytime activities  
1 
 
 
 
 
COPING WITH 
a 
Mental stress was a factor in making him stop work 
2 
PRESSURE 
b 
Frequently feels scared or panicky for no obvious reason 
2 
c 
Avoids carrying out routine activities because he is convinced 
1 
they will prove too tiring or stressful 
d 
Is unable to cope with changes in daily routine 
1 
e 
Frequently finds there are too many things to do that he gives 
1 
up because of fatigue, apathy or disinterest 
F 
Is scared or anxious that work would bring back or worsen his 
1 
illness 
 
 
 
 
INTERACTION 
a 
Cannot look after himself without the help of others 
2 
WITH OTHER 
b 
Gets upset by ordinary events and it results in disruptive 
2 
PEOPLE 
behaviour problems 
c 
Mental problems impair ability to communicate with other 
2 
people 
d 
Gets irritated by things that would not have bothered him 
1 
before he became ill 
e 
Prefers to be left alone for six hours or more each day 
1 
F 
Is too frightened to go out alone 
1 
 
 
 
 
 
PCA EXEMPTION CATEGORIES 
 
These were defined as follows: 
  Severe learning disabilities, defined in legislation as a condition which 
results from arrested or incomplete development of the brain, or severe 
ESA Filework Guidelines 
7 Final 
MED-ESAFWG~001 
Page  85 
 
 

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Medical Services 
 
damage to the brain which involves severe impairment of intelligence 
and social functioning. 
  Severe and progressive neurological or muscle wasting disease. 
  Progressive impairment of cardiorespiratory function which severely and 
persistently limits effort tolerance. 
  An active and progressive form of inflammatory polyarthritis. 
  Dense paralysis of the upper limb, trunk and lower limb on one side of 
the body. 
  Multiple effects of impairment of function of the brain and/or nervous 
system causing motor, sensory, and intellectual deficits. 
  Severe mental illness, defined in legislation as the presence of mental 
disease which severely and adversely restricts his social functioning, 
or his awareness of his immediate environment. 
  Severe and progressive immune deficiency states characterised by the 
occurrence of severe constitutional disease or opportunistic infections 
or tumour formation. 
ESA Filework Guidelines 
7 Final 
MED-ESAFWG~001 
Page  86 
 
 

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Medical Services 
 
Appendix F -  Prognosis Matrix  
No functional 
Factors that suggest a 
Factors that suggest 
restriction 
shorter return to work 
a longer return to 
identified 
(with change likely) 
work (with change 
prognosis may be 
unlikely) prognosis 
appropriate. Also 
may be appropriate 
consider adaptation. 
3 month 
Acute condition 
Chronic condition 
prognosis 
 
 
 
Single condition 
Multiple conditions 
(or call for 
 
 
assessment if 
Diagnosis unclear 
Diagnosis confirmed 
at file work 
 
 
stage) 
Mild to moderate 
Significant Disability 
disability evident at 
evident at assessment
assessment 
 
 
Medical evidence 
Medical evidence 
suggests chronic 
suggests improvement 
course 
possible  
 
 
Medical probability 
Medical probability 
suggests chronic 
suggests improvement
course 
 
 
Active treatment 
No active treatment 
 
 
Further treatment 
No further treatment 
awaited/planned 
awaited/planned 
 
 
Younger age 
Older age 
 
3, 6, 12, or 18 month 
2 years or in the 
return to work 
longer term return to 
prognosis 
work prognosis 
 
ESA Filework Guidelines 
7 Final 
MED-ESAFWG~001 
Page  87 
 
 

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Appendix G -  Glossary of Terms 
Throughout this document you will various terms and abbreviations used. The 
following is a list of some of these terms. 
ESA   
Employment and Support Allowance 
Revised WCA   
Revised Work Capability Assessment 
LCW   
Limited Capability for Work: The term used to identify those with a 
certain degree of disability defined in the legislation which means there are likely to 
be limitations on their ability to engage in work. 
 
“Treat as LCW”: The term used for claimants who are considered to have 
limitations on their ability to work due to specific criteria defined in the legislation 
namely having certain types of regular treatment, pregnancy around dates of 
confinement, radiotherapy and restriction on work due to a Public Health Order. 
LCWRA 
Limited Capability for Work Related Activity: The term used to describe 
those with the most severe conditions where it would be considered unreasonable 
for them to engage in any type of work related activity or training. Those who meet 
criteria to be considered as having LCWRA are entered into the Support Group. 
LCWRA may be as a result of severe functional restriction or certain specific 
circumstances such as Terminal Illness. 
WFHRA 
Work Focussed Health Related Assessment: A face to face 
assessment conducted by an Atos Healthcare HCP to explore the claimant’s views 
on their abilities and restrictions in relation to work and health.  
WFI   
Work Focussed Interview: A series of interviews conducted by a 
Personal Adviser at the Job centre Plus (or private contractor) to help those with 
limited capability for work to begin a journey towards work readiness and ultimately 
employment. 
TI Check (also known as SR check) 
 
Terminal Illness Check/ Special 
Rules check: An initial stage of ESA Filework completed by those who claim they 
are terminally ill. 
PBC   
Pre-board check: A stage of filework completed on all claimants at 
their initial referral other than cases where definitive advice has been provided at the 
TI check 
LCWRA Only Advice referrals: A type of referral where the Decision maker has 
identified “treat as LCW” and requests advice on LCWRA status 
ESA 55: The file jacket where documentation relating to the claim is inserted 
ESA 50 
A form completed by claimants detailing their medical problems and 
stating their functional abilities and restrictions in both physical and mental function 
activities. 
 
ESA Filework Guidelines 
7 Final 
MED-ESAFWG~001 
Page  88 
 
 

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ESA 50A 
A form completed by claimants who have been identified as having 
“treat as LCW” by the DM and where FME is not available or adequate to provide 
advice on LCWRA status. The form is an abridged version of the ESA 50 and 
relates to LCWRA criteria.  
IB 
Incapacity Benefit 
PCA  The medical assessment process to those applying for Incapacity Benefit 
IB85  The medical report completed by an HCP following a face to face assessment 
to advise the Decision Maker about the PCA 
IB85A 
A report produced advising on Filework outcomes in Incapacity Benefit 
FME: Further Medical Evidence 
113: A form used to request FME. Used in Incapacity Benefit (IB113) and ESA (ESA 
113) 
FRR2: A form used to request FME where there is a requirement for specific 
questions to be addressed. 
FRR3: A form used to request FME from an HCP other than the claimants GP 
FRR4: A form used to document any telephone contact with the claimant or any 
HCP involved in their care. 
ESA 85 
The medical report completed by an HCP following a face to face 
assessment to advise the Decision Maker on LCW/LCWRA status 
ESA85A 
A report produced advising on Filework outcomes in ESA 
ESA86 
A form used to record advice on LCWRA only clerical referrals 
DLA 
Disability Living Allowance: Disability Living Allowance is a non-
contributory, non-means tested and tax-free benefit that is based on an assessment 
of care and mobility needs for people with disability. DLA is payable to those with 
qualifying needs where the claim is made before the age of 65. 
AA 
Attendance Allowance: is a non-contributory, non-means tested and 
tax-free benefit that is based on an assessment of care.  AA is payable to those 
whose needs arise after the age of 65 (or who claim after that date) and it relates to 
personal care only. AA does not have a Mobility component. 
DAL/AA Special Rules Claim: A type of claim within the DLA/AA benefit for those 
claiming a terminal illness. 
MSRS:  
Medical Services Referral System:  An automated workflow and case 
management system used to register details of Incapacity Benefit and ESA claims. 
SMART: 
System for Medical Allocations, Referrals and Tracking. An IT system 
used in Atos Healthcare by administration staff with a variety of functions including 
recording of appointments and brief outcomes of advice relating to DLA/AA claims. 
DV Domiciliary 
Visit 
ESA Filework Guidelines 
7 Final 
MED-ESAFWG~001 
Page  89 
 
 

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Medical Services 
 
DWP  
Department for Work and Pensions 
GMC 
General Medical Council 
GP General 
Practitioner 
MEC 
Medical Examination Centre 
NINo 
National Insurance Number  
NMC 
Nursing and Midwifery Council 
PV 
Potentially Violent (Now obsolete – see UCB) 
IRG 
Incapacity Reference Guide – list of coded conditions \ diagnoses the 
DM uses to record diagnosed cause of incapacity. 
UCB 
Unacceptable Claimant Behaviour 
ESA Filework Guidelines 
7 Final 
MED-ESAFWG~001 
Page  90 
 
 

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Medical Services 
 
Observation form 
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Please return this form to:    Angie Rhodes 
                                   
Training and Development Co-ordinator 
 
 
 
 
 
Atos Healthcare 
     3300 
Solihull 
Parkway 
     Birmingham 
Business 
Park 
     Birmingham 
B37 7YQ 
 
ESA Filework Guidelines 
7 Final 
MED-ESAFWG~001 
Page  91 
 
 

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Document Outline

• 1. Introduction
  • 1.1 Introduction
  • 1.2 Categories of ESA Filework
  • 1.3 Objectives
• 2. General Principles of ESA Filework
  • 2.1 Purpose of ESA Filework
    • 2.1.1 General Considerations
  • 2.2 Overview
  • 2.3 Sources of Evidence/ Information
    • 2.3.1 MSRS Information
    • 2.3.2 Evidence/Information contained in the ESA 55 Jacket
  • 2.4 Analysis of the Evidence
    • 2.4.1 Using Medical Knowledge of Condition
  • 2.5 Deferring for FME in ESA Filework
    • 2.5.1 Consent for Further Medical Evidence in ESA
    • 2.5.2 Requests for FME
• 3. The Special Rules Check (TI check)    
• 4. The Pre-Board Check 
  • 4.1 The Pre-Board Check
• 5.  LCWRA Only Referrals
  • 5.1 General LCWRA Only Referrals
  • LCWRA only referrals are generated when the Decision Maker has already established that “treat as LCW” applies.
  • 5.2 Income Related ESA LCWRA Only Referrals
• 6. ESA Re-referral Filework 
  • 6.1 ESA Re-referral Scrutiny 
  • 6.2 Scrutiny of Evidence in Re- referral cases
    • 6.2.1 MSRS Information
    • 6.2.2 ESA 55 Information
    • 6.2.3 MSRS/ESA 55 information
• 7. IB Re-assessment Scrutiny
  • 7.1 Background
  • 7.2 IB Re-assessment Scrutiny
  • 7.3 Scrutiny of evidence in IB Re-assessment Cases
    • 7.3.1 MSRS Information
    • 7.3.2 ESA 55 Information
    • 7.3.3 MSRS/ESA 55 information
• 8. Prognosis
  • 8.1 Overview
  • 8.2 How to formulate prognosis advice
  • 8.3 The Work Programme
• 9. Justification 
• 10. Miscellaneous
  • 10.1 Harmful Information
  • 10.2 Unexpected Findings
  • 10.3 Domiciliary visits
  • 10.4 Practitioner type
  • 10.5 Miscellaneous ESA filework
• 11. Medical Quality
  • 11.1 Audit
  • 11.2 Amending filework reports
    • Appendix A - Revised WCA 2011 Support Group Functional Categories
    • Support Group Criteria – Special Circumstances
      • Appendix B - Revised WCA 2011 LCW Descriptors
• Physical Function Descriptors
• Mental Function Descriptors
  • Appendix C - ESA 2008 Functional Support Group Categories 
    • Support Group Criteria – Special Circumstances
      • Appendix D - ESA 2008 LCW Descriptors
• Physical Function Descriptors
• Mental Function Descriptors
  • Appendix E - IB \ PCA Descriptors & Exemption Categories
  • Appendix F - Prognosis Matrix 
  • Appendix G - Glossary of Terms

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