The DWP have published details of how they will identify people with ‘Severe Conditions’

who will not need to be routinely reassessed for ESA or Universal Credit.

This change only applies to ESA and UC, NOT PIP or any other benefit.

HOW WILL PEOPLE WILL BE IDENTIFIED AS HAVING A SEVERE CONDITION?

It is the DWP decision maker that will decide if someone has a Severe Condition and is
exempt, on the recommendation of a Maximus assessor.

To get that recommendation, you need to be assessed by a Maximus assessor at EITHER a

face-to-face assessment OR by a ‘paper’ assessment of your file. This is a change from earlier
announcements.

At the face-to-face or paper assessment, the assessor will apply strict guidelines to see if you
have a Severe Condition. These are set out below.

WHAT EVIDENCE IS REQUIRED TO PROVE THAT YOU HAVE A SEVERE

CONDITION?
The assessor will look for evidence that you meet the strict guidelines set out below.

The assessor will look at the evidence they have, including any clinical or medical evidence.
This might include the ESA OR UC claim form, any face-to-face assessments, and any extra
medical evidence that has been sent in by you or that the assessor has requested from your
doctors. (Note that assessors rarely request information from your doctors).

The rule is that assessors will assume people do NOT have a Severe Condition unless there is
evidence that they have a Severe Condition or that there is a strong possibility that you might.

If the evidence is already on your file, or you provide it at a face-to-face assessment, then the
assessor should decide that you have a Severe Condition.

If the assessor thinks there is a strong possibility that you have a Severe Condition but does
not think there is enough evidence to prove it, they should ALWAYS ask for more medical
evidence. This might be medical evidence from you or your doctor, or it might be medical
evidence in the form of another face-to-face assessment. However, DWP say that assessors
should not automatically ask for a face-to-face assessment and have set out a ‘Half Way
House’ option so that people with suspected Severe Conditions do NOT have to be called for
face-to-face assessments. See below for the ‘half-way house’ assessment option.

If the assessor decides to ask you or your doctors to provide more medical evidence, they will
only ask you or your doctors ONCE. They will only chase your doctor once and you twice if
the extra evidence isn’t provided quickly. After those reminders, the assessor will decide that
you do not have a Severe Condition as the evidence isn’t available to prove it.

If the assessor thinks that they need more medical evidence in the form of another face-to-
face assessment, they do not necessarily have to call you in. They have a ‘half-way house’
option which is to not make a decision about whether you have a Severe Condition, but
instead to put you in the Support Group for a review ‘in the longer term’. In practice, this
means you won’t be assessed for at least two years. But you won’t be exempt from all future
routine assessments.
WHAT GUIDELINES DO I NEED TO MEET TO HAVE A SEVERE CONDITION?
ALL of the following needs to apply before you can be assessed as having a Severe Condition
and exempt from routine reassessment.

1. You need to be in the Support Group for ESA or the LCWRA group for UC *because* you
CURRENTLY meet at least one of the 15 ‘functional criteria’ to do with walking, reaching,
etc. See important note below.
AND
2. The assessor must judge that you will ALWAYS meet one of those 15 functional criteria
AND
3. The assessor must judge that the condition causing your loss of function is lifelong, that is
it will be present for the rest of your life and cannot be cured or removed by any
currently known NHS treatment
AND
4. The assessor must judge that you have no realistic prospect of recovering the lost function
(that entitles you to be in the Support Group) using currently known NHS medical treatment
AND
5. The assessor must judge that you must have an ‘unambiguous condition’, that is you have
been diagnosed with a recognised medical condition.

Important note about Support Group - some people are in the Support Group because they
didn’t meet a functional criteria but because their health would be at substantial risk if they
were not placed in the Support Group. We are looking to see if these people cannot qualify as
having a Severe Condition.

WHO MIGHT QUALIFY AS HAVING A SEVERE CONDITION?

DWP have made it clear that NO medical condition will automatically qualify someone as
having a Severe Condition. Regardless of the disease, condition or disability, every case will
be looked at individually against the 5 criteria above.

DWP have said that the following conditions are accepted as examples of life long
conditions, but even people with these conditions will still have to meet the other criteria,
such as being in the Support Group because of a loss of function, and having no realistic
prospect of recovering the lost function. The conditions are Motor Neurone Disease (MND),
severe and progressive forms of Multiple Sclerosis, severe and progressive Parkinson’s
Disease, dementia, chromosomal conditions such as Downs Syndrome, Huntington’s, severe
irreversible cardiorespiratory (heart and lung) failure, or severe acquired brain injury.

WHO WON’T BE ABLE TO QUALIFY AS HAVING A SEVERE CONDITION?

Anyone with any condition which is potentially curable, or which might improve in the future
so that you no longer qualify for the Support Group, cannot be counted as having a Severe
Condition, even if it is severe at the moment. This rules out people who have recently had a
stroke, diabetes, most lung and heart conditions, early stages of neurological conditions like
MS, Parkinson’s and so on, milder dementia, most head injuries, anyone who might get a
transplant or joint replacement in the future, people with pain conditions like CRPD and
fibromyalgia, and nearly anyone with chronic fatigue or a fatigue-related condition

Most people with cancer will NOT be able to be assessed as having a Severe Condition,
because many people with cancer potentially can go into long-term remission and then not
qualify for the Support Group. Only people with confirmed incurable cancer with a
permanent loss of function which will always qualify them for the Support Group will be
judged as having a Severe Condition.

Most amputees will NOT be able to be assessed as having a Severe Condition, because most
amputees potentially can benefit from prosthetic aids which would disqualify them from the
support group. Only the most severe amputee cases might qualify.

Nearly everyone with a mental health condition will NOT be able to be assessed as having a
Severe Condition, as nearly all mental health conditions can potentially be improved with
treatment. Only people with the most severe and incurable mental health conditions will be
able to be judged to have Severe Conditions.

Anyone who does not have a confirmed diagnosis of a specific incurable or lifelong condition
cannot be judged to have a Severe Condition.

WHAT IF I DISAGREE WITH THE ASSESSMENT?

While you can still appeal against the assessor’s and DWP’s decision to award you points and
place you into a Group, BuDS thinks you CANNOT appeal against the assessor and DWP’s
decision not to judge you as having a Severe Condition. This is because this is a voluntary,
non-legal, scheme without any set appeals process. In particular, BuDS thinks that Tribunals
will NOT have any power to order DWP to assess someone as having a Severe Condition and
exempt from reassessments, because Tribunals can only do what the law allows them to do,
and this is a non-legal scheme.

You might be able to seek a judicial review of a decision about your Severe Condition status
on the grounds that it is irrational or unreasonable, but this is a High Court process which
costs tens of thousands of pounds and is available only to people entitled to legal aid or free
legal representation.

WHAT THIS MEANS FOR YOU

For the vast majority of people, this change means nothing. Only people with very severe
conditions will qualify for this new exemption, and those people will probably never have
been called for face-to-face assessments anyway. This is because the law already allows
assessors to put people with severe conditions in a ‘longer term’ assessment group.

BuDS feels that this change is, in short, a political confidence trick. It gives the impression of
helping ‘the most disabled people’, but actually does nothing for probably 99.5% of ESA
claimants. It will help a few people with the most severe impairments.