Whether or not you are entitled to Universal Credit on the basis of being unable to work is based on how your illness or impairment affects you, and what very specific things you are unable to do without assistance. This is called the work capability assessment and it uses a point system that is the same for Universal Credit and Employment and Support Allowance claimants.

For example, if you cannot usually stay standing or sitting (or a combination of the two) at a desk for more than an hour because it makes you too tired or it hurts, you get 6 points.  If you cannot usually go to even a familiar place on your own, you get 9 points, etc. You can see all the activities, descriptors and points on Limited capability for work and work related activity components of UC.

You only score one set of points from each activity (for example, getting about), so use the one that you meet that gives you the most points.

In order to be found unable to work (and therefore receive ESA or Universal Credit on that basis) you need to score at least 15 points in total. Or there needs to be a ‘substantial risk’ to you or others if you were found not to have limited capability for work.

To be able to do an activity you need to be able to do it repeatedly, reliably, and safely and painlessly. So, if you can sometimes raise your arm to your head, but could not do it again and again, or if doing it hurts you, the law would see you as not being able to raise your arm to your head. Similarly, if you can move from one seat to another without help, but you sometimes fall and hurt yourself and cannot get back up, you should select the descriptor that says you cannot do it – because you cannot do it safely.

For people whose conditions are worse on some days than others, you meet the descriptor that describes what you can do for the majority of the time. So, if you can sometimes cope with a planned change, but for the majority of the time would not be able to manage it, you cannot cope with a planned change.

If you get 15 points on any one indicator (except if you choose 8a, 9b, 10a and 15a - in activities 'Finding your way and being safe', 'Extensive incontinence', 'Consciousness during waking moment', and 'Getting about'), you will be put into the limited capability for work-related activity (LCWRA) group. If you are in this group, you get extra money to support your higher needs, and you don’t need to do ‘work-related activity’ (meet regularly with an adviser at the Jobcentre, go to occasional training courses, and do various tasks that the DWP say will make you better able to get a job later). 

If you claimed Universal Credit, you can receive Universal Credit while you wait for the reconsideration and appeal on the basis of looking for work. (Don’t worry, it won’t mean you can’t argue that you are not able to work in the appeal). 

However, you will need to follow the rules in your claimant commitment about looking for work in order to keep receiving the benefit. Make sure 

• your work coach understands how your illness or disability affects you, and 
• that your claimant commitment reflects your difficulties. 

It will help if your work coach understands that you are challenging the decision that found you capable of work. Please see Claimant commitments and how to avoid a UC sanction for more help - particularly our advice on what should be in your claimant commitment if you have a health problem, disability or are neurodivergent.

If your claim was closed because the DWP don't think you sent back your form or went to your assessment,  or if they said you were well enough to work, you need to ask the DWP to look again at their decision (called a ‘mandatory reconsideration’). 

You are supposed to do this within one month of the date on the letter they sent to tell you of their decision.  If one month has already passed, don’t worry. Ask anyway. See If one month has already passed.

You do not need new medical evidence. Sometimes the DWP tell you that you do, but you don’t. They may not change the decision at the reconsideration stage, but it’s very possible to win at the appeal hearing without any new information or evidence. Indeed, they often don’t change the decision at the reconsideration stage even when presented with excellent evidence.

Don’t be put off. People who get the lower rate of the benefit, are often ‘warned’ by the DWP that they could lose their current award if they appeal and be left with nothing. This is technically true, but it is not common. We suggest that you look at the descriptors that you meet and the points that you think you should have got - if you get far more than 15 points, it is very unlikely that you will lose your benefit.

Use our free Work Capability Assessment mandatory reconsideration tool. Research evidence suggests it may double your chances of getting the decision changed at this stage. This is therefore better than using the CRMR1 form. Use the tool to set out your case and then copy and paste the letter on to your Universal Credit journal.

If you have any more evidence that you think will help (for example, a letter from your doctor, social worker, support worker, or carer, or any other recent reports you have had) put that on your Universal Credit journal too.  If you need a few weeks to get more evidence, it probably isn't worth the wait. Instead, ask for the evidence and send it later or get it ready to send with the appeal form in case you need to appeal. If you ask anybody for new evidence, send them our guide to writing effective evidence for Universal Credit health element or ESA.

If you have missed the one-month deadline to ask for a mandatory reconsideration, you should still ask but give a good reason for the delay. If you give a reason, they will usually look again at the decision if it was made less than 13 months ago.

Explain that the delay was unavoidable or a result of your disability. For example:

• you may have been unable to deal with it until now because you need help to deal with your post, or 
• you were too depressed or anxious to manage it, or 
• you needed help to understand if you should challenge the decision and you did not find that help until now.

If they refuse you a mandatory reconsideration, they still send you a decision letter which you can use to appeal.

Unfortunately, there are no time limits on how long a mandatory reconsideration should take. It can be as much as 12 weeks or even more.  

If you have not heard back after 8 weeks, you should ring them and find out what is happening. Keep a note of the phone call – date, time and who you spoke to in case you need to call again.

If you have not heard after 12 weeks, you could make an official complaint for the unreasonable delay.
 

Disclaimer

The information in this guide applies to England and Wales and Scotland. It will also be useful for people in Northern Ireland. The law is complicated. We recommend you try and get advice from the sources we have suggested if you can.

The cases we refer to are not always real but show a typical situation. We have included them to help you think about how to deal with your own situation.

If you would like this guide in another format please email [email protected]

Acknowledgement

This guide was written and updated by Advicenow.

Advicenow would like to thank all those who provided advice and feedback on this guide, particularly David Shah who peer reviewed this edition of the guide. Thanks to the Ministry of Justice for funding this update.