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When does WCA get triggered on UC?
I have had a client who is only getting the housing element and standard allowance of UC and he claims he has been handing a fit note in since June 2018. I thought they are meant to automatically trigger a WCA after a month of handing in fit notes?
Any DMG, regs around this would be greatly appreciated. Also anyone who has experience of similar issues.
Bizarrely ADM puts the onus on the claimant to request the WCA, but the DM is supposed to clarify with the claimant what they want (which seems to me to presuppose an understanding of the system that most claimants will not have).
F5034 Where medical evidence is provided, the DM should clarify whether the claimant is
1. applying for
1.1 a determination that they have LCW or
1.2 the LCWRA element to be included in their UC award or
2. exempt from the work search requirement for a limited period.
Was client previously on ESA and assessed for that?
Does client have any earnings? A referral for WCA cannot be made if claimant has earnings above 16 x NMW unless they are in receipt of DLA, PIP or AA. See https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/754948/admg1.pdf
Client could request a WCA and if found to have LCWRA request backdating to fourth assessment period after first Fit Note handed in on grounds that WCA should have been commenced much sooner.
[ Edited: 18 Jun 2019 at 11:26 am by Ianb ]They are really bad a triggering WCAs and I’d like to see something taken up nationally.
I’ve seen two people now who have done long stints in hospital but no WCA has been triggered despite med10s being provided or offered; one can’t simply load a med10 like a med3 because there’s often not an end date. Another took their CPN along to a WFI yet that didn’t ring any alarm bells. For one of them the visiting team visited the hospital to try and do biographical checks when the claimant was delusional and floridly psychotic; still no thought to the WCA…
Bizarrely ADM puts the onus on the claimant to request the WCA, but the DM is supposed to clarify with the claimant what they want (which seems to me to presuppose an understanding of the system that most claimants will not have).
F5034 Where medical evidence is provided, the DM should clarify whether the claimant is
1. applying for
1.1 a determination that they have LCW or
1.2 the LCWRA element to be included in their UC award or
2. exempt from the work search requirement for a limited period.Was client previously on ESA and assessed for that?
Does client have any earnings? A referral for WCA cannot be made if claimant has earnings above 16 x NMW unless they are in receipt of DLA, PIP or AA. See https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/754948/admg1.pdf
Client could request a WCA and if found to have LCWRA request backdating to fourth assessment period after first Fit Note handed in on grounds that WCA should have been commenced much sooner.
No earnings as far as I know. Not previously on ESA. Thanks!
My understanding is that they normally send the UC50 at day 29 of the claim (or 4 weeks after you start submitting fitnotes) - WCA guidance in the House of Commons library (which you can get from our resources section) - although we were told at the last stakeholder forum that where it is clear the illness is going to last for a while they will issue it immediately.
If they haven’t sent one you can download one and send it yourself
They are really bad a triggering WCAs and I’d like to see something taken up nationally.
I’ve seen two people now who have done long stints in hospital but no WCA has been triggered despite med10s being provided or offered; one can’t simply load a med10 like a med3 because there’s often not an end date. Another took their CPN along to a WFI yet that didn’t ring any alarm bells. For one of them the visiting team visited the hospital to try and do biographical checks when the claimant was delusional and floridly psychotic; still no thought to the WCA…
Yes the Med10 situation in itself needs taken up nationally. Local jobcentres don’t even accept them in UC area’s probably because the difficulty loading them. I have had one work coach state that this is because the Med10’s don’t have a diagnosis or any details of what their condition is. Crazy.
My understanding is that they normally send the UC50 at day 29 of the claim (or 4 weeks after you start submitting fitnotes) - WCA guidance in the House of Commons library (which you can get from our resources section) - although we were told at the last stakeholder forum that where it is clear the illness is going to last for a while they will issue it immediately.
If they haven’t sent one you can download one and send it yourself
Thanks this is what I thought- was actually told this by a UC worker on the phone once so thanks for this.
My understanding is that they should normally send the UC50 at day 29 of the claim (or 4 weeks after you start submitting fitnotes) - WCA guidance in the House of Commons library (which you can get from our resources section) - although we were told at the last stakeholder forum that where it is clear the illness is going to last for a while they will issue it immediately.
If they haven’t sent one you can download one and send it yourself
See my edit. In practice it simply ain’t happening.
and they need to make some provision for people in hospital who can’t get out to see their GPs. I can still hear the giggling from last time I asked a consultant to issue a med3.
[ Edited: 18 Jun 2019 at 12:49 pm by Dan_Manville ]and they need to make some provision for people in hospital who can’t get out to see their GPs. I can still hear the giggling from last time I asked a consultant to issue a med3.
relatedly - yesterday morning i was at my GP’s, she was running late and i ended up reading some of the leaflets they had
one called “what happens when you are referred by your GP to see a specialist”
which says
“the specialist should issue you with a fit note”
“the fit note should cover the period they expect you to be unfit for work, or until your next contact with the specialist”
and
“you should not need to see your GP to get a fit note following hospital treatment, unless your inability to work is unexpectedley prolonged”
TBF, this isn’t specifically about in patient stays - but really, it should be the same, you would have thought!
And, i don’t think I’ve ever had a consultant give me a fit note (even when i needed one, clearly!). had to go to GP…
and they need to make some provision for people in hospital who can’t get out to see their GPs. I can still hear the giggling from last time I asked a consultant to issue a med3.
relatedly - yesterday morning i was at my GP’s, she was running late and i ended up reading some of the leaflets they had
one called “what happens when you are referred by your GP to see a specialist”
which says
“the specialist should issue you with a fit note”“the fit note should cover the period they expect you to be unfit for work, or until your next contact with the specialist”
and
“you should not need to see your GP to get a fit note following hospital treatment, unless your inability to work is unexpectedley prolonged”
TBF, this isn’t specifically about in patient stays - but really, it should be the same, you would have thought!
And, i don’t think I’ve ever had a consultant give me a fit note (even when i needed one, clearly!). had to go to GP…
This is the one weakness in challenging this; there is guidance to say that consultants can issue med3s.
I have sent our local docs said guidance and I can still hear their laughter.
Our GUM Consultants issue fitnotes from time to time for our HIV clients when there is a problem getting one from a GP. But they are atypical Consultants in that they tend to act more widely than most specialists. I can’t see why hospital doctors should refuse to issue fitnotes though, my surgeon gave me one when I had a shoulder op.
I work with customers with complex needs so I’ve tended to ask support workers to assist their customers to request a WCA as soon as the claim is live. It’s worked every time so far and the UC50 arrives around the end of the first assessment period.
Can’t say we’ve had any who have been claiming for longer than a handful of months without triggering the WCA.