Sovereign AI governance of UK DWP ESA new claims — Employment and Support Allowance, WCA, LCW/LCWRA, fit notes, UC migration, permitted work. 12 entry points × 8 transformation priorities × 6 MCPs. Audit-grade. Signed. UK-sovereign.
New ESA claims via UC or legacy route. Eligibility: limited capability for work (LCW). GP fit note required. ESA50 questionnaire. Face-to-face or telephone WCA. Contribution-based ESA (Class 1 NI) or income-based (means-tested). UC migration pathway. Claim submission, evidence gathering, initial assessment decision. Digital-first journey with assisted digital support.
WCA by Health Care Professional (HCP) from Maximus (CHAI). LCW: scored activities (15 descriptors, 15 points) or exceptional circumstances. LCWRA: severe conditions, 9 descriptors — risk to health, uncontrollable episodes, significant disability. Descriptors: physical and mental health. LCWRA automatically accepted for terminal illness (SR1). Mandatory reconsideration and appeal rights.
Assessment provider: Maximus (Centre for Health and Disability Assessments). HCP qualification — doctor, nurse, physiotherapist, paramedic, occupational therapist. Evidence sources: GP, hospital consultant, specialist nurse, support worker. ESA50 self-assessment form. Face-to-face, telephone, or paper-based assessment. Decision Maker (DM) at DWP. Quality audit of HCP reports. Complaints and feedback mechanism.
Assessment rate: up to 13 weeks — £90.50/wk (25+), £71.70/wk (under-25). Main phase: LCW — no additional component (UC equivalent). LCWRA — additional component £416.19/mo (UC). ESA support group: £90.50/wk + support component £47.70/wk. WRAG: £90.50/wk + work-related activity component £47.70/wk (legacy). Premiums: severe disability, enhanced disability, carer. Christmas bonus. Pension age interaction.
Support group (legacy ESA) = LCWRA (UC). 9 descriptors: mobilising, transferring, reaching, picking up, eating/drinking, managing toilet needs, dressing/undressing, remaining conscious, communicating. Severe mental health conditions. Terminal illness (SR1). Learning disability. Significant risk to physical or mental health if required to work. No work-related requirements. Higher payment component. Permitted work allowed up to £183.50/wk.
WRAG (legacy) = LCW (UC). Scored 15+ points on physical/mental descriptors. Work-focused interview requirement. Work preparation activity. Work-related activity plan. Conditionality — lighter touch than JSA. No sanctions in ESA WRAG (legacy). UC LCW: work preparation requirements only. Work coach support. Voluntary work, permitted work. Training and skills support. Health condition management.
Med3/Med10 fit note from GP or hospital doctor. Digital fit notes (April 2022). Fit note: 'not fit for work' or 'may be fit for work with adjustments'. Duration: 2 weeks to 3 months+. Repeat fit notes. Employer notification. DWP acceptance for ESA claim. Fit note does not determine WCA outcome — separate assessment. Abolition of sick notes for ESA (proposed reform). Fit note evidence for WCA. GPs not gatekeepers to benefits.
Managed migration from income-based ESA to UC. Migration notice issued by DWP. 3-month deadline to claim UC. Transitional protection (TP) payments — SDP, enhanced disability premium. Natural migration via change of circumstances. Gateway conditions. TP erodes over time. Severe disability premium transitional element. Carer element. ESA contribution-based continues alongside UC. Run-on payments. Welfare rights adviser support.
ESA fraud rate ~2.8%. Common fraud: undeclared partner income, capital limits, work capability misrepresentation. Detection via HMRC RTI, DWP data matching, UC cross-checks. Investigation officers. Civil penalty regime. Prosecution for deliberate fraud. Overpayment recovery from ongoing benefit. Voluntary disclosure. Error (official and claimant). Accuracy improvement programme. Counter-fraud strategy. Biometric verification.
ESA and Carer's Allowance interaction — cannot receive both (overlapping benefits rule). Carer premium in income-based ESA. UC carer element £198.31/mo. Carer assessment for WCA — caring responsibilities considered. Carer's credit for NI. Carer's passport to other benefits. Young carers. Parent carers. Respite care interaction. Carer support services. DWP/Carers UK data sharing.
~2.6M ESA claimants (legacy). ~1.8M in support group. WCA outcomes: ~60% LCWRA, ~15% LCW, ~25% fit for work. Average claim duration. Off-flows: employment, UC migration, reassessment. Reassessment cycle: 6-36 months. Appeal overturn rate ~70% (with representation). Statistical bulletins. FOI readiness. Caseload by region, condition, age group. Provider performance data. HCP report quality metrics.
W&P Select Committee evidence — WCA fitness for purpose, UC migration, ESA reassessment. PQ evidence: claimant numbers, WCA outcomes, appeal rates. Terminal illness fast-track (SR1). Mental health descriptors. Assessment provider performance. Cost of WCA programme. Sanctions in UC (not legacy ESA). Work capability reform proposals. ESA expenditure. Disabled people's employment rate. White Paper contributions.
AI-powered routing: new ESA claim → UC or legacy pathway. Eligibility pre-check — NI contribution verification via HMRC RTI, income-based means test. Automatic fit note validation. Digital claim form auto-population from GP records. WCA referral automation. Evidence gathering assistant. Target: claim-to-assessment from 13 weeks to 6 weeks, 90% digital claims by 2028.
HCP report quality scoring — descriptor accuracy, evidence consideration, reasoning quality. Bias detection in WCA outcomes — condition, demographic, geographic. Automated evidence cross-check against GP/hospital records. HCP performance dashboard. Report consistency audit. DM decision support. Appeal prediction model. Target: WCA overturn rate from 70% to under 30%, HCP report quality score above 90%.
LCWRA condition clustering — identify high-risk claimants. Terminal illness fast-track monitoring. Mental health descriptor analysis. Severe condition early identification. Support group exit pathway — voluntary work readiness. Health improvement tracking. Care plan integration. Target: zero delays for terminal illness claims, support group accuracy above 95%, voluntary employment uptake 20%.
Permitted work eligibility monitoring — £183.50/wk threshold. Work start/end notification automation. Earnings verification via HMRC RTI. Impact on ESA payments calculation. Supported permitted work tracking. Transition planning to full employment. Employer engagement. Target: permitted work uptake from 3% to 12% of support group, zero overpayment from permitted work earnings.
Managed migration digital assistant — timeline, eligibility, TP calculator. SDP/SEAP transitional element calculation. Migration notice portal. Claim completion tracker. TP erode calculator. Legacy benefit interaction checker. Welfare rights adviser integration. Carer element assessment. Target: 100% managed migration completion, zero TP errors, migration satisfaction above 85%.
Real-time earnings matching via HMRC RTI. Capital limit monitoring. Partner income cross-check. Living together as married detection. Work capability misrepresentation flagging. Investigation prioritisation scoring. Recovery optimisation. Voluntary disclosure promotion. Target: fraud rate from 2.8% to under 1.5%, overpayment recovery rate above 85%, investigation-to-resolution under 90 days.
Carer's Allowance interaction checker — overlapping benefits prevention. Carer element eligibility assessment. Caring hours verification. Carer's passport benefit routing. Respite care coordination. Young carer identification. Parent carer support. Carer-to-employment pathway. Target: zero carer benefit overlap errors, carer element uptake from 45% to 80%, carer employment support engagement 25%.
Real-time ESA dashboard — claimant numbers, WCA outcomes, support group/WRAG split, appeal rates. Automated W&P Committee reporting. PQ evidence generator — caseload stats, WCA performance, migration progress. Reassessment scrutiny pack. Terminal illness fast-track metrics. Target: monthly automated parliamentary briefing on ESA/WCA/UC migration performance.
New ESA claim eligibility routing — UC vs legacy pathway. NI contribution verification via HMRC RTI. Class 1 contribution check for contribution-based ESA. Income-based means test. Fit note validation. Age/residency/right-to-work check. Capital limits. Partner income assessment. SDP/SEAP eligibility. Gateway condition check. Habitual residence test. Full-time education exclusion.
WCA management — ESA50 processing, HCP allocation, assessment scheduling. Descriptor scoring support — 15 physical, 9 mental health, LCWRA 9 descriptors. Evidence cross-check against GP/hospital records. HCP report quality scoring. DM decision support. SR1 terminal illness fast-track. Reassessment scheduling. Appeal prediction. MR request processing. Assessment type selection — face-to-face, telephone, paper.
ESA payment calculation — assessment rate, main phase, support group/WRAG components. Premium calculation: severe disability, enhanced disability, carer. Permitted work earnings impact. UC interaction — overlapping benefit prevention. Overpayment detection. Recovery from ongoing benefit. Payment scheduling. Bank account verification. Christmas bonus. Pension age interaction. TP element calculation.
UC managed migration from legacy ESA. Migration notice issuance. 3-month deadline tracking. TP calculation — SDP, enhanced disability premium, carer premium. Gateway condition verification. Natural migration via change of circumstances. Run-on payment processing. ESA contribution-based continuation. UC claim completion support. TP erode calculator. Welfare rights adviser referral.
ESA fraud detection — earnings matching via HMRC RTI. Capital limit monitoring. Partner income cross-check. Living together as married flagging. Work capability misrepresentation detection. Investigation case management. Civil penalty processing. Prosecution referral. Overpayment recovery. Voluntary disclosure portal. Recovery optimisation. Counter-fraud analytics. Biometric verification integration.
ESA caseload dashboard — claimant numbers, support group/WRAG split, assessment outcomes. WCA performance metrics — HCP quality, overturn rates, descriptor distribution. UC migration progress tracking. Permitted work uptake. Carer integration metrics. Fraud detection rates. Appeal outcomes. Regional analysis. Provider performance comparison. Parliamentary reporting pipeline. FOI response generation.