Accessing welfare benefits

General information regarding migraine and welfare benefit rights

Introduction

Please be aware that The Migraine Trust is unable to provide advocacy support regarding welfare benefits.

We have worked with Disability Rights UK to produce this general information on accessing welfare benefits, in response to the number of enquiries we get on this issue.

If you have further questions or require further support after reading this information, please see the list of further contacts at the end of the page.

welfare benefits

Migraine and your welfare benefit rights

Is migraine considered to be a disability?

Migraine may be considered as a disability under the Equality Act 2010. This will depend on the severity and frequency of the attacks and the impact the condition has on the sufferer. The Equality Act defines disability as: ‘a physical or mental impairment which has a substantial and long-term adverse effect on your ability to carry out normal day-to-day activities’. Migraine is clearly a physical impairment. To fall within the Act, you then need to establish that the effect of the condition has a substantial and long term adverse effect on your ability to carry out normal day-to-day activities.

‘Substantial’ means more than minor or trivial. ‘Long-term’ means that the impairment has lasted or is likely to last for at least 12 months or the rest of your life. ‘Normal day-to-day activities’ are not set out in the Act. However, there is guidance to the Act, which says: ‘In general, day to day activities are activities that people do on a regular or daily basis’. For instance, shopping, reading and writing, holding a conversation or using the telephone, watching TV, carrying out household tasks, walking and travelling by various forms of transport and taking part in social activities. This can also include general work-related activities such as ‘Interacting with colleagues, following instructions, using a computer, driving, carrying out interviews, preparing written documents, and keeping to a timetable or shift pattern’.

Your doctor or headache nurse may be able to advise you on whether your migraine condition is likely to be considered substantial, long-term and likely to affect such day-to-day activities.

I suffer from migraine: am I entitled to claim welfare benefits?

This will depend on your individual circumstance and how your migraine affects you, which may vary at different times. We look at what benefits you may be entitled to in different circumstances below.

What benefits are available if I am unemployed?

If you feel able to work, but do not currently have a job (or have a part-time job of no more than 16 hours a week) you may be able to apply for Jobseeker’s Allowance (JSA). There are two types of JSA: contribution-based JSA and income-based JSA.

Contribution-based JSA can only be paid for up to six months. To be entitled to it, you need to have paid enough National Insurance contributions in recent years. Income-based JSA can be paid indefinitely. It is a means-tested benefit. In a nutshell, your needs (and those of your partner, if you have one) are compared with your resources (i.e. your income and savings) and income–based JSA worked out from the result.

To claim JSA, call the national claim number (0800 055 6688) or claim online.

To be entitled to either type of JSA, you need to be available for work and actively seeking work. Your benefit can be sanctioned, or reduced, if you do not meet these conditions. You can limit your availability for work if that is reasonable given your migraine. For instance, if you suffered dizzy spells, you would not be expected to look for jobs where these would clearly be dangerous. You can ask the Jobcentre for an appointment with a Disability Employment Adviser to discuss such matters.

If you need help to pay your rent, you could claim Housing Benefit. Contact your local authority for details. If you have children to support, you could claim Child Tax Credit. To claim, call the Tax Credit Helpline (0345 300 3900; textphone 0345 300 3909).

In some areas of the country, income-based JSA is being replaced by a new benefit: Universal Credit. To find out if you are eligible to claim Universal Credit in your area (based on your postcode and circumstances), visit the gov.uk website.

I have been dismissed by my employer due to my migraine, can I apply for benefit?

If you have been dismissed by your employer due to your migraine condition, you may be able to apply for benefit. If the reason for the dismissal is because your ability to work is limited, you may be able to apply for Employment and Support Allowance (see below). If you are dismissed by your employer due to your migraine, but you have the capacity to return to work, you may be able to claim JSA instead.

My migraine condition has stopped me from being able to work: what benefit can I claim?

If you are an employee and you are off sick from work because of your migraine condition, you may be able to claim Statutory Sick Pay (SSP). You qualify for SSP if you are to unable to work due to your migraine and have been absent from work for four or more days. You can get SSP whether you are working full-time or part-time, an agency worker or on a fixed-term contract. However, you must be earning at least £112 a week. You cannot get SSP if you are self-employed. After being off sick for a week, you need to provide your employer with a doctor’s certificate (or ‘fit note’).

SSP can be paid for up to 28 weeks, either in one period, or several separate periods (each no more than eight weeks apart). If your employer fails to pay you SSP, you should request for a reconsideration and written explanation. You can make a complaint to Statutory Payments Disputes Team if you are unable to resolve your dispute with your employer (tel: 0300 056 0630).

If your migraine condition prevents you from working and you are not entitled to SSP (usually because you have already had your 28-week entitlement) you may be able to claim Employment and Support Allowance (ESA). There are two types of ESA:

  • Contributory ESA – To be entitled to contributory ESA, you need to have paid enough National Insurance contributions in recent years. Payment of contributory ESA may be limited to 12 months if you are considered to be capable of work-related activity. This is tested under the ‘Work Capability Assessment’ (see below).
  • Income-related ESA – Income-related ESA is a means-tested benefit. In a nutshell, your needs (and those of your partner, if you have one) are compared with your resources (i.e. your income and savings) and income–related ESA worked out from the result. Income-related ESA can be paid indefinitely.

You may receive either of these elements, or both together, depending on your circumstances.

To claim ESA, call the Jobcentre Plus claim-line (0800 055 6688; textphone 0800 023 4888; Northern Ireland 0800 085 6318; textphone 0800 328 3419). Alternatively, you can download a claim-form here.

For the first 13 weeks of your ESA claim, you will usually receive a lower rate of ESA. This is called the ‘assessment phase’. This can sometimes be extended beyond 13 weeks if there are any delays. During the assessment phase, you will undergo the ‘Work Capability Assessment’. This will determine whether or not you can stay on ESA, and which of two groups you are placed in: the ‘support group’ or the ‘work-related activity group’. If you are placed in the work-related activity group, you will receive a lower rate of ESA than if placed in the support group, any contributory ESA that you get will be limited to just 12 months, and you will have to engage in work-related activity (such as attending work-focussed interviews) to keep getting the benefit in full.

The Work Capability Assessment looks at your ability to perform a range of activities, both physical and mental. It tests whether you have a limited capability for work. This is a points-related test. You score points when you have difficulties performing an activity. If you get 15 points or more, you can remain on ESA. The activities, and the points awarded, are listed in the Disability Rights UK Factsheet F71. The Work Capability Assessment also assesses whether or not you have a limited capability for work-related activity. If you do, you will be placed in the support group (see above). Again, this part of the assessment is explained in the Disability Rights UK factsheet.

The Work Capability Assessment is applied by sending you a questionnaire to complete: the ‘Capability for Work Questionnaire’. This may be followed up by a face-to-face assessment with a health professional. When completing the questionnaire, consider if, taking into account your migraine condition, you can do each activity safely, to an acceptable standard, as often as you need to and in a reasonable length of time. If you cannot, explain why on the questionnaire. Do not just focus on what you are like on a good day; let them know what you are like on bad days, and how often these occur. If you are unsure about completing the questionnaire, you may wish to contact a local advice centre, such as the Citizens Advice Bureau, DIAL (call Scope on 0808 800 3333 for details) or local authority welfare rights service (call your Town Hall for details).

If you need help to pay your rent, you could claim Housing Benefit. Contact your local authority for details. If you have children to support, you could claim Child Tax Credit. To claim, call the Tax Credit Helpline (0345 300 3900; textphone 0345 300 3909).

Self employed and affected by migraine

Self-employed people can become unemployed, or unable to work their full hours due to their migraine condition. If this is your situation, you will not be able to claim SSP but could be eligible for ESA. More information in the section above.  If you have to work a reduced number of hours, which benefit you claim will depend on the number of hours you are now working.  If you are working at least 30 hours a week and are aged 25 or over (or working at least 16 hours a week if you are getting Disability Living Allowance or Personal Independence Payment), you may consider claiming Working Tax Credit. If you are working for less than 16 hours a week, you may still be eligible for ESA if the work is accepted by the DWP as ‘permitted work’. In both cases, Housing Benefit may also be available towards any rent you are paying.

What can I claim if I have mobility problems or care needs?

If you have either mobility problems or care needs as a result of your condition, you may be able to claim Personal Independence Payment (PIP). It is available for people of working age (that is, between the ages of 16 and 64 inclusive). PIP is not paid simply because you have a condition, but because of the effect that the symptoms of it have on your everyday life. PIP is not means-tested, it is tax free and is not based on National Insurance contributions. You may claim PIP if you are still working. It is paid on top of any earnings or other income you may have, and is not affected by savings or capital you own. It is almost always paid in addition to other social security benefits and tax credits. PIP can also act as a gateway to other benefits.

PIP has two components:

  • A daily living component – for help participating in everyday life
  • A mobility component – for help with getting around.

Each component is payable at two different levels: a ‘standard rate’ and an ‘enhanced rate’.  The rate that you are paid depends on whether your ability to carry out activities in relation to daily living or to mobility is ‘limited’ or ‘severely limited’. This is tested under the PIP assessment (see below). You can be awarded PIP once you have had daily living needs or mobility problems for at least three months and if you expect to continue having these for at least another nine months.

You can start your PIP claim by ringing 0800 917 2222 (textphone 0800 917 7777). You can ask for a paper claim-form instead if you are unable to start the claim by phone; to request the form, write to: Personal Independence Payment New Claims, Post Handling Site B, Wolverhampton, WV99 1AH.

The PIP Assessment is a points-related test. It looks at your ability to perform a range of activities, both physical and mental. You score points when you have difficulties performing an activity. The activities, the points awarded and the thresholds for getting each component are listed in the Disability Rights UK Factsheet on PIP. The assessment is applied by sending you a form to complete: ‘How your disability affects you’. This may be followed up by a face-to-face consultation with a health professional. When completing the form, consider if, taking into account your migraine condition, you can do each activity safely, to an acceptable standard, as often as you need to and in a reasonable length of time. If you cannot, explain why on the form. Do not just focus on what you are like on a good day; let them know what you are like on bad days, and how often these occur. If you are unsure about completing the form, you may wish to contact a local advice centre, such as the Citizens Advice Bureau, DIAL (call Scope on 0808 800 3333 for details) or local authority welfare rights service (call your Town Hall for details).

What happens if my application for benefit or payment is unsuccessful?

If your claim for any benefit administered by the Department for Work and Pensions (DWP) is unsuccessful, and you disagree with the decision, you can ask them to look at it again. You have one calendar month from the date of the date of the decision in which to do this. This is called mandatory reconsideration.

You can ask for reconsideration over the phone, but you should confirm your request in writing to the office address on the decision letter and keep a copy of it. Explain why you think the decision is wrong and include a copy of any evidence that may support your case (such a letter from your consultant addressing the points that are at issue). The DWP will look at the decision again and then send you a ‘mandatory reconsideration notice’ to let you know the outcome. If you disagree with the outcome, you can appeal to an independent tribunal within one month from the date of the notice. The mandatory reconsideration notice will tell you how to lodge an appeal.

To get some support to appeal, you may wish to contact a local advice centre, such as the Citizens Advice Bureau, DIAL (call Scope on 0808 800 3333 for details) or local authority welfare rights service (call your Town Hall for details).

Can The Migraine Trust support me with my benefits claim?

The Migraine Trust does not have a welfare benefits advisor and therefore cannot help you to make a claim. We will be able to direct you to the appropriate agency that will support you.

Where can I get help from?

Updated by Ian Greaves, editor of the Disability Rights Handbook, published by Disability Rights UK.

Written 2015