Medical Assessments and Getting Evidence

Medical Assessments

Some benefits will require a medical assessment to help make a decision about what level of support you are entitled to.

It is always helpful to take evidence to the assessment if you have it (see below for suggestions on getting evidence).  One of the assessment providers has told us “We continue to request further evidence in the majority of assessments. However, often evidence is returned after we have completed the report and submitted it to DWP. In these cases, DWP will review the evidence received and decide if they want to take action”.  They should request evidence if they think it is needed to make a correct decision, but you need to know that they won’t necessarily ask for evidence from everyone that you name.

Employment & Support Allowance

People claiming Employment & Support Allowance will usually be asked to attend an assessment at Baltic House in Norwich, although there is a possibility of a home visit if this is medically required.

The Department of Work & Pensions gave the contract to carry out Employment & Support Allowance assessments to a company called Maximus from 2015.  They run the Centre for Health & Disability Assessments, who will contact you with details of any appointments you need to attend.  They have a guide to the process at https://www.chdauk.co.uk/

The health professional will ask a series of questions and submit a report to the Department of Work and Pensions, giving their medical opinion and also suggesting how long it is likely to be before you are fit to go back to work.  The Department of Work and Pensions make the actual decision about entitlement, although their decision is often based largely on the medical report provided by Maximus.

Maximus have announced that you can now ask for your assessment to be recorded, as they have facilities for this at every assessment centre.

People have had very mixed experiences of their medical assessments, and this is partly because they don’t know what to expect.  For example many people think they will be physically examined, but the process is mainly based upon the health professional’s observations of you and relies on your answers to their questions.  You may be asked to do certain tasks, for example to show what range of movement you have in your joints, but you should not be asked to perform any action that you find physically painful (and you are allowed to refuse such a request).

It might be helpful if you have a look at the activities and ‘descriptors’ that you will be assessed on – this is a list of tasks you might find difficult, and each one is given a score from 0-15. The activities cover both physical and mental function difficulties.

You can find these on our website or you can telephone and ask for a printed copy.  You can also see them online if you read from page 17 onwards in https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/535942/esa214-july-2016.pdf

The benefit is awarded if you score enough points – you need a minimum of 15.  So you need to see if you can score a total of at least 15 points by adding up your scores from all the different activities (you can only count one score for each activity) unless you have automatic entitlement.  You may have automatic entitlement if you have a terminal illness, are having a particular type of cancer treatment, are a student who receives DLA or PIP, or in certain cases when you are pregnant or have recently given birth.

There are also some ‘exceptional circumstances’ where you can pass the assessment even if you cannot score enough points.  This might be, for example, if you have a life-threatening disease that is not controlled, or if there might be substantial risk to your physical or mental health if you did not qualify.  You would need medical evidence to prove that you came under these rules.

You also need to think about whether you could reliably repeat a task a reasonable number of times throughout a day, not just do it once.

If you already have medical evidence (such as letters which confirm your diagnosis, medical history and prognosis, or copies of test results from your GP or hospital) that is reasonably recent, it is a very good idea to take it to your assessment and ask the health professional to copy and return the originals to you.  This will help them when they write their medical report.

It will not be helpful for you to take information that you have printed out from the internet which is just general information about your diagnosed condition.

We recommend that you attend your assessment with a companion.  The Department of Work and Pensions has said this is to be encouraged.  The companion will not be able to answer questions for you, but will be able to take notes and also to help you if you struggle to remember things.

It is helpful to give detailed explanations of the activities that cause you difficulty, rather than giving just ‘yes’ or ‘no’ answers.  If you can explain why you have a problem, and also what the after-effects of attempting a task might be, and how long the after-effects can last, it can help the health professional get an accurate picture of your problems.  Otherwise they may make some false assumptions about your abilities.

Other benefits that may require a medical assessment are Attendance Allowance, Disability Living Allowance, Personal Independence Payment and Industrial Injuries Disablement Benefit.  The same general rules apply, although your assessment may take place in a different location.

Personal Independence Payment

For Personal Independence Payment, anyone living in Norfolk may be assessed by one of two different companies, Atos Healthcare (who run Independent Assessment Services, or IAS for short) or Capita, depending on your postcode. Capita just cover the PE postcode area.

Most people will be asked to go to a face to face assessment.  The only exceptions are for anyone with a terminal illness, or where there has been enough medical and other evidence provided with the claim form that a decision can be made just using the written evidence.

Atos have four assessment centres for Personal Independence Payment in Norfolk (although they will offer a home visit if required):

  • St Francis House on Queens Road Norwich
  • 11 Prince of Wales Road Norwich
  • TICCS in Great Yarmouth Business Park or
  • Laird Health & Business Centre at Croxton Road in Thetford.

There is more detail at https://www.mypipassessment.co.uk/consultation-centres/

Capita will tend to offer a home visit first, and their one assessment centre in Norfolk Kings Lynn, at West Norfolk Deaf Association. There is more detail at http://www.capita-pip.co.uk/en/locations.html

Neither of these companies should ask you to travel for longer than 90 minutes, assessed by how long the journey would take you by public transport.

Personal Independence Payment is assessed using a scoring system that is similar in style to the one used for Employment and Support Allowance.  If you want to have a look at the activities and descriptors that you will be assessed on, look at our separate Factsheet about Personal Independence Payment (which will give you more detail about how the scores are added up).  You can also look at the activities and descriptors online at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/725533/pip-assessment-guide-part-2-assessment-criteria.pdf (pages 83 to 116 show the scoring system).  You can telephone and ask for a printed copy.

The most important thing to remember is that you need to provide enough detail about your difficulties for the assessor to see how you could meet the points.  Don’t allow them to rush you, and don’t agree to do any movement that is too painful.  If you have additional supporting evidence, make sure you give it to them (they will take a copy).  Do try to go with a companion, who might be able to help with your answers.

It might be worth looking at the information available from the two PIP Assessment Providers on these websites: https://www.mypipassessment.co.uk/ and http://www.capita-pip.co.uk/en/assessment-process.html

Getting medical evidence

The most common way of getting medical evidence is to approach your GP, specialist consultant or other health practitioner.  You should ask them to write a letter explaining your condition and prognosis, and to provide information about how you are functionally affected by your condition on a day to day basis.  It is important that it is specific about how you are affected, because different people can have a very different range of experience even though they technically have the same condition.

It depends on which benefit you are claiming, but it can be helpful if they make a comment about how far you can walk, what kind of tasks you need someone to help you with, and whether there are any safety issues to consider.  Any letter can be sent attached to your claim form, or used in challenging decisions, but we recommend you send a copy and keep the original.  If we are acting as your representative in an appeal, please ensure the letter is sent to us so that we can submit it on your behalf.

It may also be helpful for any support workers or family/friends who act as a carer for you to write their own letter of support which can give some detail of the kind of help you need at home; it is accepted that any medical professionals will not know the full detail of your daily life.

If you are unable to get any letters of support from medical professionals, either because they appear to be unwilling to help or because you cannot afford the charge, there is an alternative route to getting medical evidence.  Since the Data Protection Act of 1998, you have had a legal right to apply for access to health information held about you.  This was updated in 2018 and the new law is the Data Protection Act 2018 (DPA 2018).  This includes your NHS or private health records held by a GP, optician or dentist, or by a hospital.  A health record contains information about your mental and physical health, recorded by a healthcare professional as part of your care.

If you want to see your health records, you don’t have to give a reason.  If it is your GP patient record you want to see, submit your request in writing to your surgery.  We usually recommend that you ask for your patient record for the last couple of years, including copies of any referrals and letters to and from consultants.  If it is hospital records you want to see, write to your hospital’s patient services manager.  A very simple letter will do. It’s always a good idea to state the dates of the records you want when you apply.

The health records manager, GP or other healthcare professional will decide whether your request can be approved.

Under what is known as the General Data Protection Regulations (GDPR) which applies from May 2018, there should not be any charge for getting a copy of your own information.  See https://ico.org.uk/for-organisations/guide-to-the-general-data-protection-regulation-gdpr/individual-rights/right-of-access/ for more details, but the important things to know are:

  • Individuals have the right to access their personal data.
  • This is commonly referred to as subject access.
  • Individuals can make a subject access request verbally or in writing.
  • You have one month to respond to a request.
  • You cannot charge a fee to deal with a request in most circumstances.

The only times they can charge a fee is if they can show that your request is if the request is ‘manifestly unfounded or excessive’ and in that case they can charge a “reasonable fee” for the administrative costs of complying with the request (or they may just refuse to comply with your request), or if you request further copies of your data following a request, in which case they must base the fee on the administrative costs of providing further copies.

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