Equipping People To Make Sense Of What They Are Told
Some people who make a claim for Disability Living Allowance may be asked to have
a medical examination. This is usually because more information is needed before
a decision about the claim can be made.
About the medical examination.
A medical examination involves an interview and sometimes a physical examination
with a healthcare professional who has completed specialised training in disability
awareness.The medical examination is likely to be different from what they would
expect from their own health professional. The examination is not to diagnose or
discuss treatment of the medical condition; it is to assess how the condition affects
the person.
Who does what?
The people and organisations involved in the medical examination process are:
The Disability and Carers Service - who are part of the Department for Work and Pensions
- who handle benefit claims
Atos Healthcare Medical Services, who organise medical examinations on behalf of
the Disability and Carers Service
The decision-maker - a non-medical person within the Disability and Carers Service
who is responsible for making a decision on your benefit claim
The Examining healthcare professional - the healthcare professional who carries out
the medical examination
What are the reasons for a medical examination?
A person may have been asked for a medical examination for several reasons. It does
not mean the information they have provided on their claim form is being treated
as suspicious or that the claim will be turned down.
One of the reasons for a medical examination may be to check that they are receiving
the full amount of benefit they may be entitled to.
When a claim is first made for Disability Living Allowance, the person is sent a
claim form to complete and the completed claim form is assessed by the decision-maker,
who must decide:
Whether to approve the claim.
Whether the person is entitled to one or both of the benefit's two components (the
mobility component and the care component).
How much benefit they are entitled to receive.
Decision-makers may ask for a medical examination if they need more information before
they can make a decision, or they are unsure about any details.
The decision-maker can approve the claim without a medical examination if they are
happy with the information that they have got.
If the person is already receiving Disability Living Allowance, they may be asked
to attend a medical examination as part of the Right Payment Programme. Under the
Right Payment Programme, any Disability Living Allowance award may be reviewed to
make sure the person is receiving the right amount of benefit.
The current benefit award will only be changed if the review highlights a change
in a persons current entitlement. If this happens, the award will be adjusted accordingly
- either up or down. If there are no material changes, the award will remain the
same as before.
Renewal claims and reviews.
If a person has been awarded Disability Living Allowance for a fixed period, they
will have to make another claim to renew their benefit just before their entitlement
ends. Renewal claims are treated exactly the same as new claims, so the person may
be asked to attend a medical examination.
If the benefit award is for an indefinite period, the person will not usually have
to make a renewal claim. Indefinite awards can sometimes be reviewed and the person
may need to have another medical examination as part of the review.
Your rights at a medical examination.
The medical examination will usually take place where the person lives or at a Medical
Examination Centre near where they live. The person should be given seven days' notice
of their examination but they may ask for an earlier appointment if that suits them
better.
If they miss their first examination appointment, they will be offered a second appointment.
However, If they miss two appointments without good reason, or refuse to attend,
their benefit claim may be turned down.
The person has the right:
To have a friend, relative or support worker with them at the medical examination.
To ask for an interpreter if they need one.
To ask to be examined by a healthcare professional of the same gender as themselves.
They will need to let Medical Services know ahead of time if they want an interpreter
or same-gender healthcare professional. However, this may not always be possible
in some areas.
Special rules - if you are terminally ill.
If you have a progressive disease and are not reasonably expected to live for more
than another six months, there are special rules to help you get your benefit quickly
and easily. It is very unlikely that you will have to attend a medical examination.
