Could you avoid having a face to face assessment for your Universal Credit WCA, ESA or PIP claim? Read this article to find out if you can.
Face to Face assessments for PIP, ESA and UC. The exemption from assessments to protect ‘vulnerable’ patient arrangements.
Today we will look at whether it is possible to be too ill to attend a face to face medical assessment in relation to a benefits claim.
What this article is going to look at will be of most interest to people who are suffering from mental health conditions and also receiving ongoing support for it due to its serious nature.
What follows is unlikely to be relevant to somebody who is not receiving ongoing care and support or who has not been formerly diagnosed with a mental health condition.
We know from first hand experience that the thought of having to attend a face to face assessment can induce overwhelming anxiety, panic and levels of stress and distress that can trigger serious relapses, leading to psychiatric admissions and even suicides.
Having a system for assessing if somebody is poorly enough to claim a disability benefit, that didn't recognise that for some people even the thought of having to have an assessment will make them extremely ill would be reckless and potentially negligent, wouldn't it?
There are benefit system regulations that can provide exemption from the face-to-face interview and for assessment on paper evidence alone. However applying these regulations is probably not something to contemplate without the help of a very experienced benefits adviser.
It is likely that if you mention the following arrangements to a lot of benefits and welfare rights advisers, they are likely to either deny the existence of the arrangements or look at you as though you have grown two heads. And, you certainly won't find many Facebook or internet forum "armchair advisers" knowing about them (until today!)
If you have an adviser that is going to support you with your benefit application they can quote these arrangements to protect vulnerable claimants from harmful distress and deterioration, and/or enable them to stay out of hospital.
Professionals who can state their opinion include: GP, care co-ordinator, psychologist, psychiatrist, key worker, support worker, therapist, counsellor, Independent Domestic Violence Advocate, Mental Health Advocate
Opinions from non-medical staff are relevant to describe people’s problems functioning and coping with the daily life tasks that would be associated with having an assessment completed.
It is important that your adviser recommends exemption from the face-to-face interview very clearly. Don’t let them recommend a home visit if you are of a very vulnerable nature: this can be worse than an assessment centre interview, for some people such as rape survivors, victims of abusive relationships or others, their home is their safe space which would be violated by a visit from an assessor or other strange person.
Don't mark any correspondence "confidential"
Companies hold DWP contracts to open mail, scan and distribute it and to carry out assessments, but confidentiality is used to exclude evidence. If a support letter marked “Confidential” goes to the assessor company, the DWP says under confidentiality, it won’t then be disclosed to a DWP Case Manager (PIP Assessment Guide Part One, 1.4.13).
As proper consideration often depends on DWP review, don’t mark your report confidential.
Your adviser may be contacted by the assessor as part of the initial desk top review that all claims that require an assessment go through. If you have been working with your adviser for some time, this isn't likely to be a problem.
If your relationship with your adviser is relatively new it is important that they are up-to-date with your situation and they have agreed with you the name of another medical professional that they can refer the assessor to for further information.
If your adviser has sufficient experience and knowledge, they will be aware this could happen and they will have already discussed the likely content of this call and the possible need for the preferred medical professional to talk to the assessor, with the relevant person.
Employment and Support Allowance (ESA), Universal Credit (WCA) and Personal Independence Payment (PIP) are different benefits with different reasons for exemption:
Find out more about ESA here
Find out more about PIP here and;
Find out more about Universal Credit here
Under “Exceptional Circumstances”, your adviser can say that there would be substantial risk to the patient’s health if they were put under work conditions for benefit, so they should be exempted from these and the assessment.
This regulation means the person is already accepted as satisfying the test for ESA (limited capability for work) so doesn’t have to be seen. Substantial risk to health can be mental health, or physical health e.g. risk of heart attack from stress. Risk to mental health covers not only suicide risk, but also sudden deterioration in mental state: PTSD flashbacks, panic attacks, hearing voices, or similar.
DWP guidance states that assessors should determine if they can assess the claim from the paper evidence they already have, or if they should get further evidence from professionals, before proceeding to arrange a face-to-face exam
The assessor can make a decision from paper evidence where;
“there is strong evidence on which to advise on the case and a face-to-face consultation is likely to be stressful for the claimant…”
Assessors “should also consider the needs of vulnerable claimants”, that is “someone who has difficulty dealing with procedural demands” including “a previous suicide attempt, domestic violence, abuse or bereavement.”
Official guidance goes on to say “Cases that should not require a face-to-face consultation” Although each case should be determined individually, the following types of case should not normally require a face-to-face consultation:
The medical evidence sent on paper has to be “robust” to enable the test for benefit to be met, and should include comments about how functioning is affected. Take a look at our article on what constitutes good evidence here
Getting support from your MPs’ caseworkers
If you are happy to involve your MP and ask for support for your exemption and paper-based assessment. Google “Find my MP” or search the Parliament website, choosing the constituency contacts. MPs’ caseworkers have direct lines to benefit officials and can often quickly resolve distressing situations.
Involving the MP gets your concerns taken more seriously. Assessor companies have staff specifically for MPs’ enquiries.
As with a lot of the actions that can be taken to minimise the stress of negotiating a disability benefit claim, requesting an exception from a face to face assessment requires a little bit of work to be completed before the application form is submitted.
Disability benefit application forms normally have to be returned within 28 days of them being posted to the claimant. Clearly this is unlikely to give the average vulnerable claimant enough time to complete the form and gather together the required supporting evidence to gain an assessment exemption.
If you are thinking about claiming a disability benefit or you know you have an end of claim review scheduled to take place in the near future, try to think ahead and start to put everything that will be required to successfully gain an assessment exemption into place before your application form arrives.
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