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Wednesday, 3 October 2023

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Money, tax and benefits

Disability Living Allowance - medical examination

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

Already claiming DLA and want to report a change in your circumstances - find out more

Disability Living Allowance - your circumstances

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 you would expect from your own doctor. The Medical Services healthcare professional's examination is not to diagnose or discuss treatment of your medical condition. It is to assess how your condition affects you. To do this, the healthcare professional may not need to carry out a physical examination.

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

Reasons for a medical examination

You may have been asked for a medical examination for several reasons. It does not mean the information you provided on your claim form is being treated as suspicious or that your claim will be turned down. One of the reasons for a medical examination may be to check you are receiving the full amount of benefit you are entitled to.

When you first apply for Disability Living Allowance, you are sent a claim form to complete. Your completed claim form is assessed by the decision-maker, who must decide:

whether to approve your claim
whether you are entitled to one or both of the benefit's two components (the mobility component and the care component)
how much benefit you're 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 your claim without a medical examination if they are happy with the information that they have got.

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. This is to help you get your benefit quickly and easily. It is very unlikely that you will have to attend a medical examination.

Medical examinations when you are already getting DLA

Receiving the right amount of benefit - 'Right Payment Programme'

If you are already receiving Disability Living Allowance, you 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.

Your current benefit award will only be changed if the review highlights a change in your current entitlement. If this happens, your award will be adjusted accordingly - this could be up or down. If there are no material changes, your award will remain the same as before.

Renewal claims and reviews

If you've been awarded benefit for a fixed period, you'll have to make another claim to renew your benefit just before your entitlement ends. This is called a 'renewal claim'. Renewal claims are treated exactly the same as new claims, so you may be asked to attend a medical examination.

If your benefit award is for an indefinite period, you will not usually have to make a renewal claim. Indefinite awards can sometimes be reviewed and you 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 in your own home (or where you live), or at a Medical Examination Centre near where you live. You should be given seven days' notice of your examination but you can ask for an earlier appointment if that suits you better.

If you miss your first examination appointment, you will be offered a second appointment. If you miss two appointments, or refuse to attend, your benefit claim may be turned down.

You have the right:

to have a friend, relative or support worker with you at the medical examination
to ask for an interpreter if you need one
to ask to be examined by a healthcare professional of the same gender as yourself

You need to let Medical Services know ahead of time if you want an interpreter or same-gender healthcare professional. They will try to find one for you, but this may not always be possible in some areas.